Let’s examine what sorts of images and thoughts the label ‘birth trauma’ conjures up for most of us… baby death or disability, fearing for one’s own life or the life of their baby, extreme physical harm to a mother or her baby. I would surmise that these experiences are what most people would associate with birth trauma, and for the most part they are seen as unavoidable circumstances - sometimes things go wrong in childbirth. While no-one would dispute that such experiences are highly likely to be traumatic, what I would like to contend is that these experiences are the only, or even the most common, causes of birth trauma. Also of significance is that much birth trauma is preventable.
My job as a birth trauma support worker has led me to believe that power dynamics play a leading role in the causes of birth trauma. For the vast majority of the mothers I work with, feeling disempowered in their birth process is the key player. An experience of disempowerment in birth could be the result of a number of factors - not feeling able to cope with the pain, having unforeseen complications arise, not having the right support people present, a long labour resulting in exhaustion, to name a few examples - but for most of the women I work with, disempowerment is centred around mistreatment by the maternity practitioners involved in the woman’s care.
To disempower someone is: to deprive of power, authority, or influence : make weak, ineffectual, or unimportant (https://www.merriam-webster.com/dictionary/disempower). A birthing woman experiences such disempowerment at the hands of doctors and midwives when they deny her right to informed decision making and consent, bully her into agreeing to interventions that she doesn’t want, put unnecessary time-restraints on her birth process, ignore her requirements as stated in her birth plan, treat her disrespectfully, maintain an air of authority over her, her body and her baby, are neglectful, do not listen to her, and cause her unnecessary physical or psychological harm. Practitioners may claim that they are only doing what is necessary to achieve safe birth outcomes, and indeed they may honestly believe they are acting in the best interests of the woman and her baby. However, such practitioners are ignoring two crucial elements of maternity care: the right of women to autonomy over their births (which is outlined in the HDC Code of Consumer Rights), and the psychological aspects of the ‘safe birth’ equation… Are postpartum anxiety and depression, PTSD, lack of ability to bond with or breastfeed one’s baby, or suicidal ideation able to be argued as ‘safe’ birth outcomes? Because, for many women these are the sorts of consequences that result from a disempowering birth experience (one that their midwife or doctor labelled as ‘safe’).
Why is it that those in our society, including many of the women who experience such things, fail to see the correlation between a disempowering birth experience and birth trauma? Why is it that so few women feel justified in seeking out support when they are suffering from the aftermath of a traumatic birth experience? When we clear the patriarchal fog that clouds our understanding of many everyday aspects of womanly existence, we start to gain greater clarity of how and why our current systems are so fiercely guarded by the medical men who created them, and unwittingly perpetuated by their ignorant, or fear-filled, co-workers.
In many ways, the sociocultural influences that enable and justify the disempowerment of women in birth to the point where we don’t recognise it as anything but ‘normal’, are similar to those that once enabled and justified marital rape in this country. It wasn’t until 1985 that marital rape was recognised as a criminal offence in New Zealand. How and why was rape seemingly so accepted and ‘normalised’ within Western society up until recently? We can attribute this to such sociocultural factors as traditional (read: patriarchal) views on marriage and on male and female sexuality, interpretations of religious doctrines, and cultural expectations of subordination of a wife to her husband - views which are still commonly held in many parts of the world.
These aren’t so different to the sociocultural binds that enable the ongoing abuse of women’s rights in childbirth. Women are conditioned to believe that they are incapable of making wise birth choices, they have grown up in a society which says they must not question authority and doctors know best, they are taught to view birth as excruciatingly painful, undignified and scary - a means to an end, rather than a spiritual rite of passage through which the discovery of their power was designed to ready them for the challenges of motherhood, they are led to believe their bodies are flawed, shameful, and untrustworthy… and when they are at their most vulnerable, in the throes of a long and challenging labour, they are let down by the ones they are most dependent upon to remind them that they can do it, that they are doing it, that they are trusted, supported and protected.
Many of us reflect on past (and current) injustices against women and wonder how it ever was that wives were the legal property of their husbands, that they were unable to vote, that they were not allowed an education, and we feel sickened and angered. We can see we have come a long way, and we can see how damn far we have yet to go. I am sure that the growing awareness and intolerance of the abuses of power within the birth room will gradually lead to a better understanding of birth trauma, in all its forms. One day humanity will look back on this era of medicalised childbirth and its inherent violence towards women, and wonder how we ever allowed it to happen, how we ever tolerated such violations to occur. Let that day be sooner rather than later. Let us never hear our birthing daughters utter the words, “I wasn’t allowed to…”