Think of a person suffering from post-traumatic stress disorder, and perhaps the last person who probably comes to mind is a new mother.
Flashbacks, nightmares and nameless fears are something we mostly still associate with soldiers returning from war, survivors of terrorist attacks or victims of rape and extreme violence. But what’s not so widely known is the connection to childbirth.
Around 4% of women are thought to suffer from PTSD symptoms after giving birth. If you’re pregnant and reading this, don’t panic; that’s still a tiny minority, and it doesn’t make labour wards the equivalent of a combat zone. (The estimated rate among troops who served in Iraq and Afghanistan was 9%.) But it’s still a pretty shocking outcome for what we are always told is a perfectly natural, normal and even blissful female experience and, since vastly more Britons give birth every year than go to war, it’s surprising we don’t hear more about the dark side of labour. If this many people were staggering out of any other part of the NHS clinically traumatised by the medical procedures they’d been through, there would be an outcry. But the pressure on new mothers to shut up about the gory details, and just be grateful they’re taking home a baby, can be intense.
So two cheers at least for Matt Hancock, the health secretary, whose new plan to boost maternity care includes better access to physiotherapy for the one-in-three women who suffer incontinence after giving birth. If you didn’t know it was that common, that’s because so many women still don’t talk about it, so good on the Department of Health for putting the issue on the front pages. Perhaps we’re finally starting to learn the lessons of the vaginal-mesh scandal, where squeamishness about getting gynaecological in public meant women suffered agonising complications for far too long before the scale of the problem was dragged out into the open. (I’ll never forget the Labour MP who was invited in by her local radio station to discuss her mesh campaign, but told she couldn't say “vagina” on air, leaving her mumbling something about pelvic areas that would have baffled half the women she was trying to reach.) The extra staff in neonatal units and other measures to help cut stillbirths and infant deaths will obviously be pretty welcome, too. But that should really be only the beginning of an investigation into what, exactly, is going wrong for some women on maternity wards.
A bad childbirth experience isn’t just about the specifics of what happened. It’s about whether you felt you had any choice or control over what was happening, or felt supported through it
It’s not hard to understand why women might be left traumatised by one of those rare labours that ends in intensive care, or sadly even in the loss of a baby. But the most surprising thing I learned from interviewing experts on birth trauma last year is that PTSD can also follow what midwives would call a clinically “normal” birth; one where nothing particularly unusual happened. That raises some pretty obvious questions about what’s deemed normal, obviously, and whether women in labour are expected to put up with a level of pain that would be unthinkable anywhere else in a 21st-century hospital.
But it also suggests that a bad childbirth experience isn’t just about the specifics of what happened. It’s about whether you felt you had any choice or control over what was happening, or felt supported through it. Women who feel cared for and listened to are unsurprisingly likely to fare better than women left feeling abandoned and frightened, on short-staffed wards where the midwives are understandably run ragged dealing with other people.
And that’s where politics comes into it. It’s politicians who decide at what point the national shortage of midwives (last year, the Royal College of Midwives reckoned we were about 3,500 short, and that’s before Brexit when it gets far harder to recruit from the EU) becomes a genuine crisis. It’s politicians who can question why guidance from the National Institute For Health And Care Excellence on giving women choice in childbirth doesn't always seem to filter down to some wards.
And it’s politicians who can choose to make maternity services a priority, even when new mothers feel too embarrassed or too guilty or just too bloody exhausted from being up all night to complain. Matt Hancock should make it a New Year’s resolution to do so.