Hormones have to dance

As you read this sentence, someone, somewhere in the UK, is giving birth. What do you picture when I tell you that? For many, it’s a woman, lying on a brightly lit hospital bed on her back, surrounded by several midwives and doctors telling her to “Push!” She looks distressed and sweaty. Perhaps she’s in a state of panic or even screaming. And then the baby is born and she is swiftly handed her child as she sinks back on the pillows, exhausted.

There are some human activities that we don’t do very effectively with an audience, and childbirth is one of them

Afterwards, she may be shocked, distressed and – in an estimated one in three cases – traumatised. These feelings may develop into PTSD, the same condition soldiers may suffer after the violence of combat. Experts suggest that around 4-5 per cent of new mothers will suffer from PTSD, with symptoms such as flashbacks, nightmares and extreme anxiety. Being traumatised to such an extent that you start motherhood feeling as if you have been in a war zone is surely not ideal. And yet it seems to be widely accepted as just another part of the raw deal of being a woman, because, as traumatised women are frequently told, “a healthy baby is all that matters”. But does it really have to be this way?

My passion is to get the message out that no, it truly doesn’t. Currently, we are failing women by allowing this epidemic of trauma to happen, and, worse still, we are allowing them to take the blame for it, by perpetuating the myth that childbirth itself is an inherently traumatic event, something terrifying that women simply have to endure if they wish to become parents. Essentially, we are putting women in birth environments that are not optimal for the natural progress of labour and then, when the inevitable happens and intervention is needed, we are allowing them to believe that “this is just what giving birth is like”.

Women are mammals. Mammalian birth – whether you are a human, a cat or a panda – requires a dance of hormones to take place, and there are optimal conditions for this that those who have seen their pets give birth and zookeepers who have worked hard to create special birthing zones all understand. Mammalian birth needs a warm, cosy, dimly lit, uninterrupted space. In this space, they need to feel safe and nurtured. It’s not really rocket science. There are some human activities that we don’t do very effectively with an audience, and childbirth is one of them. And yet so often we are asking women to give birth in unfamiliar, sterile hospital rooms, attended to by people they have never even met before.

This lack of basic understanding of female physiology has been a problem for decades, and has only been exacerbated by the pandemic, with services requiring women to labour or, in some cases, even give birth alone. A “Covid-safe” birth room, in which a woman may have been in hospital, isolated from those she loves and attended by people in masks, would almost certainly be rejected as a birth place by your family dog or any self-respecting panda. The argument that this was 100 per cent necessary in the midst of the pandemic doesn’t really wash either. In September 2020, for example, you could visit a pub with five friends or have a wedding with up to 30 guests, but only one birth partner was allowed at the birth of your baby. Women’s choice and bodily autonomy has also taken a hit under Covid, with home birth and birth centre options being stripped back, and mandatory vaginal exams given to women in order to establish if they were sufficiently progressed in labour to be allowed their partner with them.

As a result, new mothers have reported increased levels of anxiety, depression, birth trauma and PTSD. One study of women in England who gave birth during the pandemic found increased levels of distress and anxiety, in particular due to the fluctuating guidance and lack of certainty over whether their partner could be there. Nearly 50 per cent of participants in the study reported that their birth experience was “predominantly negative”. The Birth Trauma Association (BTA) has reported a big increase in those contacting their support inbox, with numbers roughly tripling between 2020 and 2021.

“At the end of 2020, our Facebook group had 9,200 members, it now has 15,000,” Kim Thomas from the BTA told me. “Anecdotally, many of the women who come to us had particularly traumatic experiences during the pandemic. Being isolated from partners during scans, postnatally or even during the birth was compounded by a lack of support postnatally, with no visits from health visitors and postnatal checks over the phone rather than in person.”

The fact that isolation is such a common theme in women’s traumatic birth stories under Covid is not surprising to me, because if a decade of listening to women sharing both positive and negative birth stories has taught me one thing, it’s that it’s how a woman feels emotionally during childbirth that has the biggest impact on how she then feels about it afterwards – much more than the basic details of how and where she gave birth. Thomas agrees.

“Most women tell us that their trauma came from poor interpersonal care, for example not having their concerns listened to during labour; procedures such as vaginal exams being performed without consent, being denied pain relief, or being bullied or threatened during labour.”

Within the NHS, the pandemic compounded an already existing problem of underfunding and understaffing in maternity care –the so-called midwife crisis. For every 30 new midwives trained, 29 leave the profession, citing burnout, an inability to provide safe care and disillusionment with a job in which they feel overstretched, taken for granted, and unable to form meaningful relationships with the women they care for. The Royal College of Midwives chief executive Gill Walton has appealed to the government for more funding, describing how maternity services are “bottom of the list for investment”.

But we cannot simply blame the overstretched system or the pandemic for the high numbers of women who continue to be traumatised by their birth experiences. For a long time now, we have known that relationship-based care, in which a woman is cared for by a person she has had the chance to get to know and trust, is key to positive birth experiences, and we have also known that the birth environment has an impact on how safe women feel and how labour does or does not progress. We even know that the bed – so often the central feature of the labour room – can be an unhelpful place for women to labour, restricting their movement and the size of their pelvic opening, and preventing gravity from working in their favour. But as is so often the case with women’s health and wellbeing, women’s voices and needs have been ignored. Instead we have a birth system that, rather than trying to understand the female body, seeks to manage and control it in the name of safety.

Safety is of course important, but what do we mean by safety? If we mean everyone getting out of the experience alive, then nobody is going to argue with that, but shouldn’t this be the baseline of our expectations, rather than the pinnacle? True safety means more than just having a pulse. Women want to begin motherhood feeling powerful and strong, healthy and energised, and mentally well. This in turn helps them to bond with their babies, breastfeed successfully if this is their choice, and can have a ripple effect on their relationship with their partner, their sex life, their body confidence and more – an impact that can last a lifetime.

Birth is a feminist issue because too many women are being traumatised unnecessarily. At the start of this article I asked you to picture the women giving birth right now, and it’s likely that many of you envisaged something similar to the births we all see on programmes like This Is Going To Hurt or One Born Every Minute. I would like this typical image of a woman in labour – on her back on a bed, frightened and disempowered – to become a thing of the past. Instead, each labouring woman should be in a beautiful, dimly-lit, woman-friendly space, cared for by people she knows, nurtured, cherished, allowed to move freely, treated with kindness and respect, her consent always sought, her bodily autonomy respected, her choices fully informed. Is this too much to ask? Because a healthy baby is not all that matters. Women matter too.

Give Birth Like A Feminist by Milli Hill is published by HQ, £9.99