Pressure on women from antenatal classes, social media and healthcare professionals to have a natural birth is causing lasting psychological harm when it does not go to plan, new research shows.
The University of Reading study found that the messages women receive during pregnancy are directly linked to the shame and self-blame many feel when those expectations are not met. For the first time, the research provides an explanation for why unmet birth expectations contribute to psychological harm.
Several women involved in the research said they felt they had not given birth “properly”, even when medical intervention had saved their lives.
Published this week in Social Science & Medicine, the findings come as figures show an increasing problem of mental health crises among post-natal women. The latest BBC Panorama, ‘Maternity Failures: The Fight for Justice’, which airs Monday, 1 June, highlights issues raised in the new study.
Rebecca Matthews, lead author and PhD researcher at the University of Reading, said: “These women were not failed by their bodies, they were failed by the messages they were given.
“Birth trauma does not begin with birth. It begins in the ideology sold to women throughout pregnancy. For the first time we can explain precisely how, by showing how birth culture creates a moral standard for women that defines what a good mother does and then leaves them to blame themselves when birth does not match that.
“Until we reform the way we prepare women for birth, we will keep seeing the same devastating consequences for mothers and their babies.”
Pressure from all sides
The researchers interviewed 21 first-time mothers in the UK whose births did not go as planned. From
NCT and hypnobirthing classes, to social media to midwives, the researchers heard how women are surrounded by messaging that frames natural, unmedicated vaginal birth as the “gold standard”, not just medically preferable, but as a mark of being a good mother and the first test of maternal worth.
Research shows around half of women report their birth differed significantly from their expectations – and for the women in this study, all of whom experienced exactly that, the psychological consequences were profound. Women judged themselves against the internalised moral standard that the ideology had created. Stories the women (all given pseudonyms) shared include:
- Alexandra nearly died during labour but still felt she had not given birth properly because she needed an emergency caesarean.
- Maggie, who needed an unplanned caesarean after being induced, asked, “Why couldn’t my body birth the baby that it had grown?”, describing a sense that her body had betrayed her at the moment that mattered most.
- Elizabeth, who was separated from her baby immediately after birth, said she felt she had “ruined” her relationship with her baby from the moment of birth, a fear rooted in antenatal messaging about the critical importance of immediate skin-to-skin contact in the first hour after delivery.
- Ellie said she felt pressure to “rectify” the feelings she had towards her baby in the months after birth, to make up for the bond she felt she had missed.
- Gabriella described how an unplanned caesarean “shaped the way I see myself as a mum”.
Reform needed
The researchers are calling for antenatal education to stop treating one kind of birth as the goal and to present all birth outcomes as equally valid routes to motherhood. They also call for better postnatal screening for women whose births did not go as expected, specifically targeting the shame, self-blame and identity disruption that this research identifies as mechanisms underlying birth trauma.
The findings align with and extend the conclusions of the Kirkup, Ockenden, and Birth Trauma Inquiry reports, all of which documented how the institutional pursuit of ‘normal birth’ contributed to preventable harm. This research provides the first theoretical explanation of how that ideology generates individual psychological harm and points to antenatal messaging as the primary site of such preventable harm.
The study was funded by the Economic and Social Research Council.
