Terminology note: I’m going to compress the distinct phases of pregnancy, labor and delivery, and post-natal recovery into the shorthand term “maternity.”

Longer follow up on that earlier post about “birth rape” and the more-recent post about the way environmentalism tends to have credibility and to get more respect* than do feminist maternity activists.

Seems kind of startling given that genuinely essential but temporary changes during those roughly 10-13 months — from somewhere in the first trimester to the end of the (little discussed) post-partum “fourth trimester” — is one of the most common “natural” justifications for building entire civilizations (including most of ours) around the notion that at all times women should only be 2nd-class citizens at best… and no more than livestock at worst.

But issues of the process of pregnancy get short shrift. Why? I dunno. Could be denial maybe? Ideology? Speculation? Avoidance? Blunt lack of experience until one’s in the thick of it? Maybe. Or maybe its women in maternity’s near-total invisibility, especially right before and after birth?

Or could it perhaps be because for most women involved in the conversation, and their partners, there really isn’t enough time spent in maternity to develop and promulgate critical consciousness, let alone activism? Because before you get into maternity you’ve got other fish to fry. Then when you’re in it you’ve got other fish to fry. And then when you’re far enough through the process for your partner(s) to shoulder half or more of the load and you can start thinking about trying to return to the workforce you’ve… once again got other fish to fry.

Consequently in contemporary culture the majority of feminism-oriented people who are in it, and who tend to stay in it long enough to start developing theories and policy founded in the reality of pregnancy/childbirth/return, tend to trend far enough towards, I dunno, “hippie-ness,” “woo-woo,” or feminine-gender essentialism to be comfortable around — or even having — multiple births. And those same qualities tend to create a mutual alienation between them and their more professional, academic, or “mainstream” counterparts.**

I’d add that thanks to that mutual alienation between mainstream and maternity-oriented feminists the people maternity-rights feminists instead butt heads with most often area) the medical/obstetrics profession, b) religious conservatives and other “quiverful” style activists. In that context of opposition from mainly socially conservative forces and absent engaged support from progressives it might seem perfectly logical for maternity activists to equate the atrocious, violating treatment too many women receive as tantamount to “birth rape.”

I happen to think “birth rape” is still a terrible term for that treatment. Largely because broader society’s reluctance to recognize and deal with permutations of the real thing. But it’s also because I still think the term misstates rather than overstates the sort of violations, great and small, medical and merely social***, that are inflicted on women in maternity. And finally because, as FiveofNine and I and others have noted, the generally rotten, disrespectful, and abusive treatment… and some-time medical violations, assaults, and batteries laboring women receive at the hands of some maternal medical professionals is materially similar to what’s received by women (not to mention men) who are merely elderly, juvenile, developmentally or mentally disadvantaged, incarcerated, suspected of substance abuse, or simply suspected of “malingering.”

* With the result that a birth-rights activist catches more quite a bit shit for invoking the metaphor of “birth rape” than the average environmentalist gets for invoking the same metaphor as in, for instance, “raping the planet.”

*** For instance nearly everyone knows better than to put their hands on a woman’s ass, breasts, or even hair without being invited to. Even the ones who do it know better. Yet hardly anyone recognizes how rude it is to put their hands on a pregnant woman’s abdomen without permission.

Long before I first posted anything about sex and even longer before became an outright sex blogger my first experiences with online participation came in the pages of the old Usenet usergroups on pregnancy, childbirth, and infant care. My partner had terrible insomnia when she was pregnant and so I’d spend hours sometimes, late at night, on an old dial-up account, reading voraciously and nervously chiming in.

I was nervous in part because I’m a man (albeit a well-informed one who’s maternal grandparents had themselves been well-regarded authors in the field) but also because passions ran intensely high… or more accurately ideologically so… on certain topics such as vaccination, circumcision, breast feeding, episiotomies, and c-sections.

And because I was nervous I relied very heavily on a handful of texts and magazine articles, written mostly by well-regarded midwives, doctors, and other caregivers who trended heavily (but non-obsessively) towards natural childbirth, nursing, and childcare.

While on balance I’d rather have been in bed asleep most of those nights, became reasonably well-regarded, became very well informed, and generally had a very good time. (One of my last posts described the birth of our first child and I still treasure the kind words and best wishes we received from online friends and adversaries literally all over the world.)

Well, as my children have moved on to middle school those days are long behind me. And I’m still a man. And I’m still a little nervous getting into this. But remembering the intense rhetoric of those (still-ongoing, incidentally) debates I’d like to chime in alongside Amanda Marcotte and, just now, Linday Beyerstein of Big Think as being strongly in support of respect for women’s childbirth preferences and decisions but even more strongly opposed to calling it “birth rape” when their decisions are not respected.

Some factions within the natural childbirth movement are attempting to popularize the concept of “birth rape.” The idea is that women who are handled roughly, verbally abused, or bullied into unwelcome interventions during labor are literally being raped by their health care providers.

...

Some of what [UK-based reproductive-rights activist Amity] Reed is describing here _[link to the F-Word]_sounds like plain old assault and battery or verbal abuse. She also implies that some instances of so-called birth rape are medical procedures performed against the patient’s will. If a doctor performs a procedure on a competent adult patient against her will, that’s assault. Women in labor should have the right to refuse treatment if they’re mentally competent to do so.

...

“Birth rape” is an emotionally manipulative metaphor that encourages women to re-frame  traumatic experiences in a way that makes them seem even more traumatic. It’s difficult enough to come to terms with a disappointing, painful, or terrifying birth. To encourage women to recast that experience as a sexual violation, even when everyone agrees that the doctor did nothing sexually inappropriate, is cruel, not liberating.

She said it here.

I ought to add that I absolutely agree with the outrage Amity Reed and many other activists feel at the sometimes appalling treatment they receive, especially at the hands of “mainstream” industrial medicine. My first introduction to how bad that treatment can get came from a student-nurse friend who told me that where she was interning one of the Ob/Gyns was very up front with her staff about how she hated conscious patients (this was back in the day when anesthesia was common for deliveries) and how forceps were great when she was in a hurry for a cigarette! And by all accounts (such as Reed’s) that attitude is still alive and well. And disgraceful. And demeaning. And dehumanizing. And can be encountered not just among surgeons but right down the line to receptionists*. And most of all unnecessary and wrong.

In other words I recognize the reality of medical malpractice. But I also agree with Beyerstein and Marcotte that the treatment described amounts to legal definitions of answerable malpractice, and (one would hope) even assault and battery. But I also agree with them that it’s counterproductive on dozens of layers to call it rape.

In their respective pieces Marcotte and Beyerstein articulate why. I’d like to add two more:

First, all too often the callous mistreatment women receive in the delivery room is reflected in the emergency rooms, operating rooms, geriatric wings, psychiatric care wings, cardiac- and intensive-care suites, and neonatal wards of many of the same facilities. One can note that routine childbirth is not a medical event — as many natural childbirth advocates argue and as I’m inclined to agree. But to the extent childbirth happens in multi-purpose medical facilities it’s infuriating but not surprising that laboring mothers would be treated little different from other patients.

Second, and it’s a point related to the first, what in the Sam Hill has happened to us that we’re unable to recognize, let alone acknowledge, the emotional and psychological impact of “mere” assault and battery? When a merely inconvenient or uncooperative but non-violent geriatric or psychiatric patient is strapped to a bed and forcibly catheterized we call that highly traumatic and dehumanizing treatment assault and battery, not rape. And when a nurse slaps or quietly slips sedatives into the IV of a wailing teenager not because he needs it but because he’s disturbing other patients we call that instrumental abuse of a human being assault, not rape. Amplifying effectively-identical behavior in delivery rooms denies the severity, and the impact, of that behavior elsewhere in medical care.

Conversely, calling it medical assault and battery in the delivery room just as we call it assault when it happens anywhere else highlights what’s really going on rather than allowing mistreatment to be divided and conquered, sequestered, partitioned and, I think, gendered into one thing that happens to women in the maternity ward vs… something less significant should it instead happen (perhaps to the very same patients under other circumstances!) in, say, the burn unit, recovery room, or ICU.

As Beyerstein says, to call it “birth rape” is to invoke a grossly manipulative metaphor that we correctly don’t tolerate when it’s invoked by others consumed past reason by their own agendas. We shouldn’t tolerate from advocates of causes we support, no matter how strongly we support them. Update: Speaking of causes we support, we shouldn’t tolerate metaphor in the rhetoric of environmentalism either, where it’s entirely too common… and entirely not called out often enough. (Hat tip to Chingona.)

Note: I don’t think I should have to say this but I will: almost all direct providers of all forms of healthcare, from radiologists to reflexologists, from naturopaths to neurologists, and from cardiac surgeons all the way down to candystripers are skilled, diligent, effective, and compassionate towards their patients needs. The few who aren’t — the ones who sometimes seem determined to tar the whole enterprise with their own sordid and abusive antics — should be dealt with appropriately, not hyperbolically.

* Even midwives are not immune to mistreatment of their patients. While waxing enthusiastically about my partner’s experience with our midwife (a nurse practioner with admitting privileges at all area hospitals) a friend from the east coast told us her midwife had rarely looked at her, talked on the phone, stepped out for cigarettes, or just sat rubbing her forehead saying “oh my god, oh my god” during most of her very long but otherwise completely routine labor!

Back in June, 2008, when George Bush was still president, Barack Obama was nothing but a junior in-the-minority-party Senator from Illinois who thought he could get away with challenging Hillary Clinton for the nomination, Denise Grady of The New York Times wrote

When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.

“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

Read the article here.

I admit the impression I got when I read the write-up at DailyKos was that this had all happened just a day or two ago and just around the corner. But just a little bit of Googling demonstrated it’s not actually topical at all…

...or wouldn’t be if…

...it wasn’t a perfect snapshot of the kind of jackass crap that drove the initiative for healthcare reform in the first place!

And why didn’t we hear howls from various and assorted right-wing psycho teabaggers, tenthers, and deathers with travel and sign-making expense accounts from Fox “News?” Well, you could say it was because Golden Rule is a private corporation and therefore more Infallable in Every Decision than the pope. But it could also be because Golden Rule’s founder was a major right-wing moneybags. But I digress.

The fact of the matter is that (going perhaps against common progressive wisdom) the environment private insurance operates into is aggressively stacked against it — yeah, they make money… and for that matter yeah, they can only make money by fucking sick people over — and it’s bull-whiz like telling healthy women they have to get sterilized before they can get insurance is a perfect example of why they’re not up to the task.

Golden Rule, a relatively small insurer (however pretentious its erstwhile pretentions of grandeur might have been) didn’t have the clout to negotiate efficiently with major medical centers that provide things like, oh, say, birthing centers and obstetrics surgeries. So they did what by the “logic” of the marketplace made the second-most sense: they refused to insure someone with FHPS (fecund healthy person syndrome.)

The idea behind healthcare reform, even the really watered-down versions, is in classic (Teddy) Roosevelt style, to create big enough markets for medical services to rebalance the market clout of service providers.

The reason people keep talking about a public option (and why, by the way, we need one) is that insurance-industry assholes like the little pencil-pecker at Golden Rule who cooked up the get-sterilized-first exception are still there pecking away with their pencils. A public option will help keep them in check as well. Not so much by increasing their profitability as giving people an alternative when their private insurer of choice starts making out-of-control demands.

But seriously? Get a caesarian before you get Healthcare? That might have been fine for George Bush and what was left of his party in 2008. But this is America and that kind of crap… from a pro-life private company, by the way, was and is intolerable.