Disclaimer: This is a quick and dirty blog post–I am pushing this one out (no pun intended) quickly so that our community can engage in a critical dialogue about this statement as soon as possible. If you find typos or issues, feel free to privately message me–and be forgiving of errors, please!
This past December, the American College of Obstetrics and Gynecology (ACOG) released an opinion statement titled, “Sexual Misconduct.” Their Ethics Committee put together a list of “recommendations and conclusions” on sexual misconduct in the clinical and labor & delivery settings. While it is great that they have put forth something toward acknowledging the rampant abuse and violence that we as women, doulas, nurses, pelvic PTs, therapists, etc., experience, hear about, or witness on a daily basis, this statement falls so very short; and speaks to the tone deaf ethos of the organization.
To start, the statement’s abstract effectively gaslights those who have experienced obstetric abuse by stating, “The patient-physician relationship is damaged when there is either confusion regarding professional roles and behavior or a clear lack of integrity that allows sexual exploitation and harm.” How often do we really think people are being abused (or to their point perceiving to be abused) due to confusion about their practitioner’s role? The abstract, and also the caption of ACOG’s facebook post of the statement, makes sure to emphasize the “uncommon” nature of sexual misconduct in clinical care. They make sure to throw in, “even one episode is unacceptable.” But what of the doctors who continue to practice and have numerous allegations of sexual misconduct? How does ACOG enforce discipline upon these “uncommon” occurrences? That’s the thing… they don’t. If they did, the landscape of OBGYN would look a lot different in America and, wild thought, maybe women and birthing people wouldn’t walk away from their experiences with PTSD, disfigurement, or worse.
A lot of this statement rings as placating. They acknowledge that obstetric sexual “misconduct” violates trust, that it is unethical, and that measures such as the use of chaperones will improve outcomes, but the tone continues to feel paternalistic and disingenuous. I’m not at all shocked by that. I did a simple word search for “may” in the statement. It came up 39 times. “Sexual misconduct may be grounds for disciplinary action,” numbers of reported sexual misconduct maybe underreported, “Sexual misconduct by clinicians during labor and delivery may be more prevalent than previously thought. A large survey of U.S. and Canadian obstetric support personnel raised concern that clinicians may at times use sexually degrading language with laboring women or perform genital examinations or procedures without appropriate consent or despite the patient’s refusal.” You get the point…This language is dismissive and offensive.
The give “trauma informed care” one measly paragraph of acknowledgement. This is a HUGE, glaring issue in medical care of all kinds, but especially in OBGYN. They make no mention of providing any training on the subject, just that there are other articles physicians can read to obtain more information. Hey ACOG, REQUIRE TRAUMA TRAININGS FOR ALL MEDICAL STUDENTS AND CONTINUING EDUCATION FOR PRACTICING PHYSICIANS STARTING IMMEDIATELY.
The statement gives a lot of space for the discussion of chaperones. They mention that chaperones should be used in all settings, regardless of the sex or gender of the clinician. This seems like a fine practice standard, as it’s know that medical staff behave differently when there are witnesses. However, chaperoning may work better in the clinical setting than during births. The inherent power dynamic between OB and physician seems to override any witnesses in the birth room. I have personally seen numerous subtle and overt violations during births by both nurses and doctors, and neither my presence, nor the presence of the client’s partner or family, seems to make a difference.
Obtaining patient consent for examinations (or care of any kind) is mentioned as important, but there is little acknowledgement of the coercive tactics used to perform these exams (especially when it comes to vaginal exams in pregnancy and during labor). The statement makes sure to remind us that in cases of medical emergency, consent doesn’t need to be given in order to perform medical interventions. Or that, if the patient is unable to give consent, the same goes. But this seems highly subjective and interpretive to me. I know too many doulas who have witnessed doctors violating a patient’s right of refusal, or taking advantage of a patient’s altered state of consciousness in labor to bypass consent.
They leave us with, “Routine use of chaperones, in addition to the other best practices outlined in this Committee Opinion, will help assure patients and the public that obstetrician–gynecologists are maximizing efforts to create a safe environment for all patients.” So it looks like their only concrete solutions are the use of chaperones, making hospitals “safer” places for patients and staff to report abuse, and that (sort of undefined) medical education will take place. Again, this is all wonderful, but it isn’t enough and it doesn’t give any concrete consequences to the hundreds, if not thousands, of OBGYNs who routine abuse their patients. It doesn’t offer any solution for educating the public on this subject either–much of the time obstetric violence goes unreported because patients do not even know that they were abused. Forceful and unnecessary vaginal exams, not listening when patients give clear refusals, manipulating patients, etc., are all normalized in this culture and ACOG has a responsibility to educate the public that this way of practicing is abhorrent. I doubt that will happen, and the responsibility will fall on doulas, childbirth educators, midwives, and others to spread the message that the way we are treated in OBGYN is unnecessary, abusive, violent, harmful, and traumatizing.
Thank goodness for the (truly) uncommon doctors who do not practice abusively. They are out there and we see them, support them, send our clients to them, and lift them up as exemplary in our communities. This statement focuses on overt sexual abuse, but what is equally rampant is psychological abuse, coercion to consent to medical care that is routine or convenience-driven, fear mongering, and so on. Until ACOG addresses all of it, with more than words, with ACTION, I cannot take statements such as this seriously.
ACOG, DO BETTER. DO IT NOW.