Listening to Women: What Maternity Systems Must Hear

How many times must we ask for sensitive care?

Over nearly two decades of clinical work in perinatal mental health, I have listened to women describe experiences of birth trauma rooted not only in medical emergency, but in the absence of respectful maternity care.

A Composite Narrative

Note: The following vignette is a composite of many women I have seen over nearly two decades as a licensed psychotherapist, childbirth educator, and doula. Any resemblance to one particular person is coincidental.

She sat down in my office with exhaustion in her eyes.

Her baby was healthy. Breastfeeding was going well. She loved her child deeply. On the surface, things appeared “fine.”

But something had shifted during her birth experience.

She described being spoken over. Procedures performed without meaningful consent. Staff joking with one another while she lay exposed and afraid. Requests dismissed as trivial. She felt observed, not cared for.

“I felt less than human,” she said quietly.“I can’t stop replaying it. Will I ever feel like myself again?”

Over the years, I have heard variations of this story in different forms, from different hospitals, under different circumstances. The medical charts may read “normal delivery.” The outcomes may be described as “successful.”

Yet the emotional themes are strikingly consistent: powerlessness, loss of dignity, abandonment, humiliation, and a profound sense of being unseen during a moment of immense vulnerability.

Women are not asking for perfection. They are asking for humane care.

Empirical research identifies that experiences of mistreatment and discrimination during childbirth predict more negative subjective birth experiences, which in turn are linked with more severe birth-related PTSD symptoms.

When Birth Becomes Traumatic

Researcher Cheryl Beck defines traumatic childbirth as an event in which a woman experiences actual or threatened injury or death to herself or her infant — and/or feels stripped of her dignity during the experience.

Because childbirth is a common and “normal” event, it might be difficult to understand that a mother may find her experience to be “traumatic” in the same way as, for instance, war may traumatize a young soldier.

In my clinical practice, I’ve come to understand birth trauma in two broad categories.

The first is the kind most people readily recognize as traumatic: births marked by clear medical danger—preterm birth, preeclampsia, stroke, hemorrhage, or other life‑threatening complications—or situations where the baby is stillborn, injured, or faces a life‑threatening crisis.

The second category is about the woman's lived experience. It's when the birth is outwardly normal, but the mother experiences treatment as callous, does not feel as if she gave informed consent, or there were many medical interventions that the medical team viewed as necessary but were experienced by the mother as unwanted, coercive or violating.

The emergent themes of this type of birth trauma are consistent: powerlessness, abandonment, being stripped of dignity and worth, loss of control and feelings of actual body and emotional victimization. Many birthing women describe feeling disconnected and alone. And that is how this feels traumatizing: during the most significant event in her life, childbirth, the woman feels devalued and dehumanized.

Research reveals that women report higher levels of birth-related psychological trauma when respectful maternity care is perceived as low, and that respectful care is associated with fewer trauma symptoms.

Post-Traumatic Stress After Childbirth

Data suggest that a measurable percentage of women meet criteria for postpartum PTSD following childbirth — emphasizing that psychological impact is not rare.

After a distressing birth, many women experience post-traumatic stress (PTS). This can include intrusive memories, hyperarousal, dissociation, sleep disturbance, shame, anxiety, or emotional numbing.

For many, these symptoms gradually resolve as the nervous system processes and integrates the experience.

For a smaller percentage — estimated at approximately 1–6% of birthing women — symptoms persist and intensify, meeting criteria for post-traumatic stress disorder (PTSD). Risk increases when there is a prior history of trauma, particularly sexual abuse.

Importantly, these responses are not signs of weakness. They reflect the body and mind attempting to make sense of an overwhelming event.

A Systems Question

Integrating Mind–Body Support into Maternity Care

For three years, I served as a MindBody Specialist at a hospital-based Cancer Center. Through grant funding, patients were offered guided imagery, expressive arts, Reiki, meditation instruction, and integrative psychological support alongside medical treatment.

Emotional care was not an afterthought. It was embedded in the model.

Patients undergoing chemotherapy were recognized as whole human beings — with fear, identity shifts, family dynamics, existential questions, and nervous system stress. Support was normalized, visible, and accessible.

Childbirth, too, is a profound physiological and existential event. It carries vulnerability, identity transformation, and intense nervous system activation.

And yet, in many maternity settings, integrative emotional support is inconsistent or absent.

Childbirth, too, is a profound physiological and existential event. It carries vulnerability, identity transformation, and high emotional intensity.

And yet, integrative, trauma-informed support in maternity settings remains inconsistent.

It's difficult for me not to notice the contrast.

What Integrative Maternity Care Could Look Like

Trauma-informed maternity care does not require dismantling medical expertise. It requires expanding it.

Reviews and clinical guidance increasingly emphasize trauma-informed frameworks — including screening, continuity of care, and communication practices — as essential to compassionate maternity services.

Imagine maternity units where:

• Guided relaxation or imagery is available alongside induction protocols.

• Staff receive training in nervous system regulation and trauma-sensitive communication.

• Postpartum debriefing is routine, not exceptional.

• Emotional processing is normalized as part of recovery.

• Women who feel shaken are met with validation rather than dismissal.

  
  

Mind-body programs are not “extras.” They are protective factors.

They buffer stress physiology. They reduce shame. They support bonding. They may reduce long-term mental health complications.

When we know that birth can alter the nervous system profoundly — for better or worse — the absence of structured emotional support becomes harder to justify.

Toward Dignified Maternity Care

Studies exploring patient preferences find that pregnant people want trauma-sensitive care environments and meaningful, respectful conversations about past trauma and emotional needs.

When women describe birth trauma, they are not rejecting medicine. Many are grateful for lifesaving interventions.

They are asking for something fundamental:

• Clear communication

• Genuine informed consent

• Respectful tone

• Privacy

• Emotional attunement

• Recognition of vulnerability

  
  

Sensitive care is not a luxury. It's part of safety.

Over nearly two decades, I have watched women heal when their experiences are validated and their nervous systems are supported. I have also witnessed the long shadow cast when dignity is stripped away during childbirth.

We can do better.

Maternity care can be clinically excellent and emotionally humane. The two are not mutually exclusive.

And women should not have to keep asking.

Sources

Ahsan, A., Nadeem, A., Habib, A., Basaria, A. A. A., Tariq, R., & Raufi, N. (2023). Post-traumatic stress disorder following childbirth: a neglected cause. Frontiers in global women's health, 4, 1273519. https://doi.org/10.3389/fgwh.2023.1273519

Benton, M., Wittkowski, A., Reid, H., Quigley, T., Sheikh, Z., Smith, D. (2024).

Best practice recommendations for the integration of trauma-informed approaches in maternal mental health care within the context of perinatal trauma and loss: A systematic review of current guidance, Midwifery, 131 (2024103949)

https://doi.org/10.1016/j.midw.2024.103949.

Beck, C., Driscoll, J., & Watson, S. (2013). Traumatic Childbirth. New York: Routledge

Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010). Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. Journal Of Advanced Nursing, 66 (10), 2142-2153. doi:10.1111/j.1365-2648.2010.05391.x

Ford, E., & Ayers, S. (2011). Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology & Health, 26(12), 1553-1570

Koç, Ö., & Oğlak, S. C. (2025). The effect of respectful maternity care on the perception of traumatic birth among mothers in southern Türkiye. BMC pregnancy and childbirth, 25(1), 532. https://doi.org/10.1186/s12884-025-07553-9

Porstendorfer-Almeida Froz, C., Vollert, B., Hansen, I., Schurig, N., Seefeld, L., Weise, V., Birdir, C., Wimberger, P., & Garthus-Niegel, S. (2025). Mistreatment and Discrimination during Childbirth, Associations with Symptoms of Childbirth-Related Posttraumatic Stress Disorder and the Mediating Role of the Subjective Birth Experience: A Quantitative Analysis Within the Prospective Cohort Study RESPECT _PARENTS. Geburtshilfe und Frauenheilkunde, 85(12), 1304–1325. https://doi.org/10.1055/a-2717-7798

Westphal, M., & Bonanno, G. A. (2007). Posttraumatic Growth and Resilience to Trauma: Different Sides of the Same Coin or Different Coins?. Applied Psychology: An International Review, 56(3), 417-427. doi:10.1111/j.1464-0597.2007.00298.x