“All that matters is a healthy baby!” The importance of language and why we have to be more mindful of our words.

On the face of it, the phrase “all that matters is a healthy baby” seems harmless enough, doesn’t it?

Birth can be a polarising conversation topic and can be especially challenging if a woman opens up about her negative birth experience. We tend to avoid difficult conversations and will often deflect them by changing the subject or attempt to gloss over the issue by making statements starting with “oh well…” or “at least…” Using phrases like these only serve to make us feel better. Our words are interpreted by the mother to mean that her feelings are invalid; we place little to no value in her experience; she is selfish for feeling this way. Phrases laden with toxic positivity are silencing women when they need to be encouraged to speak up.

“All that matters is a healthy baby” completely removes women from their birth experience and reinforces the analogy that women are reproductive machines with a focus on “product” not “process”. A healthy baby and a healthy mother (and I refer to health holistically here, not just in terms of physical health but all aspects of the self) are what we expect from every pregnancy and birth. It goes without saying, surely? The health of the mother has such a significant impact on the postpartum period, including the health and wellbeing of her baby. How can we focus solely on a “healthy baby” when a “healthy mother” is at the heart of this? The two are intrinsically linked.

The motherbaby diad – two beings who are interconnected

In order to understand how the language we use around birth experiences can be emotionally damaging, we need to understand more about birth trauma. 1 in 3 women will describe their birth experience as traumatic – this statistic is alarming. Trauma is an emotionally-loaded word, and most of us associate it with dangerous or life-threatening situations. Fiona Rogerson, a trauma and perinatal counsellor in Perth, defines a traumatic event as “an event that causes an individual to experience intense feelings of terror, horror, helplessness or hopelessness”. Trauma is also highly subjective; two people can share the same experience but will be affected differently. Trauma can stem from experiencing an event first-hand, witnessing the event or even from hearing accounts of the event. When you consider how childbirth is portrayed in the media, how can we be surprised by the significant number of women who experience birth trauma (see my previous post for more on birth and the media here)? Society convinces us that birth is painful, dangerous and should be managed by the experts in a hospital setting. We are now seeing the third generation of women who regard hospital birth as the norm. Home births are rapidly disappearing in the rear-view mirror.

A typical reflection of modern birth

Having a healthy baby should not be the sole focus of our pregnancy and birth journeys. There isn’t a woman on this planet who would consciously put her baby’s life at risk just to have the birth experience of her dreams, yet women who make plans or preferences for their birth, or whose choices do not mirror the recommendations of healthcare professionals, are vilified. Placing the health of the baby above all else is almost a justification to the increasing incidences of obstetric violence and abuse that many women are suffering at the hands of their care providers.

We are plagued with the notion that babies are “delivered” and there are many birth professionals who, like me, physically shudder whenever they hear this. Again, the mother is completely removed from the birth experience. It is often met with “pizzas are delivered, babies are born”. Let’s run with this analogy. You order a pizza for yourself and your friends. It arrives but it is cold; the toppings are different to what you ordered; it doesn’t taste great, and it was expensive to boot. You begin to voice your complaints to your friends when one of them replies with “at least it was delivered safely”. Does the fact that the pizza arrived in one piece negate everything else? Should you not have the right to feel disappointed or angry that it wasn’t what you ordered? That you weren’t listened to, and the restaurant gave you what they thought was best rather than what you wanted? Isn’t the customer always right? Now transfer those thoughts back to the birth experience...

Most research around childbirth is quantitative and focuses on physical outcomes. Our healthcare system places more value in numerical data, analyses, and statistics than it does in the lived experiences of the people who access these services, or indeed those who work within the system itself. Research examining women’s experiences of birth is given much less merit. The data collected by maternity hospitals is regurgitated as monthly or annual statistics and they focus solely on short-term, physical outcomes such as the percentage of women who had a Caesarean. There is no consideration given to long-term implications; these are problems for another healthcare sector to deal with down the line.

Catherine Bell gives a succinct definition of ‘birth experience’ – “how the mother feels about the birth”. This provides perspective – birth experience goes much deeper than the physical act of birth, however that may unfold for each woman. There is a misconception that a positive birth experience must be free of any drugs, medication or interventions. This is not the case. We need to look beyond the clinical report of birth. This ultimately tells us nothing about how the woman feels about her birth experience, which research shows is influenced by the quality of interactions with care providers, the quality of communication, being treated with compassion and respect, feeling in control, and being at the centre of the decision-making process. Birth is a significant rite of passage for women. It is one of the most life-changing moments we can experience, vivid memories from which will stay with us forever. So why is the birth experience given such little value?

“We are entering the sacred domain of motherhood post-operatively, even post-traumatically, rather than transformationally.” - Dr Sarah Buckley

So, what can we do about this?

One of the taglines I often use on my social media posts is “birth experiences matter”. I want to go deeper into this with women and challenge perceptions of what constitutes a “positive birth experience”. The research highlights that it is the quality of care rather than the physical outcome women value most - I want to spread the word so that every woman feels confident in achieving a birth experience which is positive for her and identifying factors along her journey which may hinder this. I want women to know what excellent maternity care should look and feel like. I want women to know that they can walk away from care providers who do not respect their choices. I want women to realise that they hold the power to make decisions about their care at every stage of their pregnancy and birth, and to have confidence in those decisions. Creating a birth plan is a great start, but we need to think beyond that. We live in a society which places great value on information and technology; we need to find the balance between information and intuition.

Ultimately, our maternity system requires a complete overhaul. Woman-centred care is being replaced with fetus-centred care – the mother’s experiences are sacrificed to ensure the safe “delivery” of a healthy baby. The system pushes what Rachel Reed calls a “baby-focused doctrine” upon us, whereby the importance of the mother is obliterated. The system needs to shift its focus from short-term outcomes to long-term outcomes and acknowledge that emotional and psychological implications need as much attention as the physical. This one-dimensional approach simply reinforces the analogy of birth as a conveyor belt, with women as machinery which can simply be fixed by using more technology when they become defective or inefficient.

Could this be a glimpse into our future?

The medicalised model of childbirth has eroded the role of the midwife. The system has chipped away at their autonomy and now they are answerable to administrators, hospital boards and obstetricians. The rise of obstetrics has resulted in a risk management approach and physiological birth in a hospital environment is becoming a myth. Midwives should be the guardians of normal birth; they shouldn’t have to fight for this. We need to flip this hierarchy on its head and move towards professional equality and collaboration.

“A woman’s birth experience is about who she is, it’s about who she becomes, it defines her, it unmakes her, and it re-makes her, it unravels her, and it puts her together again.” – Hannah Dahlen

For me, Hannah’s words capture the significance of women’s birth experiences beautifully. Every woman’s birth experience is valid; it is valued; it is valuable. How can we ignore the impact of the greatest transformation a woman will experience in her life? A woman’s birth experience will determine how she navigates her transition to motherhood; how she bonds with her baby. We know that the birth experience will impact the mother’s emotional wellbeing, which in turn is fundamental to the baby’s overall health. Why aren’t we getting this right?

My name is Mel Howells and I am a doula who has trained with the Doula Training Academy. Every pregnancy and birth are different, and no two women will experience the same journey to motherhood. The philosophy which underpins my services acknowledges every woman’s uniqueness and my work is tailored to meet your every need. If this resonates with you and you want to learn more about what I offer, please feel free to send me an email at mel@serenebirths.com.au or reach out to me via social media on the links below. I would be honoured to walk alongside you on your birth journey. If you would like to find out more about my offerings, please click here for packages or contact us.

Sources and Recommended Reading:

o   Reclaiming Childbirth as a Rite of Passage by Rachel Reed.

o   Gentle Birth, Gentle Mothering by Dr Sarah Buckley.

o   The Birth Space by Gabrielle Nancarrow.

o   The Birth Map: boldly going where no birth plan has gone before by Catherine Bell.

o   Do Birth by Caroline Flint.

o   https://fionarogerson.com.au

o   https://www.positivebirthmovement.org

o   https://www.frontiersin.org/articles/10.3389/fpsyt.2021.776922/full#h6

o   https://midwifethinking.com/2011/04/09/judging-birth/

o   https://www.sciencedirect.com/science/article/abs/pii/S0266613807000824

o   https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-082313-115826#_i24