Thinking positively about childbirth – why did Milli Hill’s article provoke such an angry response?

 

Two weeks ago, Milli Hill published an article in the Telegraph about why we shouldn’t focus on pain when we talk to pregnant women about childbirth. Originally published under the clickbaity headline (which Hill didn’t write, and has since been changed), “The myth of the painful birth – and why it’s not nearly so bad as women believe”, the article argued that by emphasising the pain of childbirth when we talk to women, we are “setting them up to fail”.

The article provoked a number of responses challenging Hill’s view, including my own piece in the Independent, a characteristically robust blogpost by “skeptical OB” Dr Amy Tuteur in which she accused Hill of “gaslighting” women and an article by Cath Janes in Standard Issue, which talked about her own experiences of a painful birth that triggered severe PND and PTSD. Cath’s piece was, as is her style, both dark and funny – but Hill didn’t like it and asked Standard Issue to take it down. The magazine initially complied, and then republished it minus one sentence that Hill had particularly objected to, and also gave Hill a right-of-reply. The whole saga also provoked a debate on Mumsnet about who was right, with Tuteur, Janes and Hill all weighing in.

There is probably not much hope at this point of a calm, rational debate about the issue. Hill, I think, was taken by surprise at the impassioned response to her article – she thinks of herself as one of the good guys, whose sole aim is to help women have a better experience of childbirth. So what is it about her piece that made women so angry?

Minimising women’s pain

Judging by comments I’ve seen on Mumsnet, Twitter and Facebook, the answer is that, for many women, their experience is the opposite of what Hill describes. Rather than going into childbirth frightened, they went in feeling positive and upbeat – and were then shocked that the experience was much more painful and unpleasant than they expected. Instead of feeling that the pain of childbirth was overstated, they felt it was minimised. When women have had a particularly traumatic birth, they often find that other people play down their experience and tell them that it can’t have been as bad as they thought, that they must be exaggerating, that the health professionals who let them down during labour had their best interests at heart – and in any case, they have a healthy baby, so what else matters? This is why Hill’s article touched a nerve – if you’re already used to having your experience minimised by others, the idea that you shouldn’t talk about the pain of childbirth feels like yet another attempt to get you to shut up.

Think positive!

People also took issue with Hill’s article argument that going into labour with a more positive attitude can help women have a better experience. In her words: “At the moment, we simply do not know what birth would be like for women if they were given more positive messages and went into labour feeling strong, confident and capable.”

The idea that “positive thinking” can help create a different reality is one of the most pervasive – and pernicious – ideas of our times. Even cancer patients are exhorted to think positively about their illness, as if mere thinking can banish one of the most deadly of diseases. It’s a view that Barbara Ehrenreich has magnificently demolished in Smile or Die: How Positive Thinking Fooled America and the World.

For anyone on the receiving end of this view, it’s worse than exasperating – being told that a positive attitude can reduce pain has an unspoken corollary, which is that if you felt pain anyway, it must have been your fault for not being positive enough. The most inflammatory part of Hill’s piece reads: “…when you talk to women who are prepared to break with convention and say their labour was not painful, words like ‘intense’ and ‘powerful’ come up again and again. It suggests that it’s the way that these women talk and think about these sensations that’s different, rather than the sensations themselves.”

Well, no. What it suggests to me is that women have vastly different experiences of childbirth – some women experience “intense feelings” while others feel extreme pain. Even the book of Genesis, written 3,500 years ago, talks about the pain of childbearing, with no word from God, unfortunately, about focusing on the positive.

No wonder some women, reading Hill’s article, felt that their desire to tell their own story was, once again, being undermined. It’s a wearily familiar pattern: a news report in the Telegraph this week reveals that women reporting gynaecological problems to their GP are often ignored or belittled.

So, here’s my bold suggestion: why not listen to what women actually say about their experiences, rather than telling them how they ought to feel? If we all, health professionals included, do that, there’s a chance, just a chance, that women’s experience of childbirth will improve.

 

 

 

 

 

Advertisements

6 thoughts on “Thinking positively about childbirth – why did Milli Hill’s article provoke such an angry response?

  1. Thank you for this well balanced comment. As a clinician who is researching ‘maternal consequences of traumatic vaginal deliveries’ I have observed that physical pelvic floor and perineal injuries with subsequent morbidities like urinary and fecal incontinence, organ prolapse and sexual dysfunction are not a fabrication. We need to hear women’s own perspectives and work together as health professionals to change these adverse maternal outcomes world wide. At present many women are too embarrassed to discuss these ‘hidden injuries’ and assessment is often sub optimal. Mothers often feel they are not believed and need to be ‘positive’ because they have a baby. With the advent of 3D/4D imaging this damage can be diagnosed by urogynaecologists and women given treatment options. Women in my study who were examined accurately felt clinicians at last believed them and their mental health improved.
    Worryingly, perinatal distress is often caused by lack of informed consent for unexpected procedures and injuries that were underplayed and not explained during the antenatal period. We need to treat women as adults and inform them of possible risks. PTSD and related symptoms are serious and can have long term consequences regarding baby bonding, relationships and self esteem. Professor Susan Ayers and her team at City, University of London have a plethora of research demonstrating that women are very distressed during and after birth.
    Many women have very positive experiences during and after birth but it is not reasonable to ignore the others who ‘suffer in silence.’ Untreated maternal physical and mental health issues are a serious public health problem.

    Like

    • Thanks very much for this – it’s great to see a comment from you, as I am familiar with the excellent work you’ve done in this area. It’s been interesting (and worrying) to see in the UK that the rates of third and fourth degree tearing nearly tripled in the space of about 12 years – they now stand at six percent of vaginal births. And it is very much under-diagnosed, or women are told that it will heal in time. I think some doctors just don’t understand the physiology of it, and so many women simply suffer in silence. The good thing about the internet is that it allows women to discover they’re not alone.

      I agree the issue of informed consent is hugely important. Women are treated in childbirth in a way that probably wouldn’t be accepted in other areas of medicine. I realise that there is a view that we shouldn’t frighten pregnant women by telling them horror stories, but there must be a way of communicating the risks without terrifying them – I don’t think that ignorance is a good alternative.

      Like

  2. Glad this research is being read. It appears the ‘zeitgeist’ regarding childbirth is to ignore evidence and continue ‘hoodwinking’ women and ‘romanticizing’ birth. New mothers in my study regularly used these words and then asked why they had not been informed during the antenatal period about potential physical damage and pelvic floor and perineal dysfunction. Medical terms like ‘rectocele’ were then applied to their injuries by clinicians and women said they “…had never heard them before until they actually had them…”- they felt betrayed.
    The reason my study is different is because all 40 women had been assessed by urogynaecologists using 3D/4D imaging. 40 women had sustained levator ani muscle (LAM) avulsion and 22 suffered from obstetric anal sphincter tearing (OASI) as well.
    Most people it seems, do not know the difference between LAM avulsion and OASI.
    LAM avulsion was discovered in the early 21st century and involves a ‘disconnection of the muscle from its insertion on the os pubis’ that can affect women’s evacuation and sexual function. Damage is often sustained when forceps are used to deliver a large baby over an extended 2nd stage of labour.
    [ Dietz HP. Pelvic floor trauma in childbirth. Aust N Z J Obstet Gynaecol 2013; 53: 220–230. doi: 10.1111/ajo.12059]
    OASI is severe tearing of the anal external and internal anal sphincter during delivery that can cause faecal incontinence.
    To date, there is minimal qualitative research of women’s own perceptions of childbirth-related somatic trauma. This is not surprising, given that most midwives and obstetricians are not aware of the high prevalence of sphincter trauma, and most are unaware of the existence of levator ani trauma causing chronic pelvic floor morbidity.
    A study of primiparous women, observed that only 15% reported post-natal dyspareunia and discussed it with a health professional, yet 64% suffered intercourse-related problems at 6 months. Findings suggested a lack of awareness by health professionals regarding post-natal sexual problems. [Barrett G, Pendrey E, Peacock J et al. Women’s sexual health after childbirth. BJOG 2000; 107: 186–195]

    Furthermore, the association between somatic and psychological birth trauma seems to be under-recognised and under-treated by health professionals. Birth is typically realized as a benign physiological event, despite huge maternal physiological and neuro-hormonal alterations and breaches of bodily integrity not observed in normal life.
    [Skinner EM, Dietz HP. (2015). Psychological and somatic sequelae of traumatic vaginal delivery: A literature review. Aust NZ J Obstet Gynaecol; 55 (4): 309-14. doi: 10.1111/ajo.12286]

    Yet there is nothing benign about urinary and faecal incontinence, vaginal prolapse and sexual dysfunction that can affect women’s identity, physical health and close relationships over a life time. Postpartum symptoms of PTSD appear to be sequelae of unexpected traumatic vaginal births with resultant pelvic floor and perineal injuries.

    Like

    • This is fascinating – thank you. I had no idea about LAM avulsion and am sure most people don’t. Your observations about health professionals not understanding the physical impact or psychological impact of a traumatic birth ring true – I volunteer with the Birth Trauma Association, and this is something our members run up against time and time again.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s