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Notes from Sheila Kitzinger Talk - "Crisis in the Perinatal Period".

Nov.7, 1990

I attended a conference in 1990 called "Crisis in the Perinatal Period". Sheila Kitzinger was the keynote speaker. Her talk on Birth Crisis Counseling including a lot of focus on Birth as Rape. Here are the objectives of the talk:

1. Understand ways in which postnatal depression and distress may have its roots in the childbirth experience.
2. Recognise the possible long-term psychological effects of the disempowering of women in childbirth.
3. Know how to assist women who seek help with their overwhelming emotions through active listening, validation of their experience and birth crisis counseling.

First, she said there has been a medicalization of birth - doctors "define" birth while women "experience" birth. A commercial model has been developed where women are seen as "consumers" and not "producers" as they should be. The woman's experience disappears in the statistical examination of birth. We need to place less emphasis on the statistics, and more on the "meaning" of birth. When the woman's experience is lost, unhappiness results. Postpartum depression often results. Men dismiss the women's unhappiness as a normal part of women's lives - and trivialize the anguish. Men and doctors (generally male) do not recognize that a lot of the anguish is a result of a poor childbirth experience. It is not the number of obstetrical events that leads to a greater incidence of unhappiness. A woman's sense of control determines how she perceives her birth and effects the % of PPD cases. A short labour doesn't necessarily make the woman happier. Women feel more positive when they are informed and share in the decision making (this works for ALL educational and income levels). Women must feel that they have a right to have their feelings heard, and to be acknowledged. Women in the birthplace are often disempowered - especially if they experience a cesarean birth - they feel a sense of powerlessness, a loss of autonomy, and a lowering of self esteem. Women often feel violated - and use the language of rape to describe their experience.

Sheila's daughter Polly is a rape counselor in Britain. Another daughter Jenny is a social anthropologist and was writing a book on child survivors of abuse. Her daughters did a study looking at the language women used when describing their difficult births. All 345 women used some description which was linked to rape. (She said we must interpret the result with caution - this was not a randomized controlled trial - but a retrospective self-selected sampling).

Induction of labour was seen as disempowering and discouraging. Invasive technologies combined with depersonalization leads to greater distress. Epidurals resulted in good pain control yet leads to more depression and feelings of powerlessness. The husbands gained more control with the epidural - because he didn't have to watch her in pain anymore. This leads to greater loss for the woman. Women feel robbed of their identity. Many women described the pain of labour in terms of genital mutilation - being torn, cut, being infected, etc. Women who'd had a forceps birth said, "It was if I was on show for them." "It was if I wasn't there."

Emotional blackmail is used on women in labour to produce compliance. They are told they must accept a certain protocol "for the sake of the baby". This is done to legitimize the medicalization of birth.

Women described their physical exposure and display as having their "legs splayed and tethered", "like being a piece of baggage at an airline terminal". With the use of draping, the women's bodies are fragmented, as in a centrefold - the woman is not seen as a person, but as a "vulva". In birth, as in rape, women feel a sense of relief in the fact that they've merely survived. They try to accept the birth as no different from what everyone else gets, and try to return to normality.

As with rape, there is often a time lag before a woman can express her emotions. There is often a halo effect right after the birth, and she seems unable to comprehend the horror of what happened (though others may see it). You cannot get a true sense of her emotions around this time. It is around 6 weeks postpartum that the woman reassesses the birth critically. She needs birth crisis counseling!

Then the women start to talk in more graphic terms about the birth - in terms of butchery ("I was trussed up like an oven ready turkey", "they treated my body like a hunk of meat"), dirt and pollution ("I was trash...a bloody mess...rubbish...used like a public lavatory...") The women feel mentally stripped, begin to feel self-distrust, but still feel grateful to the doctor/abuser. Just as some hostages feel a sense of loyalty to their captors, so too birthing women often feel a sense of gratitude towards their torturers. The women turn on themselves - blame themselves. After a rape, they say "I shouldn't have walked home alone". After birth, they say, "I should have pushed harder", "I should have practised my breathing more", "I shouldn't have screamed", or "He told me I had the episiotomy because I was too tense".

Very few official complaints are made. Only 1/4 of rape victims report the rape. Making complaints regarding hospital care are just as daunting ("I was so dazed by the horror of it all I couldn't complain"). Women, as always, are SILENCED.

The woman feels abnormal, unwhole. She may not be able to let anyone touch her sexually. It's not something you can share with anyone, least of all your mother. She feels alone with her feelings. This is just the same with rape survivors. She feels "robbed" of the experience that "other women" have. She feels cheated - her trust has been betrayed. She feels it was all her fault when she mentions unhappiness about the outcome and is called uncaring, selfish ("What did you want...a dead baby!" the doctor asked me when I expressed dissatisfaction with my first birth.)

The doctors and others try to calm the woman down..."you must put things into perspective", "forget it - you've got a healthy baby". Survivors feel that they should be coping better. After a year, one woman said, "I should be feeling better by now". Their anger turns inward and can result in PPD, anxiety attacks, post traumatic stress disorder, etc.

We must remember that obstetric management is part of the widespread male violence against women (87% of OB's are male). Interventions in labour are VIOLENCE if the woman is not in control of the environment. Women often conform to the system - they feel bound to follow the male system. Postpartum depression is the grief that follows the helplessness in the face of male violence.

So, what can we do? We need to set up a system which is separate from the medical system. CBE's, midwives, psychologists must offer their help "as women", start a birth crisis network. We must support each other, question obstetric policies and practises, and get involved in the politics of birth. We must help the woman to process her experience and make it whole for her by using active listening. A woman needs to feel validated, to know she is believed, and to help herself feel she can find the strength within herself to cope - to regain control.

We need to do research not only "on women" but "for women". We need to explore women's experiences in a way that is not trapped by medicalization. We need to create an environment for birth in which women are not dis-empowered, but empowered.