Historicising ‘Birth Trauma’ and ‘Birth Experience’: Lessons for an Incoming Government

Jennifer Crane , Maria Fannin , Victoria Bates | 24 June 2024

In May 2024, the All-Party Parliamentary Group on Birth Trauma published their report, ‘Listen to Mums: Ending the Postcode Lottery on Perinatal Care’.  The report aims to ‘break’ a ‘taboo’ around birth trauma, and to ‘share the stories and experiences of mothers and fathers publicly’, as well as to ‘start a public discussion on the realities of giving birth and how we can practically improve maternity services’. It brings together a number of concerns:  inadequate resourcing of midwifery, maternal mental health, and post-natal services; support for partners; medical negligence claims; racial and ethnic disparities in health outcomes and the economic costs of birth injuries.

Echoes from this report have influenced manifestos published in the 2024 General Election. The Conservative Manifesto pledged to create a ‘comprehensive national strategy for maternity care, as recommended by the APPG’. Labour’s manifesto emphasised that childbirth ‘should not be something women fear or look back on with trauma’.  

 The APPG report makes challenging and emotional reading.  Taking a granular historical perspective, examining archival materials from 1950s-1980s, shows that there have been complaints around maternity services since the inception of the NHS in 1948. Despite this, calls from a government body to directly understand birth ‘experiences’ in detail, as above, have been rare.

 An influential 1956 report on healthcare costs identified maternity services as particularly ‘complex’ and ‘in a state of some confusion’. In this context new voluntary organisations emerged to enable women to share negative experiences of birth, particularly in hospitals, and to lobby for change. In 1957, Prunella Briance launched the Natural Childbirth Association – later the National Childbirth Trust (NCT).

 The 1959 Cranbrook Report, drawing on advice from medical professionals and the NCT, had stated that:

We received a general complaint that there was in many hospitals too little regard for the personal dignity and emotional condition of women during pregnancy and childbirth.

The report detailed also how hospitals were too often ‘unfamiliar and sometimes frightening’ places, with women left alone for too long in labour or with staff 'too busy to bother about analgesia’. Yet it still called for 70% of births in the UK to take place in hospital. And in many other contemporary reports, women’s voices were not prominent or mentioned.

In 1960, Sally Willington formed the Society for the Prevention of Cruelty to Pregnant Women – later the Association for Improvements in Maternity (AIMS). Writing to The Guardian in 1960, Willington wrote that mothers in hospital experienced: 

loneliness, lack of sympathy, lack of privacy, lack of consideration, poor food, unlikely visiting hours, callousness, regimentation, lack of instruction, lack of rest, deprivation of the new baby, stupidly rigid routines, rudeness, a complete disregard of mental care, or the personality of the mother. Our maternity hospitals are often unhappy places with memories of unhappy experiences. 

Complaints about maternity care in the 1950s and 1960s can be seen in policy reports and newspapers, amidst the rise of consumerism. Yet these complaints did not typically involve the sharing of  significant detail. By the 1970s and 1980s, however, the context of sharing birth stories was changed by a powerful cultural trope that a birth experience could be a wondrous ‘moment’, to be enjoyed or savoured, and where birthing people could feel empowered and in control. This was visible in a new genre of ‘birth stories’, shared in far more detail than before through, for example, newsletters of voluntary organisations like the NCT, and in newspapers and magazines. In such materials, women discussed how their births – often but not always at home or unmedicated – were special, ‘more fulfilling than they had expected’. These ideas emerged in the context of a more experience-centred culture. They also reflected women themselves increasingly pushing ‘back against care they defined as inhumane’ in maternity, as Paula A. Michaels argues. Campaigners were able to use a language of experience to represent earlier complaints about institutional care, and to emphasise that the moment of birth mattered.

 The APPG inquiry of 2024, explicitly seeking experiences of birth trauma, received more than 1,300 public submissions. The language of trauma, specifically, is new to these discussions and has helped to make legible many longer-standing complaints around institutional care. This inquiry has given women a space in which to share longer accounts of birth experience, including detailed information about physical, as well as emotional, effects of birth. Public conversations on birth trauma could - and should - begin to make more visible the suffering experienced during traumatic births - given that the inquiry reports that now, in 2024, nearly one in three mothers consider their births to have been traumatic – many with lasting consequences of injuries sustained. Importantly, these conversations position birth trauma as a collective concern, not a private problem. Discussions of birth trauma must, also, enable us to end unacceptable health inequalities, with Black and Minoritised Ethnic women two-to-four times more likely to die during birth than white women. Responses to the APPG report from voluntary organisations have, indeed, pointed to the need for consideration, also, of the legal status of gaining consent in emergencies, the need for integrated maternity strategy, and the relatively minimal effort to acknowledge structural racism in maternity care.

Given the public’s attachment to it, any incoming government will feel under pressure to solve the huge challenges faced by the NHS at present. After the 2010 election, the Conservative and Liberal Democrat coalition enforced a period of austerity, with disastrous effects for the Service. The NHS budget fell as a percentage of GDP annually, and so it has struggled ‘to keep pace with the combined demands of higher costs and the expanding health needs of an ageing population’. In recent months, waiting lists to start elective surgery have increased, and stand at 7.57 million. Over 40,000 trolley waits of over 12 hours took place in May 2024 alone – 100 times more than during the same month in 2019, before the pandemic.

Experiences of birth trauma must be made central within any broader reforms to the NHS, in future years. Birth trauma debates are rooted in historical questions about institutional care, long raised by voluntary organisations – the response to these must also make space to expand and problematise historic ideas of ‘birth experience’. The experiences shared, recently and historically, show that we need to think about birth trauma in the broadest possible terms: as reflecting issues with culture, relationships, and power, as well as related issues of understaffing and underfunding.

• Tags:
• Bates, Victoria
• Medicine and public health

About the author

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Jennifer Crane is a Lecturer in Health Geography at University of Bristol. She writes about activism, the NHS, and childhood, and has a forthcoming monograph about equality, elitism, and gifted children with Oxford University Press. She also has forthcoming, with the co-authors below, papers about the birth pool and childbirth ‘experiences’, in Medical Humanities and Cultural History.

Maria Fannin is a Professor of Human Geography at the University of Bristol. Her research interests include feminist theoretical approaches to health and new medical technologies, and the social and governmental dimensions of pregnancy and childbirth. She is the co-editor of Reproductive Geographies: Bodies, Places and Politics (2018).

Victoria Bates is an Associate Professor in Modern Medical History at University of Bristol.  She currently leads the UKRI Future Leaders Fellowship project, ‘Sensing Spaces of Healthcare: Rethinking the NHS Hospital’, as well as leading several projects and networks in sensory environments and health.  She recently published Making Noise in the Modern Hospital (2021).