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Kimberly Turbin and son. Photo courtesy Yahoo Parenting.

by Terri LaPoint
Health Impact News

It has been a year and a half after a birthing mother’s video went viral of a doctor cutting an episiotomy, despite the mother’s numerous refusals and impassioned pleas for him to stop. Now, that particular doctor will no longer be practicing medicine. The advocacy group Improving Birth worked with the mother, Kimberly Turbin, to file a lawsuit against Dr. Alex Abbassi in June, but only recently have they learned that the doctor voluntarily surrendered his license in August.

Advocates hope that this victory is just the beginning, and that this case will bring awareness to the abuse of childbearing women that is all too common.

From the time the video went live on YouTube, public reaction was passionate. It was never that what happened to Kimberly Turbin was more violent than usual, or even out of the ordinary. It isn’t. It is one of the reasons why doulas, or labor assistants, have become so popular. What made the difference was that the obstetrical violence, and utter disregard for the mother’s right to refuse a medical procedure and being cut with a knife, was caught on video and posted on YouTube for all the world to see. (Link to video here. Trigger warning: graphic video of birth trauma.)

For thousands of women, the video brought back memories of  the violence that they, too, experienced in birth. Kimberly’s courage in making the video public suddenly gave a voice to all the women who were shushed, ignored, or told to “just be thankful – at least you have a healthy baby.”

The video shines a spotlight on the very real violence that happens to birthing women all across the world, even in the U.S., where the medical system is theoretically supposed to be among the best in the world. It isn’t, at least for birthing women, where the maternal mortality rate has more than doubled in the past 20 years. There are now 59 countries with better rates than the U.S.


Obscene Increase In Maternal Mortality Rates In The United States

Some call what happened to Kimberly and many other women in childbirth “obstetrical violence.” Others refer to it as “birth rape.” Some simply say that it is a “denial of informed consent.” In Ms. Turbin’s federal lawsuit, as well as the police report against Dr. Abassi, the words used are “assault and battery.”

Dr. Abbassi Served with Lawsuit Last June

Dawn Thompson, founder of ImprovingBirth.org, is thankful that she was able to be the one to serve Dr. Abbassi with the lawsuit papers last June. She posted a video she recorded on her way home from that encounter. There was great triumph in her voice as she described telling the doctor:

Your abuse of women stops today.

In a culture that elevates doctors to almost god-like status, it is uncommon to hear the actions of doctors described as abusive, at least in the media or the mainstream. Yet, there have been groups advocating for birthing women and fighting against such abuse for many years.

The late Sheila Kitzinger, British anthropologist and childbirth activist, wrote and taught for several decades about women’s experience of trauma during birth. She established the Birth Crisis Network, to listen to and help women who had experienced traumatic or abusive childbirth. She describes many women’s experience of trauma in birth:

Women usually feel numb at first, simply relieved that it is all over. Later the floodgates open, and gratitude that they and their babies are alive is mixed with a sense that they have been violated: “I felt butchered, assaulted, raped.” “I felt like an animal being slaughtered.” Scenes from the labour and birth are played over and over again in their minds like a video on a loop that cannot be switched off. They suffer nightmares and flashbacks to the trauma. People who are trying to help often tell them, “You expected too much”. They have little confidence in their bodies, and breastfeeding is turned into a struggle. These women suffer from post traumatic stress which may last months or even years, it may adversely affect their relationship with a child and with their partner.

Empowering Women Against Medical Abuse

There are numerous blogs, such as Improving Birth, Birth Anarchy, Birth Without Fear, and even Birth Rape, which seek to empower women and to educate the public about harmful things that happen all too often in births. They hope to bring awareness and support the mothers who come to them.

The Trust Birth Initiative is a movement started on Labor Day weekend in 2005 by Carla Hartley, the director of Ancient Art Midwifery Institute, after Carla saw the cesarean rates reach an all time high of 25%. (It is now about 33% nationwide.)  There was an outcry to “Take birth back” from the broken system that has taken control in birth away from the mothers themselves. There are groups that meet all over the U.S. and Canada, and there have been several Trust Birth Conferences since then, geared to shifting the paradigm of birth as a scary, medical event where the doctors or midwives have all the control, to the ideal of the mother owning her own birth, recognizing that she is the one responsible for her choices and that birth is a normal part of life:

“Birth is safe; interference is risky.” – Carla Hartley

Trust Birth quotes meme

When Kimberly Turbin stepped into the Providence Tarzana Medical Center in Los Angeles, California, to give birth to her first baby, many of her choices were taken away from her. She had an epidural, but she had decided beforehand that she did not want an episiotomy – a cut on the perineum that used to be routine. She had only been pushing for about an hour, when Dr. Abbassi came in and decided that he wanted to speed things up and cut an episiotomy. She told him “No” repeatedly, but he did it anyway, cutting a total of 12 snips.

At the time that Kimberly gave birth in 2013, the standard protocols for the pushing phase was to allow 2 hours for a first-time mom, and an hour for mothers who had previously given birth. Since then, the American Congress of Obstetricians and Gynecologists (ACOG) has revised that protocol, increasing to 3 hours for first-time mothers and 2 for multips, before calling for a c-section, provided the baby was not in trouble.

Kimberly was only given 1 hour before the doctor felt the need to intervene. But there is no indication given that the baby’s birth needed to be expedited. The baby’s heart rate can be clearly heard on the video, and it was at a very normal, reassuring rate of 130s to 150s with audible variability for the duration of the video. There were reportedly no decels in the baby’s heart rate, which would have indicated a need for him to be born quickly.

The mother was, however, lying flat on her back with her feet up in stirrups – the lithotomy position – which is the position least suited physiologically to facilitating birth. The doctor told her that he was going to do the episiotomy,

because there is no space to come out, ok? Baby’s head is about that big and your vagina is only that much, ok? … And if it comes out, it’s going to rip the butt hole down clean.”

The baby weighed all of 6 lbs. The baby was not too big. This is what birth advocates call “doctor dystocia” – failure of the doctor to wait.

Hospital beds made for childbirth are designed where the mother can be sitting up, at least somewhat. They also come equipped with a “birth bar” that can be attached to the bed for the mother to use to help her to squat or sit upright, where she has the benefit of gravity to help her to push the baby out. They can be used even if the mother has an epidural. There are many other positions that also utilize gravity and facilitate easier birth. Yet none of these tools were used. Instead, Kimberly was forced to push against gravity, uphill, without the use of any tools or position changes that would have helped her body open up to birth her baby. Being upright opens up several more centimeters.

Instead of utilizing non-invasive methods for facilitating the birth, the doctor and nurses appeared to ridicule the mother for simply wanting to “try a little longer.” Kimberly’s mother can be heard in the background encouraging her daughter to go along with the doctor:

He has to do his job. … You can’t fight with the doctor.

Many times birthing women find that their family support comes from an era or mindset that says that they should go along with whatever the doctor says, because the doctor always has the best interest of the patient in mind. Many do not yet realize that doctors often have a host of other interests that come before the best interest of the mother and baby.

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Kimberly with her son. Photo source: Lindsay Askins at spotofserendipity.com

A nurse can be heard in the background of the video telling Kimberly something that flies in the face of numerous medical studies:

But if you rip, you’ll rip more than a cut, and it’s a lot more pain, too.

Her statement is an obstetric myth, oft recited, that is not supported by the evidence. According to the study, “Routine use of episiotomy in modern obstetrics. Should it be performed?” (link here):

Although episiotomy does decrease the occurrence of anterior lacerations, it fails to accomplish the majority of goals stated as reasons for its use. Episiotomy does not decrease damage to the perineum but rather increases it. The midline episiotomy increases the risk for third-degree and fourth-degree lacerations. Episiotomy fails to prevent the development of pelvic relaxation and its attendant complications. Rather than decreasing maternal morbidity, episiotomy increases blood loss and is related to greater initial postpartum pain and dyspareunia. It has been associated with a more difficult and lengthy repair as measured by the need for suture material and operating room time. The claims of a protective effect on the fetus in shortening the second stage of labor, improving Apgar scores, and preventing perinatal asphyxia have not been borne out.

Renowned Australian homebirth Dr. John Stevenson wrote in Midwifery Today of his philosophy that episiotomies are simply not necessary:

Early in my homebirth experience I learned that as labour progresses, mother’s pelvic and perineal tissues become soft and elastic to an extraordinary degree. The reason is so obvious: How else could a woman give birth to a baby through such a narrow channel without tearing? It is a fact that some mothers do tear, but if we are patient and careful enough, the tears are few and trivial. Stitches are often unnecessary. I have often wondered, but do not know, whether the softening agent affects the whole body or just the pelvic tissues. Although the standard teaching is that a large episiotomy is essential for breeches or forceps, I don’t agree, and simply never do episiotomies. With care, breeches and forceps births can be managed without a tear.

The Rights of Birthing Mothers are Being Abused – Time to Fight Back Against Medical Tyranny

Dr. Abbassi did what obstetricians do every single day. He ignored the refusal of his patient for a procedure. This time, however, he was hit with a lawsuit. After the video went viral, donations came pouring in to help Kimberly Turbin pay for an attorney. Dawn Thompson of Improving Birth worked with her to find an attorney who would take the case. Even with video evidence, Dawn reports that it took a year and a half to find one. After talking with more than 80 attorneys, civil-rights attorney Mark Merin agreed to take the case.

Shortly after the federal lawsuit was filed against Dr. Abbassi in June, the doctor voluntarily surrendered his medical license in August. Thompson reports that he was scheduled for a deposition, but Turbin’s attorney was contacted by Abbassi’s attorney and told that “Dr. Abbassi was now suffering from a cognitive impairment and could not participate in the deposition.” According to court documents, because of the cognitive impairment, he:

took proactive measures during the months of March through June, 2015, to protect his patients by referring all of them to other health care providers, ceasing the practice of medicine and closing his office to all patients.

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Dr. Alex Abbassi. Photo source: Providence Tarzana Medical Center

That explanation, however, reportedly contradicts his actions in June. Dawn Thompson told Health Impact News that she called Dr. Abbassi’s office the day before she served the papers about the lawsuit to verify the hours that he would be there. She says she spoke as a potential new patient, and asked if the doctor was taking new patients. She was assured that he was. He was in a solo practice, so the question arises – when did Dr. Abbassi make the decision to shut down his practice? Did that process begin in March due to “cognitive impairment,” or was the decision made after he learned of Kimberly’s lawsuit against him?

At any rate, he is no longer practicing, and Dawn Thompson hopes that this will set a precedent that will get people to recognize that:

There’s a tremendous amount of disrespect going on, and they [obstetricians] tend to forget that this kind of behavior is inappropriate.

It’s become so common that they don’t even see the harm that they are causing.

Kimberly Turbin is rejoicing in the victory as well:

Having Dr. Abbassi give up his license feels like a big victory. I didn’t want him to continue hurting other women. My hope is to continue with the suit and set a precedence and put doctors all across the country on notice that this kind of abusive behavior can’t happen.