Birth is an event that has the potential to be both joyous and traumatic. Before the introduction of anaesthetics, births were often characterized by the pain and fear experienced during delivery. Following the discoveries of chloroform and ether in the 1840s, however, the biblical pronouncement “in sorrow shall thou bring forth children” was increasingly up for debate. After Queen Victoria gave birth to two children while under chloroform anaesthesia in 1853 and 1857 – events that did much to increase the respectability of anaesthetized birth – growing numbers of white, well-to-do, urban-dwelling women throughout the western world gave birth with some pharmacological pain relief.[i] Despite these shifting birth experiences, the advent and growing use of obstetric anaesthesia had little impact on ongoing associations between birth and trauma in the eyes of many women.
Trauma can be and has been defined in various ways, with the majority of modern definitions offering at least some recognition of both the physical and the emotional or psychological components of traumatic experiences. While women giving birth without anaesthesia may have found the pain they experienced to be the most traumatic part of delivery, the use of medical interventions, including those intended to relieve pain, also had the potential to render birth traumatic. This was, and is, especially the case when women are unable to exert their own power in making choices about the events taking place in the birthing room.
Changing Childbirth Choices
By the first decades of the twentieth century, anaesthetized birth – or, at the very least, the provision of some analgesia or pain relief for the majority of white, well-to-do, urban-dwelling women during delivery – was increasingly commonplace throughout much of North America and Britain. The medicalization of birth reached new heights during the interwar period, with groups such as the British National Birthday Trust Fund advocating increased access to anaesthetics for all women. At the same time, however, the beginnings of natural childbirth movements represented some of the first significant and organized opposition to this medicalization.
Taking interest in the ideas of the British Dr. Grantly Dick-Read – and later, in the 1950s, the work of French obstetrician Fernand Lamaze – growing numbers of women sought a new type of birth experience in which they were conscious, confident, and active participants in their own deliveries. In seeking drug-free births, these women went against the existing trend in North American and British obstetric practice. As a result, many encountered difficulties in finding physicians who were willing to allow their expectant patients to attempt a so-called “natural” delivery. Women also voiced increasing criticisms of post-war obstetric practice.
“Obstetric Violence” and Trauma in the Birthing Room
In writing to Grantly Dick-Read and relaying their enthusiasm for natural childbirth, North American women also took the time to express their criticisms of medicalized birth to what they recognized as a receptive and sympathetic audience. Women regularly criticized the interventionist treatment that expectant mothers received at the hands of medical professionals. They described painful and humiliating preparatory procedures, as well as harsh treatment from both physicians and nurses, including slapping and other forms of physical abuse. Women also reported that on some occasions, the nurses who attended their confinements forced their legs together or administered anaesthesia without consent to delay birth and prevent ‘untimely’ visits beyond physician control. Many expressed regret and disappointment in reporting that, as a result of these actions, they had “failed” to achieve their ideal conscious and “natural” births.
These abuses are by no means a thing of the past. Anticipating the arrival of her fourth child in 2012, Caroline Malatesta of Birmingham, Alabama chose the Brookwood Baptist Medical Centre based on the hospital advertising its willingness to “accommodate” mothers who sought “natural births.” When it came to the delivery, however, Malatesta’s experience overwhelmingly failed to live up to expectations. Though her doctor had assured her that she could freely move about during labour, Malatesta was ordered – and later, forced – by a nurse to remain on her back for fetal monitoring. With the baby crowning and no physician on hand, a nurse allegedly held the baby’s head in for an estimated six minutes until the on-call doctor arrived to complete the delivery. Experiencing lingering pain after the birth, Malatesta sought answers, and was later diagnosed with a nerve disorder called pudendal neuralgia. In 2014, she filed a lawsuit filed against Brookwood and its principal company, Tenet Healthcare Corporation, and in August 2016, a jury awarded Malatesta $16 million, finding the hospital responsible for both medical negligence during the delivery and “reckless fraud for its natural birth ad campaign.”
Prompted, in part, by popular attention to cases like Malatesta’s, other women who have experienced birth trauma have increasingly spoken out in recent years. Using the hashtags #BreaktheSilence and #ImprovingBirth, hundreds of women have voiced their criticisms of mainstream obstetric practice on social media, recounting their experiences of bullying and coercion at the hands of medical professionals, as well as unconsented procedures including episiotomy during birth.[i] Medical and legal professionals have recently categorized these practices as “obstetric violence”, a specific category of gender-based harm “exercised by health personnel on the body and reproductive processes of pregnant women, expressed through dehumanizing treatment, medicalization abuse, and the conversion of natural processes of reproduction into pathological ones.”[ii] While the structural dimensions of obstetric violence remain understudied, this categorization draws much-needed attention to the ongoing relationships between birth and trauma, as experienced by many women.
[i] Farah Diaz-Tello, “Invisible wounds: obstetric violence in the United States,” Reproductive Health Matters 24 (2016): 56-64.
[ii] See “Obstetric violence: A new legal term introduced in Venezuela,” International Journal of Gynecology and Obstetrics 111 (2010): 201-202, and Carlos Herrera Vacaflor, “Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina,” Reproductive Health Matters 24 (2016): 65-73.
[i] For more information see Stephanie Snow, Blessed Days of Anaesthesia: How Anaesthetics Changed the World (New York: Oxford University Press, 2008).
Whitney Wood is a postdoctoral research fellow in the Department of History, Classics and Archaeology at Birkbeck, University of London. Her most recent research project is a history of natural childbirth in postwar Canada. Her first book, Birth Pangs: Maternity, Medicine, and Feminine Delicacy in English Canada, 1867-1940 is currently under contract with McGill-Queen’s University Press. She tweets @whitneylwood.