Birth trauma is common, NOT normal.
My response to the birth trauma inquiry.
Before I begin, I must emphasise—please share this message widely! It's a common misconception that the topic of birth doesn't concern everyone. However, we all come into this world through birth, many of us know someone who is pregnant, and we all have a fundamental responsibility to support women in taking ownership of their birthing experiences. The way we are born is critically important.
Birth Trauma Inquiry
Recent headlines about the inquiry into traumatic births confirm what many of us have feared for a long time. Unfortunately, poor treatment during childbirth has become normalised, but being common does not mean it's acceptable. I've been advocating for awareness on this issue for years. Following today's media coverage, I hope more people will become aware and take active steps to ensure their health and birthing experiences are handled with the respect and care they deserve.
Nickita Starck on the Doc Malik Podcast - The Truth About Childbirth - See more episodes here
When Push Comes To Shove
For those of you who don’t know me ,my name is Nickita Starck, and I'm the founder of When Push Comes To Shove, a decentralised maternity support organisation. We specialise in helping women navigate the complexities of the maternity system through our deep understanding of human rights in childbirth. Additionally, we offer support to women who choose to birth outside the system entirely. With 15 years of experience as a holistic birth keeper, I also run accredited training courses, and we now boast WPCTS doulas and birth keepers in 10 different countries.
I was compelled to start this movement because the issues you have read about today the news are not new. Frankly, many women experience their childbirth being undermined by a maternity system that is fear-driven and often not backed by solid evidence.
I'm not here to extensively criticise the maternity system—it's not productive. Instead, I focus on creation over criticism, blending intelligence with wisdom. While the current system may function efficiently on its own terms, it often fails the very women it's supposed to serve.That being said, it is important for women to have informed consent, and in order to do that you need information! I have no intention of ‘fixing’ the system, I am here to show women a new path. I'm here to tell you there's another way! You have the right to question what you're being told and to decline any procedure. Too often, women enter the system full of trust, only to leave feeling downtrodden and traumatised, misled into believing their bodies have failed them.
Why has birth trauma become common?
Let's set the scene with a typical pregnancy journey to provide some context. Often, there is a glaring lack of continuity of care in the current system—many women don't see the same midwife consistently throughout their pregnancy. This inconsistency significantly increases the risk of traumatic outcomes. Women feel unsafe with unfamiliar faces, often describing feelings of being bullied and ignored. Despite this, many still place unwavering trust in a system without knowing the essential questions to ask.
Nutrition, a critical component of prenatal care, is rarely a focus. When discussed, it's typically treated as a mere checkbox, not a priority. However, understanding the relationship between blood volume expansion in pregnancy and the role of protein could dramatically reduce complications like preeclampsia and placental abruption. Yet, this vital knowledge isn't emphasised in standard care.
Shockingly, only about 8% of maternity care practices are based on Category A evidence (Prusova, Tyler, Churcher, and Lokugamage, 2014). This means that when women are told what they can or cannot do during pregnancy, these directives are often not backed by solid evidence. Furthermore, the common practice of inducing labour based on predictions of a 'big baby'—which often turns out to be incorrect due to a 15% margin of error in scans—is rarely questioned. This issue highlights the systemic gaps and the critical need for informed choices in maternity care.
Is it normal for our bodies to fail us?
This leads us to discuss the issue of induction. In some hospitals, the induction rate is alarmingly high, reaching up to 50%. For such rates to be justified, one might assume that human bodies have suddenly become incapable of natural childbirth without medical intervention. A typical scenario unfolds as follows: women are told they are "overdue" and therefore "must" be induced. Many believe this directive is non-negotiable and feel compelled to comply without question, assuming that the medical professionals have their best interests at heart. They are often unaware that guidelines are, in fact, optional, and might still consent under the belief that their baby could be at risk if they do not comply. What I find even more devastating is that women even believe that their body genuinely failed them, and will never correlate the domino effect of intervention being the cause of their trauma.
It's important to stress that while there are genuine medical emergencies where medical intervention is necessary and should be appreciated, this should be the exception, not the rule. The problem is that the maternity system often treats women like they're on a conveyor belt, leading to numerous negative experiences that are frequently a result of standard hospital procedures.
Moreover, the concept of being "overdue" needs critical examination. Every woman is different—with varying cycles, ethnic backgrounds, and other unique factors. Our bodies are not machines with an expiration date, and it's vital to challenge one-size-fits-all approaches to childbirth.
The induction process
Before I continue, I must clarify that not every woman will undergo this exact experience, but it remains a prevalent scenario, and it's crucial that women are aware of the risks involved. More importantly, for those who opt for induction, understanding how to minimise interventions during the process is essential. This isn't about inciting fear; it's about empowering women to make informed decisions.
Let’s consider the induction experience of "Emma"—does this sound familiar to you? Emma was advised to undergo induction because her baby was "overdue," and she was told the risk of stillbirth "doubled" after 41 weeks. That's a frightening statement, and it's no wonder Emma didn't question it. She likely had no reason to doubt the professionals around her. But what if Emma had asked a simple yet critical question: "Double of what?" The specifics matter. Is the risk doubling from 1 in 500 to 2 in 500, or from 1 in 5 to 2 in 5? Actual numbers are vital. Here are the stats:
Risk of unexplained stillbirth by gestation:
At 35 weeks: 1 in 500
At 37 weeks: 1 in 556
At 38 weeks: 1 in 645
At 39 weeks: 1 in 730
At 40 weeks: 1 in 840
At 41 weeks: 1 in 926
At 42 weeks: 1 in 826
At 43 weeks: 1 in 769
At 44 weeks: 1 in 633
Cotzias 1999
Recent research, such as that by Rydahl et al. (2019), has questioned the value of recommending induction at 41 weeks and three days instead of waiting until 42 weeks. The studies highlight a lack of benefit and even point to increased risks associated with earlier induction.
Perhaps if Emma hadn't been so frightened, she might have taken a moment to tune into her gut instinct—a powerful intuition often overlooked, surprisingly, by other women. So, Emma proceeds with the induction. It begins with 'prostin,' but that doesn't kickstart sufficient contractions. Her waters can't be broken because, simply put, her body isn't ready. That's when the medical team opts for 'syntocinon'—the drip.
However, Emma isn't informed about the risk of uterine hyperstimulation or the increased likelihood of a caesarean section and other interventions that might follow from this approach—starting a domino effect of medical actions. Now, Emma finds herself essentially confined to a bed, unable to use gravity to aid her baby's descent, positioned unnaturally for birth, although it's convenient for the midwives. They can perform vaginal examinations more easily—a choice Emma wasn’t informed she had, so she reluctantly complies.
The intensity of the artificially induced contractions overwhelms Emma, leading her to request an epidural for the pain. This epidural, containing 50% bupivacaine and 50% fentanyl, slows her labour further, prompting an increase in the syntocinon drip rate. Emma, unaware of the specific contents and their implications, assumes the epidural is safe.
Emma's experience continued to deteriorate over the next few hours as several different strangers conducted vaginal exams—interventions she didn't realise she could refuse. Why? Because such deeply ingrained generational trauma often prevents women from questioning whether they are comfortable with these procedures. Some may argue that these exams are necessary, but it's essential to question their true utility. Vaginal exams provide information only about the position of the cervix at that specific moment, not where it will be in the next few hours or even minutes.
This highlights why informed consent is critical in maternity care. Just today, a headline read, "I wasn’t believed and gave birth in the toilet." Such stories underline the importance of understanding and exercising your right to consent. Vaginal exams, like any medical procedure, require your consent—you have the right to say no.
As Emma's induction progressed, the excessive stimulation from the drip began to compromise the oxygen flow to the placenta, and unsurprisingly, the baby, who was not yet ready for birth, went into distress. The situation escalated rapidly when Emma, already terrified, saw six people rush into her room where she was confined to a bed by a CTG machine monitoring fetal heart rate and contractions. Her baby's heart rate had dropped dramatically.
In a flurry of urgency, Emma was whisked into the operating theatre for a caesarean section. Amidst the chaos, she thanked the medical team for saving both her and her baby's lives. Yet, despite their survival, Emma walked away deeply traumatised—haunted by the significant blood loss, the near loss of her baby, and feeling a profound disgust towards her own body. She believed firmly that "if this had been a home birth, both I and my baby might have died."
This scenario raises a critical question: Would the cascade of interventions have occurred if Emma had gone into labour naturally, without medical inducement? This reflection underscores the importance of understanding all potential outcomes of elective medical interventions and considering how a natural onset of labour might have differed in outcomes. It’s essential for expectant mothers to be well-informed and feel empowered to make decisions that align with their values and understanding of risk.
Emma’ second birth
Emma shared her story with me after hearing me speak on a popular health podcast. I had described her exact experience, so she felt the urge to reach out. She knew something wasn't right about her first birth experience; she felt let down by the system rather than her own body and was determined to approach her second pregnancy differently. Labelled "high risk" without any clear, individual-specific reasons, Emma was ready to take charge of her birthing experience.
She reached out to When Push Comes To Shove for holistic, non-clinical support. With my guidance as a natural birth keeper, Emma addressed her diagnosis of gestational diabetes through diet alone and saw remarkable improvements within just 10 days. Empowered by her newfound knowledge and support, she chose to have a home birth following her previous caesarean. This time, there were no interventions, no one telling her what to do, just her own motherly instinct and an abundance of love based support around her. Emma caught her own baby, leading to a profoundly beautiful and life-changing experience.
Healed from her initial birth trauma, Emma educated herself further, took one of my courses, learned her rights, and took full responsibility for her birthing journey. This transformation allowed her to regain control and ensure her birth was an empowering experience.
Emma is not alone in her journey. Fortunately, she realised that she had choices. She actively gave birth, rather than simply having birth happen to her. At When Push Comes To Shove, we don't subscribe to dogma or tell women how they should give birth—there's already a system for that, and we want no part in perpetuating it. Instead, my colleagues and I advocate for choice, informed consent, education, and empowerment. We encourage making decisions based on love, not fear.
Take control of your birth experience
There is indeed another way to advocate for yourself and another way to approach birth. At When Push Comes To Shove, we serve women, not the system. We even have an access fund for low-income families because we believe no one should be denied continuity of care. Our outcomes speak for themselves: a 77% home birth rate, an 11% caesarean section rate, and only 4% of mothers we serve give birth on their backs. While we aren't serving thousands yet—only hundreds—I urge you to consider our statistics thoughtfully.
Ask around you—just five people—and see how many had caesarean or vaginal births. The statistics might surprise you. We even have birth keepers who were former midwives; since training with us, they have achieved a 100% vaginal birth rate over two years of practice. Let this be clear: there is nothing inherently wrong with the pelvis of a woman in 2024. Women of the world, empower your birth. You have a choice, and it's yours to make.
In conclusion, our journey through the intricacies of modern maternity care reveals a landscape where informed choice and empowerment are not just beneficial—they are essential. This won’t change from the system, this has to come from YOU. Ask questions, get yourself a birth keeper or doula. Do the inner work to uncover core wounds, take courses, read books and arm yourself to the teeth with knowledge. From the universal significance of birth to the personalised account of Emma's experiences, we have seen how critical it is for women to be fully informed and actively involved in their birthing decisions. At When Push Comes To Shove, we are committed to dismantling the outdated practices that dominate the current system and to create an environment where women can choose their birth paths without fear or coercion.
Peace on earth really does begin at birth. We are not broken, we do not need saving, we need to remember who we are, take control of our bodies and realise we do have choice. By sharing this message, engaging in informed discussions, and supporting initiatives like ours, we can contribute to a future where birth is not just a medical event, but a celebration of life, strength, and empowerment.
Use us!
If you need support navigating the maternity system and would like a birth advocate, doula or birth keeper, please get in touch. We offer non-clinical, holistic for women who would like to have an empowered birth experience.
https://whenpushcomestoshove.co.uk/services/doula-birthkeeper-services/
Train with us
If you would like to help prevent birth trauma as mentioned above, train with us! Change the world, one birth at a time.
https://whenpushcomestoshove.co.uk/courses/doula-training/
