Out of control: power dynamics in the birthing bays

I have revisited the day my daughter was born over 450 times now. Almost every night in the 18 months since it happened it creeps back. And yet the medics involved will not have given that day a fleeting thought.

It feels like an insulting paradox; that such a life-changing moment for one person is but an everyday event for another.

I wish it weren’t so, but I am sure that the doctors also feel the same, given the chance to step back, breathe and process. In order to churn out ten babies a day, what option is there but to detach from and clinicalize an incredible, spiritual moment of humanity?

Pregnancy was an incredible time of connection for me; I was awe-struck by the way strangers were so invested in me and the life I carried; feeling the need to connect, protect and even empower. Grown men in pubs came up to kiss my belly. It was a time for humanity, in its truest form.

So it was a stark contrast when I became a vessel to be emptied of cargo in the birthing room. At the birth I was supposed to be giving, I become an object, rather than the subject.

You see, something happens when you and your baby become a number on a whiteboard. You stop being a friend, a sister, a daughter, a mother-to-be in the eyes of those around you. You become Patient A and Baby B.

Some might argue that this is essential under the pressures of today’s medical system. I argue that removing humanity in the most human of situations is dangerous. It changes the dynamic of a room from two equals with equal rights, to Powerful and Powerless. And both parties suffer as a result. Because what happens then under the stresses of pain and unfamiliarity, is that Patient A, already scared and at her most vulnerable, starts questioning herself, doubting her abilities and the validity of her thoughts and feelings as she lays in a submissive position under the gaze and advice of white coats. Advice that gains in power to become unquestionable, because of the shift in dynamic in the room.

Meanwhile white coats dart from one medical urgency to the next, tired, pressing their brains to recall the pages of medical text books, the times they saw that type of illness before, the protocol they are supposed to be following in this situation, and what time their family is expecting them to be home to see the kids. What time is there to prioritize treating Patient A with dignity and respect, when Patient B, C and D all need to be seen too?

And with Patient A now in a physically and mentally submissive position, who is there to remind him, amongst the urgent beeps, of the dynamic at play? That this dominant-submissive role play requires extra efforts on his part for sensitivity and communication? No-one. Especially when family and friends are equally stunned into silence by White Coat fear and the panic of seeing their loved ones in pain.

It might not even occur to a busy White Coat who is ‘just doing their job’ that communication and humanity is so vital to the health of their patients. But that’s because we have all been led to believe that physical health is all that matters in the emergency room.

It isn’t.

A lack of dignity and respect for a fellow human being in a vulnerable position can have devastating effects. Terrible things can happen when a vulnerable person is forced into a submissive position and then given the impression that they have no rights. They are both helpless and under attack.

The brain has no choice but to protect. It flicks into its most primitive mode. In autopilot it assesses the danger and decides on a fight, flight or freeze response. Women in the vulnerable situation of giving birth, lying naked on their backs with strangers’ hands and faces around their exposed groin, are not in a position to fight back, or run away. And so, they freeze. And they remain frozen, in a state of fear-induced hyper vigilance, until the deep emotions that are housed in the body can be released at a later date.

White coat violation is literally leaving new mums like me shell-shocked.

Post traumatic stress disorder (PTSD) is usually associated with soldiers. Fragmented memories are not properly filed in the brain’s memory boxes, they float around the brain homeless, haunting a person day and night as smells, people, words, situations, anything catches them unaware and floods their senses with dread. Flashbacks, night terrors and intrusive thoughts add to the already sleepless nights they face, insomnia leaving them even more vulnerable to mental health issues that follow continuous sleep deprivation; a known form of torture.

I can tell you for a fact that PTSD is not an affliction faced by traumatised soldiers alone. It affects anyone who has been in a situation where they felt helpless, in great danger and left fearing for their own lives and those of people dear to them.

So, in frank terms then, what is the real cost of a doctor not having enough time to consider the importance of dignity, respectful communication and sensitivity to the power dynamic that their very presence in a room causes? What is the return on investment of a few kind words and moments of sincere eye contact, for the individual, family and for society at large?

The financial cost is this:

• 2 sessions of EMDR, to stop flashbacks associated with early PTSD (£200).
• 18 months of specialist counselling and psychotherapy (~£10,000)
• 18 months+ of unemployment, or reduced working capacity, due to post-natal anxiety and depression. (~£50,000)
• Total = £60,200.

The individual and family’s emotional cost is this: 

Low self-esteem, due to anxiety, depression and reduced capacity to contribute fully to the household due to poor mental health.

Strained relationships as partners struggle to understand and cope with the emotional rollercoaster of their spouse, whilst also adapting themselves to the shift in family dynamic brought about by a new baby.

The social cost is this:

In a society where we are already seeing record levels of depression and anxiety, we are looking at babies whose most critical stage of development is spent in the care of a primary care giver who is impacted by poor mental health.

If the individual and social costs are so great, how can we continue to say things like a healthy baby is “all that matters”? If we can avoid all this by giving doctors a little more time for compassion and empathy, then why don’t we? If we don’t push for doctors to have enough time for more humanity in their days, we all lose. Time for a rethink.