Nikki Wilson is the CEO of Make Birth Better. She is passionate about social change and has direct experience of birth trauma. Make Birth Better is a unique collective of parents and professionals working together to end suffering from birth trauma through support, campaigning and training.
I asked Nikki about how she found the transition to motherhood and how our preparation for labour and birth could be better.
How did you find the transition to motherhood?
Well, I have transitioned three times because I've got three kids. I'd use a different word for each of them: transition one, terrifying; transition two, euphoric; transition three, challenging.
I suffered from postnatal PTSD and the onset of very acute symptoms really quite quickly after the birth. Within a matter of days I wasn't able to leave my house without having a panic attack, I couldn’t fall asleep without somebody holding my hand and telling me that I was safe and wasn't going to die. I couldn't look out the window because the light was too bright. Anything that was in any way stimulating from a sensory perspective was too much. And I had a very strong urge to run, the flight feeling was really real for me. So yeah. Terrified is the right word. I had no idea what was wrong with me, and nor did anybody around me and that was also really terrifying for them. I felt like my whole nervous system was jangling. Anything that would normally elevate your nervous system, I felt ten times more intensely.
It was a huge shock and that first year was really just spent clinging on.
Antenatal preparation currently has a really strong emphasis on how calm and positive giving birth can be. What effect do you think that has on the person giving birth?
I think the societal narrative is very strong around this. We all carry a huge amount of bias within us that comes from the societal narratives around us. I was privileged enough to have access to antenatal education but it was very broad and very much focused on vaginal birth. The narrative was clear: a calm, natural birth with no intervention is more valid. I really held on to that. I’ve always been very holistic in the way I like to live my life and I guess I was in the early uptake years of hypnobirthing.
I remember saying to friends “listen guys, it’s going to be fine, I’m just going to meditate the shit out of it”.
Control is such an important coping mechanism for fear and for me both the bias I picked up towards calm natural birth and the sense of control hypnobirthing offered reinforced each other and made me feel safer during my pregnancy and preparation for labour. Did it work for me during labour? No. But I do think it’s important to acknowledge that it does work for some people.
There are a lot of false dichotomies in the birth world.
There are a lot of perspectives about things being right or wrong, good or bad and these perspectives can feel black and white when actually there’s a lot of grey.
How would you like to change the way that we are prepared for labour and birth?
I would love to see the narrative change to recognise that all birth is birth. Our beliefs have to catch up with the reality here. More than a third of births are by caesarean. Yes there’s an important debate to be had about what method of birth is best physically but the mental health implications are just as important.
At Make Birth Better we’ve been considering what it would look like if we put a trauma informed lens over antenatal education. Of course physiology is important- the mechanics of birth- but it’s not enough.
Antenatal education should involve examining our own expectations about birth and where these have come from. We should be considering how we manage stress and how we respond to situations being out of control- helping people to know what their stress responses look like and what happens to them when they’re really stressed. What sounds, people, environments make you feel really stressed? We should also be helping people think constructively about environments that we are all taught to believe are stressful, such as operating theatres. 36% of births are by caesarean so you need to know what theatre looks like and what the physiology of a caesarean birth is as well.
We might need to face some hard truths and really talk about what it looks like to give birth in Britain in what is a very traumatised system.
Everyone you interact with will have their own biases, their own pressures, and possibly their own trauma. Pretending otherwise doesn’t help anyone.
I also wonder what would happen if antenatal education involved discussions of the very common emotions of guilt and shame that lots of us feel as we adjust to motherhood. We’re often very cautious about discussing these difficult issues. We don’t want to scare people or ‘put them off’.
But I believe that we’re all a lot more capable of holding difficult information than we give each other credit for.
I feel confident that as long as it's well managed, we actually could hold space for a lot more nuanced, challenging and empowering conversations in that antenatal stage.
If you could get people to stop self-censoring about one aspect of motherhood, what would it be and why?
The challenge and stress of balancing work and life and being a parent. The constant rubik's cubing. How do we do motherhood now? We’ve been ‘liberated’. The world knows we’ve got good brains and can do jobs just as well as men. We want money and we want intellectual stimulation. When we’re lucky enough we also have choices about exactly how much paid work we undertake.
My work has always been a really important part of my mental health, and it contains my brain in a way that nothing else does but for me, and I know this doesn’t go for everyone, I’ve always been really drawn to being with my kids. Being at school gates, hanging out before they go to school.
I feel like we need to expose the messiness of it all.
It’s still too easy to just put the full time working mum on a pedestal and to overlook people who have chosen to stay at home or who are trying to find a more hybrid approach.
Personally, I feel like I’m never getting it quite right. I’m not gunning it in my career, I’m not a full-time stay-at-home parent. So what am I? That’s the real headfuck for me. I’ve been rubik’s cubing for 10 years and I still haven’t found a formation that works for me.
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