Listening? Amplifying the Loud Silences of the Birth Trauma Report

Anna Nelson, Zaina Mahmoud, and Manna Mostaghim introduce the Birth Trauma takeover, which will run throughout this week and next.

“Research evidence shows that 4-5% of women develop post-traumatic stress disorder (PTSD) every year after giving birth, amounting to approximately 30,000 women in the UK, while about a third of women experience birth as traumatic”. 

Listen to Mums: Ending the Postcode Lottery on Perinatal Care

On 9 January 2024, the All-Party Parliamentary Group (APPG) on Birth Trauma launched an inquiry into birth trauma in the UK (‘the Inquiry’). Through oral evidence sessions and written submissions, the APPG heard from hundreds of women and birthing people about their birth experiences, culminating in a report published on 13 May 2024, Listen to Mums: Ending the Postcode Lottery on Perinatal Care (‘the Report’). 

The stories included within this Report provide stark and moving accounts of harms caused when maternity and birthing ‘care’ systems are chronically under-resourced (Nazmeen, 2024). Moreover, the harm is reproduced when institutional logics remain antithetical to inclusive care (van der Waal et al, 2023). The Report highlights how deeply problematic, pervasive instincts of our social and political landscape (e.g. classism, racism, sexism, and homophobia) bleed into maternity care settings. Therefore, we note that while it is important to recognise the substantial impact of under-resourcing, we must avoid seeing ‘resource’ as a panacea solving all problems.

Healthcare practitioners and patients continue to be subjected to a system which  invisibilises their needs, a system where effective and holistic dialogue between healthcare practitioners and patients cannot thrive, and in which the need for efficiency supersedes care as a driving force.

The 2024 Report and broader conversations surrounding it, demonstrate an urgent need to re-centre care within our maternity and birthing services. The status quo is unacceptable and harms both those who birth within it (and their families) and those who work within it. Though the stories within this Report are shocking, there is little excuse for the shock expressed by politicians and policymakers. We know that maternity and birthing care is not working in this country: this fact has been underscored by numerous reports and campaigns in recent years (e.g. Birthrights, 2022; Ockenden, 2022; Kirkup, 2022).

Our admiration for the women and birthing people who shared their stories as part of the Report cannot be overstated. And yet, in reading the Report, we were left with an overwhelming sense of déjà vu. The Report’s policy proposals were neither new nor radical, and they failed to articulate a clear plan for how existing or new services would be funded or driven forward.

The Context

At an online event, on the 4 June 2024, we brought together activists, academics, and policy and healthcare practitioners, to share our frustrations, not only with the current status quo regarding the state of maternity and birth care in the UK, but also with the Report. We organised our discussion across three key themes: reproductive justice, queering birth, and obstetric violence. These themes enabled critical exploration of the Report, to consider what was present and absent, to situate the Report and its findings within its socio-cultural and historical context, and to imagine a more just, care-full maternity system and how we might start to bring this about. 

• Reproductive justice: Developed by Black feminist activists and scholars, the Reproductive Justice (RJ) framework recognises that equal access does not necessarily follow from the provision of rights and access to services. The RJ framework advocates for policies allowing individuals “the right to have a child; the right not to have a child; the right to parent children in safe and healthy environments” (Ross, and Solinger, 2017).

• Obstetric violence: Stemming from Latin American activism, obstetric violence refers to a form of gendered violence occurring during maternity and birthing care. It “exposes and names more ‘subtle’ and invisible forms of violence” experienced by labouring women and birthing people, as well as encompassing the “more obvious and extreme manifestations of abuse” (Pickles, 2023, p. 621). Importantly, though the exact parameters of the concept remain debated, it draws critical attention to the gendered and institutional nature of this violence.

• Queering birth: Current birthing and maternity services are built upon cis-heteronormative ideas about their service-users. These practices risk harming transgender and non-binary birthing people and queer families. Drawing from queer theory and queer scholarship provides a “disruptive lens” enabling identification and deconstruction of limiting structures (Hrynyk et al, 2023, p. 953), thereby supporting the drive towards a system providing better care for all who access it. 

Moving Forwards: Call to Care

This 7-part Polyphony takeover responds to and engages with the call to care in different ways. The pieces in this collection consider the context within which maternity care is delivered and experienced, illuminate how the language used in the report problematically obscures the violence of traumatic birth experiences, and question whose voices are listened to and represented in both healthcare and the report itself. They encourage us to look beyond (so-called) norms and think creatively to deconstruct harmful healthcare structures. This series of posts ultimately keeps the promise of the Report’s title: We want to Listen to Mums and others who birth, and subsequently create a dialogue to improve maternity care services. 

Though this Takeover responds to a particular moment in the fight for safer birthing care in the UK, it would be remiss not to emphasise that the fight for safe, care-full birthing and reproductive care is a global one. While the Birth Trauma Report focuses our attention to events in the UK, we must not forget that pregnant and birthing people in countries such as Palestine (Syed. 2023) and Sudan (Bonavina et al, 2024) feel the sharp end of harms emerging from obstetric violence and reproductive injustice.  Our recognition of this should not be interpreted as drawing comparisons between the UK and these countries, nor should it minimise the experiences of those in the UK in any way. Rather, we aim to emphasise how conversations about – and the fight for – good birth is a global one; and that it is our obligation to recognise the harms occurring near and far, and to advocate loudly for solutions to bring about an end to such harm.

About the Authors

Anna Nelson (she / her), is a socio-legal researcher, with a primary research focus on the way that (gendered) socio-medical realities shape experiences of consent and care during labour and childbirth. She has a PhD in Bioethics and Medical Jurisprudence from the University of Manchester, and has worked as a Research Associate on a wide range of projects. Follow her on Twitter/X at @Anna_Nelson95 

Manna Mostaghim is a researcher on the provision and politics of sexual and reproductive health in the UK and a PhD Candidate at LSE. She is a Trustee of the Reproductive Justice Initiative charity, the Policy Advisor and Public Health Specialist for Ida XR Studio, and a National Executive Committee Member of Abortion Rights. Follow her on Twitter/X at @manna_mstghm  

Zaina Mahmoud is a lecturer in law at School of Law and Social Justice, University of Liverpool. After completing her PhD at the University of Exeter, she worked in various research roles developing industry-based socio-legal research. She is a co-investigator on the Children’s Voices in Surrogacy Law project. Her research interests include (assisted) reproduction and gestation from a legal and health regulatory perspective. Follow her on Twitter/X at @zaina_mahmoud94.

References

All-Party Parliamentary Group on Birth Trauma. 2024. Listen to Mums:  Ending the Postcode Lottery on Perinatal Care. 13 May 2024. London.

Birthrights. 2022. “Systemic racism, not broken bodies An inquiry into racial injustice and human rights in UK maternity care” May 2022. Online.

Bonavina, Guilia et al. 2024. Women’s health amidst Sudan’s civil war. Lancet Correspondence 403(10439): 1894-1895. 

Hrynyk, Nicholas et al. 2023. Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine. Canadian Journal of Anesthesia 70(6): 950–962. 

Kirkup, Bill. 2022. Maternity and neonatal services in East Kent: ‘Reading the signals’ report. Department of Health and Social Care. 19 Oct 2022. Online.

Nazmeen, Benash. 2024. Birth trauma report highlights “under-funded, under-resourced” maternity and postnatal care. University of Bradford. 13 May 2024. Online.  

Ockenden, Donna. 2022. Final report of the Ockenden review. Department of Health & Social Care. 30 Mar 2022. Online. 

Pickles, Camilla. 2023. ‘Everything is Obstetric Violence Now’: Identifying the Violence in ‘Obstetric Violence’ to Strengthen Socio-legal Reform Efforts. Oxford Journal of Legal Studies 44(3): 616-644.

Ross, Loretta and Solinger, Rickie. 2017. Reproductive Justice: An Introduction. Berkeley: University of California Press.

Syed, Rimsha. 2023. We Won’t Have True Reproductive Justice Until Palestine Is Free. Truthout. 26 Dec 2023. Online.

van der Waal, Rodante, et al. 2023. Obstetric Violence: An Intersectional Refraction through Abolition Feminism. Feminist Anthropology 4(1): 91-114.