In this paper, I will discuss how poetry can become a site of revelation, and a testimonial to the experience of perineal tear, episiotomy, prolapse and hysterectomy. By embracing a personal resistance to the coercive and idealised constructions of motherhood, I will consider the wider implications of maternal life writing which makes visible concealed obstetric/birth trauma and so creates scope for social change.
‘The Birth Trauma Association uses the term ‘birth trauma’ to describe the experience of [Post-Traumatic Stress Disorder] PTSD or PTSD symptoms after birth.’[1] Symptoms are similar to PTSD and include: hyper-arousal, functional impairment, numbing, and intrusive recollections, however, birth trauma is distinct from PTSD in that specific traumas pertain exclusively to birth and post-birth events. For example, ‘When a woman has given birth … she has to live with the baby, who will be a constant reminder of the traumatic birth.’[2] Furthermore, ‘… adrenaline and cortisol, which disrupt the functioning of the hippocampus, a part of our brain responsible for memory processing and consolidation,’[3] ensure trauma retains its sense of immediacy regardless of time passed. Cortisol is also known to have a negative impact on the hormone oxytocin which is instrumental in bonding and lactation and can impact a mother’s relationships.
Despite its harmful consequences, birth trauma has only recently been acknowledged and it is apparent that further creative and scholarly work is needed to increase the visibility of birth trauma and improve provision of maternal care. ‘Estimates of the prevalence of birth trauma range from 1.5% to 6% of women who give birth [and] … About 700,000 women give birth each year in England and Wales. At the low end (1.5%), this translates into about 10,000 women a year going on to experience full-blown PTSD [birth trauma].’[4] Birth trauma is a worldwide problem, and although the 2005 World Health Report[5] records 20 million birth-related illnesses from 136 million annual births, variable terminology hinders the assessment of birth trauma as a category within worldwide birth-related illness.
In January 2011 I experienced a traumatic birth. After an uneventful pregnancy, the heavily medicalized, forty-one-hour labor and consequent admission of my daughter into the Neonatal Intensive Care Unit (NICU) was devastating. My labor included the use of pethidine (a synthetic opioid pain medication) that rendered me unable to convincingly communicate my repeated concerns of maternal fatigue. By consenting to the use of pethidine, I had unwittingly relinquished my autonomy and the use of Entonox (oxygen and nitrous oxide) had further disorientated me. Thirty-hours into labor, I had begged for a cesarean section, confident that I did not have the energy reserves to give birth. Instead, I was administered syntocinon (a man-made hormone used to stimulate stronger contractions) which is widely acknowledged to further increase labor pain. I underwent multiple, painful canula reinsertions by a trainee midwife, and eventually was administered an ineffective epidural in which I felt excruciating pain in my right hip. I tore and underwent an episiotomy which was partially felt. Two attempts at a forceps delivery were made and eventually my daughter was hauled out with friction marks to her face.
Within a few hours of birth, my daughter was admitted to the NICU with an infection. The admission was a necessary but horrifying experience. We were fortunate, and my eldest daughter rallied. We were sent home after a week, stunned and fatigued in a way we had never experienced before. I struggled to hold the weight of my daughter because of the pain I was in. She was fragile and I was constantly anxious I’d be deemed an unworthy mother and she’d be taken from me. I avoided other mothers and babies and spent most days in front of the television trying to breastfeed. I struggled with being touched even by my closest relatives. This self-imposed isolation lasted for two years. I received no therapy until 2013 when my marriage had started to fail. We sought guidance and through that I started to access the therapy I needed.
I have grown to understand, not necessarily agree with, the causality of that first birth and that provided me with some solace. Medical intervention was necessary in the birth of my daughter due to her becoming stuck, but it was not timely, and I was denied medical interventions, such as a cesarean section in first stage labor. I was silenced by opioids and my pain dismissed. I was often left alone, disempowered and vulnerable. I’ll never forget the unkind words of the midwives who commented on the noise I made during contractions; who made me feel shame. I’ll never forget the agonizing damage to my sexual organs, the terror of sex, a subsequent pregnancy and birth in 2012. I also continue to be disheartened when reading medical studies, especially those involving episiotomies, that ‘Women’s views in the different policies were [are] not reported.’[6]
A few months after the birth of my second daughter (and that’s another story), I discovered a posterior vaginal prolapse, or rather my eldest daughter did, as I climbed out of the evening bath. Unsure as to what to do, I phoned the NHS out of hours service, where after some confusion I was asked in a condescending tone, whether I was sure I hadn’t left a tampon in. Taken aback that my body was viewed as ‘irrational and unknowable’[7] and too anxious to re-enter a hospital environment, I did not seek further medical intervention to correct the posterior prolapse until 2016, where fed up with the discomfort, I sought private gynecological care. The gynecologist identified both a posterior and anterior vaginal prolapse, the need for perineal reconstruction (from another tear left unstitched), hysterectomy, and the removal of my cervix and fallopian tubes.
Unfortunately, after the hysterectomy, despite repeatedly communicating what I felt was unusual post-operative pain, it was discovered seven days later, that I had been bleeding internally and a hematoma had gathered where my uterus had been situated. I’d also acquired an infection. A further two operations occurred, and I was frustrated that yet again my experience of pain had not been taken seriously until I was at the seriously sharp end of the situation.
I still struggled with intrusive thoughts about being cut, specifically episiotomy scissors, their straight blades and dull ends, the noise they made when cutting my flesh. I was enraged about the subjugation of my body and the complete disregard of my voice. I’d only begun to comprehend the harmful monist notion of mind-body dualism. I’d learnt that ‘… there is no clear distinction between inside and outside, and instead, a unity in which there is an inflection into body and mind.’[8] What had happened was injurious to all aspects me. I had retreated and no longer occupied the healthier, permeable space between inner and outer life. I needed to reclaim my estranged Self.Writing poetry was an uncomplicated source of positivity in my life. It offered an opportunity to make visible my experience of traumatic birth in a way that was not condemned to discrete areas such as hospitals or therapy rooms. As the ‘… human body is the site of the interaction between biological and social processes …’, writing poetry became my site for reconciliation. Poetry allowed me to explore my transforming identity as a mother which was not predetermined or mediated by social constructs, such as the toxic social notion that ‘… motherly virtue is associated with passivity and conformity …’.[9] I wanted to gaze at my own body and strive for a creative and emotional truth that would allow me to acknowledge the full capacity of my being.
These pursuits, however, felt insurmountable after years of expressive dormancy and trauma-induced disembodiment. How could I access and artistically embody my inner life? Embodiment literally means ‘the Word made flesh.’[10] I wrote down everything I could remember from the birth. My emotional reaction to this process was intense and unsettling, but it also initiated a deepening and expressive artistic force within my writing. At that point writing a collection of poems about my experience of birth trauma and mothering became a conscious decision.
I applied for a two-week residency at the Museum of Motherhood (M.O.M.) in Florida in 2017. I responded creatively to MOM’s varied galleries and exhibits and nourished my creativity. I also learnt about the power of working with symbolic and emotionally-laden objects, such as forceps. I went beyond a passive, object-centered approach, descriptive composition using just the five senses and instead, gauged my own object-driven ‘… organic – awareness of heartbeat, pulse, breathing, digestion’[11], ‘…kinesthetic – awareness of muscle tension and movement, also gravity, mass and density’[12], and ‘synesthesia [synesthetic] – a sense impression produced by another sense’[13] responses. This allowed for a sensual, full-bodied appreciation of the object. I had started to reclaim my selfhood by becoming an active producer of meaning. I questioned and began to rebuke the rigid and idealized cultural constructions imposed on me. This fuller-bodied approach allowed me to transcend difficult emotions and begin to articulate freely. I became:
‘… attentive to the blind spots of self-perception and bodily perception, attentive to the elisions that both obscure and render readable the objects of our gazes. It is, in its limitations, a mode all the more valuable for exercising and exorcising our griefs.’[14]
I had what writer, Barbara Turner-Vesselago describes in her book, Writing Without a Parachute a ‘… nervous breakthrough.’[15]
Some months later, I purchased a pair of episiotomy scissors similar to the ones used during my procedure. When holding the scissors, I experienced nausea and an anxiety-induced tightness in my chest but coupled with techniques I’d learnt from Acceptance and Commitment Therapy (ACT), I worked towards accepting my emotions and was flexible enough with them to begin to write. Contact with the scissors became a repeated action of ‘surrender’,[16] and I began to free-write. Turner-Vesselago posits this approach as a:
… ‘surrendered’ way of writing, [where] you become truly present for what comes up as you write, with an open heart, able to let things emerge on the page that you didn’t anticipate. You may find you’re able to convey human complexity at a depth that surprises you or proceed on the basis of insights you didn’t know you’d had.[17]
I opened myself to the scissors object-centered and object-driven capacities in a sensitive and self-aware manner. This process of surrender was self-revelatory and creatively compelling and offered a deeper cross-examination of my lived experience. I was able to both reflect and interrogate what episiotomy scissors represented to me? What did they say about my culture?
The scissors represented failure: the failure to take into account mothers’ experiences and attitudes towards episiotomy; the failure to provide timely and adequate education of mothers in the antenatal period about the short and long-term consequences of episiotomy; the failure to equip ourselves to make informed decisions before we are under physical and psychological duress. By equipping ourselves with knowledge, we can work towards dispelling the prevalent and damaging notion of birth as something that happens to us, rather than something we are a part of. The need for social responsibility has become a powerful driving force in my writing.
Although I did not follow Turner-Vasselago’s full writing strategy, the process of free-writing enabled me to ‘… to summon the courage … to put aside skills and beliefs …’[18] in order to access and testify to my lived experience in a raw and socially unmediated manner. I ‘… allow[ed] words that you [I] had not planned to write to surface on the page.’[19] To write about mothering experience, or any other autobiographical matter with validity, the articulation of ‘emotional truths’[20] is paramount. I claimed and made visible my ‘emotional truth’ without trying to ‘… rush to coherence ….’[21] This gave my writing an immediacy and momentum I’d not previously experienced. I grew to be less alarmed at the ‘emotional truth’ of my experience and my confidence grew. I began to disarm unrealistic and warped expectations of ‘natural’ motherhood.
My voice transformed. I came to understand ‘… the poetic voice as something that is not a given, but that has to venture into becoming itself,’[22] and the organic and unique ‘… aural fingerprint …’[23] of my identity as a mother was distinctly ferocious. I had become involve[d] in a process of ‘unmasking’ myself, a concept first articulated by sociologist, Susan Maushart in her book The Mask of Motherhood.[24]Andrea O’Reilly and Elizabeth Podnieks assert Susan Maushart’s idea that motherhood should be ‘unmasked’ because ‘…to be masked in motherhood, Maushart explains, ‘is to deny and repress what we experience, to misrepresent it, even to ourselves.’[25]
I was concerned, however, that the artistic shaping of ‘surrendered’ free-writing into a poem using the resources of poetic craft would dilute or misrepresent my experience. The crafting process was a particularly emotionally arduous one, in that I was determined to ensure that I didn’t compromise my ‘emotional truth’ for the sake of poetic artifice.
I economized on language, removing unnecessary words to reinforce meaningful communication, and used syllable counts that facilitated a pace comparable to the pace of my felt emotion, whilst ensuring space within the poems for reflection and reflexivity. I paid attention to the positioning of words on lines for audible and visual effect; to portray disconnection from my physical self, and finally, arranged the poems into an emotional arc that gave the full picture of my lived experience.
The artistic embodiment of birth trauma in my poetry was ultimately a positive experience which allowed for the cognitive processing of my trauma. Although the poems remained visceral on the page, I grew more desensitized to the trauma and felt mobilized into a site of action to testify and help others, and to ‘… heighten[ed] [the] visibility and legitimacy to the theme of motherhood as a topic for art-making.’[26] The creative exploration of mothering also creates a ‘…discursive site where ideology, consciousness and one’s own personal life experience meet and give voice to a unique and altogether different ‘I’.’[27]
I was able to develop a voice that was heard through the publication of my poems in magazines and journals. But importantly, I could see the potential to make visible and challenge medical dogma, where lived experience of birth ‘… sink[s] beneath discursivity …’[28] and is managed as a productive process. Instead, I could see that matrifocal narratives that ‘… hold fast to a maternal perspective’[29] offer significant resistance to medical intervention by increasing awareness of mothering experience, such as birth trauma, and therefore contribute to a wider, more responsible social narrative.
The artistic embodiment of mothering is vital because it resists ‘universalizing’[30] mothering experience and provides an opportunity to recount the inexhaustible nuanced perspectives of mothering, reinforcing diversity, and greater insight in ‘…show[ing] how motherhood functions as an intellectual practice and social/political site across these differences.’[31] In writing candidly about my experience of birth trauma, I hope to encourage others to do so in an emotionally safe way, to share their experiences and to promote mothering as a fundamental experience worthy of creative and scholarly attention, and that:
‘…embodiment within a network of relations to others, and the sense of openness and vulnerability this can bring, should lead to an emphasis upon our necessary interconnectedness as human and to an ethics of care and responsibility.’[32]
We must strive to express the fullness and authenticity of mothering experiences. By doing so, we can effectively communicate about the harmful lived experience that birth trauma is and explore possibilities for meaningful social change.
Works Cited
(Author Unknown) ‘The body: A phenomenological perspective’, module handbook from The Open University (8 June 2017) <https://www.open.edu/openlearn/society-politics-law/sociology/the-body-phenomenological-psychological-perspective/content-section-0?active-tab=description-tab> [accessed 9/1/19]
Burkitt, Ian, Bodies of Thought: Embodiment, Identity & Modernity. (Sage: London, 1999)
Daly, Brenda & Reddy, Maureen T., (eds.) Narrating Mothers: Theorizing Maternal Subjectivities (Knoxville:University of Tennessee Press, 1991) in Andrea O’Reilly & Elizabeth Podnieks Textual Mothers/Maternal Texts: Motherhood in Contemporary Women’s Literatures (Waterloo: Wilfrid Laurier University Press, 2010)
Dunmore, Helen in Norgate, Stephanie (ed.), Poetry and Voice: A Book of Essays (Newcastle upon Tyne: Cambridge Scholars Publishing, 2012) pxii-xiii
Epp Buller, Rachel, Visualizing Motherhood: The ‘Memory Work’ of Mother-Artists in Dymond, Justine & Willey, Nicole (eds.), Motherhood Memoirs: Mothers Creating/Writing Lives (Bradford ON: Demeter, 2013)
Feaver, Vicki, ‘Body and Soul: The Power of Sharon Olds’ in Mark, Alison & Deryn Rees-Jones (eds.), Contemporary Women’s Poetry Reading/Writing/Practice (London: Macmillan Press Ltd, 2000
Fischer, B. K., Shake Forth a Nest: Feminist Ekphrasis and the Example of Louise Bourgeois (2014) <https://lareviewofbooks.org/article/feminist-ekphrasis-example-louise-bourgeois/#!> [Accessed 16 October 2017]
Grosz, Elizabeth, Volatile Bodies: Towards a Corporeal Feminism. (Bloomington IN, Indiana University Press, 1994) posited in (Author Unknown) ‘The body: A phenomenological perspective’, module handbook from The Open University (8 June 2017) <https://www.open.edu/openlearn/society-politics-law/sociology/the-body-phenomenological-psychological-perspective/content-section-0?active-tab=description-tab> [accessed 9/1/19]
Jiang, H, Qian X, Carroli, G & Garner, P, ‘Selective versus routine use of episiotomy for vaginal birth (Review) Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD000081 (2017) <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449575/pdf/CD000081-0001.pdf> [accessed 9/1/19].
Maushart, Susan, The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It (New York: Penguin Books, 2000)
O’Reilly, Andrea & Caporale Bizzini, Silvia (eds.), From the Personal to the Political: Towards a New Theory of Maternal Narrative (Selinsgrove: Susquehanna University Press, cop. 2009)
O’Reilly, Andrea & Podnieks, Elizabeth, Textual Mothers/Maternal Texts: Motherhood in Contemporary Women’s Literatures (Waterloo: Wilfrid Laurier University Press, 2010)
Petit, Pascale, Poetry from Art Mslexia <https://www.mslexia.co.uk/pdfs/workshops/MslexiaPC12WritingWorkshop1.pdf> [accessed: 9/2/19]
Schwartz, Mimi in Brenda Miller & Suzanne Paola Tell It Slant: Creating, Refining, and Publishing Creative Nonfiction (New York: McGraw-Hill, c2012)
Shaughnessy, Nicola, ‘One, Two, Three: Sylvia Plath’s Verse Dramas’ in Donnell, Alison & Pauline Polkey (eds.), Representing Lives: Women and Auto/Biography. (London: Macmillan Press Ltd, 2000)
Thomas, Kim, Birth Trauma: A Guide for you, your friends and family to coping with post-traumatic stress disorder following birth (Chorley: Nell James Publishers, 2013)
Turner-Vesselago, Barbara, Writing Without a Parachute. The Art of Freefall (Bristol: Vala Publishing Co-operative, 2014)
World Health Report ‘Make Every Mother and Child Count: Risking Death to Give Life’ (2005) in reference to Neilson JP, Lavender T, Quenby S, Wray S. Obstructed labour. British Medical Bulletin, 2003, 67:191–204. <https://www.who.int/whr/2005/chapter4/en/index1.html> [accessed: 10/08/2019]
Footnotes:
[1] Kim Thomas Birth Trauma: A Guide for you, your friends and family to coping with post-traumatic stress disorder following birth (Chorley: Nell James Publishers, 2013), p5
[2] Ibid., p20
[3] Ibid., p11
[4] Ibid., p20
[5] World Health Report ‘Make Every Mother and Child Count: Risking Death to Give Life’ (2005) in reference to Neilson JP, Lavender T, Quenby S, Wray S. Obstructed labour. British Medical Bulletin, 2003, 67:191–204<https://www.who.int/whr/2005/chapter4/en/index1.html> [accessed 10 August 2019]
[6] H Jiang, X Qian, G Carroli, & P Garner, ‘Selective versus routine use of episiotomy for vaginal birth (Review) Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD000081 (2017) <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449575/pdf/CD000081-0001.pdf> [accessed 9/1/19]
[7] (Author Unknown) ‘The body: A phenomenological perspective’, module handbook from The Open University (8 June 2017) <https://www.open.edu/openlearn/society-politics-law/sociology/the-body-phenomenological-psychological-perspective/content-section-0?active-tab=description-tab> [accessed 9/1/19]
[8] Elizabeth Grosz, Volatile Bodies: Towards a Corporeal Feminism. (Bloomington IN, Indiana University Press, 1994) posited in (Author Unknown) ‘The body: A phenomenological perspective’, module handbook from The Open University (8 June 2017) <https://www.open.edu/openlearn/society-politics-law/sociology/the-body-phenomenological-psychological-perspective/content-section-0?active-tab=description-tab> [accessed 9/1/19]
[9] Nicola Shaughnessy, ‘One, Two, Three: Sylvia Plath’s Verse Dramas’ in Donnell, Alison & Pauline Polkey (eds.), Representing Lives: Women and Auto/Biography. (London: Macmillan Press Ltd, 2000) p248
[10] Vicki Feaver, ‘Body and Soul: The Power of Sharon Olds’ in Mark, Alison & Deryn Rees-Jones (eds.), Contemporary Women’s Poetry Reading/Writing/Practice (London: Macmillan Press Ltd, 2000) p146
[11] Pascale Petit, Poetry from Art Mslexia <https://www.mslexia.co.uk/pdfs/workshops/MslexiaPC12WritingWorkshop1.pdf> [accessed: 9/2/19]
[12] Ibid.
[13] Ibid.
[14] B. K. Fischer, Shake Forth a Nest: Feminist Ekphrasis and the Example of Louise Bourgeois (2014) <https://lareviewofbooks.org/article/feminist-ekphrasis-example-louise-bourgeois/#!> [Accessed 16 October 2017]
[15] Barbara Turner-Vesselago, Writing Without a Parachute. The Art of Freefall (Bristol: Vala Publishing Co-operative, 2014) p8
[16] Ibid., p13
[17] Ibid., p2
[18] Ibid., p25
[19] Ibid., p12
[20] Mimi Schwartz in Brenda Miller & Suzanne Paola Tell It Slant: Creating, Refining, and Publishing Creative Nonfiction (New York: McGraw-Hill, c2012) p155
[21] Barbara Turner-Vesselago, Writing Without a Parachute. The Art of Freefall (Bristol: Vala Publishing Co-operative, 2014) p124
[22] Helen Dunmore in Norgate, Stephanie (ed.), Poetry and Voice: A Book of Essays (Newcastle upon Tyne: Cambridge Scholars Publishing, 2012) p xii-xiii
[23] Ibid., p xii
[24] Susan Maushart The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It (New York: Penguin Books, 2000)
[25] Andrea O’Reilly & Elizabeth Podnieks Textual Mothers/Maternal Texts: Motherhood in Contemporary Women’s Literatures (Waterloo: Wilfrid Laurier University Press, 2010)
[26] Rachel Epp Buller, Visualizing Motherhood: The ‘Memory Work’ of Mother-Artists in Dymond, Justine & Nicole Willey (eds.), Motherhood Memoirs: Mothers Creating/Writing Lives (Bradford ON: Demeter, 2013) p35
[27] Ibid., p19
[28] Ian Burkitt, Bodies of Thought: Embodiment, Identity & Modernity. (Sage: London, 1999) p55
[29] Brenda Daly & Maureen T. Reddy, (eds.) Narrating Mothers: Theorizing Maternal Subjectivities (Knoxville: University of Tennessee Press, 1991) in Andrea O’Reilly & Elizabeth Podnieks Textual Mothers/Maternal Texts: Motherhood in Contemporary Women’s Literatures (Waterloo: Wilfrid Laurier University Press, 2010) p3
[30] Andrea O’Reilly & Silvia Caporale Bizzini (eds.) From the Personal to the Political: Towards a New Theory of Maternal Narrative (Selinsgrove: Susquehanna University Press, cop. 2009) p16
[31] Ibid., p15
[32] Ian Burkitt, Bodies of Thought: Embodiment, Identity & Modernity. (Sage: London, 1999) p152
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