The Sharp Scissors Sarah Never Invited to Her Party

I was ensconced in a particularly grimy booth at a coffee shop last Tuesday with my cousin Sarah - a woman who once successfully litigated her way out of a speeding ticket while her vehicle was being hoisted onto a tow truck - and she relayed a story that turned my morning espresso into ice water in my veins. (The lighting in the establishment was mercifully dim enough to hide the fact that I had not brushed my hair since Sunday, a personal record I am not keen on breaking.) Sarah is the kind of woman who radiates a level of competence that makes me feel like a sentient pile of laundry. She is formidable. Yet, she told me something that made my blood run cold. (And I am usually quite difficult to rattle, having survived both the 2008 financial crisis and a disastrous attempt at home perm kits.)

She was recounting the birth of her firstborn, a chronological milestone that one assumes would be saturated in that soft, filtered-lens glow typically reserved for diaper commercials. I expected stories about soft blankets. I expected baby breath. Instead, she recounted the precise, metallic snip of surgical scissors slicing through her skin. She had most certainly not requested this intervention. She had recorded her refusal in her birth plan with the meticulous care of a scholar. She was clear. She did not want an episiotomy. (The doctor apparently viewed her birth plan as a suggestive haiku rather than a legal document, which is a level of arrogance I find personally insulting.)

It is a common story. Too common. I am still vibrating with a very specific, caffeinated rage on her behalf. (If I were any more tense, I would be a tuning fork.) According to findings published in the Journal of the American Medical Association, the frequency of episiotomies remains stubbornly high in various geographical clusters despite a mountain of evidence suggesting they cause tangible physical harm. This is despite evidence suggesting they do genuine harm. (I checked the data twice because I did not want to believe it, much like I do not want to believe the price of artisanal sourdough these days.) This is not a medical disagreement. This is not a difference of opinion. It is a systemic failure. Gone is the idea that the doctor always knows best. (I learned that the hard way when I let a dentist pull a tooth I actually needed back in 2012, an experience that left me both whistling and incredibly bitter.)

🤔 The Medical Reality versus the Medical Habit

As early as 2006, the American College of Obstetricians and Gynecologists - often referred to as ACOG, which sounds like a poorly designed IKEA shelf that you inevitably assemble upside down - recommended against routine episiotomies. They noted that these incisions actually increase the risk of severe third and fourth-degree tears. Read that again. The procedure meant to prevent tearing actually makes it worse. It is illogical. It is absurd. (It is also incredibly painful, or so Sarah tells me between sips of her very expensive latte that costs more than my first car.)

Yet, the practice persists. Why? Because habits are hard to break. Because hospitals are bureaucratic machines that eat autonomy for breakfast. Because some doctors prefer speed over patient autonomy. (I am not being dramatic. I am being clinical, which is a rare treat for me.) The numbers are not subtle. ACOG was clear nearly two decades ago. (Two decades! I have shoes older than that recommendation, though they are admittedly falling apart.) Yet, women are still being cut without their permission. A 2018 report from the World Health Organization suggested that the only acceptable rate for this procedure is zero percent for routine cases, yet some American hospitals still report rates upwards of 20 percent. (I find that number to be a staggering indictment of modern obstetrics.)

🔴 The Legal Reality of Medical Battery

We need to stop using polite, soft-edged euphemisms. (I have never been good at being polite anyway, especially after my second glass of Riesling.) We label it obstetric violence or perhaps disrespectful care, but in the eyes of the court, the precise legal designation is often battery. It is simple. (It is essentially an unauthorized touching that results in injury, which sounds like something that should happen in a dark alley rather than a sterile delivery room.) If you say no and they do it anyway, the law has a name for that. It is not "a medical oopsie." It is battery.

According to a 2019 study in the Journal of Medical Ethics, the failure to obtain consent for invasive procedures like episiotomies is a direct violation of human rights in childbirth. (I am not making this up for dramatic effect, though I do enjoy a good flourish.) The law generally assumes that by entering a hospital, you have consented to basic care. But the word "basic" is doing a lot of heavy lifting there. An incision into your perineum is not basic. It is invasive. It requires a specific "yes." (A "maybe" is not a yes. Silence is not a yes. A scream is definitely not a yes.)

I once attempted to negotiate with a plumber who insisted I required a three-thousand-dollar water heater, and even in that mundane setting, I felt entirely paralyzed by his supposed expertise, so I cannot begin to fathom the courage required to do so while in the throes of active labor. (I am a writer; I am not built for confrontation, unless it is over the Oxford comma.) The challenge is that hospitals are designed to be rigid hierarchies where the person in the gown has the least amount of power. It is a structure that frequently rewards compliance and punishes those who dare to ask "why?" (It is essentially high school, but with higher stakes and much more blood.)

🤔 Advocating for the Birth You Deserve

So, how do you protect yourself? You can be loud. (I am excellent at being loud, as my neighbors can attest when I am watching the news.) My friend Dave, who is a patient advocate, says the best defense is a vocal support person. You need someone who will stand at the foot of the bed and remind the staff that "no" means "no." It sounds exhausting. It is exhausting. (I am tired just thinking about it, and I am sitting in a comfortable chair with a plush cushion.)

It feels like preparing for a battle you should not have to fight. Life is too short to be stitched up by someone who thinks your consent is a joke. Hospitals behave differently when there is a witness who is not under the influence of powerful labor hormones. Whether it is a partner, a mother, or a professional doula, you need someone who knows your wishes and is not afraid to speak up when you are unable to articulate your needs. I once had to tell a mechanic that I would not pay for a transmission flush I did not ask for, and I felt like my heart was going to jump out of my chest like a frightened rabbit. (Imagine doing that while pushing a human being out of your body.)

The practice of unconsented episiotomy is a relic of a patriarchal medical system that viewed patients as passive recipients of care rather than autonomous human beings with their own agency. It is a practice that flies in the face of modern science and basic legal principles. When a doctor cuts you without your permission, they are not just making a clinical choice; they are committing a physical violation that can have lifelong consequences for your physical and mental health. We must cease referring to this as a mere complication and begin identifying it by its true name: battery. (And if the medical bureaucracy happens to forget that your anatomy is not public property, I am acquainted with several litigators who would find great professional satisfaction in reminding them of that fact.) I do not say this to scare you. I say it because I am tired of seeing women like Sarah leave the hospital with more than just a baby - they leave with a trauma they never signed up for. (It is a systemic rot, and we need a lot of bleach.)

Myth vs. Fact

Myth: Episiotomies are necessary to prevent severe tearing during childbirth.

Fact: According to ACOG and the Cochrane Library, routine episiotomies actually increase the risk of deep, severe tears into the muscle and rectal wall.

Did You Know?

The World Health Organization explicitly states that an episiotomy rate higher than 10 percent is not justified by medical evidence. Many hospitals in the United States still report rates significantly higher than this threshold. (I find this statistic personally offensive, much like the existence of decaf coffee.)

🤔 Frequently Asked Questions

What is the legal definition of medical battery in a birth setting?

Medical battery takes place when a healthcare professional carries out a procedure without the explicit consent of the patient or goes far beyond the boundaries of the consent that was originally provided. In the context of childbirth, if a doctor performs an episiotomy despite a patient's prior refusal or without attempting to obtain informed consent during the process, it may meet the legal criteria for battery. (It is essentially an unauthorized touching that results in injury, and the law does not take kindly to it.)

Can a doctor perform an episiotomy in an emergency without consent?

The threshold for an emergency is often much higher than many providers assume in the heat of the moment. While implied consent exists for life-saving measures when a patient is incapacitated, a conscious laboring person generally retains the right to refuse any intervention. Courts increasingly look at whether there was truly no time to explain the risk and obtain verbal permission. It is categorized under the broader legal umbrella of unauthorized medical procedures. Because this specific practice frequently provides no tangible health benefit and is often performed based on a private consultation between the provider and a spouse, it constitutes a profound breach of both medical ethics and established legal standards.

How can I document my refusal of an episiotomy before labor?

A birth plan is a good start, but it is not a legal shield on its own. You should ensure your refusal is documented in your medical records during prenatal visits and discussed clearly with your provider. Many advocates suggest having a support person, such as a doula or partner, who is empowered to reiterate your lack of consent if the situation becomes intense. (Documentation is your best friend when things go sideways, right up there with a good insurance policy and a strong cocktail.)

What should I do if I suspect I had an unconsented episiotomy?

The first step is to request your complete medical records to see how the procedure was documented. Often, these are recorded as necessary or routine, even if they were not. You may want to consult with a legal professional who specializes in obstetric recovery or medical battery to understand if your rights were violated. It is a difficult path, but seeking accountability is a valid response to trauma. (You are not being difficult; you are being a citizen who expects her rights to be respected.)

Why is the "Husband Stitch" still discussed in medical circles?

This is a particularly gruesome piece of medical lore where an extra stitch is added during an episiotomy repair under the guise of "improving" the partner's experience. It is not a recognized medical procedure. It is a violation. If this is done without your consent - or even with it, under false pretenses - it is a significant ethical and legal breach. (It is the kind of thing that makes me want to scream into a pillow for several hours.)

Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice. Episiotomy and birth interventions involve complex clinical and legal factors that require expert analysis. Always consult with a qualified medical professional for health concerns and a licensed attorney for legal matters related to medical battery or obstetric violence.