Why women want a culture change in maternity care

Another call for women's treatment in birth to be addressed.

Yes, I know, it’s been ages since I last did a substack! Let’s just move on as if nobody noticed shall we?! You didn’t notice? Oh, I’m not sure how to take that…;-)

This week I answered some questions for the wonderful journalist Tanya Sweeny at the Irish Independent, for her great piece, (here, paywalled).

Tanya was good enough to write a piece about my book Give Birth like a Feminist back in 2019 (here, and not paywalled), and she got in touch with me again to ask for my thoughts as she wrote her recent article.

I thought I would share the questions Tanya sent me and my responses.

TS: There seems to be a recurring idea that within maternity services, women don't feel they are listened to, respected or cared for. What do you think that is? What are the main issues (ie, bodily consent, autonomy, gaslighting)?

MH: I think there is a wider problem across the whole of health care of women not being listened to or respected that is currently beginning to be highlighted, thankfully. This issue gets compounded within maternity services because of the very long history of treating the pregnant woman as ‘a means to an end’ – as a ‘vessel’ or ‘container’ for the baby. We see this reflected in phrases like ‘a healthy baby is all that matters’ – which is well meaning but has the subtext that ‘women don’t matter’. In Ireland there has in the past been a religious element to this, as we saw with the 8th amendment and the at times shocking priority that has been given to the unborn child over the mother, for example in the case of Savita Halappanaver.

Because of all of this underlying, systemic misogyny, we also have a system that was never built with women’s needs in mind. Our current system is usually very good at getting everyone through birth alive, but again, gives little consideration to the woman’s feelings, needs and experiences. The system wasn’t built with an understanding of female physiology - for example, oxytocin, which all women need to produce to give birth, and which we can only produce when we feel warm, safe, uninterrupted, loved and secure. In spite of not offering women environments in which they are likely to produce this birth hormone, the system then often shifts the blame to women if they struggle to give birth. Many women go into birth thinking that their bodies are unlikely to be able to give birth without help, that humans somehow have a ‘design fault’ in this area. Birth in the current system then seemingly proves them to be right about this. They blame themselves and their faulty female bodies when in fact, it’s often the system that should be accepting at least some of the blame. To quote Germaine Greer, ‘Women believe that their bodies are so mysterious that only a person in a white coat could unravel them, and so defective that there was never any hope of their functioning properly in the first place.’ So yes – this is wide scale gaslighting and victim blaming!!

And yes, consent – or a lack of it – is part and parcel of the same attitudes. There is often a fear of litigation and a poor understanding of the law around consent among clinicians who will often say that they support a woman’s right to make choices, but, if you drill down, you will find that there are qualifiers to this, i.e “I support women’s choices, but not THAT choice!”. So if a woman announces she is making a choice which her care providers don’t consider to be the ‘right’ choice – she will meet resistance rather than support which can leave her feeling like she is being disrespected or treated like a child. If we are going to support women’s choice and bodily autonomy, this must come without qualifiers, we cannot cherry pick which choices we support – we have to support women in choices that we would not make ourselves or even that we consider to be ‘wrong’ choices. We have to trust women

TS: There is an idea that women should be prepared to ditch their ten-page, laminated birth plan if it means delivering a healthy baby. But why is this not a helpful approach?

MH: I think, if a woman does have a ‘ten page laminated birth plan’, it might be useful for clinicians to ask, ‘Why?’. Again, there is not much capacity for self-reflection here, there is simply an assumption that such women are ‘mad’ or ‘control freaks’ or ‘misinformed’. But ten page laminated birth plans are a response to a system in which women do not feel safe or listened to or cared for. Otherwise they wouldn’t feel the need to make them. 

I think all women are prepared to bend and give way if their baby’s life is genuinely at risk. Again there is a myth here of the dangerous ‘selfish mother’, who only cares about tea lights and getting nice birth pics for Instagram, not about her baby. I’ve never met that woman in real life! Women care deeply about their own safety and the safety of their babies. But they also have a right to a birth experience in which they don’t come out the other side physically and emotionally damaged for life. The ‘healthy baby’ should be the baseline, not the pinnacle, of everyone’s expectations. 

TS: Why is the culture within the maternity services like this? Why are healthcare professionals dismissive or brusque?

MH: I think the current maternity culture has got such a long history that it’s hard to summarise – I’ve tried to explore it in depth in my book Give Birth like a Feminist. 

I think healthcare professionals are often doing their best in an overstretched system, but they are also part of this culture and will have been influenced by it – maybe they have a belief, as many people do, that birth is inherently traumatic, and that it’s just another part of the terrible package of being female – the short straw! Many professionals have never seen a home birth or a water birth or a birth with absolutely no intervention. To give you an example of how the culture is all pervading, the other day I shared a birth film on the Positive Birth Movement Instagram account. 

It’s a beautiful film, and I shared it because I thought it was beautiful. It wasn’t until someone commented on it, “Am I the only person not loving that the midwife is all up in their space rubbing the vernix off the baby while the parents are trying to savour the first moments??”, that I even noticed this was happening. And they were right! Right in the midst of this beautiful moment, there are a pair of gloved hands, fiddling around with the baby, in a way that is almost certainly surplus to requirements! But – even though I’ve written a book about this! – I didn’t notice, I didn’t take it in. “Fish can’t see water” – we cannot always ‘see’ the culture that we are living in. 

TS: What are the psychological effects of a traumatic delivery on women, and on their subsequent relationship with their baby?

MH: Traumatic birth can have a lifelong impact on women and we know that as many as 1 in 3 women have a traumatic birth with between 4 to 18% of those going on to develop PTSD. Still more women will have births that they don’t classify as ‘traumatic’ but which they might still feel upset by or feel like they would rather forget. Of course this can have long term impact on women’s mental and emotional health and their start to motherhood. However, it’s also important to stress that this is not yet another thing for women to feel bad about – and traumatic birth doesn’t necessarily mean their baby or their bond with their baby has been affected. 

Maybe it’s more interesting to ask – what are the psychological effects of a positive birth experience? I love talking to women who have had an amazing birth. It’s often the women who have had what we could call ‘hands off births’ who report this the most strongly. The midwife stayed in the background and the woman was able to tune into her own body, listen and find that knowledge of what she had to do. Nobody yelled ‘Push!’ or had the energy around her that she was vulnerable or might need them to take over at any moment. They trusted in her, stayed back, and ‘sat on their hands’. These women report that birth had a massive, ‘transformative’ impact on them. They felt amazing during and afterwards, full of health and power and vitality. They report that this impacted positively on all areas of their lives, from their confidence in their parenting, to how they feel about their bodies, to their relationships with their partners, to their careers, to their sex lives. They report feelings like, ‘I will never be afraid of anything again’ ‘I feel like I can now achieve anything’ ‘It was the most powerful thing I have ever done’. One has to wonder, when it sets women up for a lifetime of strength, why this kind of ‘hands off’ birth is probably the hardest type of birth to come by?

Thanks to Tanya for her great article and for quoting me. A reminder that you can buy Give Birth like a Feminist, in which I explore all of the above and much much more, from Amazon and all good book sellers. On Amazon it’s currently 40% off.

What am I up to now?

A few things! First and foremost I am trying to recover from a year of pandemic and home education, which has taken its toll on us all in a number of ways. I’m trying to be ‘selfish’ after a lot of time spent putting others first and I’m working on my shocking fitness levels and my mental health. I’m trying to ‘mother’ myself a little in the way that I have been intensively mothering others. I’m currently doing a course in writing historical fiction and thinking about other fiction and non-fiction book ideas. I’m about to start work on updating The Positive Birth Book for publication in March next year, when it will be its 5th birthday! And I’m very much looking forward to August 19th, when my new book for preteen girls, My Period, will be published! You can preorder a copy now from Amazon and all good book shops and I’ll be doing a lot of posting and talking about it as the time comes closer, you can be sure! In the meantime, love to all, Milli x