‘Completely violated’: Unnecessary intervention in birthing process leaves long-lasting pain

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.