There’s a perception in our culture that birth is inherently traumatic — we tend to view it as an emergency rather than a normal physiological process. Births on screen usually involve a woman lying on her back, feet in stirrups, screaming in agony while saviours in scrubs administer life-saving procedures off-camera.
Birth is a complex issue, but as a core principle, we know that most humans can deliver without medical intervention. Despite this, one in three women and birthing people in Australia are estimated to have experienced physical and/or psychological trauma through interventions during pregnancy and birth. That’s 100,000 people a year.
This week, the first hearings of the NSW parliamentary inquiry into birth trauma took place. It received more than 4,000 submissions detailing disrespect, coercion and a lack of informed consent.
Maternity health professionals have been calling this a “#MeToo” moment. Yet media coverage of defensive statements made by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Medical Association (AMA) offer insight into how news outlets are framing the issue and co-opting stories of harm and suffering for culture wars.
For example, a piece in The Sydney Morning Herald led with a quote from the AMA’s submission:
Social media and birth plans are giving parents unreasonable expectations of control during labour and setting them up for unnecessary distress.
By framing social media as the problem, a reasonable subset of audiences are no doubt ready to dismiss the submissions as trivial, categorised along with reality TV and TikTok dance trends. But from my work with women and midwives, my own experience, and reading many of the 4,000-plus submissions to the inquiry, I know that Instagram influencers and expectations of “perfect” births are deflections from the real issues.
The AMA’s submission, having blamed women for wanting a say in their births, then criticises parents for not being fully informed: “Often parents do not understand why decisions are taken because they have not been fully educated about the potential need for intervention before birth … setting themselves up for failure.”
Yet Dr Jared Watts of RANZCOG said sharing antenatal education information with pregnant women is “hard”: “You don’t want to scare women, because you wouldn’t want to have a child if you knew of every complication that could happen.”
This condescending attitude reveals the unspoken tensions that play out in maternity wards, turning the bodies of mothers into the site of an ideological battleground. But the submissions show it’s not intervention per se that causes trauma, but the way women report being bullied.
We’re extremely lucky to have access to obstetric care when it’s needed, but our rates of intervention are skyrocketing, and the inconvenient truth is that those rates are driven by commercial imperatives. Pressure for intervention happens more frequently in the obstetric model of maternity care because women giving birth in shorter timeframes, or scheduling elective caesareans, has a financial benefit for obstetricians.
Evidence shows that midwifery-led continuity of care, in which women see the same midwives throughout pregnancy and birth, has the lowest rates of intervention and the best outcomes for mothers and babies — coincidentally at the lowest cost to the family and taxpayer. In Australia, only around 10% of women can access that model of care.
The World Health Organization has said between 10% and 15% of births should be expected to be via caesarean section. Australia’s caesarean rate is a staggering 38%, a significant rise from 17.5% in 1990, yet maternal and infant health metrics have barely changed.
Intervention in birth has become systemic. Yet birth is unpredictable and idiosyncratic; we don’t all labour at the same pace. Many submissions speak of pressure to “speed things up”.
I knew my body and baby weren’t ready. The urgency and pressure put on me by medical staff was stressful, they told me I needed to get the baby out now. They used the vacuum against my wishes and I experienced a second degree tear which I contribute [sic] to their actions.
Submission to the inquiry, name withheld
When women feel threatened, it inhibits the production of the hormone oxytocin, essential in birth and mother-infant bonding. In fact, stress can cause labour to slow down, which seems to validate the “need” for intervention. It’s a vicious cycle.
Many women aren’t aware that when they acquiesce to synthetic oxytocin to “speed up” labour, or an epidural to manage pain, what is termed the “cascade of intervention” often follows, making it increasingly likely that they’ll have a forceps or ventouse delivery, or a C-section. That is unquestionably a failure in antenatal education, but also a failure in the birth suite.
The Australian Charter of Healthcare Rights says: “Bodily autonomy and informed choice are fundamental human rights.” But for many birthing people, consent is coerced. Women say no. They say no loudly and often, and their refusal is ignored in ways that make harrowing reading.
I was completely violated through vaginal examinations even when I said no.
Submission to the inquiry, name withheld
I was physically restrained, my arms were held down and my legs were held down and forced apart while I lay on the bed. I screamed STOP STOP due to the immense pain of the forceps going into my vagina and pulling out my baby. The pain was so extreme I felt like I was going to pass out and die from it. After the forceps I had extensive vaginal tearing and underwent a very painful 40ish minute repair with inadequate pain relief.
Submission to the inquiry, name withheld
Some submissions describe examinations being “like rape”.
In its defensive submission to the inquiry, RANZCOG takes issue with the term “obstetric violence”, bedevilling the details with a frankly sophomoric discourse about semiotics.
The word ‘violence’ has a grounding in the social and political philosophy literature, with a paradigm of victimhood and oppression by a powerful privileged group who deliberately cause suffering. Whilst RANZCOG acknowledges that interventions can cause harm or psychological stress to the patient, the term ‘obstetric violence’ implicates that the obstetrician ‘intended’ the harm — which is unfair and vastly incorrect.
Fighting for autonomy sets up a harmful dynamic, whether intentional or otherwise. But the system they work within isn’t woman-centred, and the result is compassion fatigue at scale. Staff either burn out and leave, or if they stay they often become traumatised and desensitised.
The AMA’s response to a study that found one in 10 women experienced obstetric violence was “what that data shows is there is an incredibly emotional element to birth that hasn’t been addressed in the current care system”.
This is a tactic many women are familiar with. “Emotional” is shorthand for silly, bothersome, feminine. The insinuation is we can ignore it; just ladies having feelings. Another attempt to deflect from the many stories of significant and long-term injuries, physical and psychological. A midwife said in a submission:
Whilst there may be a perception that healthy babies are leaving hospitals and that is a measure of success … they are leaving with traumatised mothers who are struggling to bond and attach to their babies after being left to navigate their trauma, grief and physical recovery without support. I am certain this can only be detrimental to their child’s development long term.
Midwife submission to the inquiry, name withheld
Trauma affects recovery and mother-infant bonding, and has long-term implications for the physical and mental well-being of families, which in turn impacts society and the economy.
The solution is clear: better funding for our maternity system, and a requirement for respect, safety and choice for all women, whatever their cultural needs or economic situation. Our collective future is at stake.
Thank you for the article.
I still remember the trauma of the birth of my son, 37 years ago. The rudeness of the doctors, the gruffness of the midwives.. we wanted it to be perfect and were told to expect it so. How naive we were.
Why isn’t there more education about how damned dangerous giving birth actually is. It terrified my and I’m a male. I worried for my wife and would have taken some of the pain if I could.
There should also be more education about the damage that giving birth does to the female body, splitting of the labia minora, urinal incontinence… just to name a few… and that’s not even getting to the really life threatening things like the placenta ripping from the wall of the uterus, causing life threatening bleeding.
Maybe if women (girls) were better educated about this there’d be fewer births.
My daughter gave birth to my first granchild this year (at age 36). I was saddened to see things haven’t changed in 36 years… the pressure to give birth on time… inflating things in her uterus, synthetic oxytocin… and then caesarian. How I felt for her and her loving partner… I wish I could have made things better for them.
I was actually hoping to not have grandchildren, but she is lovely.
“There should also be more education about the damage that giving birth does to the female body, splitting of the labia minora, urinal incontinence”
Is one reason for the growth in caesarians women being more aware of this?
That would be a yes.
There was an Obstetrician Gynaecologist in Australia who had funding from the NHMRC, researching surgical techniques for the repair of major pelvic damage done usually by the use of forceps when the baby really gets stuck.
Keep in mind that forceps were invented in the 1900’s have saved a lot of babies lives.
He fell foul of the militant midwives of NSW fronted by Hannah Dahlen currently a professor at the University of Western Sydney.
I believe that he left Australia.
The Obstetrician Gynaecologist’s crime was suggesting that “If it had to be forceps it should have been a cesarean” because after 15 years there was no successful surgery possible to repair the damage done when either one or both of the muscles that attach to the sacrum at the back and under the pubic arch at the front, are torn off the bone at the front of the pelvis. Pelvic floor exercises don’t work when the muscle has snapped back under the skin.
Mostly the extent of the damage doesn’t show up until the mother is well into her 50’s or 60’s.
They spend the rest of their lives in nappies.
@Zeke The “delivering on time” pressure is because the placenta is meant to last 40 wqeeks and can suddenly fail.
Result is dead baby.
Ratty: show me the evidence that the placenta is “meant” (by whom, one wonders?) to last 40 weeks? Women’s bodies, menstrual cycles and gestation period can all vary.
40 weeks is an average. Language like “suddenly fail” is the very sort of fear-mongering that is both unhelpful, and frankly not evidence-based.
Actually my statement is evidence based.
“Suddenly” is not quite accurate because as a sonographer I watch the placenta slowly cease being functional by measuring the blood flow in the Middle Cerebral Artery of the foetus.
If the baby is of an age where they can be rescued by immediate cesarean, great.
Otherwise we document and hope.
This is how the Terminal Cascade was identified and calculated.
In a “normal pregnancy” with a “normal placenta” the decrease in function is slower, however, there are a lot of late intrauterine deaths, in Australia 7 per 1000 live births.
These are postulated to be placental failure by the Still Birth Society of Australia.
I have performed weekly or more closely spaced scans of the MCA and over the years a significant number of so called “Normal pregnancies” would have ended in a dead baby, except for the vigilance of the Obstetrician.
Live baby happy mother.
As an aside, and speaking of the relevance of “term”, I was at a European conference, when the midwifes of a university hospital in Sweden were forced by their ethical standards body to report a negative result.
They recruited women with a “normal pregnancy” to prospectively allow their pregnancies to go over term.
They managed to recruit 2,000 women who allowed their pregnancies to extend past 41 weeks and unsurprisingly they had a result of 17 deaths per 1000 births or in essence they more than doubled the stillbirth rate. The longer the pregnancy went on for the higher the rate of still birth.
The ethics committee which gave them the permission to do this study also forced them to present it to this research conference so that someone else wouldn’t attempt the same thing.
I really object to the term “birthing people” – why not just say females. To my knowledge no males give birth. During my first delivery (55 years ago) I experienced a total lack of any care. I was admitted, given an enema, dressed in a hospital gown and left alone in a room with a bed, a locker, a very large clock on the wall, and a glass of water. That was it, and for over 10 hours I saw nobody until I pressed the buzzer, was snarled at by a midwife, and moved to the delivery room. My point is that intervention is sometimes desirable, even it is only a kind word.
For a really frightening example of the madness du jour, check out the recent (and REPEATED, as if it didn’t receive sufficient pushback when originally published!) Grauniad photospread of “pregnant men” –
https://www.theguardian.com/artanddesign/gallery/2023/aug/08/difference-is-beautiful-pregnant-trans-men-go-for-a-swim-in-pictures
Can you just get over yourself? You’re not doing yourself any favours.
Thank you for your comment Mary. I hear you.
I wrote “women AND birthing people.” I don’t believe this small token of inclusivity took anything away from me or anyone else. I don’t say “females” because I’m talking about humans, not livestock.
I’m sorry for the experience you had during birth. You deserved care, as every woman (and birthing person!) does. Let’s hope in the future that kindness and compassion is the minimum standard.
Why not just call them ‘mothers’?
Or womb-men.
Sorry. Look, I don’t think we should be distracting from the issue at hand with exhausting semantics.
Let people call themselves what they want. Sure, it can seem a bit silly here and there, but we certainly have bigger fish to fry.
Oh, we’re livestock alright. The Matrix was a true story.
Nowhere in this article do you discuss the role of the legal profession in all of this. The threat of being sued for anything other than the delivery of a completely well, normal child drives many obstetric interventions, particularly in the private sector where the obstetrician carries the full legal responsibility.
I didn’t have space to discuss a great many of the factors, but in response to your point, the data show birthing under the care of an obstetrician (in the private sector or otherwise) isn’t the model of care that’s appropriate for most women.
The threat of losing registration is a significant one for midwives as well as obstetricians, and I understand the concern about litigation. Nevertheless, a scenario in which we continue to see 100,000 traumatised women and babies a year because legislative change is hard and causality is complex doesn’t seem ideal.
We need change, and that includes autonomy of practice for midwives, better allied care models, and crucially, choice for women.
@Cat McGinn
I am appalled at your stated bias and, may I direct you to the Ockenden Report into birthing practices and the entirely preventable deaths of hundreds of mothers and thousands of dead or damaged babies in the UK released in 2022?
Once you have digested that report by a midwife and decide whether we are going to set aside 1 in every 5 dollars spent on Obstetrics for compensation for predictable and preventable deaths and damage done, as is the situation in the UK.
I work as a Sonographer specializing in Obstetric scanning, which is a bit like being the crow on the fence, I see and hear all.
I am also a woman with a history of a spontaneous delivery in under 2 hours for my first baby, no stitches or pain relief needed and breast fed until my son weaned himself at about 9 months or so.
The so called painless delivery everyone speaks about and is a proven genetic trait of about 1 in 10,000.
Pain and the responses to it, are not learned or a product of fear.
I watch young pregnant women drawing up birth plans, as if they are a shopping list.
The build up to the “perfect birth” is a recipe for post partum depression.
The patients I have encountered on their second pregnancy usually have a more realistic attitude to their next delivery or a hardened resolve to achieve the “perfect birth” this time round, frequently ensuring post psrtum depression, only more significant.
The group I find most confronting and distressing are those who have PTSD from a long hard labour (3 days or so) with no pain relief and then 3rd or 4th degree tears, blaming themselves for the disastrous delivery. Some report the midwives in the birthing center telling them that a shot of pethadine risked turning their child into a drug addict.
Why are we setting up our pregnant women to fail??
Why are we importing the failed “Birthing Center” and “Midwife led model” into Australia when we know that the maternal mortality rate is likely to move from our current 5-7 per 100,000 births to the current UK rate of 35 to 40 per hundred thousand births?
I note that neither the Obstetricians or midwifes from the UK are not required to review the standards that they trained with before they commence practice in Australia.
And so, we are also importing the slovenly practices of the NHS, rather than require a lift in practice standards.
One such specialist who also teaches stated that “He didn’t think it necessary to check women’s hearts or breasts during pregnancy or make recommendations for nipple preparations prior to commencing breast feeding.
This means that women who are pregnant for the first time will not be checked to see if their heart, under the stress of pregnancy, has had an undiagnosed heart problem become significant, when there is time to do something about it.
If this slovenly approach is adopted through out Australia , the single biggest preventable cause of mother and baby’s deaths will keep rising.
As far as nipple preparation is concerned, there is an excellent article about the sheer force of a baby’s suck……………
All I can say is “Why are people, trying to do the right thing being indoctrinated that natural birthing is right for everyone and if can’t you are a failure?”
Thanks for your under-appreciated contributions here.
I’m a big fan of science, but hugely sceptical of its application. The hippies (I’m also one of those) make a lot of great points but are horribly idealistic and prone to magical thinking.
We need much more informed debate.
When my wife went into contractions with our son, she was urged to have a caesarian. When the contractions stopped, she was urged to have a caesarian. She refused and walked out of the hospital. Eight days later he was born perfectly normally without intervention of any kind. This was back in the late 1980s. Luckily, she knew her body and was strong enough to say no.
And, would she have taken responsibility for the still birth, if that was the result of her decision?
Or would both of you blame the doctor?