Trigger warning: this article contains references to traumatic childbirth.
Poor maternity care is tolerated as the norm in the UK, according to a parliamentary inquiry into traumatic childbirths. The inquiry, which heard evidence from more than 1300 women, found that high-quality care for pregnant women “is the exception rather than the rule”.
Women reported being left in blood-stained sheets for hours, being belittled or mocked by hospital staff, and being denied pain relief. Others said their babies had suffered life-changing injuries due to medical negligence, such as oxygen deprivation.
The report calls for overhauling the UK's maternity services, including introducing a dedicated maternity commissioner reporting directly to the prime minister.
Health Secretary Victoria Atkins said she is “determined to improve the quality and consistency of care for women throughout pregnancy, birth and the critical months that follow”.
Here, Lottie Winter reflects on her own experience of traumatic childbirth and how no one – not even medical professionals – prepared her for it…
“I can’t feel a pulse.” Words you never want to hear. Especially when they’re about you. About an hour earlier, I had given birth to my son and had started haemorrhaging due to complications with the placenta. So, there I was, lying on an operating table, in and out of consciousness, three litres of blood down as the doctors called a ‘Code Red’ (an emergency call out to relevant hospital departments when a patient has life-threatening blood loss). The veins in my limbs had collapsed, and my non-vital organs were shutting down. The reason the doctor holding my wrist couldn’t detect a pulse was because there wasn’t blood circulating in my arms anymore. My kidneys stopped, and I went into hypovolemic shock. 21 attempts at cannulation had failed, and I was running out of time. Eventually, they inserted a central line directly into my heart and transfused six units of red blood cells and four units of plasma. According to one of the doctors, the first thing I said when I came around was, “What the fuck just happened?”
What the fuck had just happened? I read all the birthing books. I went to all the antenatal classes. There had just been a lot of chat about contractions and pain relief, with a footnote on caesarean sections and instrumental births. The possibility of haemorrhaging or encountering other serious complications was never, ever mentioned. Every risk, no matter how small, is explained to you when you go for any other medical procedure. Even when I’ve been for a cosmetic procedure like Botox, I’ve been more informed than I was about the risks of giving birth.
Caesareans have overtaken vaginal births in England for the first time. The ‘too posh to push’ tabloid headlines followed.
On the whole, giving birth in the UK is statistically very safe. However, health professionals should still adequately communicate the probability of the most common complications. For example, 22% of births in the UK are by an emergency caesarean; 10% of births in the UK are by instrumental assistance (like forceps); 17% of birthing people have an episiotomy (a cut made into the perineum and vaginal wall to make more space for your baby to be born); and 30% have 1st or 2nd-degree tears and 5% have 3rd or 4th-degree tears. The rate of PPH (blood loss of 500ml or more) requiring transfer to obstetric care is 3.7%.
It’s also important to know that medical professionals are prepared for and capable of dealing with all of these complications with favourable outcomes.
Still, knowing about the complications may influence your decision over where and how to give birth. Or, of course, you might weigh up the probabilities and feel happy that these things will most likely not happen to you. But at least you would be going in with your eyes open. Medical complications aside, there’s a huge psychological impact of feeling utterly blindsided during one of the most significant moments of your life.
I (along with many others) was sold a pretty romanticised version of the birthing process, one that could be well managed with breathing techniques, an oxytocin-inducing playlist and 12 LED candles off Amazon. It would be painful, sure, but I was told all about my pain relief options. Plus, I was repeatedly fed the idea that my body was “made to do this” and “my baby and I are a team”. I now consider these mantras to be harmful tropes that likely contribute to feelings of failure and inadequacy.
In fact, having a birth experience that was not as expected or far from what you had hoped for is one of the main risk factors for developing birth-related trauma – symptoms of which up to 45% of birthing people experience, and 4-5% develop PTSD. In fact, it’s become so prevalent that on 9th January, an inquiry into Birth Trauma was set up by the All-Party Parliamentary Group (APPG) in the UK Parliament to investigate the reasons for traumatic birth and to develop policy recommendations to reduce the rate of birth trauma, with findings due to be published in April.
Pelvic floor muscles are no joke.
“The myth persists that childbirth is supposed to be a lovely, joyous event, so when it doesn't turn out to be so lovely, it can be very scary and really hard to come to terms with afterwards. There’s the shock that it wasn’t what you expected, but also a sense that you’ve failed and it’s your fault,” says Kim Thomas, CEO of Birth Trauma Association UK.
“Unfortunately, there’s still quite a paternalistic attitude in maternity services, and there’s this underlying idea that maybe women don’t deserve to be informed about their choices and that they can be easily scared or a bit silly. There’s a lot of wishful thinking as well. A kind of ‘tell them it will be fine, and it will be. If there's a problem, we can deal with it when it arises’. I think there are flaws in that strategy. One being that obviously things can go wrong and when they do, you have no idea what's happening to you and start panicking.”
“Not knowing makes it hard for women to make informed choices when they go into labour.”
When I was pregnant, the only whispers of warning I received were from other parents who had experienced their very own “what the fuck” moment and were clearly still traumatised. Their words came from a place of fear, not fact, and left me either feeling terrified, or annoyed that they’d brought it up at all, when I was weeks away from giving birth myself. It really shouldn’t be the job of the traumatised to issue medical warnings. A factual and calm explanation of possible complications from a professional, as well as the ways each one is treated, should be part and parcel to birth preparation and covered in every antenatal course. We can handle the truth. And to deny us of the information needed to make decisions surrounding the biggest moment of our lives is at best, disempowering and at worst, deadly.
A little more candour surrounding the, albeit rare, complications is urgently needed. “Obviously things can then go wrong,” adds Kim. “Not knowing makes it hard for women to make informed choices when they go into labour. For example, you might be told that you need either a forceps delivery or an emergency caesarean. If you have never considered this possibility before, it's really late in the day to start weighing up the pros and cons of each. Or take postpartum haemorrhage. If you knew this could happen and that doctors were prepared to deal with it and are very effective at treating it successfully and efficiently, you might not be so terrified when you suddenly see lots of blood.”
A year and a half later, I’m better. It took two months to recover physically and many more to come to terms with what happened psychologically. But I was lucky in many ways. For starters, my local hospital is ranked one of the top in the country (the doctors, midwives and nurses were amazing, and I will never adequately be able to express my gratitude to them), and I have an incredible support system. But with the recent scandals in maternity units across the UK and news that maternal death is at the highest rate in 20 years (leading causes including blood clots, sepsis due to infection and suicide), it’s more important than ever to be as prepared as possible, not only so you can be aware of various complications and how they’re treated so if they do arise you’re a) not absolutely terrified and b) able to advocate for yourself, but also to help bridge the gap between a romanticised expectation of birth and what is often a very different reality.
The millennial motherhood revolution is here.
