This blog is a metaphorical opening of the door to all doctors: an invitation into the world of knowing how you can prevent trauma in the birthing arena. It isn’t a tongue-in-cheek invitation, and there is no sarcasm. It is a serious request, because you are needed here.
It’s a brave choice to step through. We get it: you went to medical school and trained really hard in how to fix patients. You did your rotational placements, learnt how you could change and affect people’s lives for the better, not least in A&E where you were thrown in at the deep end, challenged, and given the opportunity to grow in confidence. You are amazing at what you do.
The elephant in the room is that there is a dichotomy in obstetric-led care of childbirth. You are there to fix: to fix things when they go wrong, when they aren’t going as expected, when medical conditions outside the norm make things different. Of course, you know all of this. However, in a normal, healthy pregnancy, where all signs for mother and baby are good, there is nothing to fix. That’s the elephant.
It’s great that you want to say hello to all the mothers on the maternity ward when you do your rounds. You may think it puts her more at ease later if you need to intervene, because she already knows your face. But let’s think about the underlying message you are giving. Firstly, it suggests a hierarchy with midwives. Yet no amount of residencies will give you the training that an experienced midwife has in normal physiological birth- unless you also trained as a midwife. A birthing woman must have absolute confidence in the team around her so that she can relax into what is essentially a primal state, allowing her neocortex to switch off. In some way, when you introduce yourself ‘just in case’, you imply that her midwife might not be good enough. You also plant the idea that her body might not work properly.
Finally, and you may not be aware of this, but your educated awesomeness can be pretty intimidating for someone who hasn’t had the education that you have. You are confident and clever and here I am laying on my back with my legs akimbo. Notice the power dynamic here? I implore you in the case of a normal pregnancy, where birth is progressing, that you please stay away. The midwife knows what to look out for and when she needs you. Trust her, she will call.
Fortunately, unlike America, we don’t have a medical system where midwives act under the authority of obstetricians. We have a fabulous system that teaches incredibly skilled midwives how to look after birth in the best way possible, where generations of knowledge have been passed down from midwife to midwife. They can listen to the sounds a mother is making and know what it means. They can walk into what appears to be a stalled labour in a noisy, bright birthing room and recognise that the mother’s neocortex is switched on and that she is unlikely to birth without medical intervention. So, they close the curtains, ask unnecessary people to leave, and whisper a kind word in the mother’s ear to boost her confidence and help her relax.
They can see the rhombus of Michaelis and know that the baby is moving down, or they might see someone lying on her back pushing hard, and know that she needs to turn over so that gravity can help. What they do is work with nature, nurture and intuition.
When a midwife calls you, that is when you are absolutely needed. This is your moment. And for a birthing person, this can be the moment that dictates whether a family is left traumatised or not. You only need to read the outcome of the 2024 All-Party Parliamentary Group on Birth Trauma (link below) to know that it isn’t always what happens to the mother but rather how she is treated or not considered that leaves trauma.
Of course, you are there to do the most important job: to save the life of mother and child. And of course that is the primary outcome that you and we all want. But perhaps you might consider that it is not the only outcome to wish for, and that you have the power to make things different. Imagine building a reputation not only for physically well patients but for emotionally well ones too. Sending home an emotionally well family also saves lives. According to MBRRACE, 40% of maternal deaths in the first postnatal year are due to mental ill-health.
We know that trauma and PTSD come from a fear of danger to one’s life, or fear for the life of loved ones. Imagine this scenario:
The midwife presses the emergency button. Quite rightly, a number of duty doctors, midwives and medical staff arrive at the same time. Machines are bleeping, the room is chaotic, instructions and updates in medical terminology are being thrown around. All this is happening while the mother lies on her back, in pain, scared out of her mind, and the partner is at a loss as to how to help. Things happen without being explained, the partner feels helpless and, in some cases, is pushed aside. Machines and alarms keep bleeping. Anyone would fear for their life in that scene.
The doctor tells the midwife to put the mother in stirrups and, donning a gown, proceeds to put their hands inside her to try to assist the baby’s descent. With their help, and lots of screaming from the mother, with the father distressed, the baby is delivered and all seems well. Obstetricians congratulate everyone, say “well done” to the mother, and leave the midwives to clean up. Then the mother says she feels something isn’t right, realising she is bleeding, not just a little, but a lot. She’s told not to worry, but she knows this isn’t normal. There is so much blood. No one is even looking, because they are so busy and have left her with the baby. Her partner can’t catch anyone’s attention. Then the mother faints. The emergency button is pressed again, the room fills once more, and the partner fears she is going to bleed to death.
In this whole scenario, there is so much space for trauma. But what if you could change that, by simply changing or delaying a few things? What if this was the script…
Midwife: “You’ve been trying wonderfully, but I’m a bit worried that the baby is finding it hard to move down. It’s not an emergency yet, but I’d like the doctor to come and have a look. I’m going to press the emergency button because it’s the quickest way to get their attention. Don’t worry about all the people rushing in, that’s their job. Some of them will leave once they realise they aren’t needed.”
Doctor arrives
Midwife: “Thanks for coming, doctor. I was just explaining to Lucy and Tom that the baby might be struggling a bit.” (gives the necessary medical information)
Doctor: “Hello Lucy, hello Tom. Tom, I’m going to ask you to sit on that stool next to Lucy’s head so you can quietly support her while we work together.”
Doctor: “Lucy, your fabulous midwife Jane is going to stay right with you too. She’ll tell you what’s happening in the simplest way, and if either of you have any questions, you can ask her or me.”
Midwife: Reassures both parents that they are doing brilliantly and that baby is okay.
Doctor: “Lucy, I’d like to have a feel to check that nothing is obstructing your baby. Are you okay with that? I’ll be as gentle as I can, so as to interfere as little as possible.”
Lucy: (looks at partner and midwife for reassurance; a hand is offered, encouraging eyes and words are shared, and she agrees)
Doctor: “You’re doing brilliantly, Lucy. I can feel that baby is just a little stuck, and I think I can help by gently making space with my hand. Shall we give it a go?”
Lucy: “Okay, but it really hurts when you put your hand in.”
Midwife: “All the stats look good. We can wait a few minutes while we increase the pain relief.”
Doctor: “Yes, we’ll keep a close eye on you and baby while that takes effect.”
(A short time later)
Doctor: “Okay Lucy, I know this hasn’t been easy, but you’re doing brilliantly. Do you feel ready to try now?”
Lucy: “Okay.”
Partner: “What happens if it’s too painful for Lucy?”
Midwife: “You’re worried she might not cope. She has the pain relief now, and Lucy is stronger than you think. But if it feels like too much, she can say so, and we’ll pause if possible. Does that sound okay to you too, doctor?”
Doctor: “Yes. Lucy, just shout if it feels too much and we’ll pause if we can. Now, I’m going to ask you not to push while I get into position. Well done, that’s brilliant. Do you feel able to give a little push now?”
Lucy: “I’m scared.”
Midwife: “We’re all here for you. Look into Tom’s eyes and focus on him being here with you. Lovely. Can you take a few relaxing breaths before we try again… brilliant.”
Doctor: “Okay Lucy, can you give a gentle push? I’m working with you… wonderful. I can feel your baby moving down…”
(The baby is born. The midwife and doctor check in with Lucy and Tom, telling them how well they did.)
After the baby is birthed, the midwife and Dr check in with Lucy and Tom and tell them how well they did.
Lucy doesn’t experience a postnatal haemorrhage, probably because she and the doctor worked together, rather than Lucy fighting against the pain.
When we look at both scenarios, the second is all about assuming that the parents will be traumatised from the experience unless they are held, supported, empowered and well informed. It fulfils the oath of “do no harm”.
Clearly, this is a fictional situation. But by changing the tone of the room to be inclusive, respectful of consent, and non-coercive, you can build trust and confidence. And how long does this take? Merely seconds longer than if you were just talking to the medical team.
I’ll leave you with an image that illustrates this beautifully. I’m sure all of us at some point have watched a David Attenborough film of a doe birthing its fawn. Do you remember when the lion spots her, she freezes, the fawn’s head and front legs already birthed? In that moment, the birth stops. She has no choice but to run. Weaving and turning through trees and shrubs, she outruns the lion. Once safe, she shakes off the cortisol, finds a hidden spot, and goes on to birth her fawn.
Now, the physiology is different for humans, but the primal need for safety is no different. When a mother doesn’t feel safe, everything stops. It’s labelled “failure to progress” but in reality it’s “failure to ensure she feels safe” and then failure to wait. It’s simple: sphincter muscles are shy. If someone barges into the loo while you are using it, everything stops as your amygdala reacts. But once you relax, things start working again.
The journey of childbirth is a profound and vulnerable experience. This blog has been an invitation to the medical community, particularly doctors, to consider how their role in a birthing environment can be a source of either trauma or empowerment. By recognising the expertise of midwives in physiological birth, and understanding the primal need for a birthing person to feel safe, doctors can significantly impact the emotional and mental well-being of new families.
This proposed shift isn’t about diminishing the vital role of doctors in emergencies. It is about a subtle yet powerful change in approach, one that prioritises collaboration, communication and emotional awareness. When doctors and midwives work together, respecting each other’s unique skills, and when the birthing parents are treated as active participants rather than passive patients, the likely outcome is not only a physically healthy mother and baby but an emotionally resilient family.
This change in practice, a commitment to the principle of “do no harm” in its broadest sense, has the power not only to save lives but to truly transform the birthing experience for the better.
NPEU. (2023). MBRRACE-UK Reports. Retrieved September 23, 2025, from https://www.npeu.ox.ac.uk/mbrrace-uk/reports
Theo Clarke. (2024). Birth Trauma Inquiry Report. Retrieved from https://www.theo-clarke.org.uk/files/2024-05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf