The birth trauma taboo

New Statesman​

10-05-2025

Photo by Genna Naccache / Millennium Images, UK
Giving birth in England is not safe. Half of all maternity units are rated either inadequate or requiring improvement. Just 5 per cent – one in 20 – are outstanding. The UK is performing worse than many of our European neighbours when it comes to deaths of mothers within 42 days of the end of pregnancy. And gross inequalities remain: black women are twice as likely to die in childbirth than white women; women aged 35 or older are three time more likely to die than those in their early twenties. These numbers paint a damning picture of the care given to many women.
It is perhaps unsurprising, then, that women are being left traumatised from giving birth. We don't know for sure, but it is estimated that each year about 25,000 women who give birth are so distressed that they meet the diagnostic criteria for post-traumatic stress disorder (PTSD). Hundreds of thousands more are traumatised, but don't meet that threshold. In Breaking the Taboo, the former Conservative MP Theo Clarke describes her own experience of trauma in heartbreaking detail, in the hope that safe maternity care will become a priority for the government.
'I felt like I was being raped,' Clarke writes of one of several vaginal examinations she received while in labour. The book is not an easy read, and certainly not for the faint-hearted. The descriptions of childbirth and its aftermath are graphic and highly distressing. Clarke describes how she was convinced she was going to die, after haemorrhaging and tearing. Having experienced a deeply traumatic birth myself, I had to pause reading several times. Like Clarke, I suffered a severe tear during birth, and, like Clarke, was rushed to surgery immediately afterwards, taken away from my daughter after a matter of seconds. Like Clarke, I was left in blood-stained sheets, and, like Clarke, I had no idea what had happened to me, or even that such an injury was possible.
But this is a book that must be read: by politicians, obstetricians, anaesthetists, midwives and anyone involved with women's care or who has the power to improve it. The vivid, upsetting descriptions are the point. Clarke should be applauded for her bravery and for using her position to raise awareness and help others. The truth can be painful, but nothing can improve unless people are prepared to confront it.
The treatment Clarke describes from staff at Royal Stoke hospital seems, at times, downright cruel. Having received major surgery, she was not given timely pain relief afterwards, nor anything to eat. 'They gave me lactulose to help avoid constipation,' Clarke recalls, 'but the dosage seemed too high, as excrement kept running down my legs.' Unable to move, Clarke describes not being able to lift her baby without help in order to feed her. 'After a long time calling out repeatedly, a nurse entered the room. She took one look at me lying pitifully on the bed and told me, 'Not my baby, not my problem.''
The lack of compassion shown by some NHS staff will shock even the hardest of hearts: midwives who 'resorted to manually pumping' Clarke's breasts 'to start colostrum production' or who chastised her for requesting pain relief. Thankfully, at other times, Clarke received good care from mental health experts and specialists who advised on her injury.
Like so many women who tear during childbirth, Clarke found it excruciating to sit down afterwards and found breastfeeding exceptionally difficult. Her daughter, Arabella, 'did not magically crawl up my chest, as the NCT class had led me to believe'. 'I was constantly needing the loo and it was impossible to control my bowels,' she adds. 'I found passing urine excruciating and I had to pour a jug of water over the area to help with the painful stinging.' There is no shame in these admissions. They are things women are not told about, but should be.
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The last third of Breaking the Taboo 'gives parents an opportunity that they were not given by the NHS', the midwife Donna Ockenden writes in the foreword to the book: 'a chance to be heard'. In many ways, it is the hardest part to read. Within these stories there are health professionals who behave like 'angels', caring deeply for these women, but each has been let down at their most vulnerable. While Clarke tells her story in painstaking detail, these unflinching narratives feel relentless: horror upon horror. We hear from Sarah, who after losing three pints of blood was left with a 'prolapsed bowel, bladder and womb'. Thirteen years on, she still bleeds profusely if she lifts anything heavy. Eilidh suffered a severe postpartum mental health breakdown. Rachael has PTSD a decade on from the traumatic birth of her twins, while Lillian's account of giving birth at 21 weeks and subsequently losing her baby is harrowing. I cannot get any of these stories from my mind.
Many mistakes were made during the Covid-19 pandemic, but among the cruellest was forcing women to give birth alone or refusing to let their partners stay afterwards. In some cases, mothers were separated from their newborn babies. Even for those who had a trouble-free birth, it must have been lonely – but to be in extreme pain, unable to move, and alone, is torture. 'I asked to go with my son in the ambulance and this was refused… because of Covid rules,' Lisa recalls. 'My son wasn't even 24 hours old.'
While the book's focus is on birth trauma and improving maternity services for women, it is also an indictment of parliament and what Clarke describes as its 'toxic culture'. Throughout her pregnancy, she 'spent months having mental health specialist care with the NHS' to help with chronic anxiety. Yet she told no one in Westminster. 'Weaknesses were something to be exploited by opponents,' Clarke believed. Her pregnancy coincided with one of the most turbulent spells in modern British politics. In July 2022, at 36 weeks pregnant, she resigned as Boris Johnson's trade envoy, days before Johnson himself resigned as prime minister. In the leadership contest that followed, Clarke backed Penny Mordaunt (and later Rishi Sunak), but she is scathing about Liz Truss, who 'came across as overly ambitious'. 'I thought she often oversold her brief, took credit for the work of others,' Clarke writes.
The whips, whom Clarke likens to 'bullying prefects in a dysfunctional boarding school', come off worst. She is scathing about Mark Spencer, the former Tory chief whip, as well as the deputy chief whip Craig Whittaker. Clarke says she came to 'never truly' trust the Whips' Office again following a threat to be thrown out of the Conservative Party if she failed to back a crucial, chaotic vote on fracking while on maternity leave. Clarke, who believed the policy went against the Tories' manifesto, says the tone used was 'nasty and bullying'.
The behaviour of some of her constituents and local party members is something they should be ashamed of, too. Within a week of Clarke giving birth, a local resident lodged a complaint that they could not have a face-to-face surgery appointment with her. 'They referenced that I had had my baby nearly 'a whole week ago' so I should be available to them as their local MP,' Clarke writes. Others criticised her for not attending a church service to commemorate the death of Queen Elizabeth II, despite the fact that Clarke was unable to sit down at the time.
There are also several heroes. First and foremost, James, Clarke's office manager in Stoke, who dealt with anything important in the aftermath of her traumatic birth. Her husband, Henry, is also a rock. Clarke has good words to say about both Sunak and Kemi Badenoch, but it is striking how the only people who truly support her politically are other women. Theresa May, Mordaunt and Gillian Keegan all helped Clarke fight back against her local Conservative Association, which had deselected her four days after returning from maternity leave. She 'was not seen out and about enough locally as the MP', they argued.
While giving birth has clearly changed Clarke forever, she has been left bruised and bitterly disappointed by her experience in parliament, too. 'I felt that no one looked after us as people and we were seen only as politicians to be mocked and abused,' she says. Clarke reveals she had a panic button fitted in her home because of harassment, and that during maternity leave she received 'abuse in person, on the telephone and via [her] staff'. The House of Commons, she argues, 'is not a modern workplace that is compatible with raising a young family'.
In Breaking the Taboo, Clarke describes both a parliamentary and maternity system that are failing. Each and every inquiry held into poor maternity care has highlighted similar problems. But recommendations for improvements are ignored as governments come and go, and other things take priority. The Labour government has not yet committed to implementing any of the recommendations from the parliamentary inquiry into birth trauma published in May 2024, led by Clarke and Rosie Duffield. The ongoing inquiry into Nottingham University Hospitals NHS Trust has heard evidence from over 2,000 families who have suffered potentially avoidable harm or death over a ten-year period – 'a whole school full of missing children', as Sarah and Jack Hawkins, whose baby was stillborn in 2016 after mistakes by maternity staff, put it. This has to stop. This book is a vital tool in achieving the change that is so urgently needed.
Breaking the Taboo: Why We Need to Talk About Birth Trauma
Theo Clarke
Biteback, 384pp, £20
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[See also: Who are the white working class?]
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