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. 

15 thoughts on “Out of control: power dynamics in the birthing bays

  1. Such a powerful and eloquent article. Thank you for sharing. I’m just so sorry that you had to go through this! This is why, at SyntonicBirth, I am so passionate about supporting women (and their partners) to have empowering birth experiences, nurturing them postpartum onwards, and why I’m committed to helping those who have suffered birth trauma (and birth grief) to heal from it with Matrix Reimprinting. It is such a profoundly powerful, quick yet gentle technique for overcoming trauma without the risk of re-traumatising that can come with months and months of talk therapies. I would be very happy to offer you or anyone reading this in need of support a free no-obligation call to see if I’m the right practitioner to help. (Sessions can be conducted via telephone or Skype if not in person). You can find me at https://www.facebook.com/SyntonicBirth

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  2. Sarah, thank you for speaking for so many of us. When my son was born 18 years ago, none of my caregivers had words for what had happened to me. Not the naturopath/midwife, not several psychotherapists, not the well-known author who taught my childbirth class. I just knew that what I’d gone through was monumentally difficult, it was followed by one of the worst postpartums my naturopath/midwife had ever witnessed, and it led to the end of my marriage 10 months later.

    It took me 16 years to put words to my experience and realize that I had postpartum PTSD. Today, articles like yours will help women understand and put words to their experience much sooner. I just wish we hadn’t needed to find words for that experience in the first place.

    The damage is wide-reaching. Trauma takes place at the intersection of overwhelming helplessness and fear, and as you say, laboring women can’t fight or flee, leaving freeze as the only viable survival response. That freeze, that numbness, that dissociation can last for decades and is a profoundly difficult circumstance to parent through.

    My thoughts are with all the incredibly wanted babies whose mamas’ post-partum PTSD or depression prevented them from being the parents they wanted to be. And so much love and solidarity to those mamas.

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  3. Thank you for writing these articles.
    I am a FTM with a 8wk old and I had the most horrible birthing experiences. I struggle to talk about it, to write it down, and have spent the last three weeks trying to write a complaint to the hospital. I am up to page seven of my complaint and have documented no less that 40 individual incidents so far. Writing it down has been a form of therapy in itself and has allowed by brain to stop recalling each event. It’s as if I don’t have to try and remember it anymore as it’s on paper now.
    I thought I was the only one. Everyone else’s birth seems to have been magical. Mine was full of terror, fear, pain, emptiness and I felt entirely alone. I was entirely alone – I knew no one in the room full of Drs, nurses, midwives, trainees, experts and specialists. Epidural didn’t work properly and as they were running around trying to figure out what went wrong, no one communicated to me. I was offered a caesarean several times, each time I agreed, then they retracted the offer every time. No internal exams to see how far along I was, despite me asking. When I was finally taken for a caesarean, the Spinal didn’t work there either. Again, the medical staff were baffled. I was then given a general and wasn’t even awake for the birth.
    The following week in hospital was a fiasco. For example, following my major surgery, they forgot to give my medication after day three. I was in so much pain.
    I’m not exaggerating. I really wish i was.
    So thank you for your articles. I don’t feel so alone.

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  4. Thankyou so much for writing this article.
    It comforts me to know that I am not alone and that there are people who understand not only the physical but mental torture experienced from traumatic childbirth.
    I lost all control of my own birth plan when I developed gestational diabetes. As a first time mum I never argued or questioned the medics believing they had mine and babies health as their top priority.
    My induction failed twice over the course of 3 days in which I had not slept a wink. On the 4th day I went into labour and was not examined for 16 hours. By this stage I was 7-8cm dilated and struggling to breathe through my contractions.
    I was taken to a labour room and placed on an insulin drip, my babies heartbeat had to be monitored continuously and I had to lay on my back through each agonising contraction.
    When baby went into foetal distress we were rushed to theatre where an episiotomy and forceps delivered my Son.
    In the process I sustained a 4th degree tear extending right back to my bowel and spent approximately two hours being sewn back together. I narrowly avoided a colostomy bag at 26 years of age due to how badly I had torn internally.
    I was not elated but felt violated and back on the ward with the effects of the morphine wearing off I found myself feeling so alone.
    Husband was sent home and here I was with my baby…I had waited years for this…I couldn’t even move to hold him.
    I was in shock, exhausted, overwhelmed and traumatised.
    Back at home I was haunted by flashbacks and nightmares of my labour.
    Four years later your article has just taken me back to that experience.
    I keep getting asked when I’m going to give my son a brother or sister, the truth is I’m too scared to mentally and physically go through this experience again.
    Due to the amount of damage childbirth caused I’ve been advised that vaginal delivery word not be recommended because if my scar tissue opens up internally I will have to have a colostomy bag.
    It makes a c section sound like a breeze…..so why doesn’t it feel that way?
    I am angry we had to go through this, I am angry when people tell me I have a son and should be thankful, I am proud that people like you have shared your story so others know they are not alone.
    It’s the silence around this subject that destroys confidence and breaks down your mental health.
    When I looked on the internet when it happened to me there were very few women who had shared these stories.
    At times I felt like I was going mad and I felt too scared to say how I felt in case people thought I was.
    Thank you brave woman for sharing a little part of you that will help another woman feel warmth and love to know she is not alone.
    I don’t know how many of us are out there but what I do know is it does get better. Time does heal, our scars remain so do the memories, but we are not alone.
    PTSD can be helped and I urge any of you reading this article who thinks this could be you to speak to your GP or Health Visitor. Do not wait to be diagnosed, please feel empowered to speak up and get the support now that you deserve.

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    1. Natalie, thank you so much for sharing your story, and for reaching out with support. It is really humbling to hear from women like you that speaking out has made such a difference to you. We are not alone – and the more we speak up together – the more we can change things for women in future. Solidarity and hugs to you! Sarah

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  5. Thank you ladies for sharing your stories, it’s put into words some of the experiences and challenges I too have faced since my son was born nearly 4 years ago. I had a traumatic labour too where I sustained a 3rd degree tear. The aftermath of that labour led to flashbacks, 19 weeks recovery time for my wound to simply heal, 18 months of fear and a corrective operation to undo some of the damage in order for my husband and I too be intimate again and 3 years of post natal depression to overcome which also contributed to 2 episodes of long term absence from work. Worst of all I feel cheated out if those early months with my son.

    I’m pleased to say that I now have an 8 week old daughter who was born by c-section. I had to fight to have this section, despite the fact that the physical scars which I’m left to cope and the complications they cause wouldn’t allow for me to have had a vaginal birth, even if I wanted too. Not once was I examined by the numerous consultants i saw, which is unbelievable.
    Unfortunately, the care I received following my section was terrible. I was sent home 24hrs after this major invasive surgery with no pain relief and no information to aid my recovery. My pain levels weren’t managed in hospital and I was made to feel like I was over exaggerating the pain. We were readmitted to the same ward 3 days later due to the baby not gaining weight and the fear of being placed back on that ward with inadequate pain relief caused me to breakdown and have a huge panic attack. The care was terrible and there is no further care for me out there which has shocked me. I didn’t even get asked how I was doing at the 6 week check!!

    I hope one day that there will be more help out there for mum’s but I fear that there wont. These sorts of articles are so important because it truely was the most lonely and scary time of my life. I’m thankful to be on the other side of it now with my mental health and my marriage and family intact.

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    1. Casey, I am so sorry for the ordeal that you have been through. You have every right to feel cheated for the special times you have missed, and angry for everything you have had to go through as a result of your trauma. Thank you for sharing your support for the article – it really helps me feel stronger about speaking out when I hear from people like yourself. We are not alone. If you need support, reach out to the Birth Trauma Association private Facebook group. There are so many like us there night and day, sharing and supporting each other. Sending you hugs. Sarah

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  6. This! Finally someone who speaks out and brings up the fear.

    We had the most traumatic birth with my son last year, to the point where my husband had PTSD after. Our wanting any children had come to a complete haul and we debated whether we could ever try again.

    Come this spring, we decided we would brave it and try for just one more… I researched the best medical care. We had our ultrasound yesterday, and its twins. And while I’m unbelievably excited.. I’m so fricken scared.

    So thank you for reminding me, I’m not alone. 💙

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    1. Maddie, the very best of luck for the birth ahead! I am so glad that you are excited about it, and I really hope that continues to overpower any feelings of fear. You and your partner have been through a horrendous ordeal. I can tell that you are already putting every step possible in place to protect yourself however you can. You are not alone and you can do this! And for any wobbles along the way, there is a whole community behind you at Birth Trauma Association’s private Facebook group so don’t hesitate to join. Hugs!

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  7. 16 years on the birth of my first child still haunts me. Does the midwife whose callous uncaring attitude destroyed the moment I became a mother and nearly kieedmy daughter think about that day? No ! it was just another shift to her.
    Do the staff we left us waiting for 2 hours to find out if our baby was alive still remember the fear every time we heard footsteps outside the delivery room – No!
    Did the health visitors who told me that I should be grateful I had a healthy baby ever notice the scars on my body where I self harmed because I felt like such a failure think about those weeks – No!
    So why am I stuck in the loop of reliving that time over and over again?

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  8. I am a compassionate , experienced midwife who feels so deeply saddened by these tragic stories of women who are suffering internally so deeply following their birth journey.
    I have been fortunate enough to have just successfully completed a life-changing course to treat women or partners with PTSD , based on the rewind therapy to provide a safe, fast and effective way of releasing the memory of the trauma from the primitive part of the brain to place it in a part of the mind which will no longer cause triggers or distress .
    My experience in midwifery and also debriefing following birth is paramount in providing an empathetic and holistic approach to allow you to be listened to and to have your experience validated in a non-judgemental way to start your journey of healing and finding light again from a very dark place.
    The course I will be certified on has been accredited by the Royal College of Midwives to Gold standard and our qualification is : Certified Birth Trauma Resolutuion Practitioner. We are a small group nationally to be trained by Jennifer Mullan and the numbers of trainees are escalating as the course continues in it’s success.
    Please do not hesitate to contact me @ helengraham992@btinternet.com if you require any further information .

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