For a year after her daughter’s birth, Jessica Santos felt disappointed in herself.
When she arrived at Sydney’s Royal Prince Alfred hospital to give birth, the midwife who had supported her throughout her pregnancy was not able to help her, despite being on shift that day.
Instead she had a midwife she had never met before who she says made her feel like an inconvenience, “that I had to be the good girl and somehow make her like me to survive that experience”. During the birth there was a series of interventions which Santos felt she had no choice but to accept.
When she returned home from hospital, she began processing her experience.
“I felt guilty that I didn’t push Gilly out on my own. Like I wasn’t strong enough and I didn’t try hard enough. For over a year thoughts and feelings around that hung over me like a cloud and preoccupied me on a daily basis, sometimes multiple times a day.”
Santos is one of a number of women who shared their experiences with the New South Wales select committee on birth trauma. After six hearings and thousands of written submissions, the committee on Wednesday made 43 recommendations to address birth trauma in the state’s hospitals.
Birth trauma is a woman’s experience of interactions or events related to childbirth which lead to negative impacts on a woman’s physical or psychological health and wellbeing.
The report calls for urgent efforts to address avoidable and preventable factors that contribute to birth trauma, which include lack of continuity of care, lack of trauma informed practices, inadequate antenatal education, inadequate informed consent practices, a lack of respect for women’s birthing choices and experiences, and a lack of inclusivity and culturally appropriate services.
The chair of NSW’s birth trauma inquiry, Emma Hurst, said: “We need to recognise that many forms of birth trauma are a form of gender-based violence.”
NSW’s example has inspired an inquiry into birth trauma in the UK, Hurst says, in what is only the beginning of a “global conversation.”
Greens MP and committee member Amanda Cohn said “the critical factor in preventing birth trauma is that trusting relationship with one known health professional.” For the majority of women, that is their midwife, but for others it might be a specialist obstetrician, Cohn said.
The inquiry received 4,000 submissions including from patients, doctors, midwives and experts around Australia. Studies by Western Sydney University showed one-third of Australian women have experienced birth trauma, which can range from near-death experiences to injuries.
Witnesses told of humiliating birth injuries, non-consensual procedures and insensitive or abusive treatment by staff.
In 2022 Santos also experienced a miscarriage at 16 weeks pregnancy at the same hospital, which gave her a different experience where she received care in accordance with her wishes. She said that experience “was only possible because my baby wasn’t alive”.
When her son was born, Santos chose to employ a private midwife to attend her home birth to ensure she would receive continuity of care.
The committee’s report paid tribute to the bravery of witnesses, who shared highly vulnerable and intimate details.
“The large scale of submissions received speaks to the impactful and complex nature of birth trauma for the individual giving birth, their support people, the health practitioners involved and the broader community,” it said.
The state health minister, Ryan Park, said the government would review the findings, while NSW Health’s maternity blueprint would lead to policy changes.
Park also thanked witnesses for sharing their experiences and those who work in birthing units across the state.
“They do an incredible job, often under high pressure, and I want to take the time just to acknowledge that,” he said.
“[I] also acknowledge that this is an area that we do need to continue to improve.”
– with AAP
