Sydney, Australia – Sam Hall, an Aboriginal woman from Ormiston in south-east Queensland, was 40 weeks pregnant when she felt her baby’s movements slow. She was already worried about her child’s safety – previous scans had detected potential problems with her pregnancy and her partner had genetic heart problems.
But when she tried to raise her concerns with medical staff at the local hospital, she was dismissed and sent home.
“I knew something was wrong,” Hall said. “They made me feel like a nuisance. They attributed a lot of it to me being a ‘paranoid mother,’ so they never took me seriously.”
The next night, she went into labor. Terrified, she called the backup midwife assigned to her. She was told to wait until her scheduled induction the next day.
“All he told me was to take some Panadol, have a shower and go back to bed,” Hall said.[In the morning] She said to me: “I wish you had endured longer” [to the preplanned induction time].”
When Hall arrived at the hospital, her son’s heart rate was worryingly fast and she couldn’t feel him move. It wasn’t until a shift change six hours later that the medical staff decided to perform an emergency C-section. When Hall’s son, Koah, was born that night, one of his lungs had collapsed and he had inhaled meconium, or infant fecal matter.
“When I first saw him, it was about 9pm,” Hall told Al Jazeera. “I couldn’t see him properly or touch him. He was so tiny, with so many wires and tubes attached to him. He was on a CPAP (a mask that opens the airway and supplies oxygen to newborns with breathing difficulties) for the first few days. His face was so swollen it was red. Seeing your child like that changes something in you.”
When a pediatrician came to give her an update, the trauma of Hall's experience was compounded.
“I was going through everything that was wrong and I started to get angry. He shushed me and told me I needed to be calm so he could tell me what he needed to tell me,” Hall said.
Hall is one of thousands of women who have spoken out about their experience of giving birth in Australia amid a crisis in its health system that has left fathers traumatised, mothers with lifelong physical injuries and forced health workers to leave the profession.
A world-first parliamentary inquiry in the Australian state of New South Wales (NSW) has called for sweeping reforms to better protect women giving birth. But as the state government prepares to respond this week to its recommendations, mothers and advocates argue the inquiry did not go far enough.
An invisible epidemic
A landmark study from Western Sydney University in 2022 found that up to a third of mothers in Australia experience some form of birth trauma – physical, mental and psychological injuries and distress experienced during pregnancy and childbirth.
The study also found that more than 10 percent of women experienced obstetric violence, a form of violence in which pregnant or laboring women experience abuse or dehumanizing treatment at the hands of medical professionals.
That same year, around 30 women from the rural Riverina region of New South Wales filed a class-action complaint with the state’s Health Care Complaints Commission. They shared shocking stories of their experiences giving birth at their local public hospital: doctors sending them home with debilitating injuries, medical staff performing invasive physical procedures without consent, and being denied pain relief during labour.
As public interest in the women's stories grew, other women from across the state and country began sharing their experiences. Public pressure forced the New South Wales parliament to convene a special inquiry into birth trauma, the first inquiry of its kind anywhere in the world.
“As a GP who used to provide antenatal care, I had heard these stories before I came to parliament, but the sheer number of people involved in this inquiry was unprecedented,” said Dr Amanda Cohn, a Green Party politician in New South Wales and a member of the parliamentary committee that conducted the Australian inquiry.
A similar inquiry in the UK, prompted by the New South Wales precedent, found “a maternity system in which poor care is too often tolerated as normal and women are treated as a nuisance”.
While Australian parliamentary inquiries are usually open to the public, they rarely generate broad public engagement. The birth trauma inquiry was different: it received more than 4,000 comments, largely anonymous, from members of the public who revealed the pain, trauma and humiliation they had suffered during pregnancy and childbirth.
The inquiry recommended that the state government review maternal healthcare, including by ensuring that new and expectant parents received ongoing care. It also said that free postpartum psychological care and physiotherapy should be provided, and that medical staff should receive more training on how to support women's decisions during childbirth.
But as the state government considers its response, many of the mothers who told their stories to the inquiry are furious that the report fails to recognise obstetric violence as a form of gender-based violence. In a dissenting statement, the inquiry’s own chair, Animal Justice Party politician Emma Hurst, said the final report “fails to recognise the very clear evidence that this is a gender issue”.
Rebecca Collier, one of the mothers who gave evidence, told broadcaster ABC that the definition “was omitted to make it more palatable”.
“I think we need to call things by their name and we need to be quite firm with the words and the language we use on this issue.”
The inquiry also exposed the appalling conditions faced by healthcare workers caring for parents and children. Nurses, midwives, doctors and support staff spoke of huge levels of burnout, psychological distress, vicarious trauma and compassion fatigue across the healthcare sector. They also spoke of not being given the support they needed to provide adequate healthcare or cope with the traumatic incidents they witnessed and experienced.
“We heard really heartbreaking stories from health care workers who were thrown into workplaces where they can’t provide people with the care they want to provide,” Cohn said.
“Nurses and midwives are leaving the profession because their salaries are too low and they don’t have the support they need. We cannot adequately address birth trauma if we have understaffed hospitals and care units. There is a strong expectation from the community that policy makers will back up this research with action.”
'A trauma for generations'
Amy Dawes suffered life-changing injuries after giving birth to her daughter in 2013, but it took 16 months before she was diagnosed with pelvic floor muscle damage.
“That changed the course of my life,” she said. “I was told I shouldn’t do any physical activity or hold my daughter. I fell apart, to the point where I started to think my daughter would be better off without me.”
Dawes founded the Australasian Birth Trauma Association (ABTA), a not-for-profit organisation that works to provide support and raise public and political awareness about birth trauma, as well as the underlying culture that dismisses and normalises women’s pain and suffering during pregnancy and childbirth. Dawes hopes the research will mark a turning point in the way Australia’s health care system treats pregnant women.
“There is a misconception that birth is just one day in a person’s life, but birth trauma can have ripple effects that last for generations,” Dawes said. “It can affect a parent’s ability to bond with their child, which affects the child’s development and life in turn. It can cause relationships to suffer, especially as partners experience trauma as well.
“The long-term effects of birth injuries, which largely go unnoticed (incontinence, pelvic organ prolapse), can prevent women from raising their babies and children, returning to the workforce and exercising, which in turn has a huge effect on people’s mental health and well-being. The implications for society are enormous.”
Although Koah is now thriving, Hall has not forgotten the pain surrounding his birth.
“He's a beautiful, happy, healthy little boy now and I'm lucky to be his mum. But it still seems harsh and incredibly unfair that this was the start of his life,” Hall said.
“I wish they would listen to me and take me seriously. A lot of things could have been avoided.”
