When Samantha gave birth to her daughter in 2022, she was told by medical staff that being in “excruciating pain” was normal.
They were discharged two days after the birth. It wasn’t until a community midwife told her the severe bruising on her buttocks was not normal that Samantha, who asked that her full name not be used, presented to the hospital again. Examinations and an ultrasound revealed she had suffered a haematoma and a third-degree perineal tear that had been improperly repaired. For months afterwards she struggled with symptoms resulting from her injuries, forcing her to spend thousands of dollars with private specialists.
“I took a lot of the blame for my experience for a very long time,” she told Guardian Australia. “After every accident I was so ashamed.”
That changed when a New South Wales parliamentary inquiry into birth trauma was announced in June.
“Before this inquiry came to light, I thought there was something wrong with me. Everyone else I’d spoken to in Wagga had had a fine experience in their pregnancy. But since this has come about, I’ve met more and more people who’ve had horrible experiences.”
Samantha said a birthing culture that “normalises trauma”, like that she experienced, leaves women vulnerable to mental distress and self-blame that can be as debilitating as physical pain.
“I get things can happen during birth, but one doctor told me ‘everyone comes away with a story’,” she said. “The fact that this happens to so many women is so upsetting.”
The inquiry held a public hearing in Wagga Wagga this week. Samantha did not give evidence, but healthcare workers, politicians and other witnesses who spoke at the inquiry called for an overhaul of pregnancy and maternal healthcare services in the state.
The NSW Nurses and Midwives’ Association has urged the inquiry to adopt midwifery-led continuity of care for all birthing women, education for healthcare workers on providing trauma-informed care, and greater support for midwives and midwifery students to improve recruitment and retention.
NSWNMA deputy secretary Michael Whaites, a former midwife, said understaffing and lack of support causes “moral injury” to midwives by forcing them to prioritise care for some patients over others.
“The Atar score that’s needed to get into an undergraduate midwifery course is in the 90s,” Whaites said. “These are predominantly young women who could choose any career, but they want to be midwives. Undergraduates are leaving because they can’t afford to be on clinical placement while they’re working two jobs. We have to ask ourselves why we can’t hang on to these intelligent, committed women.”
Speaking at the hearing on Tuesday, local mum Laura Johnston said: “There needs to be a basic respect and belief in a woman’s ability to birth and that she does know her own body.”
“It’s quite simply just listening to women and following normal practices around informed consent,” Johnston said. “We would expect that in other areas of medicine, [but] as soon as we’re in a maternity ward, it just goes out the window.”
Johnston said she “was continually dismissed, ignored and coerced into accepting interventions” while giving birth two years ago, and that her attempts to raise concerns with her treatment were dismissed by hospital staff.
“The obstetrician said to me ‘I’m giving you an episiotomy now’ as I was being cut,” Johnston said.
The CEO of the Murrumbidgee Local Health District, Jill Ludford, offered an apology at the inquiry to women who had experienced birth trauma in the region.
“As a previously practising midwife, a child and family health nurse and a mother, the experiences you have shared with us have significantly impacted me and, I know, many of my colleagues as well,” Ludford said. “I’m sorry we let you down.”
The member for Wagga Wagga, Dr Joe McGirr, was present at the hearing, and said the inquiry has exposed the need for cultural change across the health system.
“Women are turning up to hospital at 39 weeks and hearing ‘we’ve booked you in for an induction next week’ when no one’s even told them what an induction is,” McGirr told Guardian Australia. “Unless we take the time to walk people through their options and explain the risks and benefits, of course it’s going to turn to porridge.”
McGirr said women should receive more antenatal and postnatal support. “On the birthing floor it’s too late,” he says. “It costs a little more but it will save us in the long run.”
