We always have a choice, no matter how much we are made to feel otherwise

AIMS Journal, 2024, Vol 36, No 3

After the birth of her baby, Rachel initially believed a midwife’s ill-considered throw-away comment. She writes:

“I trusted her words far too much. I've now come to see her remark with a great deal of anger and frustration. How on earth is intervening in the natural process of birth; synthetically bringing it forward before my body or baby was ready; being placed in a stressed environment where I was poked and prodded and the membranes artificially ruptured; needing a c-section simply because their intervening had failed, and then being left bleeding from that surgery - how on earth is this natural or even safe? I trusted them so blindly and was left feeling so utterly broken and useless - and it's all from the things they did to me and my body, not from my body doing anything wrong on its own. Then, to cap it all, that midwife said I might have died if it weren't for them "saving" me.”

In this article, Rachel tells the full story sharing what she learned and how she wishes that she had been less ‘obedient’.

By Rachel Wolfe

“What would have happened to me, you know, in nature, before modern medicine?” I asked from where I lay on the hospital bed, unable to move without intense pain. I had my newborn son tucked in beside me.

The midwife, whose face I could not see, paused and looked at me over her mask. “Well, one in twenty women died in childbirth” she shrugged, before stepping out of the room and leaving a heavy imprint on my life I doubt was ever her intent.

I don't remember anything else of that particular midwife. The whole experience of my first birth during April of 2021 is a blur of faceless people doing things to me. I know I am hardly alone in this experience. I also know that, had I seen their faces, it may have been less traumatising, but it would not have changed the underlying issue that caused the trauma; and that is trust. My trust had been abused and I didn’t even understand it, not at that moment, and not even in the coming months of difficult, gradual recovery.

I gave my trust to our NHS maternity care system, or ‘uterus on a conveyor belt’ system as it felt like at the time, and I haven't since changed my opinion. I was at my most vulnerable, trusting my life and that of my unborn baby to the hands of people I'd never met before; people who will forever remain faceless to me. It is only their eyes, staring over the edge of masks that I remember and the tone of their voices casting judgements and coercive lies that I oh so trustingly lapped right up.

Trusting was my mistake. I gave my trust to these people, to this system. Why? Because for most of us, it is the only option we have. But there is a choice - we always have a choice, no matter how much we can be made to feel otherwise.

My journey into motherhood started like many from my middle class background. I read some books, I did an online NCT antenatal course, I did hypnobirthing courses and I learned about the physiology of natural birth, which, like many women, was what I wanted for myself and my baby. It made sense and felt empowering to trust in this natural process, and, most importantly to me, it had the best clinical outcomes. I come from a scientific family and I simply wanted the best potential outcome, not just physically, but psychologically, too, at this important point in my life where I was now responsible for another person.

I am writing this as I lie in bed on a sunny, summer's afternoon, feeding my three-month old daughter. I am so content, oxytocin is flowing, just as it is meant to. I can hear her swallowing a nice even flow. There is no pain, no discomfort, no stress or worry, just lovely warm feelings as I watch her lie here with her eyes peacefully closed, swallowing that gentle flow of milk from mother to baby, just as our species is designed to do.

I cannot remember ever feeling this level of peace with my son - my first baby, born three years before. What I remember is fear, anxiety, and worry; worry over everything from, do I have enough milk, to what if he cries and I can't make him happy. You might think these are normal first time mother fears, but it is not normal to find that your body will not let you sleep, that every time you drift off, you wake back up with a terrible sense of falling. It is not normal to fear leaving the house, because doing so feels like wading through a bottomless sea of worries and stress; and then to feel so riddled by loneliness and guilt that you are forced to take that risk. It is not normal to swim in that endless ocean and to hear every cry as if it is the end of the world with the walls closing in.

I was told it was simply a common reaction to the physical trauma of my birth, but I have since learned it is so much more than just that.

Trust is at the heart of all care. That's what I wish I had understood then, before I obediently handed over my trust to people in a system where avoiding litigation seems more important than patient care. That is my personal opinion, but it is also the opinion of many midwives, sonographers and even doctors that I have spoken to. Sadly, this is simply the reality. It should be different. I know that people do not become doctors or midwives in order to hurt women or to bombard them with negativity simply because they are terrified of being sued, but that seems to be the reality we are now living in.

So, I am writing this personal account hoping that just one other person might be saved from the needless suffering that I endured. If I had seen an account like this, before I'd had my son in 2021, my first experience of motherhood may have been the beautiful, happy experience that my second baby's birth has been. If only it could have been so. If only it could be this way for everyone.

Here is the story of my two birth experiences, both under the NHS. The first in Devon in 2021, the second in Lincolnshire in 2024.

My son’s birth

There was never a more wanted baby. I was over the moon, blessed with a wonderful pregnancy and so happy. Classified as low risk, I instinctively decided on a home birth with the community midwives. If things changed and I needed or chose to go to the hospital with my homebirth midwife, that was fine too. I trusted in myself and my body.

This plan all came to a sudden and distressing halt when I was diagnosed with gestational diabetes in my 3rd trimester. This is the first point where my trust was abused. I was informed that I ‘could no longer have a home birth’ and ‘would need to be induced’. This is the language that was used. I trusted this without question. I thought I had no choice. This is not the case in the UK. Any woman legally has a right to birth wherever she chooses and to receive midwife-led care. I was lied to. Why?

Well, the doctors would say for my own good and my baby's, I'm sure.

My blood sugars were beautifully controlled through diet, exercise and medication, I was reassured my baby was not measuring large, and none of the potential issues diabetics can face were ever of concern. In short, my pregnancy remained entirely ‘normal and healthy’. But diabetes in pregnancy is never regarded as normal and, despite all being well, I was repeatedly told that my baby would ‘need’ to come out by 38 to 39 weeks. I never really questioned this as I had always been someone who trusted doctors and medical care implicitly. I asked questions to understand their advice better, but never to question their advice, and I had no notion of how their use of authoritarian language secured my obedience.

I did a lot of research. I came to a decision that I would ask to have a planned c-section if my baby had not come naturally by the point they deemed an induction necessary. This was a purely personal decision mainly based on the statistical outcomes of induction of labour for first time mothers. I wished to avoid a drawn out medicalised process as I was afraid of how that might negatively impact me and the early days of motherhood. Sadly, as it turned out, I could not have been more right.

When I requested the planned c-section, I was talked out of it by a seemingly caring and well-meaning obstetrician. I could blame her for what was to come, and there is certainly a part of me that does, but ultimately I am responsible for being my own voice. I did not express myself strongly enough. I approached with meek, obedient language because I trusted her. I trusted she would understand and listen to me. I trusted this hugely important decision to someone I had never met before and who only saw me for a few minutes. I was passive. I was obedient. I was so meek, and now I wish so much that I could go back and tell myself to “Stand up for what you need - don't trust her, just because she's a doctor wearing a kind smile”.

The long and short of it is this: I trusted that doctor that day, I let her talk me out of what I knew was the right choice for me. I wanted to be a good patient. I wanted her to think well of me, so her coercive language worked a treat.

I also trusted the doctor that happened to be there on the day they finally decided to induce. I was 39+5. Everything was fine, except I needed a little less insulin than previously and they feared this might be an indication the placenta was failing, despite there being no other sign of this. I requested a scan to check and was told that wasn't possible for some garbled reason I don't even recall. Once again, I was lied to. Once again, I was far too meek, far too trusting.

I was actually ready to refuse the induction. I was in early labour and already 3cm. I felt well and they said nothing was wrong with my baby. It felt best to wait, but the doctor stood beside me and looked me in the eyes and I asked what he would recommend, if it was his wife or sister in this situation. Naturally he raised the issue of stillbirth, making it sound as if this was likely when I know now that it isn’t, and he said that induction was the safest thing for my baby. So I agreed. I had an induction. I went into it excited and positive. I was going to meet my baby. I knew I had to embrace this for it to work. I really tried.

It didn't work at all, not even 16 hours solid on pitocin maxed out, it didn’t work. Thankfully there was no concern over my baby, but they ‘needed’ to get him out after this point because the induction was clearly not working and I was on that conveyor belt you can no longer get off because they had broken my waters.

So my wonderful, beautiful son was born by an emergency c-section. It was a blessed relief to have that nightmare of an induction end and to finally have him in my arms.

My memory of that birth was of being in shock, lying stunned and shaking, unable to think.

I was so tired I couldn't hold my eyes open afterwards.

About 12 hours later, having only just got the feeling back in my legs from the epidural, I was returned to theatre, this time with a spinal block. Blood was coming out of my incision and would not abate. I had to sign away my uterus in order to have this operation. I now know my life wasn't in imminent danger or I would have been given a general anaesthetic. I felt very scared yet strangely detached. I was in shock but none of the communication I recall suggested I had a choice. I saw no one's face.

The midwife and the obstetrician both advised me that I should be happy just to have a healthy baby and to be okay myself. I so wanted to be happy. I tried. It was the comment by another midwife that stuck with me and that angers me to this day. I wanted her reassurance that I had at least experienced active labour, but she replied, “Oh no, you never reached active labour”. She made me feel so weak. I had required an epidural and it hadn't even been active labour. What could possibly be more intense than what I'd experienced? I never dilated any further than 3cm, but I was certainly in active labour as far as contractions go. That's what that woman should have told me. Why she felt the need to belittle my experience, I'll never know. Again, I put far too much trust and care in strangers.

I went home 2 nights after this. I was in agony from breastfeeding. Everything was darkness that only got worse as I could not sleep. I got into a very bad state where I felt I had to die. Not because I wanted to. I was blessed with such an instant, overwhelming sense of care for my son. I'm not sure if love is the right word, as I don't recall happiness, only a desperate care for him. It was this very anxious, all encompassing care that made me feel I had to die, because how could I take care of him without sleep? I had this piercingly sharp feeling that he needed better than I could give.

Thankfully the one community midwife who I had some continuity of care with picked up on this and immediately had sleeping pills prescribed for me that day. My immediate crisis was dealt with and I felt so much better from just getting some sleep, that I don't think I realised how bad things still were. I didn't want them to be bad and I very quickly bonded with my son and was utterly enraptured with him. I've always been a happy person and I just wanted to get on with it. So I did.

A miscarriage

In late 2022, I suffered a miscarriage of an unexpected but very much wanted pregnancy. I had known something was still very wrong with me at my booking-in appointment when I experienced a terrible wave of darkness washing over me.

I learned of the miscarriage on a scan and fled the hospital after being left waiting alone in a room for over half an hour. I did not feel cared for. I answered their follow up call outlining my options and chose to wait for nature to take its course, and a few days later it did. In the midst of loss, I found healing.

With my miscarriage, I felt waves of natural contractions. These were very different; something my body did all by itself. I could move about. I wasn't trapped. And it was so, so powerful. It hurt, it was intense, and yet it was beautiful, somehow. Despite how utterly broken and defective my first birth had left me feeling, my body knew how to do this thing after all. It was this experience that gave me the courage to pursue birth on my terms when I fell pregnant again.

My daughter’s birth

I started my second pregnancy with no trust in my care and I left my first appointment in tears. The diabetic doctor suggested termination at 7 weeks gestation because of my Hba1c¹ at conception, but she would not give me the information I needed to make an informed decision. I had asked for care when I was first trying to conceive but my diabetes had been left un-tended. Even in this, my trust was abused and I now feel so utterly foolish to have trusted in the system rather than being proactive in my own health. I believed my diabetes wasn’t a problem because no one seemed concerned. It was only once I was pregnant it seemed like a panic button had been flipped.

This time, I did things differently. I was no longer the pliant, passive patient who did as she was told. I educated myself. I researched. I found the moral and emotional help of the most wonderful doula a mum could ask for. I even paid to speak to a private obstetrician to provide me with actual statistics of the risks I was facing with my pregnancy.

I am so very glad I did not place trust in the NHS doctor. I do not doubt their job is a hard and difficult one, and I certainly do not envy their role working on the conveyor belt system, but I would not have my happy and healthy daughter if I had given my trust to this person whose concern, I felt, was not for me or my baby, but simply for avoiding litigation due to NHS neglect in treating my diabetes.

As the birth approached, I found myself trusting the home birth midwives. They made me feel heard. They made me feel sane and sensible. Every appointment left me feeling uplifted, excited and optimistic. They understood my thinking and supported my informed choice for my birth and I know I had their genuine support. If one of these women had turned to me and voiced concern over anything, I would have trusted in their judgement.

The consultants were another thing entirely. Each one I saw left me feeling utterly hopeless and defective. The closest I came to feeling trust in them was one who admitted that they just don't know, so they err on the side of caution. However, without strong clinical evidence to support medical intervention, erring on the side of caution was not good enough. This was an informed decision I made for myself and my baby. I understood the risk of stillbirth for women with well controlled gestational diabetes to be the same as for any non-diabetic pregnancy. They could not tell me this was wrong.

I had a choice to make - to trust myself or the fear mongering of the consultants. It was very difficult to go against medical advice. I refused any induction outright, and was not pushed on this, probably as I had been diagnosed with PTSD. The offer of a sweep or a planned c-section was discussed but I made an informed decision that felt right for me.

My body had safely and effectively miscarried at home, which was like a mini labour. I trusted in this natural process and trusted the midwives. I did not want an obstetrician breathing down my neck, focusing on the tiny chance of stillbirth. I needed people who believed in my ability to give birth, and I trusted in those that believed in me, including my doula Emily.

In Emily I found the continuity of care that was not being provided in my antenatal appointments. She was deeply invested in my experience being a positive, empowered one. She was a sounding block, cheerleader and advocate who wanted the very best outcome, however that looked like for me, and in the end she helped me achieve what truly mattered, a positive birth experience.

I knew from reading on birth trauma that I must trust whoever was providing my care. In the case of a c-section, I narrowed it down to one thing I needed above all else. I needed the surgeon on that day to look me in the eyes beforehand and promise to take extra care to avoid the bleeding that happened the first time. This was not just about avoiding blood loss, it was about feeling heard. It was about that obstetrician seeing me as a person and not merely a womb. I needed to know I could trust this person to really listen to me and to understand the impact of my first birth, and to do everything possible to avoid such a negative experience this time, and that is exactly what happened. He was also the first doctor to apologise to me for what had happened to me that first time.

Almost three weeks after the proposed date for induction - three weeks of enjoying the delight and wonder of my pregnancy, and three extra weeks for my baby to become ready to enter the world - I gave the go ahead for her to be born through what Emily refers to as a calm and gentle belly birth. It was nothing like the first c-section. Seeing her emerging was the most amazing moment of my life. I then had five wonderful hours holding her skin-to-skin and all my wishes were honoured. Everything was perfect and there was nothing wrong with my placenta. Do I regret not holding out for longer? I find it hard to regret the best moment of my life, so no.

In my first birth my unquestioning trust was abused and broken, I know that now. With my second, I only bestowed my trust once my needs had been met. The goal of a live mother and baby shouldn’t require widespread brutality. That is a low standard in anybody’s book. We are told that birth is but a brief moment in our mothering journey, but it is also an important and defining part of our story. This revelation helped me to heal from the trauma and enabled me to trust myself and to approach the birth of my daughter with hopeful excitement rather than with the anxiety and fear that had crippled me for years.

Author Bio: A 37 year old full time mum of two in Lincolnshire, Rachel works on the side in virtual fashion design when time permits.