Consent is consent is consent. Period.

By Emily Varnam

Over the summer I wore the same red dress with yellow roses on it. It was the only thing that I felt comfortable in, and recently, since it’s been snowing, I’ve been packing away my summer clothes and came across it. I looked at it and recalled all the memories that were made in its cotton comfort. One memory stood out to me.

Weirdly, it was not running in the park, riding my bike around Brooklyn, or going to the beach. It was visiting my OB/GYN. You see, this dress was part of one of the most empowering experiences of my year. One hot day in June I went to my OB, battling through the crowds in Times Square, I arrived just on time. Once it was my turn to see the doctor, I was excited to ask my questions. I had removed my dress and was waiting to have a breast exam and pap. After three years of fertility awareness method charting, I had grown accustomed to looking for clues, and my charts were telling me that I had not been ovulating. I wanted to know more and was here to ask for more information. My doctor explained that I would not need to ovulate unless I was trying to conceive. Here is where we got into a disagreement, where I suddenly was able to get up-close-and-personal with the experience of a doctor offering opinions and not facts. There are important health benefits to ovulation and it is important to know why one may not be. My doctor began to raise his voice to me as I questioned him further. “You’re going to argue with a doctor?!” At this point I suddenly realized that I did not feel safe. So instead of letting someone who was shouting at me put their hand into my vagina to examine me, I calmly responded with: “You’re going to hand me my dress, and I am going to leave, because it is unacceptable for you to speak to me like that.”

Fast-forward six months and here I am at my local Planned Parenthood to get my STD screening done. I was seen by two midwives and was surprised at how gentle my pelvic exam was. I was asked for my consent to do it and was relaxed when it happened. The difference between this experience and the aforementioned one is disturbing. It took me having an experience of true consent to understand how noticeable and disturbing its absence is. What really brought this home to me was a Facebook conversation I was having while I was in this appointment. Noted below is a friend’s reaction to her obstetric treatment.

Emily. Apologies for the random PM, but I am just trying to process something that happened less than an hour ago. Something that felt really fucking horrible and like a violation, and I thought I'd like to check whether I'm overreacting with someone who is unlikely to judge me and an expert in the field.

I've just had my first cervical smear for years and I started to cry a little on the way home

Firstly, the nurse apparently didn't realise that's what I was there for. So I waited while she did some admin and complained to me about the new receptionist not informing her etc. No calming words/chit-chat/humour... I was already nervous as it's been a while and I can get a little awkward about my vag

So I got ready as told, and without warning or asking me to relax she jammed it in and I was squirming and said it was painful but she kept pushing I felt so fucking stupid but it really really felt horrendous

I know it's not a fun experience but I can't recall it ever hurting that much. Like, at least warn me? I rushed there after work and was probably already tense for more than this reason. Then she had a go at me for being too tense and that there was a lot of discharge, and I didn't make it easy for her to find my cervix. I stupidly said I forgot that being relaxed helps and tried to laugh it off. I even apologised. Yet she kept going on that I was too tense.

No reassurance at the end either, she just said how long it'll take to get results and went quiet while I got dressed. I hope this is just an overreaction and I'll forget it soon. Maybe it's just been too long. Am I being a little silly? I feel like I can trust your opinion.

Sorry about being so long-winded. Can't stop playing it in my head and just wish it didn't make me feel this shit.

So here’s the thing: It is never okay to touch someone without consent or in a situation where that person is made to feel intimated or unsafe, and I am tired of seeing it happen in a medical setting, whether that is as a patient or doula. There is a cultural norm of expecting and accepting lack of consent and its perpetuated by a culture of victim blaming. We do not protect people with the tools to combat it and need to call on providers to do no harm, to honor people’s boundaries. Coercive language is used in health care settings that create an environment in which it’s easy to forget that you are the authority on your body. It took me practicing as a doula to see that I would have to set my own boundaries with my health care provider. I could not just assume I was safe.

Cristen Pascucci writes, “It is so very hard sometimes to explain our maternity care system to expecting mothers. The challenges they face are so unbelievable, it sounds like a paranoid fantasy to tell the truth, which is: “It is not unlikely that you will be lied to or completely misinformed by the people you trust. It is not unlikely that the things you think are making you safer are actually making things worse for you. And, yes, I know you won’t believe me until you go through it and learn this all the hard way. I’m sorry for that.” This idea goes beyond maternity care.

In my profession as a doula, there are conflicting ideas about whether we are advocates are not. In some doula trainings the scope of practice would ask me to simply encourage my clients to frame their experiences in a positive way, rather than challenge them. The issue is in a situation where consent is violated or not explicitly gained, if I tell someone that what happened is okay or minimize what happened, then I’m going against their body, which recognizes trauma, creating more internal conflict for them and in some cases an inability to heal from something. If I witness abuse and do not speak up, I become complicit in it.

 We need to normalize the idea of people saying “No” and other people respecting it. No is a full sentence and idea; it doesn’t need to be justified, but in all cases needs to be respected.

-For more information on knowing your rights as a patient: http://birthmonopoly.com/

-You can bring this free pamphlet with you to your provider’s office to discuss what you are and are not okay with prior to any consult or procedure.

Recent cases of violation of consent in maternity care:

http://www.al.com/news/birmingham/index.ssf/2016/08/jury_awards_mountain_brook_cou.html and https://birthanarchy.com/an-interview-with-kimberly-turbin/