The below article discusses themes of obstetric violence and abuse, as well as stillbirth, which may be distressing for some readers.
Mothers; expecting mothers; bereaved mothers; midwives – thousands of their stories have been submitted to the NSW Legislative Council’s Select Committee on Birth Trauma. One woman described the moments her newborn was “corkscrewed out” and placed on her belly. Needing resuscitation, her son was rushed to the special care unit for six hours; mum left dizzy and confused. Six weeks later, with a thankfully healthy baby, she returned to hospital for a rushed debrief, no counselling, and more questions than answers. This was just one of 4000 submissions.
“The sheer number of submissions alone demonstrates the prevalence of birth trauma and the urgent need to consider legislative, policy or other reforms that can be enacted to prevent birth trauma,” said Committee Chair, the Hon Emma Hurst MLC.
With decades of health marginalisation in healthcare, from dismissed symptoms to under-representation in medical research, this is hardly the first time women have been forced to fight for reform.
Gender bias in healthcare
Women’s historical exclusion from medical research has created a significant gender bias in the healthcare industry. Despite women being at higher risk of experiencing chronic pain and autoimmune diseases, the Royal Australian College of General Practitioners (RACGP) explains that these conditions and their affect on women are under-researched, often misdiagnosed, and commonly mistreated.
The reason? Clinical studies would commonly exclude women. The justification? A misguided belief that what worked for men would work for everyone. Plus, menstrual cycle hormones would complicate the results… requiring more trial subjects… meaning higher costs that most were unwilling to pay. In 1977, following the thalidomide scandal, it was even recommended that women of childbearing age should be excluded from clinical research studies as a protective measure, as per the RACGP.
The result of this gender bias? Women’s health is playing catchup. As part of the 2022 to 2023 budget, the Australian government committed to invest over $333 million into areas of women’s health. Two of these areas include maternal, sexual and reproductive health, and supporting families who have lost a baby.
But what is being done about the birth trauma inquiry, specifically?
The birth trauma inquiry
There is currently an investigation underway into the key themes of the NSW birth trauma inquiry, which include:
Lack of consent: “The woman was screaming and crying for the obstetrician to stop,” one midwife submitted. “The doctor screamed back at her: ‘YOUR BABY IS GOING TO DIE’ before she continued to scream at us to hold her down. I told the doctor the woman had a history of sexual assault and to stop. The doctor did not stop. I do not believe the baby would have died. It was born healthy and crying.”
Insufficient pain relief: “The contractions got so bad that I was just screaming in pain (mainly in my lower back),” one submission read. “I was told to be quiet and not swear and or make screaming sounds. I asked them urgently for an epidural. It was only hours later they came to give me one. The epidural failed… I was begging and pleading with nurses and doctors to help me but no one would listen.”
Under resourcing: “There were no less than 28 mothers and babies – at least 56 individuals – being attended by only 4 qualified midwives alongside a handful of support staff recruited from your antenatal team,” as per a submission. “The situation is simply dangerous – not only for vulnerable new mothers and babies, but also for staff who are visibly under enormous strain trying to provide even a basic level of care.”
Lack of continuity of care: “No one had time to understand me,” one mother wrote in to the inquiry. “I was given conflicting and judgemental medical advice, both to take and not take Endone (an Opiod painkiller). I felt unheard and gaslit into believing I was not in labor. I felt no alternatives to a C-section were provided, only the suggestion/threat of a missed birth due to general anesthetic.”
Lack of communication: “They never talked me through anything that was happening to me or my baby,” another submission said. “At birth my baby was taken from me, and I was sent to recovery for 2 hours. My husband was with the baby and they just left him in the hospital room with no one for the whole time. He didn’t pick the baby up as he was worried he might do the wrong thing. For two hours my baby had no milk or hugs. I begged in recovery for them to take me to him.”
Issues with clinical staff: “I had a hematoma the size of an orange just inside my vagina which was found by the doctor doing the stitches,” as per a submission. “There was a lack of care/compassion and any bedside manner from him. I cried and asked him to be more gentle as I could feel the stitches being done and his reply was: ‘Look, I can be done in 10 minutes or you can go to theatre, without your baby’.”
Lack of after care: “I felt numb when I met my baby, who was then promptly whisked away as I went to recovery alone,” one wrote of their experience. “When I was reunited with him, my husband had to leave immediately. I was in agony, distressed, and left alone in the middle of the night with a baby who I could not get up to tend to. I felt like I had been in a plane crash. This was my start to motherhood, and the next few months were the most difficult of my life. I sank into a deep postpartum depression, where every night I would dream of my son’s birth and wake up in a sweat and in tears. I couldn’t think of anything else.”
What is obstetric violence?
The Australasian Birth Trauma Association defines obstetric violence as “inappropriate, disrespectful or abusive treatment before, during, and after birth”. In one submission, a midwife claimed that this form of violence stems from the “belief that a woman’s body is faulty and it requires medical interventions to overcome these faults”.
“Instead of providing medical interventions to those that truly need it, the over medicalisation of birth is impacting the majority of births. I have heard a woman being told by an obstetrician immediately after birth using forceps*: ‘Well, at least you got your vaginal birth’.” *Forceps are tong-like instruments that are used to gently pull the baby out if needed.
“I’ve witnessed a young woman having forceps applied by an obstetrician with very little consent and explanation. When I tried to quietly explain to her what was happening was told by the obstetrician: ‘Enough of the theatrics and commentary’.”
The ‘Me Too’ of childbirth
With stories like these, it’s apt that University of Sydney professor Hannah Dahlen has described the inquiry as the “me too of childbirth”. “No means no except apparently in childbirth, and it’s time to change that,” she said. This comes a year after Dahlen’s study, which found that one third of women will experience a traumatic birthing event.
Back in March, NSW Health published a blueprint for action surrounding maternity care. In it, they outlined 10 goals, among which included: women receive maternity care that is socially and culturally respectful; adequate information prior to conception; appropriate services based on circumstance and preferences; and support after birth.
The biggest barrier is hospital staffing. So overextended are healthcare workers that the NSW Nurses and Midwives Association has taken legal action. “We are talking about hundreds of thousands of nursing care hours not provided on general medical and surgical wards,” said General Secretary Shaye Candish. “Meaning patients may have missed timely care, such as blood pressure checks, wound care or showers due to inadequate or unsafe staffing.”
After undertaking a survey of their members, the association submitted a proposal to the birth inquiry. Among their 17 recommendations, the Nurses and Midwives Association suggests: the implementation of a new staffing model in all maternity units; the development of resources and education; longer antenatal appointments; a review of NSW Health policy; education about informed choice and consent; access to ‘debriefing clinics’ for all birthing women; competitive remuneration for NSW midwives.
What happens next with the Birth Trauma inquiry?
NSW Health has apologised for those who have undergone birth trauma. Deputy secretary of Health System Strategy Deb Wilcox has assured they are committed “to listening and learning”. How committed? Causes and solutions for birth trauma are being investigated. Key witnesses are being questioned. Two hearings have taken place. Two more are scheduled for October and December. It has already been acknowledged that women are not provided with adequate information about the potential complications of childbirth. Some, however, justify this as a protective measure.
“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,” said Dr Jared Watts – the Board Director of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). But Amy Dawes, president of Australasian Birth Trauma Association, was quick to dispute Watts when she said: “we need to stop infantilising women.”