[Trigger warning: Violence against women]
Karin Lalush (in the photo to the right), a 31-year-old pregnant woman, died last week during labor in Soroka hospital. The official hospital report says that she suffered from a rare condition that they did know about. But the family says that isn’t the whole story: She died after a doctor sat on her. Sat. On. Her. Took his entire body weight while she was lying on her back and in labor, and swaddled his legs on her body while forcefully pushing his hands and elbows into her abdomen.
Sat. On. Her. Without asking permission first, by the way. Without even saying that this is what he was about to do.
This is really hard to write. Even writing these words gives me these chills. Angry creepy chills. I’m shaking as I’m typing. Sounds of screams are erupting in my head.
But it gets worse. Because she is not alone. HUNDREDS of women in Israel are subjected to this treatment every year in Israel. In the midst of labor, a male doctor walks in and, without asking, pushes the other people aside and sits on her and starts pressing down on their stomachs.
Hundreds.
And what happens as a result? What you might imagine.
Broken ribs.
Difficulty breathing.
ICU…..
Here is how a woman named Yulia Teller described it on Facebook the other day:
A month and a half ago, I went through a traumatic birth in which a male doctor, an intern, a very big guy, got on top of me, because he claimed that it was taking me too long to give birth. I ended up with broken ribs, time in the ICU, and an emergency C-section. After I came back from the ‘dead’ you might say, I am no longer keeping quiet. I filed a complaint against this doctor with the Health Ministry. But they decided to blame me, that instead of saying ‘thank God I’m alive’ I am, in the epitome of chutzpah, blaming the doctor. But not a single man in that pipeline of obstetrics and gynecology will silence me. I went to the press. I plan to fight the butcher shop called ‘Soroka hospital’ and I will not be quiet until those responsible for my suffering and for the death of other pregnant women pay the price for their actions. Until they lose their licenses. They should not be allowed to work in medicine! They swore to do no harm and they are doing exactly the opposite.
Yulia was interviewed for an investigative report that came out last week in Yisrael Hayom. It is absolutely sickening to read these accounts.
This is violence. There is no other way to describe it.
A man puts all his weight on a woman, without her asking. A pregnant woman no less.
Pushes her in all directions. Doesn’t care about her pain or her experience.
Not to mention that he also sitting on a baby. Another human being in there. Who is also vulnerable. Sitting on the woman and her baby. Putting all his weight and force there.
Violence. In the name of modern medicine.
It is the deep sickness of the medical establishment itself, especially when it comes to treating women, in that it sees us as bodies and not as people. As mindless, soul-less bodies who have no feelings and no minds and no volition. Just a slab of meat on a metal table. Or a bed. Whatever. A glob of organic materials that needs to be fixed or manipulated. Flat on our backs. Ideally silent and obedient. When we don’t comply, they, the great-god doctors who must know and do everything, come in to the rescue. Using all their force on our insolent bodies. And our job is to say “Thank you. You are my savior.” Just Like that. That is what the medical establishment told Yulia Teller after the doctor sat on her and broke her ribs and sent her to the ICU because she couldn’t breathe. Thank him. Thank him!
This story is about power. It is a story that highlights who has power and who doesn’t. The woman in labor, despite the fact this this is her life experience and her body, has no power in this situation. Physically, she is in extremely vulnerable due to the pregnancy and labor, and even more vulnerable by the fact that she is lying on her back and half naked while everyone around her is standing up, fully clothed, and working. The fact that a man can simply climb on top of her like that speaks volumes about how women are stripped of our power in hospitals, especially in pregnancy and labor.
But it’s not just about physical power but also decision-making power. Knowledge. It is about stripping away of our mental power and our authority. The woman in labor doesn’t get a say in how this happens, in what actions are taken on her body. Plus, a woman who dares resist medical authority is branded as difficult. Hysterical. Not only is a woman’s voice not listened to in her own life situation, in these stories the woman was never even asked. As if she doesn’t have a voice at all. A ton of new research has uncovered just how much women’s lives and experiences are systematically excluded from medical thinking and procedure. It’s maddening.
All this despite the fact that pregnancy and labor are exclusively female bodily experiences, and that women have been passing down knowledge about labor throughout cultures and centuries. All of this knowledge has been systematically erased by western male-dominated medicine. The same medical system that thinks that sitting on a pregnant woman in labor is somehow a good idea.
To wit, midwives have been recommending for many years – decades or even generations – that lying on one’s back is the worst position in which to give birth. Birth needs some gravity for help. The body has its own mechanisms for this. Sitting up, squatting, getting onto all fours, standing against the wall – these are all more natural and effective ways to give birth than laying flat on the back. Lying down is also hard on the heart and internal organs. But hospitals regularly prefer to keep people prone, like cadavers. They are easier to manipulate that way. It has nothing to do with what’s good for the ‘patient’. It has to do with what is good for the doctor. What enables more control.
Can you imagine the doctor coming in, looking at a woman lying on her back, deciding that labor is not ‘progressing’, and his response is to physically use ALL HIS MIGHT to simply PUSH her body and the baby that way? It goes against the entire notion that bodies are living things working through their own systems. It crushes life instead of supporting it. The whole image of a man sitting on a pregnant woman and pressing down, such a nauseating thought, is the exact opposite of what healing and birth are meant to look like.
And yet, this method is not only used regularly, but has been in use for a long time. The method, called the ‘Fundal Method’, was conjured up by a German man in the 19th century. He may have had a medical license, but that just shows that a person can be a “doctor” and also be a misogynistic monster. And of course, you know, 19th century, when women were not only excluded from medical schools because our minds were considered soft, but we also lacked most basic rights, like the right to own money, vote, or freely divorce our husbands. The idea that a baby could simply be forced out of a woman’s body with enough physical pressure while she lies motionless on her back under the weight of some big guy fits in with that entire world view. It’s the world view that has zero understanding or appreciation of women’s lives and needs as human beings.
And by some unfathomable reality, this method is still being used in 2021.
I’m furious. Beyond furious. I can’t come up with a word strong enough to describe how enraged I am.
I admit that I may be biased. After all, my daughter gave birth just a month ago. In Soroka. In the same ward where just six weeks ago, a male doctor did this to Yulia Teller and she nearly died. Where last week a male doctor did this to Karin Lalush and she died. Same place. Same rooms. Same staff.
It could have been my daughter.
I’m shaking all over just thinking about this. How close we were to this experience. We were right there.
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I did some research to find out why doctors are still doing this. I’m trying to find some kind of evidentiary support for this practice. Something.
What I have found is that there is zero evidence that this method is effective at all. But there is evidence that it causes damage to both the mother and the baby.
A 2017 article published by the US National Institute of Health conducted a meta-analysis of this issue and reviewed nine trial studies examining whether the fundal method is effective at shortening labor. It refers to thousands of patients, and heterogenous sampling. Here is what they report:
Manual fundal pressure was not associated with changes in: spontaneous vaginal birth within a specified time (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.71 to 1.28; 120 women; 1 trial; very low‐quality evidence), instrumental births (RR 3.28, 95% CI 0.14 to 79.65; 197 women; 1 trial), caesarean births (RR 1.10, 95% CI 0.07 to 17.27; 197 women; 1 trial), operative birth (average RR 0.66, 95% CI 0.12 to 3.55; 317 women; 2 studies; I² = 43%; Tau² = 0.71; very low‐quality evidence), duration of second stage (mean difference (MD) ‐0.80 minutes, 95% CI ‐3.66 to 2.06 minutes; 194 women; 1 study; very low‐quality evidence), low arterial cord pH in newborn babies (RR 1.07, 95% CI 0.72 to 1.58; 297 women; 2 trials; very low‐quality evidence), or Apgar scores less than seven at five minutes (average RR 4.48, 95% CI 0.28 to 71.45; 2759 infants; 4 trials; I² = 89%; Tau² = 3.55; very low‐quality evidence). More women who received manual fundal pressure had cervical tears than in the control group (RR 4.90, 95% CI 1.09 to 21.98; 295 women; 1 trial).
In other words, there is ZERO EVIDENCE that the method has any positive effects. But there IS evidence that the method caused damage to women. Like cervical tears. They did not even check broken ribs or difficulty breathing. (Here is an informative website called 'Birth Injury Help Center that lists more of the damage that happens as a result of this method.)
And yet, the authors, remarkably, came to a very mild conclusion: “There is insufficient evidence to draw conclusions on the beneficial or harmful effects of fundal pressure.” (And by the way, according to the Birth Injury Help Center, there is almost no research on the effect of this method on the babies themselves.)
This is science-talk for what happens when a study fails to come up with a finding that is considered ‘significant’. It renders studies like this unimportant, based on the whole ‘null hypothesis’ that only values studies that have a so-called ‘significant effect’. In the science world, ‘no effect’ is considered no conclusion.
But in this case, no effect is a crucial conclusion. And as an aside, this article illustrates how this flaw in the scientific method can cause serious damage and even risk human life. Because the fact that there was no significant effect in itself is worth reporting. Very worthy of reporting. Doctors are performing this awful, violent practice without any reason whatsoever to do it. They are doing it simply because it has been done and nobody in the field seems to be explicitly saying not to. Because some guy 200 years ago decided that this was a good idea and they just keep going with it. It’s so very, very messed up.
(And by the way, in case you are also curious as I am, according to the Birth Injury Help Center, there is almost no research at all on the effect of this method on the babies themselves. I can't even imagine how this might effect the babies....)
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I have so many stories of doctors who did awful things to me during my 51 years on this planet. Doctors who unnecessarily undressed me. Doctors who relentlessly commented on my body. Doctors who ignored what I was telling them about what I needed and instead mocked me or reprimanded me to lose weight, as if that is all I need in this world. A doctor who refused to let me get the wax sucked out of my ear until after I stepped on the scale because at my weight the procedure was a “liability” in the process (which is not true at all, by the way). A doctor who refused to help me remove a stone lodged in my toe and instead lectured me about cholesterol (which, by the way, was fine, it was just an expression of fatphobia, and as a result I spent two weeks not getting my toe treated and eventually cut out the stone by myself with a kitchen knife). A doctor who refused to pay attention to the fact that I couldn’t breathe and clearly had pneumonia, and instead talked about bariatric surgery leaving my lungs untreated. A doctor who left me very undressed while he invited colleagues into the room for a light chat in front of my splayed legs. A doctor who stuck something in my vagina without my permission during labor when I said not to. When I screamed not to. Because I was in the middle of a painful contraction …..She later said to me, “You need to learn to trust your doctor.” And I said, “Why in the world would I trust someone who does not listen to me when I say ‘No’?’ When I say, when I scream, ‘NO, please don’t do that to me’?” She didn’t get it. For her, the job of the patient is to sit still and shut up. Anything else is a problematic patient.
I think a lot about these stories, and I think about them every time I think I may need to see a doctor for something. As a rule, I stay as far away from the medical system as I can, although that’s not always possible…..
I realize that there are many nice doctors out there in the world. I also realize that during Corona, doctors and nurses and other health care professionals were working round the clock in life-threatening situations to try and save lives. I know all that. I know that medical researchers do things like come up with vaccines. This is all valuable work. Someone reading this is going to start a thread about #notalldoctors. I can see that happening. So, for the record, I’m saying from the outset that I know and I agree. Not all doctors.
That said, the system is extremely broken. And causes lots of damage. Sometimes very serious damage. Especially to women.
When my daughter went into the hospital for labor, I dropped everything and reported to the ward. I didn’t fully know the details of all the risks she was facing. I didn’t know there was a monster circulating there with a certificate and job calling him Doctor, a man who was willing to use violence on pregnant women. A doctor who was given power and authority by his colleagues to do this thing to women patients. But I knew I needed to be there. On guard. Because of lots of other stuff I’ve seen and experienced. So I showed up. And stayed and I was on guard from medical professionals. I was on guard, even when that was uncomfortable for myself and those around me. Because I already know what this culture does to women.
I know what the culture does to women. And the memories keep coming.
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This story about the doctor sitting on the woman brought back a memory that I’ve had in my head for a long time. When I was around 7 or 8 years old, the pediatrician sat on me. I was in his office to get a shot and I did not want it. First I had to undress down to my slip, which I also hated. I did not want to get undressed, but my mother and the doctor made me. And then, I was apparently being unhelpful by resisting the shot. So Dr. Mogilner, our family pediatrician and our neighbor who was beloved by the entire community, just sat on me, laughed, and pricked me. Just like that. And he and my mother laughed. They thought it was very funny.
My mother laughed about this story often. She told the story for years. To illustrate how difficult I was. Maybe she was trying to gather sympathy. Like, poor mother who has to deal with such a difficult kid. So difficult that the doctor had to SIT on her. I don’t know.
For the record, some of the doctors who have done traumatic things to me have been women. Women internalize and protect patriarchal cultures all the time. Everywhere. I grew up that way. I don’t know why it even surprises me. Maybe it doesn’t anymore.
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I would like to finish this essay with something helpful. Something optimistic. Even though I can’t stop shuddering as I write this…. I’m glad that women are speaking out, like in twitter threads or in blogs or to investigative reporters. This is our greatest weapon against the violence and injustices that we face. But it doesn’t help the women who have been physically and emotionally damaged by this. It won’t help Karin Lalush whose family now has to carry on in her tragic absence. In any case, it takes years – decades, a generation – for cultures to change. If at all. If people in power are willing to be part of the change. That’s a big if. I do hope that these reports start the process.
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24/6/2021 EDIT:
In a closed FB group of midwives in Israel, some of the midwives from Soroka are saying that in the case of Karin Lalush, the reason why the doctor sat on her was not to apply fundal pressure but rather to massage her heart because she had gone into cardiac arrest. They asked that I report this on my post, so I am. I have no way of validating either way, and an official report on the cause of death has not yet been released. In any case, the story has brought much-needed attention to the alarming use of fundal pressure in Israel, including the horrifying practice of doctors sitting on patients. (And I must admit that the idea of sitting on a patient to work on her heart instead of violently pushing her baby out does not give me much comfort. It is still objectifying a person and ignoring their humanity in order to make the doctor heroic. I'm certain there are other options for action...) Anyway, I'm sharing what I know.
The story also highlights the difficult position that many midwives are in as they participate in violent practices that hurt women. Many women go into midwivery in order to support and protect women and to be vehicles of female wisdom, power, and compassion. It can be extremely difficult to practice those values in a patriarchal system. This is true in many different forums, in which women try to bring women-centric practices to a culture where those values are not wanted. It is the quintessential dilemma of trying to make change to a system from within. It can be a powerful position for making change and protecting women. But it may also entail being an unwitting sustainer of that system. My heart goes out to midwives working on the frontlines to protect women who sometimes find themselves protecting the patriarchy as well....
Dr. Elana Sztokman is an award-winning author, anthropologist, activist, indie-publisher and writing coach. Her latest book, Conversations with my Body: Essays on my Life as a Jewish Woman (Lioness Books 2021) is available here