My first daughter’s birth introduced me to birth work. That labour culminated in a cascade of interventions, including an emergency manual removal of the placenta after the cord broke during a forcefully managed third stage, then the routine separation from my baby for hours after she was born.

I had prepared and negotiated for a natural birth, as we called it in the 1970s, so this series of interventions was definitely not what I had expected. I was a physical education teacher, swimming and outdoor adventure instructor. I trusted my body. I was fit, healthy and ready to have a much-wanted baby. I believed that birthing was a healthy function, not an illness, and that my body would instinctively know what to do. So I was left in shock. What had happened?

The external story

What I came to understand about that labour profoundly informed all the work I have done in the decades since. I realised that, while I had a realistic trust in the process of birth, I had been naively trusting of the hospital in which I would be labouring. I had believed the birth system – its experts, practices and procedures – was set up to support and facilitate my innate birthing capacity. In answer to my queries during pregnancy I was reassured by the hospital that it did not follow routine admission procedures, nor did it routinely speed up labour, offer pain-relief, or perform episiotomies. I was also reassured that my baby would be ‘rooming in’ with me. The reality was that all of these medical procedures were routine.

I came to see that I had trusted the hospital’s assurances in pregnancy because I (like so many first-time mothers) was unconsciously acting out of what I call the trance of acquiescence – the culturally conditioned compliant state so many of us enter when we face medical authority.

The choices I made for the births of my second and third babies were what I’ve come to call savvy choices, in contrast to the naïve status quo choices I made before the birth of my first daughter.

As those who have read it will know, my first book focused on these savvy choices—the important decisions a woman needs to make about the external circumstances of her labour.

But I’ve long been aware that there is a deeper psychological layer at work when we birth. A woman’s past, her present life circumstances and her dreams for the future all contribute to how she will feel in the midst of her labour. I can only assume this has always been the case.

After all, birth is about family, about creating a future, about parenting. How many of us do not have a place of emotional vulnerability among these life themes?

For me, choosing to be at home for the births of my next two daughters took care of the externals – the hospital routines and practices that had hijacked my first labour. But I still had to work on the internals: the unconscious fears I carried that had also had their place in the way my first labour unfolded.

The internal story

Reflecting on that birth during my second pregnancy I came to see that, as well as my general naïveté about the hospital, unconscious fears stemming from my childhood were part of the story. My older brother, born eighteen months before me, was born with a major hole in his heart and was not expected to live beyond his fifth year.

His early years were characterised by limits on his physical activities and heightened concerns for his health and wellbeing. My mother was a ‘mother-nurse’ to my brother through his early years. Combining fierce protective mothering with her nursing training, she, together with my father, kept him alive well past the predicted age of his death. At fourteen, due to advances in medicine, my brother was one of the first few people in Victoria to receive the gift of open-heart surgery and is still alive and thriving in his seventies.

As a young girl I had two unconscious responses to my brother’s story. These acted as psychological wild cards during my pregnancy and eventually played out as the deeper story in my daughter’s birth. The first of these was the unconscious fear that my baby may also be born with some type of life-threatening problem. The second, due to the miracle of the operation that saved him was a powerful trust in medicine.

Unconscious and therefore unknown to me at that time, these inner responses nevertheless created a shaky foundation on which to build my true birthing confidence. Because I was fit and healthy I felt arrogantly confident in my body and translated this, in a

simplistic way, as a guarantee of my birthing ability. But, in reality, my trust and belief in my pregnant body and birthing capacity was only a thin veneer. It was easily and progressively dismantled by a system that, unbeknownst to me then, fundamentally distrusted birth.

Birth today: A culture of fear

In the years since my own first labour I’ve witnessed our wider cultural trust in birth and in women’s capabilities being increasingly undermined. This has reached the point now where the idea of birthing without medical intervention actually feels impossible for many women.

This pervasive culture-wide fear of birth now does exactly what my own personal fears did back when I was having my first baby, it guarantees that women acquiesce to the system. This is understandable. Of course women go into hospital believing, consciously or not, that, ‘a hospital’s job is to keep me medically safe. Knowing this, I’ll feel safe.’ But medical safety is not the same as emotional security. And birthing women need both.

Birth has always brought up emotions, vulnerabilities in our relationships and within ourselves and, for some, past trauma. The difference for women birthing today is that because our system has essentially come to address only the physical pain, it has lost the ancient arts of birth support that required care of the whole woman.

Across time and cultures, the journey of pregnancy and birth have been seen as a rite of passage, enabling the transition to motherhood. And deep, connected, human care has traditionally been part of the story.

Nowadays, the idea of birth as a rite of passage is given short shrift. But we ignore the traditional notion of birth as a strengthening rite of passage at our peril. Because when a baby is born, so is a mother. And her health, both physical and mental, matters. When the emotions and life challenges that birth brings forward are not acknowledged or addressed in pregnancy and labour they do not simply disappear. In fact, research shows that they are exactly the factors that increase a woman’s chance of postnatal depression.

The gift of my first birth

My first baby, according to routine was taken from me immediately after her birth and I, like all other new mothers, was sedated (so I could get a ‘well-deserved rest’). I barely remember saying goodbye to my husband and being wheeled up to the large twelve-bed postnatal ward before I dropped into a disturbed sleep.

The next thing I remember was struggling up from a drugged depth and feeling somebody gently stroking my hand. I heard the familiar West Indian accent of Mirabella, the mother of twins (her fourth and fifth babies) whom I’d met over the past few months at the hospital’s pregnancy physio classes. She asked me what was the matter; she was in the bed next to mine and had heard me crying in my restless sleep. With that I became aware of my tear-soaked pillow, and, prompted by her asking, managed to croak out that I didn’t know where my baby was.

Well, that was all it took for Mirabella in all her majesty to stride off down the ward demanding that the midwives find my baby. Not a compliant ‘good patient’ but modelling a fierce protective mother on a mission to find her baby – my baby. No trance of acquiescence here! Within a few minutes, in a triumphant procession down the ward came Mirabella followed by a midwife pushing a baby’s cot, with my sweet wailing baby inside – she needed me as I longed for her. In those moments, Mirabella offered soothing and a feisty modelling of protective mother. I was humbled by her presence.

It’s over forty years since my first baby was born. I’m now a grandmother of four home-born grandchildren, and great-aunty to five. I’ve had the privilege of being present at all the births of this next generation.

As a grandmother I feel a rising urgency – what will birth look like for my grandchildren and my great, grandchildren? I remember hearing environmentalist David Suzuki saying that all the things he has spent his life working to change have gotten worse. So he would have to say his life’s work was a failure. Then he thinks of his grandchildren and knows he can’t stop his work.

I, too, feel, when I review my years of birth work, that so much of what I have worked to raise awareness about has gotten worse. And then I think of my grandchildren and my great, grandchildren and know there is still work to be done.

So what did I do? I educated, I agitated, I spoke, I witnessed, I challenged and I wrote. As I am again writing now in this book.

Extracted from Beyond the Birth Plan, Rhea Dempsey, available now.