Do I Need to ‘Walk On Eggshells’ When Talking About Positive Birth to Traumatised Women?

A woman called Megan had written a blogpost in response to one of our articles she had seen published in Pathways magazine. She has sent us a link to her response, thus inviting a comment. We have chosen to publish our comment here, as we felt the issues Megan raised need addressing, as a few women have shared the same sentiment to us since we originally published our article.  Our article in question is : “There is a Secret In our Culture – and it is not that women are strong : why some birth quotes can be damaging to women.”.

Megan’s blog, Hippies With Babies, published a response titled “Unintentional Wounds Are Just That”, which included the following excerpts :

“There is a secret in our culture and it is not that birth is painful, but that women are strong.”

When I first heard this quote I think I immediately status’ed the inspiring words on my facebook page.  I loved it.  It made me think of laboring women in hospitals whose epidurals were being prepped before she even mentioned that she wanted one. It made me think of doctors and nurses describing labor pain as “unnecessary.”  It made me think of my obstetrician telling me that, in response to me saying that I wanted to labor without pain medication, I shouldn’t be thinking about things like that.  There did seem to be a secret.  I am strong and my body was designed to birth a baby, but it took me 25 weeks to find a health care provider who trusted it to do its job as much as I did.

Megan goes on to introduce our article, and Birthtalk.org, and describes us :

They are passionate about natural births, but even more so about helping women heal after traumatic births.  Perhaps out of an instinct to protect these women, they wrote that the quote implies that women who were unable or unwilling to have natural births are being told that they lacked strength during their birth.  The women say, “There is the added implication that if I’d just been stronger, I wouldn’t be feeling so wretched now.”   They hope that advocates of natural birth would be more careful with their words so as not to offend women who wanted to have a natural birth (or who weren’t educated enough to know that they wanted a natural birth) but were not given the nurture and support that was required to have one.

Then, Megan shares her concerns and disappointment, quoting another article we wrote, where the author of the quote, Laura Stavoe Harm, shared the context of the quote as originally written  :

A year later they [Birthtalk] posted another article about the reaction they received from the originator of the quote, Laura Stavoe Harm.  Harm congratulates the Birthtalk founders on their message, and puts her quote into the context in which it was originally written.  Harm says that natural birth advocates are misrepresenting her words.

After reading this,  my original good feelings from hearing the quote were diminished.  Harm’s quote had empowered me.  She summed up in one sentence my frustration toward my doctor, toward friends and family who guffawed at my natural birth intentions.  She reminded me that I am stronger than childbirth is painful, which is a lot!  It did not ever occur to me that the quote could be painful for other mothers.  But the fact that it does should not have kept me from the good feelings I got when I initially read the quote.

Now Megan shares how she feels about our suggestion to perhaps find a way to reframe how she shares her birth story to other women who may, unbeknownst to her, be traumatised by their birth :

You could read an implication into just about every positive feeling I have about my birth.  “I had a wonderful birth because I was determined to have one,” does not imply that you lacked determination.  “I had a natural birth because I trusted my body,” does not imply that you lacked trust.  My determination and trust DID lead to my wonderful, natural birth experience.  And I shouldn’t be robbed of my self-empowered feelings, or keep them to myself, because they drum up bad feelings you have about your experience.  It would be like asking me to not put up pictures of my wedding day because it rained on yours.

We should add that she is not the first commenter who has raised this.  Others have expressed indignation or annoyance, especially some birth workers, thinking they will need to ‘walk on eggshells’ now when talking about birth. One birth worker wrote :

“…the part I have a hard time with is that now every one has to walk on egg shells at ALL times for fear of what a quote (that could be very powerful to many women) may possibly affect another, by the way they “receive/interpret it”.  Now I just feel like every time I want to “encourage/support” moms to… take control of their birth, I am going to be worried about who all is going to be “offended/hurt” and not be proud/free to just share my love/joy/passion.”

While we addressed that in our comments section of the original article, we felt that Megan’s response deserved a separate reply, as she has raised some good issues that we’d like to address.  She finishes her article by saying :

We live in a country where one out of every three babies will be born by Cesarean section, where women are discouraged from birthing naturally, where women who want to birth naturally are looked down upon, and because of this natural birth advocates NEED quotes like Harm’s.

So I will continue to read it and repeat it in the way that I first heard it.  Not in a way where it points a finger at women and says “Be stronger,” but where it points at me and says, “Your strength is underestimated.”

Below, we share our answer to Megan’s blogpost :

Hi, Megan – it’s Melissa here from Birthtalk.org.   I wrote the articles about Laura Stavoe Harm’s quote that you refer to in your blogpost, along with Debby Gould who runs Birthtalk.org with me.  Thanks for sharing your response to our articles – you are not the only one to feel that way, and we appreciate your thoughts.

We have answered a couple of other women who had a similar response in the comments section of our own blog, which you are welcome to check out, but we wanted to address your particular concerns here…

Looking at ‘that’ quote with fresh eyes

Firstly, I loved that quote the first time I heard it too, which was when I was working towards my  VBAC.  But by then I had a whole host of information about birth that enabled me to see it as you did.  It was only in my work with traumatized women over the past ten years, and in thinking back over my own traumatic birth,  that gave me the insights into how that quote could be misinterpreted.

Birthtalk.org’s focus

I also need to clarify that at Birthtalk.org we are passionate about EMPOWERING birth, rather than natural birth.  Of course, a natural birth is usually the safest and most straightforward way for a baby to be born, with all the built-in hormonal benefits available to mother and baby…but a natural birth can still be traumatic if the woman is not empowered and supported.  We often have women contact us who feel traumatized from their planned homebirth or planned freebirth – these were natural births, but the women were disempowered at some point during the process, resulting in a less-than-great experience, with ramifications postnatally and beyond.

Good feelings from the quote

I am hearing that you feel that our articles have diminished your original good feelings from hearing the quote, and that you find this upsetting and disappointing.  I can understand that.  And I also believe you can keep those good feelings… because I think they actually are meaningful to you, and your interpretation of the quote.  However, there are some things I feel I need to point out :

Why was your birth so great?

After reading your birth stories on your blog, I would actually say that you are incorrect in saying that you had a wonderful birth because you were determined to have one.  I would also say that you are incorrect in saying that you had a natural birth because you trusted your body.  Or actually, I would say that you are only PARTIALLY correct in both these instances.

Why?  Because your ability to have that wonderful and natural birth was dependant on other things besides your determination and trust.  It was also dependant on your birth environment, your choice of carer, and on that carer’s philosophy, and the resources that carer provided you with, and what that carer brought to the birth in terms of experience, trust in birth, & trust in you.  It was also dependant on the quality of the childbirth education you could access.  It was also dependant on your own preparedness, and the quality and preparedness of your support people.   And also a bit on the path of your labour, as it sounds like once your labour actually started, it just barreled along.  So you were not having to make huge decisions about your care while in labour, which is fantastic.

Telling the truth, the whole truth

You see, saying you had a wonderful birth because you were determined to have one actually could really easily imply to another woman that she lacked determination.  Because it’s not the whole truth.  Yes, I do not doubt that you were determined, and strong, and trusted birth, which is wonderful, and so important.  But there were things in place that enabled you to access that determination, strength and birthing trust…things that many women do not have.

We talked about this in our original article, where we share what we see as the REAL secret  :

The secret is that women cannot feel their strength unless they feel safe and supported and nurtured, and trusting of their body’s ability.

So how do they get these?  Firstly, it is hard for women to feel safe and supported and nurtured unless their support people understand the importance of this for labour progression and emotional health, so great communication and education is vital.  And how do women gain trust in their body?  Not just by blindly ‘trusting’, but by being given appropriate evidence-based information and the sharing of knowledge that enables birth to earn their trust.

Because they don’t know that, women (including myself) blame themselves when their bodies do what they have been designed to do and shut down when they feel unsafe.   Women blame themselves when they begin to ‘friend-make’ with the very carers who are undermining them, because they have no choice…they need them for their survival.   (this ‘friend-making’ is an adrenalin hormonal response too, designed to ensure survival)

Many natural birth advocates talk of the amazing hormones of childbirth.  They are right – they are amazing. But they are not available if the woman is scared out of her brain, or left alone in a room to labour when she is needing support, or given antenatal education that does not enable her to trust her body’s ability, or talked down to & patted on the head with a ‘don’t worry your pretty head’ attitude, or not had her questions answered.  Yet this is how many, many women go into birth.

I have had two amazing, wonderful, empowering VBACs, my most recent one was a waterbirth, last year.  But I cannot say that it was my determination and trust in birth that resulted in these wonderful births.  Because I was just as determined in my first birth, thirteen years ago, that ended after 30 hrs in a caesarean.  But sadly, due to the setting I chose, the carers I chose, the education I had available to me, a lack of understanding of what I needed my support people to know and what my body needed to be able to do its job, and having challenges I hadn’t expected without appropriate support, I emerged with a fresh caesarean scar and so many conflicting emotions.  I thought I trusted birth.  I thought I was determined.  But these could not overcome the sheer magnitude of the hospital system and the specifics of my own situation.  But I – and many, many women like me – did not know this.  I did not know that had I chosen another environment, another carer, better education for myself and my support people, that I may have avoided a caesarean, and emerged feeling empowered and strong. I thought it was my fault.  And that’s where the problem lies.

No-one is attempting to rob you of your self-empowered feelings, that would not be fair or right…but you need to be clear about WHY you were empowered. You WERE determined, and you DID trust birth, and you sought out a carer to support you in that. It is so fantastic that you were able to access a wonderful midwife who you obviously connected with, and that you could take that journey to be so determined and trusting of birth, and thus have such a great birth. We just believe it is important to share the WHOLE story about why your birth was so positive.

Birth Day vs Wedding Day

I also understand what you are trying to say with your comparison to not putting up your wedding pictures because it rained on someone elses’ wedding day, however, I don’t believe this analogy is really very accurate or helpful.  I get what you are trying to say…but they are really very different experience with different repercussions.  For one thing, a bride has ZERO control over the weather, so she would not feel at fault or ‘worse’ than you if it rained on her day.  She might feel envious or disappointed, but would know without question that it had nothing to do with her.  A woman after a traumatic birth does not have that – most women blame themselves and assume they needed to be MORE determined, MORE trusting, say MORE affirmations.  Which is, in most cases, not true.

Plus, the ramifications of rain on your wedding day really don’t go beyond the actual day – unless you’re superstitious!  But the ramifications of a disempowered birth can go for years and years if not processed.

Unintentional wounds

I agree with your blogpost title – Unintentional wounds ARE just that…unintentional.  I am guessing you called it that in response to the title for our article when it appeared in Pathways magazine : “Encouraging Words, Unintentional Wounds”,  a title that we did not choose.  We called our original article “There Is a Secret In Our Culture, But It Is Not That Women Are Strong – Why Some Birth Quotes Can Be Damaging For Women.”  Some of the original article was edited out of the magazine version by the editors due to space restrictions, so you may find it interesting to read the blog version, if you have not already, as it may fill in some missing pieces that explains our concerns further.  One part in particular may be helpful to you in understanding our position. The Pathways article was edited to remove a section that we believe is important in learning new ways to talk to women.  The Pathways article says :

I remember being at a BBQ when my son was a couple of years old, and I was still emotionally very fragile from the birth.  An acquaintance was talking about her smooth-sailing Birth Centre birth.  She said she guessed her birth went so well because she was ‘so determined’.  This completely crushed me.  Did I ‘fail’ in my birth because I was not determined enough?  Because I was not strong enough?

But then, our own blog article continues with this :

I was lucky – Deb saw my face, and pulled me aside to explain the things this woman had access to that I had not.  Then I could see that it was not that she was more determined, just that she had (amongst other things) better care, a more straightforward labour, and a one-on-one relationship with a midwife that she knew.  But what about all those women who don’t have a ‘Deb’ to release them from these misperceptions about birth?

This is the missing piece of the puzzle – knowing the full story surrounding a woman’s birth can change the way the story is interpreted and understood.

Is this really necessary?

We wanted to share another comment we received in response to the original article, that powerfully expresses the possibility for the quote to be misinterpreted, from a mother who has had four caesareans :

I though I was totally alone in my thoughts, but now I see I am not! I know for some woman this is their mantra but it always made me feel stupid or in some way “not strong” because my body did not work as is should have 4 times and I ended up with 4 cesareans. Some would say this is all my fault.  Some who truly support me  just offer support after the fact, but this quote was given to me to “give me strength” and really all it did was put a huge boulder on my back to perform. You see for c-section moms who are going for a VBAC, HBAC, UBAC even after multiple C’s or what have you, the pressure is already on but you add on stuff like this and boy I’ll tell you!! It just seems like too many people in the natural birthing community (there are exceptions I’m sure) don’t truly understand the pressures that the a VBACing woman faces emotionally… I can honestly say that I felt like if I had moments of weakness, heads were going to roll! Put things like this “encouraging quote” into the mix and a mom somewhere is bound to feel that she can’t do it. Her birth support can know EVERYTHING about the labor progression but if the mother feels pushed, pressured or any form of performance anxiety and the support doesn’t truly support her she will more than likely fail in her attempts…

I can imagine that having access to the wonderful support and education that you did, may have altered this woman’s interpretation of the quote, and encouraged her to find carers and an environment that enabled her to feel less pressure and more power.  Having insights into what is needed to have an empowering birth is incredibly necessary, and sorely lacking in our culture, and it is possible for you to be instrumental in creating this change.

What is the best way to talk about a positive birth?

So – is it possible to talk about your wonderful births without there being implications for the listener? And is possible to provide birth education without stepping gingerly around your passion for natural birth? Absolutely! As we say in our reply to the birth worker we mentioned above :

There is no need for ‘walking on eggshells’ when offering birth education. That is doing women a disservice, and disempowering them, when you could be enabling them to understand their own situation and taking steps to process and work through their birthing experience. Rather than encouraging mothers to try to have a particular type of birth, it makes more sense to look carefully at whether they are making their birthing decisions from knowledge or fear, and then addressing their very real concerns and fears and worries. This involves getting down to the oft-hidden truths about birth, and mythbusting all the misperceptions and myths and family legends that have been passed down. This then enables them to see the reasons why other women may have had an easier journey, and see that it likely had little to do with them, and much more to do with the information they had, the support they had, their own unique situation, and the hormones they had available as a result of their situation. It is equally possible to be positive about the possibilities for a positive, empowering birth whilst at the same time supporting those who have had a rough trot in this area.

You believe this quote might be helpful and encouraging to many women…but we believe it is also causing harm, if it is continuing the misperception that ‘strength’ is what is needed, rather than an environment where strength can be best supported and enabled to blossom. What happens then, if some of these women to whom you are presenting this quote go on to have a traumatic birth? Then they may believe that the things that had ‘gone wrong’ in their birth were because they weren’t strong enough. And the cycle of self-blame begins again. Whereas, if you presented the quote within context, and expanded upon its meaning, you are offering women a chance to make sense of birth and begin to explore what birthing strength means for them. Isn’t that more empowering? And also more all-encompassing (that is, it includes both those women wanting to feel positive about birth, and also those who have been traumatised by birth)?

I tell my  VBAC stories all the time, and talk about how grateful I am that I had an amazing midwife, and access to excellent information, that I had a quiet, safe place to birth and excellent support.  I worked SO hard in these births…but so does any woman birthing.  Even if she has an epidural, or a caesarean, she is still working hard to bring her baby earthside the safest way she knows how.

Talking about your birth in this way, that is,  sharing the aspects that enabled your birth to be so wonderful, actually educates women as you go.   They can begin to see their own birth in a different light, and perhaps hope that they could have a different experience next time…and that maybe it wasn’t their fault, and they might need to search further afield to be able to have more options.  When you describe your birth and how you felt afterwards in this context, you do not need to worry that you will upset or offend someone, as you are merely sharing your gratitude for your access to excellent resources.  Resources that enabled you to access your strength and determination. What wonderful seeds you can plant simply by sharing your story within its appropriate context. Then you will truly be representing how strong women are, and be able to point your finger towards yourself, knowing that you may just help another woman to see herself standing there, strong, beside you, one day.

Thank you again for sharing your response to our articles,

Melissa from Birthtalk.org (and Deb, who edited this for me 🙂 )

This is a Birthtalk mum meeting her daughter in an empowering, positive, water birth (after a not-so-great first birth).

©Birthtalk.org 2012

Tags: birth quotes, Birth Trauma, empowering birth, Healing From Birth, Healing from traumatic birth, There is a secret in our culture, Traumatic Birth, Understanding traumatic birth