Birth: the forgotten feminist issue
By Alecia Staines
Women share their birth stories, researchers share the evidence, feminists share their insight into how birth was forgotten in the continued liberation of women.
Birth: the forgotten feminist issue Dec 11, 2020
Ep. 31 birth trauma with Dr Heather Mattner
Dr Heather Mattner, psychologist and midwife, joins me to discuss birth trauma. Studies suggest one third of women experience birth trauma. In the current maternity system, she believes 100% of birthing women are experiencing birth trauma. We discuss symptoms, prevention, the overall maternity system, previous trauma's impact on birth trauma and what women and the system can do to reduce birth trauma. Heather says: Birth trauma is preventable harm. And, birth trauma does not favour/disfavour any women regardless of age, culture, spirituality, religion, parity, gestation, intellectualism, status etc etc. That in itself is probably evidence enough to say it is a systemic issue against women - all gestational women.
Dr Heather Matter's qualifications:
Perinatal Health Psychologist
PANDA Clinical Champion
Honorary Clinical Senior Lecturer (Psychology)
The University of Adelaide
Ep. 30 Gestational Diabetes, induction, childbirth as a rite of passage, birth trauma with Dr Rachel Reed
In this episode, Dr Rachel Reed and I, discuss the all too common "diagnosis" of Gestational Diabetes, and how this affects a woman's treatment pathway, often leading to induction, women being treated as a source of risk for their baby, and the cascade of intervention. Rachel explains how so many women have come to be diagnosed with Gestational Diabetes, why else we're seeing so many women having an induction of labour, medical risk, and birth trauma. We discuss the ceremonial practice of birth, the "identity crisis" midwives are currently going through, and why birth is the forgotten feminist issue.
You can read more from Rachel at her blog midwifethinking: MidwifeThinking
Her recent books are: Why Induction Matters and Reclaiming Childbirth as a Rite of Passage
She also co-hosts the podcast The Midwives' Cauldron
You can see Dr Rachel Reed formerly from USC’s School of Nursing and Midwifery was interviewed for Birth Time: The Documentary. She states:
“In Australia we have a heavily medicalised maternity system that leads to a lot of interventions for women, many of whom do not particularly want or need them,” said the Senior Lecturer in Midwifery.
“There have been reports of coercion and manipulation. Often, it’s not done intentionally – rather more as an attempt to mitigate medical risk. But what is not counted is the emotional risks facing women if they experience disrespectful care.
“Birth trauma is not about how a woman births. It’s about how she was treated during birth. There’s more to trauma than a physically traumatic experience.”
Ep. 29 Perineal Tear Bundle and Episiotomy w/ midwife and researcher Nigel Lee
Midwife and researcher, Nigel Lee, joins me to talk about the Perineal Tear Bundle (bungle?!) that was rolled out in Australian hospitals a few years ago, in a feeble attempt to reduce the incidence of 3rd and 4th degree perineal tears. It consisted of 5 different practices applied to women during birth, in an attempt to reduce 3rd of 4th degree tears. These tears extend to include the muscles around the anus (3rd degree) or into the anal passage (4th degree). We discuss what the evidence says, the issues with most of the elements of the bundle, consent, the rise of episiotomy, what his own research found when interviewing midwives about the Perineal Tear Bundle, what other parts of the world are doing to reduce 3rd and 4th degree tears, and what Australia needs to do in order to improve outcomes.
Link to Nigel's research: 2021 Allen, J., Small, K., Lee, N. How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis. Women and Birth. In press https://doi.org/10.1016/j.wombi.2021.01.012
2018 Lee, N, Gao, Y, Lotz, L and Kildea, S . Maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage. Women and Birth. 32(4), e433-e440.https://doi.org/10.1016/j.wombi.2018.10.005 https://doi.org/10.1016/j.wombi.2018.10.005
2018 Lee, N., Firmin, M., Gao, Y., & Kildea, S. . Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016. International journal of nursing studies, 83, 11-17. DOI: 10.1016/j.ijnurstu.2018.04.002
More on the Perineal Tear Bundle and midwifery practice here: Bundles for perineal care: the impact on midwifery practice - Transforming Maternity Care Collaborative
Ep. 28 with Jolene Hutchings- the link between previous trauma and birth trauma.
In this episode, I share my childhood trauma with having my own mum suffer from Bipolar, Borderline Personality Disorder and multiple suicide attempts. As a child, I learnt that in order to survive, I needed my mum to survive, and a strong sense of self-reliance in order to not "be let down". I describe how this impacted my birth through my need to "control" the situations in order to feel safe and secure.
You can find Jolene here: Child and Family Therapist | Jolene Hutchings | Bli Bli
A recommended reading resource we spoke of is: The Body keeps the Score by Bessel van der Kolk
Ep. 27 Rachael Austin- Rural birthing and the Bush Baby media campaign
Although Rachael and I have never spoken on the phone or via Zoom before, we worked closely together during the 2018-2020 Bush Baby Media Campaign. It was the largest maternity campaign the country has ever seen- at least 8 Front Page stories, National morning TV, nightly news, The Project and international interest. It was an national award-nominated media campaign. As a result of this campaign, Queensland created a Rural Maternity Taskforce and subsequent report to ensure some sustainability of our rural maternity services. In this episode, we discuss what the evidence says for rural births, what were the results of the Bush Baby Campaign, the service capabilities of hospital maternity units and some tips on running a good media campaign to lobby for maternity services.
Ep. 26 Jodie Miller- her journey in birth activism and authoring "What Does It Feel Like Being Born?"
Jodie shares her journey to receiving care in a Birth Centre in Brisbane, her journey into advocacy and some of the amazing campaigns she helped create to improve access to the Birth Centre. We also discuss the obstetric lobbying, including the label "the killing fields" the Birth Center was known as by the obstetricians opposed to it. You can find Jodie's book here: What Does It Feel Like Being Born? by Jodie Miller.
Ep. 25 Catherine Bell - birth maps, women taking responsibility for their decisions and informed consent
Catherine Bell is the creator of the Birth Map, author of the book THE BIRTH MAP: Boldly Going Where No Birth Plan Has Gone Before takes you through the Informed Birth Preparation process leaving you Informed, Prepared and Confident. THE BIRTH MAP covers risk assessment and informed decision making, what to expect during labour and birth, and then takes you into The Beyond. We discuss the difference between the Birth Map and birth plans/preferences, making informed decisions within the maternity system and taking responsibility for our decision making process. Find Catherine's book, training and other resources here: https://birthmap.life
Ep. 24 Julie Bell - systemic oppression, midwifery and women's autonomy
Julie Bell is a well-known herbalist, doula and advocate in the birth world. Her early career as a nurse, time spent as an obstetric nurse, and her own mother being a midwife has given Julie an amazing insight into the maternity system. She shares her own powerful journey to birth outside the system, the changes she saw in the New Zealand system, the oppressive systems that dominate Australia's birthing landscape, and birth through a feminist lense. You can find Julie at: https://www.blissfulherbs.com.au.
Ep. 23 w/ Liz Wilkes, private midwife. Medicare for midwives, supporting women in hospital and home, woman-centered care
Liz Wilkes is Australia's first private midwife to have access to Medicare. Prior to this, she worked in private practice in Toowoomba, Queensland. She now has several private midwifery practices under the My Midwives brand.
In this episode we have quite nuanced discussions about private midwifery, what medicare has meant for women and midwives, the obstacles and requirements of private midwives including visiting access and collaborative arrangements. We discuss how all of this impacts women and ways forward to ensure care remains woman-centered.
Ep. 22 - Dr Kirsten Small- CTG doesn't reduce cesareans
Ep. 21 Dr Hazel Keedle- the birth experience of women + VBAC survey results
Ep. 20 Bruce Teakle - history of maternity lobbying in Australia
Link to the National Maternity Action Plan: en.wikipedia.org/wiki/National_Maternity_Action_Plan
and here: web.archive.org/web/20070329214948/http
Ep. 19 Dr Robyn Thompson- breastfeeding and the "isations" of birth
Ep. 18 Health Economist Emily Callander - will women ever be centred in maternity care
Associate Professor Emily Callander speaks about the high cost of the maternity system, and how the activity based funding and segregation of funding continues to ignore what women need and addressing inequities in the maternity system.
More information about Emily here: https://research.monash.edu/en/persons/emily-callander
Some of her research:
Ep. 17 - My own birth stories (Alecia). Part 2, birth #3, #4 and #5
Ep. 16 My own birth stories (Alecia). Part 1. 1st and 2nd birth.
Ep. 15 VBAC w/ Lizzie Carroll- politics, policies and women's responsibilities
Ep. 14 Prof. Nicky Leap - feminism in midwifery
Professor Nicky Leap is currently the Adjunct Professor of Midwifery, Faculty of Nursing Midwifery and Health UTS Visiting Professor, Florence Nightingale School of Nursing and Midwifery, Kings College, London 2010-2012 International Francine Gooris Chair for Midwifery, University College Arteveldehoge school, Ghent, Belgium.
Nicky went into midwifery as she saw it as a ultimate feminist issue. We discuss midwives role in ensuring birth isn't the forgotten feminist issue.
For over twenty-five years, Nicky has worked across midwifery research, education and practice in both the UK and Australia. She was integrally involved in the development and implementation of the Australian Bachelor of Midwifery programs in South Australia and at UTS and has had a leadership role in developing national standards for midwifery education and practice in Australia. Nicky has played a pivotal role in both Australia and the UK in the development and evaluation of midwifery continuity of care models, including the implementation of NSW's first publicly funded homebirth program. Nicky led a two year pilot study to develop, implement and test Centering Pregnancy, an innovative program combining antenatal care, education and support for pregnant women in small groups. Nicky was the Professor of Midwifery Practice Development and Research for South East Sydney and Illawarra Area Health Service from 2006 - 2010 (Director of Midwifery Practice 2002 - 2006 in the same area health service)Nicky completed her Professional Doctorate in Midwifery at UTS, her dissertation examining the role and culture of rhetorical innovations and intentional strategies in the development of Australian midwifery. Nicky has held a visiting researcher position at Kings College London since 2005.
Some of Nicky's published work:
Ep. 13 Lawyer Bashi Hazard - human rights abuse in childbirth
Bashi Hazard is an Australian lawyer and the principal of B W Law, a legal practice established to support and assist women and children, and the Legal Director of the ANZ arm of the Human Rights in Childbirth (HRiC) International Lawyers Network. Bashi’s background is in competition and consumer law, and litigation, developed while working for several years with Allens in Sydney, immediately after graduating with first class honours in Law and Economics from the University of Sydney.
She has co-authored the book Canary in the Coal Mine- birthing outside the system. This book investigates why women choose ‘birth outside the system’ and makes connections between women’s right to choose where they birth and violations of human rights within maternity care systems.
Bashi is on the board of Human Rights in Childbirth:
Ep. 12 Prof. Carolyn Hastie - building resilience in midwifery to reduce trauma
Carolyn is a mother, grandmother and midwife with qualifications in adult education, counselling, lactation, primary health care, reproductive and sexual health. She has been at the leading edge of midwifery practice and education for four decades. Now a midwifery lecturer at Griffith, having wide-ranging national and international experience in diverse settings, including commissioning and managing a quality award-winning stand-alone midwifery service in NSW, her work is well known. Her passion is strengthening midwifery and improving care for childbearing women, partners and babies; her focus is on the neurophysiological intersection of growth, development and relationships. Areas of interest include neuroscience, epigenetics, the Polyvagal Theory, Barker’s Theory, teamwork, social, emotional and spiritual intelligence, labour, birth, breastfeeding and attachment. She has researched, taught and written extensively on midwifery related subjects. A core aspect of Carolyn’s work is finding ways to optimise students' teamwork skills so midwives, women and families can thrive.
Some of her published research:
Ep. 11 Mel Briggs - Birthing On Country and Aboriginal Maternity Services
Ep. 10 Susan Vandeligt- Birth story- Trauma, induction, failed epidural, incompetent care
Susan is a Life Coach, who birthed in a Melbourne hospital.
She takes us on a journey describing her birth- from lack of informed consent, induction, to a failed epidural that left her unable to speak, instrumental birth (after a cesarean was called), 3rd degree tear and incontinence.
She describes how important it was for her to unpack her birth story afterwards to help her understand the incompetence of care and the cascade of intervention that contributed to how her birth unfolded.
Ep. 9 Prof. Sue Kildea - outcomes from Aboriginal controlled maternity services
Sue Kildea has been a midwife for over 30 years. Her research aims to support women in birth and redesign maternity services to strengthen support for vulnerable women (e.g. First Nations women, women in remote communities, women experiencing stress in pregnancy, teenagers, women from a refugee background). Her latest role is as Professor of Midwifery and Co-Director of Charles Darwin University’s Molly Wardaguga Research Centre in the College of Nursing and Midwifery, with projects focusing on providing the Best Start to Life for First Nations women, babies and families. She is involved in the international movement ‘Birthing on Country’ to return maternity services to First Nations control and communities. In this podcast, I ask Sue about what the evidence says on Aboriginal controlled maternity care and the improvements this offers for women, their babies and whole family.
More here: https://www.cdu.edu.au/mwrc
Ep. 8 Dr Joan Garvan - mothering, the forgotten feminist issue
Dr Joan Garvan, PhD (ANU) - Joan’s research is in Sociology and Gender. In December 2010 she was awarded a doctorate from the Australian National University for her thesis titled: Maternal Ambivalence in contemporary Australia: navigating equity and care. Since completing her studies Joan set-up a homepage which includes a link to her thesis, she has offered online professional development courses, and worked as an advocate for improved early years health and welfare services. Joan is currently President of Maternal Health Matters (formerly Safe Motherhood for All).
In this episode we discuss how motherhood has become the forgotten feminist issue, how it relates to birth, and mothering versus motherhood.
Resources discussed in this podcast can be found here:
Women’s Business: Birth and Beyond – you don’t have to be a feminist to expect optimal birth outcomes.
Maternal Scholars Australia: www.mothering.org.au – facebook AMIRCI (transitioning to Maternal Scholars Australia)
Baby Brain and Social Policy – youtube - https://www.youtube.com/watch?v=HxdK6ZWgN3I
Intersubjectivity mothers and infants – youtube - https://www.youtube.com/watch?v=5WKhVBcf4IY
Andrea O’Reilly Baby out with the bathwater – youtube - https://www.youtube.com/watch?v=Zl6sJcHGjSo&t=133s
MIRCI Journal with many editions available to view online – incredible resource - http://journalofmotherhoodinitiative.org/
Adrienne Rich, Of Woman Born
Nancy Chodorow, Reproduction of Mothering
Lisa Baraitser, Maternal Encounters
Ep. 7 Janet Fraser - obstetric violence, stillbirth and centering women
Janet Fraser is a mother, poet, historian and has been National Convenor of the Australian homebirth network, Joyous Birth since 2004. She writes about feminism, history, human rights, birth and parenting and presents at conferences on these as well as stillbirth and obstetric violence. Janet is on the management committee of the Feminist Legal Clinic and Maternal Scholars Australia and cofounded the NSW Women’s Guild in 2019. Her book, “Born Still: a memoir of grief” was published this year by the Australian publishers, Spinifex Press. She has work coming out in the Melbourne University journal, Hecate next year and has been published by the Hunter Writers Centre, Grieve collection and other journals. She also writes at Patreon, where she foments women’s studies and revolution at Despatches from the Matriarchy. You can also catch her on Facebook and Twitter.
We discuss obstetric violence, her own experience within the maternity system, her decision to birth autonomously, stillbirth and the subsequent trauma and punishment she endured, as well as the importance of maintaining the gendered terms of birth and mothering.
Ep. 6 Prof. Hannah Dahlen - the fear and patriarchal culture in birth
Prof. Hannah Dahlen is Professor of Midwifery, Associate Dean Research and HDR and Midiwifery Discipline Lead in the School of Nursing and Midwifery at Western Sydney University. The book, Birthing Outside the System- canary in the coalmine was co-edited by Hannah. This book investigates why women choose 'birth outside the system' and makes connections between women's right to choose where they birth and violations of human rights within maternity care systems.
In this episode we explore:
- where feminism forgot about mothers and birth throughout the various waves of feminism
- how the medicalized patriarchal paradigm of the maternity system is also upheld by midwives
- the role men played in changing childbirth
- sanctioned female genital mutilation that is occurring with the perineal tear bundles
Ep. 5 Kristyn Begnell, Bunting for Birthrights
Kristyn shares why she decided the best place for her to birth her first baby was at home, and how appendicitis late in pregnancy ended up with a huge shift in her birth preferences and how her daughter was born. She shares her trauma, as well as her deep commitment to birth her 2nd daughter at home. We discuss the interest she had very early on in homebirth, how her births shaped her advocacy, and her ongoing commitment to help women heal their own birth trauma through craftism and her Bunting for Birthrights project. https://buntingforbirthrights.com/
Ep. 4 Dr Belinda Barnett - oppressive systems inside and outside of maternity
Dr Belinda Barnett's thesis is called Becoming a mother and mattering in early 21st century Australia: An exploration of women’s perinatal transitions and equity in wellbeing. Found here: https://doi.org/10.14264/uql.2020.488.
We discuss the parallel between her research which focuses on working with communities to challenge and change oppressive systems to improve equity and access to justice, and the maternity system. Belinda also shares how her private obstetric birth and subsequent trauma led her to research other options for her subsequent birth (a homebirth, which she describes as healing). We discuss how this impacted her advocacy in maternal health and ongoing support of improving maternity services.
Ep. 3 Prof. Jenny Gamble - liberating women in birth
Professor Jenny Gamble started her midwifery career 37 years ago. She is the Director of Transforming Maternity care: https://www.transformingmaternity.org.au/ whose goal is to drive the reform of maternity services to provide a primary care model that is midwife-led in the community, is accessible to all and is centred around respecting women’s’ choices.
Jenny's research includes perinatal mental health, birth trauma, fear of birth, models of care and midwives health and well-being. In this episode we discuss the disparity between the what the evidence says about maternity care and the outcomes- physical, mental, emotional and financial. With 30% of women experiencing birth trauma and ever increasing over-intervention, Jenny discusses what needs to happen in the maternity system to ensure women have safe and satisfying birth.
Ep. 2 Ellen O'Keefe, Maternal Health Matters
Safe Motherhood for All organisation (soon to be Maternal Health Matters) is a part of the White Ribbon Alliance for Safe Motherhood. Their goal is to ensure that pregnancy, childbirth and the transition to motherhood is safe and to promote health and wellbeing for all women. Ellen is Vice President and has been involved with the organisation since it was foundered. In this episode, we discuss the:
- lack of dignified and respectful maternity care
- what women are saying when surveyed about how their care was
- reproductive rights
- what respectful maternity care is, and
-how the maternity system can achieve safe, dignified and respectful care.
Ep. 1 Justine Caines OAM - Birth is the ultimate feminist issue
Justine Caines is one of Australia's well-known and successful maternity lobbyist. Find her bio here: https://en.wikipedia.org/wiki/Justine_Caines
In this episode we discuss:
- what impacted her decisions to homebirth all 8 of her children
- why birth is the ultimate feminist issue
- the abuse and disrespectful culture in maternity care
- the popular feminists in Australia and why it is largely "pop feminism"
- sanctioned genital mutilation