In this blog, Managing Editor Paige Donaghy explores the history of birth trauma and obstetric violence in Britain and Australia for “Birth Trauma Awareness Week” 2025.
From July 14 to 20 it is Birth Trauma Awareness Week in Australia and the UK. Run by advocacy and support organisation Birth Trauma Australia, the week aims to create better awareness of the physical and psychological traumas experienced by pregnant and birthing people, as well as non-birthing parents and family. “Birth trauma” is defined by organisations and researchers as the “experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/or long-term negative impacts” on health. Patients, health professionals, researchers and advocacy groups also often use the term “obstetric violence”, described as harmful, abusive, violating or violent behaviour during pregnancy and birth, such as nonconsensual vaginal examinations or episiotomies. Birth trauma and obstetric violence can often overlap; for instance, an obstetric violation can cause birth trauma. But they are also distinct concepts and experiences: not everything a person feels or undergoes during birth necessarily constitutes ‘obstetric violence’.
The aim of Birth Trauma Awareness week this year is to bring to the foreground “what’s often hidden” in Australian birth experiences. As research in Australia shows, 1 in 3 women have experienced birth trauma, and at least 1 in 10 women have experienced a form of obstetric violence during their childbirth experiences. The situation is worse for women of colour and migrants and First Nations women who often experience “obstetric racism”, such as the ignoring or disbelief of women of colour and Indigenous women’s lived experience. For Indigenous women in particular, settler-colonial and racist medical practices remain part of obstetrics; for instance, health practitioners continue to overuse perinatal birth alerts, in which child protection authorities are notified of supposed concerns about Indigenous people’s children, even before they are born.
This blog contributes to Birth Trauma Awareness Week by exploring hidden histories of birth trauma and obstetric violence, to show that these issues have existed for as long as people have been giving birth–but of course, by different names and forms. These issues of language and history are key to how we discuss birth trauma and obstetric violence today.
Language & History
In August 2024, the NSW Parliament Select Committee on Birth Trauma handed down their findings from a year-long process reviewing birth care in NSW. During the Inquiry, the Committee received over 4000 submissions from health professionals, advocates, lawyers, and people who had experiences of birth trauma. The Committee made 43 recommendations to address these issues in NSW, including providing publicly-funded psychological care after birth. Significantly, the Chair of the Committee, member Emma Hurst, included a ‘dissenting’ opinion at the end of the report, based on the omission from the report of a “finding that some cases of birth trauma can be considered a form of gendered violence”, i.e, ‘obstetric violence’. One of the few objections to this term, and this framing of the issue, came from the Royal College of Gynaecologists and Obstetricians, who argued it “implied malicious intent” on behalf of practitioners and “hinder[s] solutions” to birth trauma.
Such criticisms misunderstand obstetric violence’s systemic, multi-dimensional causes: scholars show that it is embedded within patriarchal, racist and colonial structures, rather than necessarily being the “intention” of individual healthcare providers. Objections to the language of ‘obstetric violence’ also overlook the fact that this language forms part of the very history of obstetrics and gynaecology.
Debates about excessive or unnecessary force in midwifery care occupied much space in emerging professional journals, like The Lancet. Women and female midwives were also concerned about the use of too much force, but they also worried about rushed practice, and the overuse of instruments. In 1760, for instance, midwife Elizabeth Nihell published a polemical treatise that argued male practitioners often caused “atrocious” injuries. Nihell was concerned about men encroaching on the traditionally female space of birth. Yet we have evidence, from complaints given to the Royal Maternity Charity in the 1800s, that female midwives also harmed or upset birthing women through “prophane language” or hurried, reckless behaviour.
In early-nineteenth-century Britain, when obstetrics was becoming a (largely male) profession, formalised in universities, some practitioners wrote about their concerns with obstetric practice. In the 1830s, an influential London-based obstetrician, James Blundell, was one of the first doctors to use the term “obstetrical” and “obstetric” violence, in lectures and publications. For Blundell, this violence resulted from rushed or reckless obstetric practice, and could be caused by “instruments or the hand”. He strongly urged his students, at Guy’s Hospital, and the readers of his book, that “in scientific midwifery, violence has no place”.
While not all doctors agreed with this language, debates about birth care, violence, and harm were very pressing in this period when obstetrics and gynaecology were becoming professionalised. Facing the problem of obstetric violence today must necessarily mean reckoning with professional history, including concerns about harm and violence from obstetricians themselves.
Colonial Legacies
Current discussions in Australia about birth trauma and obstetric violence must also reckon with the legacies of how British and Australian colonialism shape people of colour and First Nation’s peoples’ experiences with birth care. Tracing the history of these issues in Australia reveals that racial categories were central to early obstetrics and gynaecology. Colonial medicine was imported from Britain, where emerging scientific racism shaped obstetric thought and practice. For instance, Manchester doctor Charles White argued in a 1799 treatise that different “human species”, like the “natives of Africa, the West Indies and America”, gave birth very easily on account of their supposed “larger hips and more capacious pelvises”. This was compared to “European women”, who had narrow pelvises and required (professional) medical assistance.
Historians have demonstrated how these ideas about the female pelvis became a racial science of ‘pelvimetry’, shaping medical practice for centuries (and in some cases, persisting even to today). As historian Deirdre Cooper Owens shows in her book, Medical Bondage: Race, Gender, and The Origins of American Gynecology, these ideas were used by American slave owners and doctors, who forced enslaved pregnant women to work in plantations right up until delivery. In Australia, racial ideas about women’s bodies and capacity for birth were present in early colonial obstetrics.
Historian Lisa Featherstone’s article, “Imagining the Black Body: Race, Gender and Gynaecology in Late Colonial Australia”, shows how beliefs about Indigenous women’s capacity for “easy” births were circulating in colonial reproductive medicine. Yet, Featherstone suggests that “the Aboriginal woman was rendered largely invisible” in medical discussions, likely because of colonial anthropology which argued Indigenous peoples were a ‘doomed race’. Alongside these ideas, the White Australia Policy, and later assimilationist and child removal policies, sought to make Australia a ‘new’, white nation. Motherhood was therefore envisioned as something for white women, and this in turn shaped the practice of reproductive medicine and obstetrics.
This history has directly shaped how First Nation’s people, migrants, and people of colour experience pregnancy and birth care in Australia. Much health research has shown how colonial and racist legacies continue to negatively impact Indigenous maternal and infant mortality, as well as causing avoidable birth trauma. Evidence given to the NSW Inquiry, for instance, revealed several instances of racism toward migrant women and Indigenous women. Moreover, a recent series by Guardian journalist Sarah Collard revealed several instances of racist and discriminatory obstetric care toward First Nations women across Australia.
Making known ‘hidden histories’ for Birth Trauma Awareness Week helps us to see that alongside the individual experiences of birth trauma, there are longstanding structural issues that continue to influence how people in Australia give birth. To best support people in pregnancy and childbirth, we must also recognise how obstetric racism and gender violence shapes birth care.
Dr Paige Donaghy is a McKenzie Postdoctoral Fellow in the School of Historical and Philosophical Studies at the University of Melbourne. She is a historian of reproduction, sexuality, and medicine in Europe c. 1550 to 1850. Paige’s postdoctoral project is entitled “The Origins of Obstetric Violence in British Medicine, 1690-1890”., which aims to undertake an historical investigation into the origins of what we now understand to be obstetric violence (harm, mistreatment and violence experienced during pregnancy and birth care). She is currently the Managing Co-Editor of VIDA Blog, and an Early Career Convenor for the Reproductive Justice Hallmark Initiative at the University of Melbourne.
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