Anyone who knows me well will know that I am a huge advocate for respectful, evidence based, consensual medical care. You would also know that I am hugely against inadequate medical care when medical care is absolutely necessary and INSANELY AGAINST biased and coercive based medical care.

If you didn’t know any of that, then congratulations! Now you know and I won’t have to say it all again later on.
Before I really get started on what this blog post is about though I’d like you all to picture something in your minds for me:

• A man goes to the emergency department of his local hospital at night for excruciating lower abdominal pain, non-stomach-bug-related vomiting and inability to walk without aid.
  The pain doesn't respond to any of the standard pain relief medication normally given when people present with severe (currently) unexplained pain – paracetamol and ibuprofen doesn’t work, the maximum doses of endone or buprenorphine doesn’t work. Usually when that happens the nurses consult with the on call registrar and stronger pain medications are ordered (morphine, fentanyl etc).
  The man gets to stay in the hospital for a couple of days or so days with regular morphine and/or fentanyl and/or every other strong pain relief available to try and get the pain under control while having in depth investigations to find out exactly what is causing the pain (by in depth I don’t just mean the standard urine and blood tests and maybe an ultrasound – I mean the full kit & caboodle testing to rule out everything from appendicitis to cancer to an obstructed bowel). The man walks out of the hospital with his pain under control and either a diagnosis or a referral to a specialist who can diagnose him.
  
  

Now I ask you to picture this:

• A woman with a pre-existing incurable and generally painful disease goes to the emergency department of her local hospital at night for excruciating lower abdominal pain, non-stomach-bug-related vomiting and inability to walk without aid.
  She is only given one endone every 4 hours and two paracetamol every 6 hours. When she tells the nurse that neither of those pain medications is helping at all she is given a heat pack and told “that will help” (what the nurse hasn’t been told is that the patient spent the previous 6 hours before rocking up at the hospital at home taking the buprenorphine she normally takes for severe pain related to her pre-existing disease with a heat pack so hot that it is burning the skin on her lower abdomen). Only the basic tests (urine, bloods and an ultrasound – a basic one that cannot pick up the disease that she has and has been proven in the past to not show serious things that were happening within her body) – are done and she’s left to suffer and cry alone in her bed on the ward while still in excruciating pain. After about 12-18 hours, and maybe in a rare case after a second overnight stay, she is sent home and told to “wait it out” as it is assumed to just be a 100 times nastier than normal flare up of her incurable condition – no in depth testing has been done, the pain is still not under control and the woman in question can barely walk let alone speak up for herself as she’s pushed out the automatic doors with no real help and told to see her GP in the morning, all so the hospital can make room for someone “who really needs the bed”.
  
  

After visualising both of those scenarios can you see the difference between the two? The differences between the tests that were done and the treatments that were given? In how both patients are cared for and the results that both received? In when and how they went home?

The man received better treatment, his pain with an unknown cause was taken much more seriously and given top priority to find out what was wrong, and he was given adequate pain relief and left the hospital with the pain in control and a plan in place.

The woman wasn’t given adequate treatment, was given inadequate pain relief, was brushed off and mostly ignored, and, potentially even more dangerously, her pain was solely attributed to a pre-existing condition with only minimal investigation done - what if it had been her appendix getting ready to burst? Or what if part of her bowel that wasn’t visible on ultrasound had ruptured? Or what if her fallopian tube and ovary had twisted right behind her uterus where it can’t be seen clearly and had gone into torsion which can result in the loss of an ovary if it isn’t picked up in less than 6 hours of onset and can be deadly if it is left untreated? All of these are valid concerns but sadly a lot of them are brushed off and ignored if there isn’t anything visible on an ultrasound or if the symptoms don’t exactly match what most doctors have been trained to recognise.

If you can’t tell already I’ll explain this now – there is HUGE inequality between how men and women (and this is not even going into how those who don’t associate as either are often treated!) are treated when it comes to the quality of the medical care given to them.

In some ways - and some places - we are still very much in the dark ages with how women experiencing reproductive, lower abdominal and pelvic issues are treated in hospital settings. This is not to say that there aren’t some wonderful care providers out there because there are, I’ve personally met some of them, but they are few and far in between and the chances of one of them being on duty when you end up in hospital are really slim.
You may think that these are just random scenarios created in the fertile darkness of my crazy mind but I must sadly inform you right now that this isn’t the case.

These scenarios are both based on very true stories – the inspiration for the man’s scenario came from a combination of my own husband’s experience and the experiences of random men who have shared their stories online, the woman’s scenario actually happened only this past week, and the woman’s scenario is also, I am very sad to report, the real life outcome that happens to hundreds of women every single day all around Australia.

When I randomly questioned a group of women (some who have children and some who don’t have children, some with a painful health condition and some without any known conditions at all) about the two scenarios above the answers were empathetic towards the woman’s scenario and many shared their own experiences.

• W- “It is like you have written the experiences of myself and my husband”
  
  
• Another, Anonymous, responded with – “The world is sexist as if a man says he is in pain he is surrounded by help but a woman has pain she is told to deal with it.”
  
  
• P says – “It's BECAUSE pain associated with women's reproductive organs is accepted as "normal".
  
  
• From B – “I'm a part of a huge Perth group and I honestly just saw a story like this on there, but it was a mental health thing. They kept the person in overnight but then said they assessed her and she wasn't deemed worthy of a bed and was discharged even though she went in with suicidal tenancies - yet someone else (male) posted their experiences with the same hospital in the same mental health unit and couldn't stop praising the hospital saying how great they were for him and how they must have been leaving something out for them to have kicked her out. Yet, when copious amounts of other women came along and said they experienced the same thing, said male 'joked' that men have it harder anyways which is why they're better looked after.
  I know it's not the same thing but in some aspects is because it shows that there are some discrepancies in care.
  I have seen this before myself and been a part of it. A few years ago, I presented to the ED with chest pains and numbness down my arm. I got taken in 2 hours later, put on an ECG machine and monitored for an hour maybe 2 before told I could go home. Given pills for the pain and dizziness I was feeling at the time too. Nothing worked and I felt so horrible and tired that while on the ECG machine, I fell asleep. Next morning, woke up and felt horrible and the pain wasn't gone but dulled down.
  A couple years later, XH goes to hospital with exactly the same as what I was feeling and ended up staying overnight and having all tests run on him under the sun (Luckily they did cause they found gall stones but still) and I remember just saying to him that he was get preferential treatment cause he was a male - little did I know how true it actually felt.”
  
  

Every single day in Australia women are treated as second class patients compared to their male counterparts and have their pain ignored, they are told to “suck it up”, that pain is “normal” (pain is not “normal”, even the scientific literature agrees that pain isn’t “normal” and is a symptom of an underlying issue that needs to be treated) and that we just need to live with it, to go and see a psychologist or therapist because it’s “all in our heads” and if we “fix our heads” the pain will “go away” (it won’t, physical pain can’t just be stopped by a psychologist or therapy, it needs adequate physical medical treatment and pain relief as well and even then it may not be “fixed”).
What can you do to change this? There are several things and I’ll outline them below.

• Contact your local members for parliament. By sending your local members for parliament letters outlining your anger at how women are treated in the healthcare system you can help to promote more awareness by making them aware. Not all of them will respond or take it seriously, but some will take action on it.
  
  
• If you or someone you know has been on the receiving end of this sort of treatment lodge a complaint with your local hospital. While most of the time you’ll only get a generic apology letter it is known that the more times that complaints are made, and the more people who kick up a huge stink about how they have been treated, the more that problems are taken seriously and the better the treatment will be for similar scenarios in the future.
  
  
• If you or someone you know are currently being treated inadequately in a hospital setting and located in QLD you can call 13HEALTH and quote “Ryan’s Rule” (you can find the details of Ryan’s Rule here - https://www.health.qld.gov.au/cairns_hinterland/html/ryan-home)
  
  
• If a specific doctor has treated you or someone you know like this you can lodge a complaint with the Medical Board (http://www.medicalboard.gov.au/~/link.aspx?_id=60F806737FE14B28AF314FB306B4BFBE&_z=z) and also with the Australian Medical Association (https://ama.com.au/tas/health-complaints)
  
  
• Share awareness amongst your friends, family and anyone else who will listen. Many won’t be interested and some may even ridicule you but there will be people who are receptive to what you have to say and will listen and take action themselves.
  
  
• Continue to advocate for yourself and those who rely on you for their care. If you don’t advocate for yourself you can’t change how you are treated. As part of advocating for yourself you can ban any practitioner from treating you or being in charge of your care and can request another practitioner if needed. You have the right to receive the best healthcare and treatment possible (and also to refuse any healthcare that you don’t want to have). The more people who advocate for better healthcare for themselves and others the more that Australia’s care providers will see how much people aren’t willing to put up with substandard treatment.
  
  

Lastly I want to say this – in order for the treatment of women in the healthcare system to be improved those who are in charge of our care need to be taught that we women are equal to and just as deserving of high quality medical treatment as our male counterparts who are also patients. They need to learn that our pain is real, that it exists physically and that a lack of adequate treatment is not only detrimental to our health and well-being (as women) but also to that of our families and friends too. Care providers need to take our pain seriously and provide adequate pain relief (not just minimal pain relief) and need to be educated on the various diseases and conditions that can cause it – not just the basic information from one paragraph in a medical text book but actual first hand information provided by a specialist in that particular field. They also need to respect us not only as fellow human beings but also as people who are intelligent, educated, able to recognise when something is wrong with our own bodies (it is our body after all and no one knows it better than ourselves) and able to make informed, intelligent and needed decisions for ourselves without being coerced, manipulated, forced or scared through fear mongering into making a decision that we otherwise wouldn’t make.

Today I took part in a discussion about obstetric violence and the doulas role when witnessing obstetric violence. It was very interesting and also sad, frustrating and made me a bit angry reading the personal experiences of going through obstetric violence from some of my fellow doulas, as well as the first hand witness accounts from those who has seen it done to their clients.
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Obstetric abuse is not new to me; I have been through it myself and know many others who have also been through it. Seeing it discussed openly and respectfully with suggestions of things that we (doulas) can do to help any of our clients who may be on the receiving end of it and hearing about the different ways that obstetric violence can be presented was very helpful and I know that I will be taking away much of what I have read and using it to help any of my future clients who may experience obstetric violence (I bloody well hope that none of them do!)

The biggest issue discussed was about many of those who experience obstetric violence AND have a doula supporting them while it is happening – specifically about the client blaming the doula for not stopping what happened and what we, as doulas who may be witness to this awful practice in the future, could potentially do to not only stop it from happening but also to potentially prevent it from happening at all. The one thing that I noticed most about this part of the discussion (and from a documentary that discussed women’s experiences of obstetric violence) was that the doula was often blamed for not stopping it, not preventing it, not fixing the problem.

Having personally experienced "birth rape" during the birth of my youngest child - I didn't have a doula during that birth and I did blame my husband for a LONG time afterwards (and still have some residual anger towards him that I have not yet been able to release, it has been nearly 6 years now and the long term negative effects of that experience still affect me to this day - I have forgiven my husband however, and I have no doubt at all that had I had a doula I would have blamed him/her for not protecting me instead of my husband) for not doing anything to stop what was being done to me (in his defence he truthfully had no idea what was going on and was focused on our baby who wasn't breathing yet and needed resuscitation). I blamed the person that I trusted the most during the most vulnerable moment of my life for not protecting ME, for not SAVING ME, for not ripping that fucking obstetric registrar away from me and ripping his damn head off. I still blamed the registrar for his actions, but most of my blame went to the person who was supposed to be my protector.

We as women who have experienced obstetric abuse still blame our care provider for what happened - that's obvious - but we also blame the person that we trusted most to protect us, either our partner, a family member/friend  or our doula (if we have one), because in our eyes they DID NOT protect us and they were supposed to.

Blame, choosing one person to blame for what happened, is (unfortunately for us) normal and is part of the grieving process, it's awful for us who are on the receiving end. And we are grieving after what happened to us – we are grieving for what should have been, grieving for the pain we have experienced that we shouldn’t have had to experience, grieving for everything that should have been perfect and right and instead went so very very fucking wrong.

WE the doulas become the scapegoats instead of the other support person (if there was one) just because of our presence in that room, WE become the ones who SHOULD have done more, SHOULD have been better, SHOULD have been able to FIX whatever was happening, SHOULD SHOULD SHOULD have done SOMETHING, ANYTHING to stop what was happening from happening in the first place. WE doulas are the ones who are trusted to protect our client, to keep our client safe, to tell our client what is happening and when. WE doulas are often expected to do more and be more than we actually are – like that old blog post about airy fairy doulas full of unicorns and rainbows from way back in 2014.

All that we as doulas are physically able to do in the birthing room is to tell our clients what is happening, speak up (out loud so that everyone present is aware of what we are saying) and ask our clients if they are ok with what is happening or if they wish for it to be stopped.

We cannot control what their care providers do.

We cannot physically stop their care providers without risking being charged with assault ourselves and as a result leaving our client alone, vulnerable and still in the hands of that care provider (here in Queensland, Australia we are now not "allowed" to even raise our voice in anger or frustration at a care providers actions, regardless of if we are in our role as a doula, as a patient or as the support person/advocate of a family member, without risking being potentially charged with abuse against that care provider ~ carries the risk of spending up to 14 years in jail if we are charged), we can do what we can within the limits of the current system wherever we are but we alone cannot change it, we can only create awareness and make sure that our clients know all of their options.

The harsh reality is that there isn't all that much that we doulas are able to do in the moment and we cannot stop all of it from happening. All we can do is support our client, inform them and their other support people, tell our clients if we see that something is being done without their consent and remind them that they can say NO and STOP and can kick their care provider out of their room if they don't stop what they are doing.

After the birth we can register complaints with the hospital and the relevant medical authority as witnesses of what occurred and we can provide a witness statement that our client can use for what we saw happen. We can support our client physically and mentally/emotionally and we can find suitable resources for our client so that our client can hopefully begin the process of healing, if not physically then at least mentally/emotionally.

It kills me inside that I cannot do more. I wish I could do more. I wish that I could save every single woman from experiencing anything like what I went through – I know that I can’t but the wish is still there – and all I want, more than anything else in this world, is to see those care providers who practice obstetric violence be appropriately punished for their actions and for all of the damage, pain and heartbreak that they have left in their wakes.

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Just a little end note:

-  If you or someone you know has experienced obstetric violence please lodge a complaint against the person who perpetrated that violence with both the hospital that it occurred in and also with the relevant regulatory authority for that persons profession.
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- If you or someone you know has experienced obstetric violence and is struggling mentally/emotionally please encourage them to seek help from a maternal mental health counsellor/psychologist with experience in treating complex PTSD caused by obstetric violence/birth trauma.