How we are groomed in healthcare.

This post may be quite a difficult read for both professionals and parents.

If you feel you need some support then please call you GP, a mental health charity or call a trusted friend.

When we think about maternity care  we envisage wonderful people who just want to make a persons life better. We think of caring humans who are doing what they can to keep people alive. 

Yet within this grooming is happening. And yes, the same tactics that the typical vision of a groomer of young girls does also happen in maternity care. 

How? Many ways. 

Coercion is the big one. Coercion is actually usually done very subtly and in many forms.

Power imbalances play a part. The NHS and maternity system is seen as some amazing institution (it is) and the people within it often seen as untouchable. Yes, maternity staff are very knowledgeable, they are also human, with emotions and biases. This is OK. They do, however,  hold a lot of power and with this means that those who aren’t as knowledgeable, appear to  have less power. With every power difference those that hold higher perceived power can very easily coerce. Simply because we are taught to believe what the professionals, those with authority, tell us.

We learn this at a very young age through our parents and teachers. Learning to listen to our parents isn’t a bad thing as it keeps us safe. Believing everything anyone with some authority tells us does not necessarily keep up safe (look up Milgram studies in authority for anyone interested in the deeper psychology.) 

A typical abuser will assert authority in order to control an manipulate/coerce. 

Language used in maternity and health care is often coercive. Think about conversations that are had around deciding a plan of care. “I’m not allowed”, “you’ll be against medical advice” etc. If you feel you cannot say no then it’s not consent and is legally assault. 

One for professionals who say “my ladies”, perhaps we should be using alternatives such as “women I work with… women I support”. Using the word “my” implies ownership. It implies control. 

Then we have gaslighting and guilt tripping involved. Gaslighting is a series of techniques that make the person its being done to feel confused and like they are wrong. Done to assert control and power. 

I would say, controversially, that birth debriefs (especially by the same person in the same unit) are a form of gaslighting the parents. (But debriefs are a whole other topic for another day) 

So, how does gaslighting exist in maternity? Usually if you’ve had one thoight and then come away with a different thought and not really sure how it happened. A lack of informed choice is likely happening which is coercive as the full information hasn’t been given therefore gaslit and manipulated into one way.

Again, this is not saying maternity workers are just abusing women. They’re not. There’s a systematic and societal problem teaching people that authority and power is good. 

As a birth worker and mental health worker it can be easy to assert authority to get someone to react favourably to your needs and often many do not even know they are doing it.

I believe if everyone has their power then no one needs to take any. 

I’ve worked in healthcare for around 18years now and we are STILL having the same conversations around power, control, coercion. This is NOT acceptable. It’s time to change this.

When a family asks questions we don’t like, let’s not scoff, let’s not talk about them in the staff room and definitely not in network meetings!  Take it to supervision! 

Let’s give workers decent supervision. Let’s give them decent breaks and pay. Let’s not burnout our care workers. Don’t accept toxic workplace environments. 

Parents, ask the questions, you have a right to know, you have a right to say no. Healthcare workers are there to care for you, but they are not the authority of you or your baby, you are. 

In short, society grooms is all to listen to authority. We’re therefore groomed to do whatever we’re told by healthcare staff. Healthcare staff do want to help and support. We need a huge societal shift but we also need to challenge behaviours that don’t allow for choices to be respected. 

Treating trauma -CPD isn’t enough

I’m just going to say it. You can’t treat trauma on a few days class.

This may be somewhat controversial and is short and rambly. I may write deeper later.

Trauma is a complex psychological and physiological situation that even the highly experienced and trained academics and mental health workers continue to discuss. 

There’s quite the influx in people doing a 1-3 day course and then selling themselves as “trauma specialists” and that they can “treat trauma”. A lot of these courses require little to no previous experience or training. (I wouldn’t count most Doula training courses  in being adequate enough and would even question whether some degrees are). 

With something such as trauma, a person seeking help could actually have worse outcomes from someone inadequately trained than they would without. I’ve seen it, I’ve had health workers contact me to ask if it’s our doulas providing this “treatment for trauma” as women have reported horrendous outcomes. It isn’t. I know our Doulas aren’t able to do that. That’s why we have Counsellors with trauma training and experience. Yes, therapy can make things feel worse before it gets better but it seems there’s a lack of this with such training. It’s really not possible to learn how to hold the space within trauma within a few days. 

Doulas are amazing and can help massively in subsequent births but they do not “treat traumatic birth” nor provide “healing birth services”.  Midwives also can’t treat trauma. What we can do is help to inform and aid a peaceful birth space. As birthworkers we really need to look at where our competencies lie. 

If you’ve done a few days training in trauma awareness or “birth trauma treatment” then it’s really not likely you can “treat trauma”. Even if your clients don’t return it doesn’t mean you’ve done the job well and they are cured. It’s likely your training taught you how to respond to trauma and that is great and fantastic knowledge that’s needed and more of it. 

As I said at the beginning, trauma is complex. There are whole degree modules and postgraduate qualifications in the area. In working  in counselling and psychotherapy I know that just because a person doesn’t return, it doesn’t mean they feel better. 

The emotions and feelings associated with trauma do not tend to fit a neat little package. Being trauma informed is great to help with understanding and how to not further impact upon trauma as professionals. This and other cpd type training can not possibly be adequate. 

If you do want to learn about trauma then please check the qualifications and background of the person doing the training. 

If you are in need of some support with your own trauma then please check what the training of the person is and how long they trained for. 

Should we be grateful for a bad outcome?

So many times, I am hearing and witnessing new parents being grateful to the “professionals” for saving them and their baby. Where this is true, the healthcare staff do save lives. What appears to be worrying trend to thank the interventions that may not have actually been necessary and actually caused the need to be “saved” in the first place.

Statistics show that on average in the UK 70% of births have some form of intervention happen. Do we really think that we have evolved so only 30% of humans can birth the next generation without help? Yes, epigenetics may be having an effect on this (watch for new blog post) but to such an extent? I’m really not convinced this should be so low.

Therefore, these interventions will, mostly, be unnecessary.

In practice as a Doula and trainee Counsellor working in this area, I am seeing that when women realise that what happened to them may not have needed to happen, they have a whole range of emotion. Anger, distress, sadness, anxiety, distrust, the list goes on. I also see women coming and saying, “They saved mine and my babies life, so why do I feel this way.”  “It was done to me, not with me” Then they do not wish to approach what happened in any detail and piece things together. Mothers, and fathers seem to enter a dissociated state, a trauma state.

Acknowledging that those who “saved” a mother and baby may actually be the one who caused the need to be saved is a really difficult journey and should not be ignored. Many parents come to us quite angry at what happened. “It was done to me. I didn’t know I could say no, I trusted them.”. This is NOT consent.

Gaslighting is a term used to describe what abusers do to their victims in order to manipulate them to be grateful to the abuser. Even manipulating the victims version of really that they doubt their reality. It appears this may be happening on a societal level.

All this is not saying that maternity professionals are deliberately causing harm to then save women and babies. This appears to be more a societal/ cultural issue. “Well at least you have a live baby”. “At least we have a free health service” “they do what they can with limited funding”. Should we be grateful for limited care? The worry within the medical professionals to act before a major incident could be contributing. The worry of litigation. The lack of education around birth expectations. The overworking of staff. The lack of funding within the health care system. Many factors can be contributing to this.

So, what can birth workers do? Listen, even if a mother comes to us reporting these things, listen. Do not dismiss.

What can we do to prevent this? This can be a difficult balance. Sometimes intervention needs to happen to save lives. Consider if the intervention is too soon and a bit panicky. For example, is this induction truly clinically indicated if she is 40+10? Does the mother and father have the full range of information to make the decision? Time can be limited to do this, I know. So, let’s think how this can be done. The lack of funding in the NHS is a real problem. Staff and the public all feel it. I’m not sure how that can change anytime soon without a real shake up of government policy. (a whole other blog/debate) I do believe that we can all ease the burden of this with compassion and acknowledging where we may get it wrong.

Antenatal education is important! Find an antenatal class or Doula who can give all the information for all eventualities so you, as parents, can have all the information available before you could be in the moment needing to make a quick decision. In our classes we talk about the BRAIN.

Benefits – what are the benefits of doing or not doing this?

Risks – What are the risks associated?

Alternatives – What alternatives are they? True alternatives. Not just carefully selected alternatives to coerce into something.

Instinct – what is your instinct saying? Listen to it, it is important.

Nothing –  what happens if you do nothing? Can you just wait? With any decision there is always the option of doing nothing.

Second opinion or Smile – Can you have a second opinion? Or just smile and ask for some time to think. Even if 1 minute.

Everything pregnancy and birth related is the choice of the parents. More than that it is the choice of the mother.

If you are afraid to say no, then it is not informed consent.

If you are reading this and are feeling some distress or that something like this has happened to you then please call us, we have trained staff to talk to. Or contact your local mental health team, Birth Trauma Association, Samaritans.

You can also feedback to your local maternity and health service as they do want to learn how to make care better.

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