Cheyenne, a birth educator and mother, asked how our birth story-listeners and instructors respond when obstetric violence comes up in birth story sessions. She wrote:
”I’ve been eyeing Birth Story Medicine courses for some time, thinking about signing up. I feel drawn to most of what I read throughout the website and adore Pam’s books. The one concern I have is how Birth Story Medicine names and deals with the topics of iatrogenic harm and obstetric violence. I understand there’s a sensitivity to not simplistically assign blame when systemic harm is part of the picture, but as a birth educator who helps mothers understand the physiologic blueprint of birth, I have seen mothers experience relief and [feel understood] when this common aspect of birth trauma is held and named in a mindful way. I’d love to hear what you have to say about this as instructors.”
Dear Cheyenne,
Thank you for your question, it’s a good one, and one that comes up often among students in the Birth Story School and is worthy of contemplation. For decades, I have been cultivating equanimity, inquiry, and empathetic acknowledgment when guiding birth story sessions. These qualities guide our approach in responding to dehumanizing care and obstetric violence.
In the industrialized medical system both patients and their providers often feel objectified or dehumanized. For providers, this can result in a lack of patience, information sharing and empathy in addition to burn out and negligence. Parents who felt objectified, deprived of dignity or decision-making share feelings of unworthiness, invisibility, powerlessness, and disappointment, often lamenting their experience did not match their expectations.
In my experience, parents seldom use the terms obstetric violence or iatrogenic harm to describe their experiences. Still, I often infer it from their emotions as they recall particular moments that felt dehumanizing, such as in the list below:
• Disrespectful, depersonalized, dehumanizing care
• An unequal power dynamic.
• Verbal abuse: shouting, scolding, shaming
• Dismissive attitudes, minimizing feelings, lack of empathy
• Abandonment of care or ignoring requests for help
• Lack of information or consent or coercion
• Disrupted newborn bonding
• Psychological trauma from avoidable injury or death
• Sexual abuse, lack of privacy
• Discrimination, unconscious bias
The Importance of Empathic Acknowledgment & Equanimity
Cheyenne mentioned the tremendous value of a client feeling understood. As birth story listeners, empathy is a crucial part of our work. It's our starting point in every session; it's the foundation that builds rapport so that the story can be shared and heard in the deepest way. Empathy melts feelings of blame, both for ourselves and others. When clients receive genuine empathy and care from us, the beauty is that they start to extend that compassion to themselves.
However, a problem occurs when a story-listener thinks commiseration is a form of empathy. While both can create a feeling of being understood, commiseration tends to assign blame, keep the narrative externally focused, and reinforce the victim mindset; this can further disempower storytellers rather than promote constructive healing and personal growth.
Story-listeners who have developed equanimity remain non-reactive (i.e., unattached to a specific outcome); this is essential to empathize with the suffering of the storyteller, their caregiver, and the system. This practice develops a radical acceptance of the nuanced reality of the situation and enables them to see possible paths to alleviate suffering.
Even the most attentive story-listener may not have enough information to decide whether a storyteller’s experience was obstetric violence, negligence, "bad bedside manner," iatrogenic, or mistreatment. Our work does not include deciding this. So, we refrain from labeling it as such for the storyteller. Instead we guide them on a journey of personal discovery, making the hour we spend together more meaningful.
Repeating emotionally charged words or phrases reinforces a single narrative which may result in “semantic satiation,” a phenomenon that can dull the story's impact and stop the storyteller's inner search for meaning.
Semantic satiation occurs when a word or phrase loses meaning and impact due to excessive repetition. The brain becomes desensitized by repetition, tunes out, and stops making accurate associations regarding the intended meaning. Instead of repeating terms like "obstetric violence” or “being violated,” we should guide the storyteller to objectively describe what happened and what they felt then—and now (while withholding personal opinions).
“One of the most difficult things is not to change society,
but to change yourself.”
—Nelson Mandala
One of the philosophical tenets of Birth Story Medicine is that each session is a personal healing journey. Therefore, our emphasis during these sessions differs from discussions about what should change in birth in our culture. Instead, we begin each training session by committing to self-awareness by examining and challenging our limiting beliefs and judgments.
When we prioritize the storyteller’s experience, their story unfolds in a way that reveals insights not yet seen. As storytellers turn their attention inward, they become aware of how repeating what happened in the past is affecting their lives now, and this motivates them to work toward changing what they are telling themselves. Changing this perspective changes their story and their relationships.
There are more layers to explore regarding this topic. In our training and personal mentoring, we delve deeper into the heart's question and breadth of possible solutions to create transformative change in storytellers. In a future blog I’ll say more about iatrogenic harm.
A final thought to contemplate:
“When we think of all the cruel things which occur in our world it is easy to lose hope. … It becomes easy to judge others, to point the finger at wrong-doers. . . Society becomes so easily polarized and divided along lines of nationality, class, color, or caste. . . [and beliefs]. We need to choose a different way. If we behave in a manner similar to people whose actions we disapprove of, what makes us different from them?
We have to choose the path of Love which is as powerful as lightning.”
—Hanuman Das, A Guide to The Hanuman Chalisa1
+ Footnotes
Our birth story listening students' training begins with self-awareness, examining their belief system, assumptions, and stories they tell themselves about birth in our culture. I drew the wisdom of this focus from a life-changing apprenticeship in the Toltec philosophy introduced by Miguel Ruiz in his renowned Four Agreements and series of books and trainings. Toltecs refer to our waking state of awareness, conscious and unconscious perceptions of the world and others, as “dreaming.” The moment Alan Hardman, my Toltec teacher, whispered in my ear, “Remember, You are Dreaming,”… my (understanding of) ‘dreaming’ changed. For the last twenty years, I’ve been remembering and forgetting that teaching, and when I forget, I inevitably create separation and suffering.
In the mega-industrialized medical model, I wish but doubt there could be a solution to burnout, mistreatment, iatrogenesis, obstetric care insensitivity, and violence. My doubt comes from having worked in the stressful environment myself. And from knowing that every minute, every human on the planet is dreaming a personal “dream” (interpretation) of whatever is unfolding—not based on “choice” but unconsciously from the conditioned mind.
When two people agree on what is happening or what should happen next, this agreement creates positive feelings, rapport, and harmony. Unfortunately, symbiotic dreaming (shared understanding) in our polarized medical-health model is rare. Disharmony increases when the patient and their caregiver see the situation, management, or protocols from different perspectives. When two or more people in a shared space and time don’t dream the same dream (share the same vision) -- whether in a private conversation or medical consultation -- they may feel misunderstood, unsupported, unworthy, and disrespected--and therein, the conflict begins.
The stronger we identify with a belief, such as what safe childbirth means or how to achieve it -- the stronger our judgments become, increasing the likelihood of a rift in the human connection. It would help if both parties “remember they are ‘dreaming’ and take things less personally.
Personal change work is an inner process. While a birth story listener may also be an activist committed to political or social change in our culture's birth practices, during private sessions, as a listener, she should set aside her activist role. Listeners should refrain from labeling an incident as “obstetric violence” or “iatrogenic harm,” regardless of how the storyteller perceives it. Instead, we focus on inner work, reclaiming peace of mind, and transforming suffering and negative beliefs into new meaning. While there are many paths to a new understanding, the storyteller needs to slow down to reflect on unwelcomed interactions, their perceptions, and the present meaning they are currently giving those experiences.
Citation
1. Hanuman Dass, A Guide to The Hanuman Chalisa. Daya press p. 70
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