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Birth trauma affects women as well as babies

When I recently came across an article entitled ‘Birth and the Origins of Violence” from The Association for Prenatal and Perinatal Psychology and Health (APPPH), my interest was piqued, after all I have read and seen of birth trauma during many years of supporting families through the journey of childbearing.

The author, David Chamberlain, offered some important insights:

“Jolted by the epidemic of violence today, parents, legislators, criminologists, policemen, theologians, psychologists, teachers, politicians, and health care providers are all alarmed and looking for some deeper understanding that might lead to practical steps to deal with the problem.”

(I did wonder at the omission of midwives from this list of professionals. The connection between rife violence throughout society and violence during birth has been a ‘doh’ concept for midwives (right up there with other enlightening gems from the scientific world like ‘oh guess what, who knew? Labour is shorter and less painful when women are not confined to bed’ and ‘oh, how amazing, women with continuity of care request less pain relief’ – and so many more) since the days of the Spartans dropping baby boys on the floor immediately after birth to breed tough warriors (read: murdering, raping, plundering villains).

Chamberlain continues:
“The result of this feverish activity is a massive and multiplying literature measured in the thousands of articles, books, conferences, and media productions. Nevertheless, in all this activity the origins of violence early - very early - in life are rarely explored.”

(Well actually, it has been, often and strenuously, by sectors of society that seem to have increasingly little voice amid the patriarchal hierarchy of the scientific elite: midwives and birthing women themselves.)

Back to Chamberlain:
“Violence in the womb and at birth has always been of concern to members of APPPAH, many of whom are psychotherapists ... We have acquired the conviction that any violence which greets a baby in the womb or around the time of birth will serve as a silent and unconscious form of conditioning which acts like a template for future relationships. This conditioning - depending upon its frequency and severity - can affect a person's physical and mental health for decades to come.
“Ironically, in modern hospital birth, violence and pain have become routine for babies!

(Uh, mate ... it’s not just the babies ...)

“For most of the last hundred years, neither obstetricians nor psychologists regarded pain as a reality for newborns. Consequently, doctors working with babies have not hesitated to expose them to harsh environmental conditions which violated their senses and routinely upset them using painful instruments and protocols. Nor have they hesitated to use powerful chemicals in the form of drugs and anaesthetics. All these sharp departures from what normally happened at a home birth have profoundly altered the experience of birth for recent generations of babies. During this time period babies have never been silent. It is virtually universal for them to protest being jabbed with needles for blood samples or vitamin K shots, to react against abrupt manipulations like being held upside down by the feet, rushed through space, or handled by a series of strangers. Their skin is extremely sensitive (and, indeed, serves as a powerful form of communication) so it should be no surprise that they show their dislike for being roughly rubbbed and "cleaned" and are known for their trademark screams and cries at birth! In sum, professionals have been making babies angry, afraid, defensive, sad, and disoriented--for the greater part of a century since medical management of birth became the "norm" in the United States.”

And, I might add, in most of the rest of the world, as cultural birth practices are steam-rolled in the imitation of the industry and economy of the American obstetric monopoly over maternity services.

“The unforseen results of this new way of birth may finally be revealed in the angry behaviour of generations of men, women, and children born in violence. We have been impregnated with drugs from the first moment of life. Are we so fascinated with drugs and the altered states they evoke because we were introduced to them at birth?”

While I appreciate the conclusions of Chamberlain and his colleagues, and concur that violence in our modern birth settings has serious repercussions for broader society, one thing stood out starkly to me as I concluded Chamberlain’s article:

Where are the mothers in all this?

I was stunned by the invisibility of the birthing women in this introductory article.

While the connection is made between birth trauma to infants and psychological disease among adults, among most professionals there is little or no comprehension that the violence done to babies in routine institutionalised birth is the outworking of the violence done to their mothers. This has its roots in misogyny - a low value of women and a contempt for women's autonomy, bodily integrity and power that causes so many women to feel they have no option but to accept being disempowered during childbirth.

As far back as the 1970’s Frederick Leboyer and Michel Odent warned of the damage done to society by institutional birth violence. Yet even Leboyer did not seem to connect that violence to infants was not isolated from violence to mothers – but rather it was the direct result of it.

Leboyer writes in ‘Birth Without Violence” (1974)
“The doctor (holding a hysterically screaming infant up by his feet) has completed ‘his’ delivery and is justifiably pleased with himself.”

But then Leboyer turns his ire on the mother:

“Radiant expression, ecstatic smile. She’s smiling because it’s over. She’s pleased with herself.”

No! In the margin, I wrote:

“She’s ‘smiling’ because her ‘inner good girl’ compels her to. She is supposed to be compliant, and grateful, and not make a fuss, or be an inconvenience, or (God forbid) be ‘strident’ and yell, “Give me my baby you prick!” No matter how traumatised she might feel by inhumane birth practices, she hides her pain, humiliation and confusion behind a mask of well-trained, ingrained politeness. Any system that treats babies so brutally is not going to treat their mothers any better.”

And now fast-forward to the current millennium. Here is a video of a newly born baby girl having her first bath, as filmed by her father. I can’t properly put into words how distressing this is to witness.

And I wonder, in a place where a tiny, precious baby girl is treated so brutally, how was it for her mother? Where is her voice? How is it that both her mother and father were so helpless to step in and stop what was happening to their baby?

You only have to watch a few episodes of SBS’ “One Born Every Minute” (if your stomach is strong) a documentary filmed in a busy labour and delivery hospital in London, to see countless examples of women being disrespected, coerced, rushed, bullied, jeered at and treated with callous indifference.

Institutionalised violence towards newborns will not end, and therefore the roots of violence in society will not be dealt with, until the way women are treated and regarded around labour, birth and breastfeeding is changed. This is why it is vital that homebirth is supported and sustained in our society.

The effect of violent practices during birth have been discussed by anthropologist Sheila Kitzinger who wrote:
"The caring environment for the newborn starts with a caring environment for the labouring woman, a respect for her rhythms, patience to wait and watch, and loving support."
The converse is sadly just as true, and affects women the world over.

We are talking about a world where the rates of episiotomy are also extremely high in China and Japan, where there is 60% caesarean rate approaching 60% in China and an even higher rate than that in parts of Brazil. Where across the world, cultural images of gravity-positive, active birth positions are being lost as, futhered by the obstetrics industry and modern media, the image of childbirth the vast majority of people conjure up is of a woman lying on a bed. The mental picture of a woman lying on her back, with her legs strapped into stirrups, screaming her head off (as shown in the popular film Red Dog) is in the collective subconscious as fairly normal scenario for birth rather than an example of appalling treatment of a birthing woman. Also in the collective subconscious is the fear, and with the fear, the control – the loss of power for individual women, and the transference of her authority to institutions and professionals who are trusted and assumed to ‘know best’.

We are talking about a world in which many hospitals still have a policy of performing intrusive vaginal exams on labouring women every FOUR HOURS. We now have a plethora of evidence showing that many routine obstetrical practices are not evidence-based but are harmful and counterproductive. Still, midwives and doctors feel bound to continue with these protocols and procedures in order to prevent getting sued. Still, homebirth midwives who do not practice aggressively risk-averse midwifery in keeping with obstetrically-determined protocols and time lines, are penalised and harassed.

I am appalled to witness how babies are still taken away from their mothers moments after birth, to an examination table out of arms reach from the mother – a galaxy away for the mother and infant, whose hormonal tapestry and biological imperative call for the closest skin-to-skin at this critical window of time in their respective life cycles. Such practices that promote separation instead of bonding and attachment are done in the name of clinical safety. That is no excuse for institutionalised violence and violation of birthing women and newborn infants. Clinical safety can be achieved and enhanced while a mother is treated with respect, patience and gentleness. There are excellent hospitals and birth centres where at least some of the staff, some of the time, seek to provide this. Homebirth statistics prove this.

If we want to address violence in our communities, take a hard look at how childbearing women are valued, treated, regarded, spoken of - in the media, the pubs, on facebook, by leading obstetricians and by politicians in their thrall. Notice how those midwives who truly strive to embody the ‎'with women' principle, who support women’s empowerment and autonomy, are treated. Are they professionally supported? Are their skills, their excellence and their experience as keepers of normal birth highly valued by a society committed to gentle childbearing options and gentle child-rearing? Or are such midwives marginalised, isolated, hung out to dry, prosecuted, criminalised, and targeted in the press?

(Want examples? Google Nan Koehler. Gloria Lemay. Lisa Barrett. John Stevenson. Katie McCall. Maggie Lecky Thompson. Graeme Reeves, the ‘Butcher of Bega’, who was instrumental in destroying Maggie’s career. Or just google “midwife arrested” and see what comes up. By the time you’ve read all relevant articles, you may well come away thinking, “These cowboy loose cannon midwives are a hazard to society! They must be found, and stopped!” Now just think. Why are you thinking this? Because it’s true? Or because of media spin? And if media spin is a factor, then ask: why?)

Think about why women the world over are treated so poorly during birth, even in wealthy countries. Think about the cultural and spiritual roots of that. Look at the history of the obstetric take-over of midwifery, and the way women have been strapped down, sedated and violated in the name of obstetrical science. Look at how the art of midwifery is being stamped out in favour of an obstetric monopoly. Read Marjorie Tew.

Consider Occupy Wall Street and We Are The 99%, and see how the corporatisation of society has done much harm. How applying the same corporate, profit-driven approach to maternity care likewise does much harm.

Then we will see that the callous treatment of our precious newborns is an inevitable result of the devaluing of birthing women, of using their bodies as fodder for a billion-dollar, lucrative obstetric industry, of continually abusing birthing women as we place them in the lie of a double-bind situation: telling them they must choose between degradation and trauma to their own selves and bodies, or the safety and life of their baby - when no such conflict ever existed: because treating birthing women gently, patiently and well INCREASES clinical safety for our babies.

To be fair to APPPH, this comment also appears in another article on their site:

"In our technological culture, pregnancy is still treated as a disease rather than a natural experience of healthy women. This continued medicalization of birth has deep psychological consequences. Authorities--doctors, nurses, or childbirth educators--who exercise influence if not jurisdiction over birth--can easily intimidate and undermine the natural authority of women to give birth in freedom, fully informed, in locations they choose, and with caregivers they prefer".

Well said. Nevertheless, a discussion of birth trauma without discussion of trauma to women as well as trauma to babies, is lacking an important perspective. Babies feel that they ARE their mother - their mother is their entire world. This poem Two Births’ was written by me to convey how interventions and separation during the time of giving birth deeply affect both mother and baby.

To rush, push, pressure, coerce, stress, bully, frighten, intimidate, or behave in a way that is lacking in kindness and patience towards a mother, is to do that to her baby. Not to mention the effects of routine separation of mothers and babies during the crucial hours after birth. How many times do we see a naked baby placed on cold scales, on his her back - startled by the moro reflex, screaming in terror, while a roomful of people look on smilingly? When laying a warmed nappy on the scales, and placing the baby tummy down, would prevent such upset. When lying skin to skin with mother matters so much more than our cultural obsession with measuring and getting the paperwork completed.

As midwifery care options are narrowed and eliminated by the obstetric juggernaut, as the culture of fear around birth grows, as birth is increasingly approached with a labour by-pass, techno-phile, ‘McBirth’ attitude from cynical care providers who conclude that a generation of fat, lazy women who are ‘too posh to push’ are at fault, the rates of intervention rise. The rates of PTSD and psychological and physical distress after birth rise. Breastfeeding rates fall. The formula companies reap the windfall. The quality of instinctive bonding is lowered. Baby-trainers step into the breach, exacerbating the undermining of womanly instinct. And the bottom line: lots of money is made.

The rising rates of distress and trauma among mothers as a result of the obstetric monopoly over maternity services is not being recognised and the warning cries evident in the fall-out for society is not being heeded. In most places, the voice of women is not heard; women are told what is good for them by those who hold the power. No feedback from the consumers of maternity services is routinely collected or analysed or used to determine obstetric policy. Articles such as the Listening to Mothers Survey indicate that the rising concerns of women are laregely dismissed. This amounts to a an effective muzzling of birthing women.

And I keep getting emails like this in my inbox:

“ I feel sick to my stomach as I consider my options for a VBAC ... then they took her off to get cleaned and left me on my own for over an hour in recovery. They kept telling me they were bringing her back in a few minutes and but they didn't and it was two hours before I even saw her. I am so so angry and hurt still and I feel like the whole system was against me. They just said, ‘at least you have a healthy baby.’ ”

What a narrow, narrow interpretation of 'safe' and 'healthy' is used whenever these dismissive, patronising, invalidating statements are trotted out.

Marsden Wagner wrote: “Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women - half of all people - that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the woman's experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong.”

When we dis-empower birthing women, we undermine society. The roots of violence in society are found in the institutionalised violence inflicted unnecessarily on birthing women and their infants in the name of profit.

A wiser woman said it all: “Heal birth – heal the earth.”

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