Birth Empowerment: Advocating For Informed Consent And Supportive Care

Giving birth is a complex, dynamic, and impactful experience for all birthing people. For many, it is also the first time they are engaging on a large scale with the medical system. For those who give birth in hospitals, it may be the first time they are in a hospital as a patient. No matter the location of the birth, the months leading up to it and following it are dictated by the parent’s health and the child’s health, and customarily in the US, a time of increased intervention in the parent’s life. From prescriptions on behavior to physical touch and assessment, the birthing person is expected to submit to these interventions for the child's health. 

This large change to autonomy can itself be traumatizing and leaves open many opportunities for the birthing person to feel violated. According to a 2022 review by the National Institutes of Health, 20% to 68.6% of birthing people experience trauma as part of birth, and between 4 and 18.5% develop Post-Traumatic Stress Disorder (PTSD). This year’s Birth Trauma Awareness Week takes place July 15th-21st, and the theme is Informed Consent. 

What is Birth Trauma

The March of Dimes defines Birth Trauma as “any physical or emotional distress that you experience during or after childbirth”. It is different than Postpartum Depression, which is a feeling of depression after having a baby that is treatable with psychotherapy and/or medication. Birth Trauma can contribute to postpartum depression, especially for parents who are unable to process their experiences or who do not receive support. There are many reasons people experience Birth Trauma: a birth that did not go as planned, resurfacing of past traumas during labor, a threat to their health or their child’s, physical trauma, the loss of a child during birth, or feeling out of control of the events surrounding their birth.

Informed Consent

Informed Consent is a crucial piece of preventing Birth Trauma. Medical providers have a responsibility to educate birthing parents about informed consent and the decisions they may have to make in childbirth. Many people have questioned whether birthing people should be asked to consent to medical procedures or changes to their birth plan while in the throes of labor. An American College of Obstetrics and Gynecology (ACOG) ethics committee opinion in 2021 states,

One woman told her story of questioning informed consent during labor in this 2018 SELF article. She states that she was asked to make a decision regarding using forceps while being “too weary to examine” the instrument, and she wishes she “had made a choice in advance of giving birth about which procedure to use in the event of an emergency,” and was “disturbed by the fact that [she] agreed to a serious medical procedure without fully understanding the potential implications”.

Women of color experience increased marginalization when it comes to healthcare decisions and power over their birthing experience. A 2019 interview of women of color in the first year postpartum found that “providers' control over information led to a power dynamic that diminished women's ability to maintain autonomy and make health care decisions for themselves and their children,” which the women felt led to poor birth outcomes. This power dynamic makes the idea of ‘opt-out consent,’ where the birthing person is assumed to have consented unless they say otherwise, laughable. Compliance is not consent, and in this case, consent cannot be assumed.

The Impact

Birth Trauma can have consequences for both the birthing person, their loved ones, and their child. Birth Trauma can cause postpartum depression, anxiety, or negative flashbacks, and can affect maternal bonding, breastfeeding behavior, future reproductive decisions, and partner relationships. Birth stories are one way parents can reclaim their power, control, and courage after a traumatic birth. Medical providers who see parents postpartum are in a unique position to listen to parents’ birth stories and to look for the impacts of birth trauma on bonding, breastfeeding behavior, and mental health. Friends and family can also listen to birth stories and encourage birthing parents to seek support. Group support after birth at parenting groups, grief groups, and feeding groups can provide additional listening ears and validating experiences. Organizations such as Postpartum Support International offer support groups specific to birth trauma.

Birth Trauma Awareness Week is sponsored by the Australasian Birth Trauma Association and the UK’s Birth Trauma Association.