Opinion: Canadian mothers need a shift in the culture of maternity care

https://montrealgazette.com/opinion/columnists/opinion-canadian-mothers-need-a-shift-in-the-culture-of-maternity-care

A shockingly high number of women in Montreal report experiences of negligence, abuse, disrespect and coercion during and after giving birth.

SUPARNA CHOUDHURY, SPECIAL TO MONTREAL GAZETTE Updated: May 22, 2019

Perhaps no one is prepared for the unique mix of numbing exhaustion and intense emotions at the beginning of motherhood. We read about it and we are told about it, but it’s not until we go through it that we understand how dramatic the changes can be to our bodies, emotions, identities, careers and families.

Now the latest science — neuroscience and epigenetics — teaches us that the foods we eat, the yoga we do, the calm we maintain and the conflict we avoid all give rise to happier, healthier babies and mothers. It tells us through the authority of brain scans and methylation patterns that our choices and environments shape our biology and mental health, and the brain development of our babies.

What happens, then, when in the most pivotal moment, women cease to have choices about their environment, and when their chosen place of birth does not offer the safety and security necessary for a positive experience? A shockingly high number of women in Montreal report experiences of negligence, abuse, disrespect and coercion during and after giving birth. For example, a 2009 report by the Public Health Agency of Canada found that after Nunavut, Quebec had the lowest reports of satisfaction with postpartum care, at 56.8 per cent. The implications are significant: increasing data on birth trauma is emerging and numerous studies report that maternal stress can induce permanent negative effects on the developing fetus and even impact subsequent generations via epigenetic programming.

Our encounters with new mothers in the community, as volunteers, doulas, researchers and health-care workers, reveal that far too many women in a country with an advanced medical system feel failed by the hospital that they entrust at one of the most important junctures of their lives. The number increases by several orders for women of colour.

We find women reporting that their requests during labour are too frequently ignored, their perceptions and sensations undermined. They are infantilized and handled roughly, and they lose their sense of agency when they feel it matters most. Postpartum, they describe feeling lost in the system, ignored by their obstetricians and misinformed. They begin their journeys of motherhood riddled with doubt, confusion, pain and frustration. Unfortunately, Quebec appears to be leading the way in medicalizing childbirth practices. For instance, it is the province with the highest rates of epidural administration (72.7 per cent) and episiotomy use (24.1 per cent) even though both the World Health Organization and the American College of Obstetricians and Gynaecologists recommend restricted use of this surgical incision. Again, vulnerable populations experience this in especially pronounced ways, as they may not be informed of their medical choices. 

State-of-the art science advises women to make sensible choices that reduce health risks for the baby. But the responsibility should not simply lie with the individual mother; the medical establishment must examine its own role. 

We need a serious debate about the accountability of hospital birthing centres. We need to look beyond Canada for models of care and regulation that ensure prevention and meaningful recourse after medical malpractice or mistreatment. Scientific research, with all its authority, might even begin to investigate the biological and mental health effects of the role of (in)justice for the mother and baby after birth. Mothers in Canada need a shift in the culture of maternity care: it doesn’t take science to tell us that the dignity of a birthing woman leads to healthy outcomes; this dignity should be an end in itself. 

Suparna Choudhury is an assistant professor, Division of Social & Transcultural Psychiatry, at McGill University. Millie Tresierra is a birth and postpartum doula, and maternal mental health advocate. This article is co-signed by  Leonora Gangadeen-King, member of Tiger Lotus Coop for reproductive health and PhD candidate in maternal mental health, Department of Psychiatry, McGill University; and Courtney Kirkby, practitioner in women’s health, Tiger Lotus Coop for reproductive health, Montreal.