In today’s Mail, a former antenatal teacher forcefully expresses the view that horror stories in the media, and programmes such as Call the Midwife, are responsible for peddling the idea that childbirth is frightening and dangerous. Reading or seeing horror stories, her argument goes, makes women feel frightened, and the fear itself increases the risk of a difficult labour and worse outcomes.
It’s a view I’ve heard expressed a lot recently – including last week, at a training day for midwives on mental health, at which I was also speaking. I couldn’t help recalling a talk I’d given a year ago, at the end of which an obstetrician expressed the view that the two most dangerous days of a woman’s life are the day she’s born and the day she gives birth. She went on to say that one of the reasons women felt traumatised by a difficult birth was that women these days were going into birth with expectations that were too high: they assumed that they would be able to give birth normally, with help from breathing exercises and a birthing ball, and were bitterly disappointed to discover that giving birth is much harder than they’d imagined.
So there you have it. In one view, women these days are too frightened of birth, which leads to them having a traumatic birth; in the other, women are too blasé, which leads to them being traumatised by birth.
What strikes me now, however, is that both views – that women should be either more positive, or more wary – are mistaken. Whether a woman has a good experience or a bad experience of birth has little, in reality, to do with how she feels about it beforehand, and a great deal more to do with how she is looked after by the people responsible for helping her birth her baby. Some things, of course, are out of everybody’s control: physiological problems that result in a long or particularly painful labour, or lead to a postpartum haemorrhage, are hard to predict and avoid.
But what we can do something about is how well the woman is treated. Is she being cared for on a one-to-one basis, or is her midwife, as a result of staff shortages, having to dash between multiple labouring women? Will the midwife ask the woman’s consent before carrying out an internal examination or breaking her waters? If the woman is in a great deal of pain, and asks for pain relief, will that request be taken seriously, or ignored or even belittled? If the woman feels the urge to push, will there be a check to see that she’s in second stage labour, or will it be assumed that she can’t possibly be that far along, as she hasn’t been in labour long enough? If something goes badly wrong, such as the baby getting stuck in the birth canal, or the woman haemorrhages after labour, will that emergency be dealt with not only quickly and efficiently but with kindness? Will someone explain to the woman what is being done and why? If she is feeling distressed, will someone take the time to hold her hand and comfort her?
All these things, as new research has confirmed, make a difference as to whether a woman finds her birth traumatic or not. It’s possible to have a potentially frightening experience, such as a shoulder dystocia delivery or a huge postpartum haemorrhage, without feeling traumatised, as long as the woman feels confident that the people looking after her are both capable and caring. Ultimately, whether the woman goes into labour feeling serene, or absolutely terrified, should make no difference, because if she is well looked after, then there is every reason to expect that she will come out of her birth experience feeling relieved and happy.