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Birth Trauma Is the Symptom. Birth Bias Is the Disease.

Updated: Aug 15

Opinion piece by Amber-lee Buendicho


I was recently chatting with a new mum about her birth experience which to me, if I am honest, was a lot. She had every intervention you could think of: stretch and sweeps, induction by balloon, synthetic oxytocin, artificial rupture of membranes, epidural, episiotomy, and forceps. Yet she described her birth experience as empowering. When I asked her what was empowering about it, she said because she had choices. She felt in control, respected, and listened to. Despite heavy interventions, she walked away content with her birth. Even empowered. I think this story is a good example of what we should be focusing on in maternity care… hint: it’s not always about what happens, it's about HOW it happens.


The New South Wales (NSW) Birth Trauma Enquiry of 2023, a comprehensive investigation into birth trauma, has underscored the pressing need for legislative reforms within the Australian maternity system. With over 4,000 submissions from women, families, and care providers who have experienced birth trauma, this inquiry has provided a platform for survivors and professionals to unite. Amidst the testimonies, a recurring theme emerged-one that lies at the heart of childbirth discourse: birth biases. These biases permeate through maternity models of care, care providers, research, and individual perceptions of childbirth.



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Here’s the real problem with bias in birth.

Bias is human. But when we don’t acknowledge it especially as care providers or support people or even the mum chatting to another mum at the park - it shapes how we speak to, treat, and support birthing women. It clouds how we share knowledge. It filters how we judge what’s “safe” or “right.” And too often, it erases the individual in front of us. Everyone has opinions about how birth should go. But women aren’t blueprints. Each birth is different. Each woman brings her own fears, hopes, history, culture, and instincts to the experience. Ignoring that is what fuels the divide between midwifery and obstetric care, between public and private, hospital and home birth. And that divide isn’t just professional, it’s personal. It’s emotional. It's hurting women.


Imagine a woman stepping into birth, overloaded with biased advice and filtered information, while her own needs and safety cues are brushed aside. That’s not trauma informed care. That’s coercion dressed up as guidance. What we actually need is to accept that there is no superior path. Midwifery or obstetrics, hospital or home - we need them all. What matters is making space for the woman’s voice in her own care.



Woman-centred care in childbirth is about the unique needs, expectations and aspirations; recognising their right to self-determination in terms of choice, control and continuity of care; and addressing the social, emotional, physical, psychological, spiritual and cultural needs and expectations [Care, 2018].



Dr Rachel Reed says it perfectly: “Care providers must release their own emotional investment in women’s decisions. It is not the role of the care provider to rescue a woman from her decision making, and to do so interferes with the woman’s ability to trust herself” (Reclaiming Childbirth as a Rite of Passage p. 123).

I think that advice applies to all of us.

We’re not here to rescue women from their choices. We’re here to be aware of our own beliefs, fears, preferences, and projections and not let them take the wheel.

Let’s listen to women. All women. Not just the ones whose stories back up our own views. When we do that, a clearer picture starts to form: birth trauma is rooted in our birth culture, our systems, our education, and our language.


After hundreds of women have shared their birth stories with me, I recognised early on the importance of biases in birth and how individuals assess risk for themselves. When people ask me about birth, I openly share that I am not against hospital births, not against homebirths, not against freebirths, not against vaginal births, not against belly births, not against midwives, not against obstetricians, not against doulas... but for myself, I have my own preferences, fears, perceptions, and biases, now I am just more aware of them.



"Not every woman is able to have a physiological birth and proclaiming otherwise is a problem... However, in modern maternity practice, physiological birth is a rarity and this is also a problem."

- @thepowerofbirth



As a [provisional] psychologist and perinatal mental health advocate, I’ve learned this: I need to prioritise her fears, her past, her needs. I used to think it was my job to open women’s eyes to the flaws in the system. But that mindset isn’t empowering - it’s paternalistic. My job is to respect a woman’s autonomy. Her story. Her body. Her decisions.


Ask yourself…

  • how do you react when someone announces their intention to birth at home with a private midwife or no care provider at all?

  • What stirs within you when a woman opts for a planned caesarean or private obstetric care?

  • What comes up for you when someone talks about epidurals and other medical pain relief methods - or doesn't believe in pain relief for birth?

  • Do you prioritise the woman birthing above the echoes of your own experiences?


These aren’t rhetorical. They matter. Because when things go wrong - and they do - mothers too often carry the blame - be it due to inadequate care or unforeseen obstetric emergencies, the burden of blame often falls unjustly upon the shoulders of the new mother.


I have witnessed obstetricians pathologising every little thing on an ultrasound report with no compassion or self-awareness around the delivery of that information. I have listened to mothers whose uteruses have been removed due to physical trauma in their birth, and others who must wear dependables for the rest of their lives. I have listened to women who have lost their babies during childbirth in hospitals and at home. I have had conversations with mothers who blamed their bodies for not being able to vaginally birth despite what that hypnobirthing course taught them. I’ve sat in rooms where midwives tore down a woman who, after being traumatised by a midwife-led birth, chose obstetric care next time. I have listened to women blame themselves for not knowing how to navigate a system that puts them on a birth conveyor belt, for not choosing the right model of care, for not advocating harder, for not knowing what modern birth was like, for not lowering their expectations, even blaming themselves for the way care providers treated them. None of this is okay. This is a deeply problematic cycle where women come to believe they are deserving of the events that occurred, whereas the reality is they have unknowingly stepped into a fragmented system, with a culture of "all that matters is a healthy baby."


We may never fully eradicate birth trauma, but we can start by turning inward as support people, care providers - even woman to woman - to see our own projections and biases and the impact it has on birth trauma.


I know many maternity care workers are already burnt out, traumatised, disillusioned, underpaid, and stuck in a broken system. I see that. This piece isn’t about blame - it’s about change. Maybe we need to redraw the boundaries of responsibility between midwives and obstetricians. Maybe we need better support for those who support us.

I don’t have all the answers. But I know this: we have to do better. Because women deserve more than survival. They deserve to walk away from birth feeling strong, respected, and whole.


Recognising birth bias provides an opportunity to stop the turf wars, challenge our own assumptions, and finally put women - not systems, not ideologies - at the centre of birth. The future isn’t midwifery or obstetrics or freebirth. It’s human-centred care. That’s all we want. That’s what women deserve.


With love,

Amber-lee Buendicho

@thepowerofbirth



If you are reading this and you are preparing for birth and feeling a little defeated, I would love to introduce you to Catherine Bell, the incredible woman behind The Birth Map (https://birthmap.life/) to help you navigate modern birth. This is a helpful guide to understanding interventions, models of care, and general practice in our current system and to help you make informed decisions and advocate for your needs and wants in birth. I also interviewed her on my podcast Can We Talk About This episode 26 (highly recommend the listen!)



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If you have experienced birth trauma or any experiences mentioned in this writing, I am so deeply sorry and I stand with you. Please consider reaching out to the wonderful organisations we have in Australia to help you:


If you'd like to share your story with this community you can use the Share Your Story tab or send me an email, I always love to connect.






 
 
 

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