One in three mothers has had a traumatic birth experience, yet the province lacks a centralized system to track complaints of mistreatment
Many women who suffer traumatic births don’t file complaints, making it tough to tell how prevalent patient mistreatment is. (Richard Buchan/CP)
At nine months pregnant with her third child, Lily Schumacher found herself comforting her own midwife, who was in tears. The midwife had told her that if they didn’t induce labour, Schumacher would be putting the baby’s life at risk.
Schumacher was two weeks past her due date but wanted to wait another couple of days, to give herself every chance of going into labour without medical intervention. Her obstetrician agreed that it was safe for her to wait, but her midwife insisted otherwise.
“I wish I had never gone to the hospital. I really wish I had not gone to the hospital,” says Schumacher, who lives in the Kitchener-Waterloo area. “Even if I had, I wish that I had walked out because I could have done that, but I was led by fear. I was pushed by fear, and I was doing a lot to please everybody else.”
The midwife told Schumacher that she’d had a dream about the baby dying. Feeling outnumbered, with her husband, parents, and in-laws all in agreement that if the midwife had said to induce labour, then they should, Schumacher reluctantly agreed.
“Within the birth community, we’ve even come to joke about ‘the dead baby card,’” says Billie Harrigan, co-founder and co-director of the support group Birth Trauma Ontario. “It’s become so common to hear of a clinician threatening a mother with a dead baby if they don’t comply that it’s almost laughable — except it isn’t. It’s a violation of the Health Care Consent Act. A person cannot consent under duress,” Harrigan continues, “and threatening a mother with a dead baby is intentionally causing duress.”
Schumacher’s midwife declined to speak to TVO.org on the record, saying that she was concerned about protecting her other clients. She said that as a midwife, she helped clients make informed choices about their care, and that she was “very committed to supporting women’s positive birthing experiences.” She added that, following births, her clinic offers mothers many chances to discuss how their labours unfolded.
Research shows that one in three mothers describes her birth experience as traumatic and, according to a recent CBC investigation, hundreds of complaints have been filed by women across the country alleging mistreatment during their maternity care. But each province collects this information in different ways — if they collect it all — so it’s difficult to get an accurate picture of how prevalent the problem is.
Many women do not file complaints, exacerbating the data shortage. Harrigan attributes this to the challenges new mothers deal with even when things go well, and the trauma they face when they go badly. New mothers are often reeling from their labours, adapting to their new roles, and recovering from surgery. Some struggle with postpartum depression or anxiety. Harrigan says it often takes years before a mother feels able to register a complaint — and by then, it’s too late.
Harrigan has more than 30 years of experience working as a doula and a birthing educator. She created Birth Trauma Ontario in response to stories shared in that community. She says very few women felt cared for, or that their wishes were respected. She was concerned by the stories she heard of mothers being coerced into medical interventions they didn’t want.
“It’s not only in hospitals. It’s also seen in midwife-attended home births,” Harrigan says. “It’s an issue of the culture of maternity services where clinicians are dealing with policy based on hospital or provider insurance, a culture of risk aversion, fear of litigation, and cultural perception and faith in the value of technology …
“Mothers who wish to make a choice that is not in line with provider preference are generally met with coercive tactics or even threats.”
Schumacher says she had an “incredible home birth” with her second child, and that’s why she had planned to have another home birth with the same midwifery clinic.
“[The clinic] felt like family, and that’s why this is difficult,” she says. “I’m not out to hurt anybody, but I need to share my hurt, too.”
The attempted induction failed, causing Schumacher a great deal of pain. By this time, her midwife was gone (as soon as Schumacher went to the hospital, it was considered a transfer of care), her obstetrician’s shift had ended, and she had a new doctor. She was in extreme pain and asked for an epidural. The anesthesiologist who administered it said she had to leave for another procedure; meanwhile, the epidural took only on one side of Schumacher’s body. Another anesthesiologist was called in, but by that time it was too late, and Schumacher had to give birth without anesthetic.
“Giving birth itself is traumatic on its own. Your life changes completely,” says Schumacher. “No one really talks about how much you’re affected just by giving birth, just by having a normal regular birth … So to compound it with all of this other stuff, it’s a big deal.”
At first, she says, “I couldn’t put my finger on it. I didn’t understand the emotions that I was having. I just felt angry. I was sad. I was disappointed. And I just thought that my birth didn’t go as planned, and I was unhappy about it and I should just suck it up because I had a happy, healthy baby.”
Schumacher says the entire experience left her traumatized, and it’s now hard for her to trust health-care providers.
“I know we can’t control everything, but to feel like you have autonomy over your own body, as a woman that is huge …. And that’s what made me feel like a failure. I have two daughters, all these people that I would talk to about birthing and how wonderful it is and all of this stuff, and then this happens. I just felt like I’m stronger than this, and how could this happen?”
She also says she felt more comfortable sticking up for her baby than she did sticking up for herself: “For those of us whose children are more or less fine, I think we feel guilty about making the complaint. Because people will look at us and ask, ‘What exactly are you complaining about?’”
While provinces such as Alberta and British Columbia have centralized systems to track complaints, Ontario doesn’t — here, complaints are addressed by the individual hospital or regional health authority. Harrigan says she thinks governments may be not be inclined to monitor complaints because that would amount to admitting there was a problem with how women in labour are treated by the health-care system.
Ontario’s health minister, Eric Hoskins, says there is further recourse, however. This past July, Christine Elliott was appointed the province’s first patient ombudsman. In that role, she is tasked with addressing patient concerns if they have not been resolved by existing medical institutions.
“Ultimately, if you’re dissatisfied by the response taken by, for example, a hospital, you have the opportunity to go to the patient ombudsman,” Hoskins says. “I couldn’t have said this even six months ago, but this is part of her responsibility, to be able to respond to concerns expressed by all Ontarians, including those who may have specific issues for recent births.”
Hoskins says that although he’s confident that there are mechanisms currently in place to allow someone to come forward with a complaint, he wouldn’t rule out having a central system for tracking complaints about maternal care.
“I think there’s always more we can do. This suggestion has never come to my attention before,” he adds. “But I’ll take it back and see what other jurisdictions are doing, and as always if there are better ways of doing things, I’m interested in looking at them.”
Kelly Dobbin, the registrar and CEO of the College of Midwives of Ontario, said she was unable to comment on the specifics of what happened to Schumacher, but that the College “expects all registered midwives to facilitate informed decision-making for their clients and to support clients’ autonomy in decision-making.” That includes recommending particular courses of action “based on evidence and the clinical situation,” she explained, but “any behaviour that undermines client choice could be considered professional misconduct.”
It’s been almost three years since Schumacher gave birth to her third child. She’s now, finally, working on filing a complaint with her midwifery clinic. “If you’re unhappy with how your birth experience went, you haven’t walked away with a good feeling, that gnawing feeling that something wasn’t right, talk to somebody about it,” she says. “This is real. People need to know about it. Women need to talk about it.