Birth pain and trauma

I read with interest Dr Emma Svanberg's article 'Changing the culture of birth' (September), as I have long felt at least some degree of the trauma that can accompany the birth process is perpetuated by negative cultural attitudes towards women who go through this.

There seems to be a culture of silence, where we don't really honestly acknowledge the pain and trauma that can accompany the childbirth process, and this can then affect everybody who is involved. Although psychoprophylaxis (the Lamaze technique) may be of partial help, Loo and Irestedt stated in their 2000 chapter 'The benefits of labour analgesia' that painless childbirth is a myth. Using the McGill Pain Questionnaire, Melzack found in 1984 that most women experienced intense pain in childbirth, exceeded only by causalgia or amputation of the digit.

However, the pain that women experience is not openly acknowledged. For example in the Royal College of Midwives 2018 documentation 'Midwifery care in Labour guidance for all women in all settings' they refer to 'Coping and comfort in labour' – pain is only mentioned in the small print!

The problem with not clearly acknowledging women's experience of labour is that their suffering can be 'played down' or overlooked. Planning for adequate pain relief falls by the wayside. If this happens, then trauma can follow.

There are also negative attitudes in society that are expressed towards women with regard to the type of pain relief they receive – see for example a 2006 article by Joanna Moorhead in the Independent entitled 'Epidurals are for wimps'. The author writes honestly about her own experience of childbirth and acknowledges the 'unspoken' nature of the pain that women experience. However the provocative title (no doubt to get readers' attention and stimulate debate!) reflects a wider cultural view whereby women who give birth can be treated judgementally by society and placed into the unhelpful categories of either 'copers' or 'non-copers'. The complexities of the birth process, the individual experiences of the women and the potential trauma involved are not acknowledged. Joanna Moorhead argued that epidurals can lead to more risks for mother and baby (the predominant cultural view at that time), but there is a body of evidence that presents the opposite view (see for example Reynolds's 2000 article 'Regional Analgesia in Obstetrics: A millennium update').

Dr Svanberg's article raises our awareness of how we can work to help support those who experience birth trauma in a positive and compassionate way. However, like her, I also feel that we need to start to look more closely at the social and cultural psychological processes involved and understand how these contribute towards people's experience of birth trauma, in order to help us fully understand this process.

Dr Kate Redman
Clinical Psychologist
Bristol