I first heard the word consent in a junior high sex ed class. Over the years, I learned along with my peers what it is and what it is not, but the last place I thought I’d have to worry about it was not at a frat party or in some dark alley, but in my own long-time and trusted midwife’s exam room. At the end of my fourth pregnancy, I learned that consent is a term that extends far beyond the bedroom and romantic relationships: I had become the victim of a cervical sweep I didn’t consent to, and I was far from alone.
In a 2019 study in Reproductive Health, researchers concluded that one in six birthing people experienced mistreatment in pregnancy or delivery, such as loss of autonomy, being threatened, ignored, refused, or even shouted at. The study also shows people of color, younger women, birthing people with a Black partner, and birth location, among other factors, impacted those rates further. My experience was much less obvious, leaving me wondering whether anything “wrong” had happened at all or if I’d misunderstood the order of events.
I’d come into my provider’s office, who had been nothing but understanding and informative my entire pregnancy, past my due date. She recommended a membrane sweep, a procedure in which the provider uses their gloved hand to loosen the amniotic sac from the uterus. It’s a common procedure after 39 weeks to induce labor “naturally,” Cleveland Clinic reports. For me (and other mom friends who have had it), it’s a physically uncomfortable and even painful procedure, but it only does last a few minutes.
The problem is, I had yet to decide I wanted to do that.
As the midwife conducted a cervical check to see how dilated I was, we discussed whether I should do the sweep. I vacillated back and forth, trying to decide if I should wait longer for my body to go into labor or give it a “boost” with this procedure. As we chatted, the cervical exam got more painful, and it became apparent she was moving forward with it despite an official decision or conclusion. She said something to the effect of, “Well, I’m already up here, so…”.
In talking to obstetric violence expert Cristen Pascucci, founder of Birth Monopoly, I have since discovered that this is a standard turn of events in the world of obstetric violence.
“I’ve heard women say that for 10 years now… they went in and thought they were having a cervical check, and suddenly it got super painful. Maybe there was a little blood later; they had some bleeding; they had some cramping; and a lot of times, the provider would after the fact say, ‘Oh, I went ahead and did a little sweep to get you going or help things out,'” she says. “Sometimes they go back for another appointment and actually find out they had a membrane sweep without their consent.” She calls her own consensual sweep “so freaking painful — I remember every second.”
Pascucci shares another example of a woman who also had doula training and thought she was in labor getting a cervical check. The provider did a cervical sweep without her permission. She contacted Pascucci to ensure that it was, in fact, a violation of consent, as she felt. She met with the hospital, but they told her, “This is appropriate medical care, and when you signed a consent to be admitted to the hospital, you agreed to treatment,” she says. “One of them actually used the phrase ‘already up in there,'” pointing to the fact that once a provider is doing something else within the vagina and cervix, sometimes providers take more liberties to make their own decisions without seeing an issue or need for consent with each procedure.
The issue? Failing to ask and inform a patient every step of the way is against the “legal, ethical and professional requirements for physicians,” Pascucci explains. It’s called the “informed consent process,” and it says that what happened to me — and the other patient in the hospital — shouldn’t have happened.
“Informed consent is a basic human and legal right in healthcare, based on the idea that each of us owns our own bodies, and that extends to our decision-making in medical treatment. It means that for any suggested procedure or treatment, we have the right to full information about the risks and potential benefits of what’s being recommended, as well as its alternatives, and the right to accept or decline,” she says. “Medical providers have legal and ethical obligations to have these discussions with their patients and then support their patients’ autonomous decisions.”
So, I was left to process what had happened, even in the presence of my supportive and attentive spouse, with a provider I otherwise trusted. Pascucci says these conversations are essential because birthing people end up feeling like “somebody made a choice for me.” “It’s disempowering, it’s disrespectful, but a lot of times, it’s traumatizing,” she says, noting that it’s much more so for those who have previously experienced other sexual violence.
What was most confusing was I didn’t suspect any malintent from my provider, especially given our positive history. It was almost as if she was putting me out of my misery of struggling to make a decision. Pascucci says that from the provider’s perspective, they often don’t think they are doing anything wrong. She points to the misogynistic roots of women’s healthcare as part of the problem, creating this culture in the U.S. “It doesn’t just change overnight.”
Multiple times as I processed what happened, I almost called and discussed it with the provider herself. What stopped me? What stops many others: doubting if I was unclear. Doubting if I misread the situation. And doubting if it was unreasonable to have higher standards for care.
As I head into my fifth birth, I know now that it wasn’t my fault and my vagina isn’t a place for medical “gray area” decision-making, as I once wondered. And you can bet I will be having all conversations with all my clothes on before moving into any procedure… though I shouldn’t have to.