“women should not have such high expectations!Honestly women these days are just so fragile”.
I took a deep breath before responding. If a healthy woman is expecting a ‘normal birth’ that is not a high expectation. That is a reasonable and minimal expectation. It is not ‘fragile’ to be disappointed by a birth that does not met this expectation. For women to lower their expectations of birth, to the reality of the current birth climate, would set a new (horribly) low benchmark. Along with “all that matters is a healthy baby” these comments tell us that women do not matter. First Class Maternity Care – it’s a political choice (first class care should be the MINIMUM we expect!).
This birth disappointment may just be putting new mothers at greater risk of Postnatal Anxiety and Depression (1) as they begin their mothering journey full of self-doubt, and uncertainty. This can then be compounded by a mothering reality that also does not meet their expectations.
Obviously – if care providers provided respectful and compassionate care, the situation would be far different. The glaringly frustrating and horridly realistic truth is we can not assume we will receive compassion or respect. The psychological impact that an uncaring physician holds, even for a basic procedure, is too quickly dismissed. Let us call this as it is: OBSTETRIC VIOLENCE. Women refer to their birth experiences using similar terms to those used for sexual assault (including rape). The consent process in maternity care is abysmal, and care providers MUST do better. Much. Better.
Just as we should be free to move through society without fear of attack or abuse, from strangers or intimate partners, so too should we be able to enter a maternity system that is culturally, emotionally and physically safe.
Understanding the reality of standard maternity care helps us to be better prepared, and better equipped to navigate it on our terms. And frustratingly in order to navigate this system, we need to acknowledge that we may face uncompassionate, arrogant, rude and pushy obstetric staff, who are more concerned with insurance, their own time management and the short sighted goal of everyone being alive at the end of the day.
My own mothering journey led to the writing of The Birth Map: boldly going where no birth plan has gone before. This was a book that almost wrote itself (2). It was a response to the inadequacies of the system, based on stories of my mother-friends and my subsequent journey into doulaing and then onto Birth Cartography.
I found myself on a mission (3):
To provide all women with the means to make informed decisions regarding their pregnancy care, labour, birth and parenting.
My hypothesis is that this is the key to helping prevent PND. That by giving women the means to make informed decisions about their birth, and beyond, during their pregnancy we are helping to safe guard families. There is mounting evidence to support this, and my PhD is looking specifically at the impact of The Birth Map as this means.
I would love to see a change in the system (4); to one that values informed decision making, mothering and families.
My own mothering journey led to the writing of The Birth Map: boldly going where no birth plan has gone before. This was a book that almost wrote itself (2). It was a response to the inadequacies of the system, based on stories of my mother-friends and my subsequent journey into doulaing.
I found myself on a mission (3):
To provide all women with the means to make informed decisions regarding their pregnancy care, labour, birth and parenting.
My hypothesis is that this is the key to helping prevent PND. That by giving women the means to make informed decisions about their birth, and beyond, during their pregnancy we are helping to safeguard families. There is mounting evidence to support this, and my PhD is looking specifically at the impact of The Birth Map as this means.
I would love to see a change in the system (4); to one that values informed decision making, mothering and families.
The system requires women to ‘provide informed consent’ for various procedures and interventions. Due to the ‘unpredictable’ nature of birth, this consent is sort in the moment…so is never informed. This is a huge contributor to the feelings of disappointment, and even trauma, increasingly experienced by new (and unsuspecting) parents. The disservice here being that there is a (misguided) assumption that the system cares (5). Midwives care, but ar held to account by the system. It is for this reason that I focus on Informed Decisions rather than consent (6).
To make informed decisions we need to know The Questions!
When we do not know what we do not know, we can not begin to be informed. When hindsight reveals the gaps in our knowledge, this is where the sense of failure, disappointment or trauma can arise. We begin to wonder, what else is not known. And without guidance, this breeds anxiety.
THREE ELEMENTS TO HELP PREVENT PND:
- The Birth Map provides the landscape, with an understanding of the key features, possible detours and the people you might met along the way. Including beyond birth.
- A doula provides the guidance (not unlike a sherpa aiding an Everest climb). The guidance and support of a doula can be engaged before, during and after the birth.
- Independent childbirth classes provides the training, if a natural birth is the expectation.
This (well meaning) advice, along with that in the opening statement of this piece, may also accompany “but your baby is healthy…”. This idea that women should be grateful for the state of maternity care is a feminist issue (7).
Informed Birth Preparation includes focusing on life with a new baby. One aspect of this is setting up support for the ‘fourth trimester’.
This practical support (chores, meals, help with older siblings) is often enough to help prevent post natal depression. This kind of support acknowledges the importance of mothering and mothers, and ensures they are not isolated and swamped by non-mothering work* by default.
*this is called ‘housework’ and is the responsibility of all who dwell in, or even visit, a house. See also: self care according to dave
(1) https://www.panda.org.au/info-support/after-birth/contributing-factors-for-postnatal-depression-or-anxiety
(2) more than just another birth book
(3) Mothers Matter!
(4) Forget the birth plan – you need a Birth Map
(5) The care factor
(6) we should be focused on choice not consent
(7) welcome to the brave new world