As the doctors began Selina’s* emergency C-section, she didn't understand why the fire alarm was going off. But it wasn’t the fire alarm; there was a problem. Scar tissue from her previous caesarean had grown back, forming a thick belt that her baby was stuck beneath. When her son was finally delivered, he was silent and blue. Doctors didn't know if he was alive. Selina cried with relief when he eventually screamed.
None of this needed to happen.
Despite having had a traumatic emergency caesarean with her first child, Selina’s husband thought she should have a VBAC (vaginal birth after caesarean) for her second. Specifically, a water birth at home with no pain relief. She recalls telling his family she did not want him at the birth, but “they thought I was this crazy, hormonal, pregnant woman.”
It was only when Selina’s mother intervened that her now ex-husband drove her to A&E. Once there, he continued to insist: “You can do this naturally. The medicine is bad for the baby. You are so strong.”
“This went on for about 30 hours,” Selina remembers. “I didn't have any pain relief and at that point I told the doctor, ‘Give me everything you have.’” In fact, her husband was secretly helping himself to her gas and air.
During their nine-year relationship, Selina, now in her early thirties, was subjected to physical, psychological and financial abuse. His controlling behaviour pulverised her autonomy. It also extended to her birth plan. “At the time I didn't think of it as pushy or sinister,” she says. “It was very encouraging and persuasive.”
Her story exists under the umbrella of coercive control, which became a crime in England and Wales in 2015. Signs include isolating someone from friends and family, depriving them of basic needs, monitoring their time and activities and humiliating, degrading or dehumanising treatment.
Selina’s experience shows how this can happen during pregnancy and childbirth, when evidence shows that over a third of domestic violence starts or gets worse.
Amy Gibbs, Chief Executive of Birthrights, which campaigns for dignity in childbirth, explains: “The right to decide what happens to your body and the circumstances of birth is protected in law. That being violated can have devastating consequences for a woman’s physical or mental health, but also for their relationship with their baby.”
Kathryn’s* abuse began when she was seven months pregnant. At first, she was prevented from attending NCT classes. Her husband was a drug user and his fascination with heroin dominated the birth. “He was very excited about the pain relief,” she remembers. “I had said that I didn't want diamorphine but when I was in the throes of labour, the first thing he did was ask if I could have it. He was asking the midwives about the effects on my body.”
In Radio 4 drama The Archers’ 2016 plot about coercive control, the victim was persuaded to have a home birth despite a history of preeclampsia – a condition that can lead to serious and sometimes fatal complications. Tim Stimpson, a dramatist and scriptwriter who worked on that storyline, explains: “It allowed us to convey how much Helen had become willing to relinquish her own autonomy to Rob. Working with Refuge and Women's Aid, we learnt that men like Rob are often threatened by the arrival of a baby… He made Helen feel guilty and that her needs were unreasonable.”
It’s an accurate reflection of Kathryn’s real-life experience. Furiously jealous of the attention she had received in hospital, her husband began screaming at her the day after she returned home. “One would normally remove oneself from an aggressive outburst,” she says. “But I had my newborn baby in my arms. I couldn’t hold him and lift my own weight. So I was subjected to this barrage of abuse, and that became habit.”
Childbirth presents many opportunities for a controlling partner to manipulate, and the overwhelming array of choices to be made is also the reason there is increasing concern over women being coerced by medical staff themselves into hasty decisions. Ultimately, consent isn’t valid if it’s achieved through undue influence – wherever that comes from.
VICE heard of a catalogue of examples where women and their needs were subdued by partners, and sometimes families, including women being spoken over and spoken for, never being left alone during hospital appointments or male partners becoming aggressive in the birthing suite. Birthrights was contacted by a woman who laboured for twelve hours at home while her husband and mother-in-law refused to call a midwife or let her go to hospital.
Ali Edwards, who has been a doula for eight years, remembers a woman who was desperate to avoid another caesarean but was overruled by her husband: “She was in the bath and labouring beautifully, but he was adamant that she not risk an assisted delivery with forceps or ventouse [a form of delivery using a suction device]. She went quiet as he made her get out of the water and everything stopped. She ended up with another c-section.”
The potential consequences of a traumatic birth include a higher risk of postnatal depression and PTSD symptoms like flashbacks and nightmares. Dr Emma Svanberg, a perinatal clinical psychologist and co-founder of Make Birth Better, a platform that aims to make the sharing of birth experiences more representative, says: “Women can feel a sense of failure or shame about a birthing experience that hasn’t gone to plan… People often try to avoid reminders of a traumatic event. You might see people passing their baby onto other people to look after. Or the converse, where people will be very overprotective. In both situations, the trauma acts as a lens through which the baby is seen.”
A woman will likely see more healthcare professionals than at any other point in her life during pregnancy and birth, but like all forms of abuse, coercive control can be difficult to disclose. Edwards is used to “reading between the lines” and midwives using “little tricks” to reach the woman in their care by finding ways to send male partners out of the room.
This can be a particular issue when a woman doesn’t have English as a first language and is reliant on family members to translate, or has learning difficulties or disabilities. Gibbs says: “One of our professionals said, ‘If you get him out of the room and a woman to speak to her in her language, all of a sudden, this monosyllabic woman turns into a complete chatterbox’.”
Make Birth Better and Birthrights report that cuts to third sector organisations makes it difficult for already overstretched midwives to support vulnerable women, whilst Naomi Delap, Director of Birth Companions, a charity that supports pregnant women affected by multiple disadvantage, acknowledges a common concern: “There’s this huge barrier because women are terrified that if they tell anyone, social services will remove the baby.”
Kathryn remembers: “I kept saying at every opportunity, ‘I’m fine but I don’t think my husband’s coping.’ I really struggled to get anybody to say, ‘Hmmm, what does she mean by that? How is he not coping? Is he angry?’ And I would have said ‘Yes. He throws power tools at me.’”
Coercive control is both difficult to recognise and to disclose, and in pregnancy and childbirth, the effects of removing a woman’s autonomy jeopardise her and her baby to a devastating and long-lasting degree. As Gibbs says: “A woman isn’t just a pregnant person. She isn’t just giving birth to a baby. She’s a human being with her own rights.”
For Selina, now divorced from the man whose decisions risked the lives of her and her baby, the consequences linger: “I think he was very cunning and manipulative. Initially I didn't really realise what was happening,” she says. “But I was completely traumatised after that birth. I don’t think I would ever have more children.”
* Names have been changed