Before giving birth, breasts are a sexual attribute, so women cover them up. In the maternity ward, this shame disappears

How do you interpret shame? Is it always a clearly inhibiting and bad emotion?

I see two kinds of shame. The first is related to taboo, hiding something we don't like about ourselves, sometimes we even feel disgusted by it. The second type is shame to protect something valuable to us. This applies, for example, to young children. We teach them social rules that are supposed to protect them. A good example is the beach: we put on bathing suits for young children and cover their intimate parts for their own safety. This kind of shame serves something.

You teach midwifery students how to deal with embarrassment.

I teach them so that they can imagine themselves in the place of the woman giving birth. You can experience this with different senses, such as by trying to close your eyes and listen to the surrounding sounds. I ask my students to lie down on the gynaecological bed and spread their thighs apart. This already causes great discomfort in them, and they aren't even naked – they're wearing a uniform.

This kind of exercise is especially difficult for all girls, because those who are watching also feel shame. But the most embarrassing for them is being with a woman giving birth in silence. It's easier to perform various activities, such as putting on a CTG pad or measuring the pressure, than to accompany a suffering woman in silence.

Helplessness is difficult. Each subsequent birth breaks this shame in midwives, and I believe that it's consistently getting better with time.

Are women's breasts taboo in obstetrics?

In the period before childbirth, breasts are a sexual attribute, and even after giving birth, women feel the need to cover them for a while, but in the maternity ward this taboo disappears. Women experience a congestion, breasts are shared between the mother and the baby, so they become public parts of the body. They are disenchanted, shame is removed from them in a way. Even in ourselves, the process of removing shame takes place, because breasts have a different function for us.

There are cultures where breasts are not a sexual attribute and are not covered up. But women in labour are not only ashamed of their bodies, but also, or perhaps most importantly, of their behaviour.

How so?

It's just the way it is. This shame resonates with me exceptionally. After giving birth, women apologise for cursing and screaming. And behaviour during childbirth should be instinctive and not be subject to cognitive evaluation.

Women are ashamed of their reactions, because they lose their temper, exceed their limits. It is embedded in our culture in which women are to be obedient, cooperative and submissive. But when a woman gives birth, she is often unable to obey medical staff because her body is mired in such a mixture of pain and emotions that it is difficult for her to respond to commands.

How can a midwife deal with this shame? To free a woman from these limitations during childbirth?

For example, it is worth ensuring that a woman puts on a bathrobe when she is going to go out into the corridor if there is a need to move. It is not obvious, because a woman in labour doesn't think about it, she feels hot and doesn't need to cover herself. But after giving birth, women thank for it, because they feel that someone has taken care to protect their intimacy.

Verbal and non-verbal communication is important. To both tell and show the woman: I am here, I accept your every behaviour. You should not show impatience but strengthen acceptance of what is happening.

What bothers those in labour? What limits or embarrasses them?

Sometimes the partner turns out to be this unsupportive element. Therefore, when running childbirth classes, I say that the presence of a partner is not necessary. We shouldn't insist on it. If there is a lack of trust in a relationship, this will negatively affect the birth and then the relationship. Partners sometimes comment, reprimand, or simply take helplessness badly. Then we have to take care of this situation, e.g. we send the husband to sign some papers, or to bring their partner's suitcase or panty liners. Sometimes couples guard each other's shame, and women feel even more blocked. Then they cannot enter the so-called reptilian phase, that is, to break away from the cognitive assessment of themselves, and this is essential for childbirth. For a physiological birth to be successful, a cascade of subtle hormonal changes must occur. And shame or discomfort can disrupt this.

Intimate ailments or illnesses also bring shame. For example: urinary incontinence in young women, a consequence of neglect in labour.

It can also be a consequence of crossfit training. The problem with urinary incontinence is wide-ranging and doesn't just affect older women. So a young woman won't recognise habitual incontinence because she thinks she is too young for the disease. Or vice versa: she is embarrassed by the fact that it is, after all, a disease of older women, and this will stop her from being diagnosed and treated. And urinary incontinence is like a painful period. It simply happens.

We assume that the lives of women are difficult by definition, they experience more pain and have their burdens, therefore various things can happen to them, and that we don't have to fight for the quality of their lives. Our culture makes us believe that women are destined for pain. The situation is similar with menopause. We joke about this topic, we think it's natural, so there is also discomfort. Naturally.

Feeling ashamed makes us delay treatment.

Not only that. It's a double-edged sword. In the case of menopause, it is easier to prescribe hormones, and in the case of menstruation to take painkillers than to accept the situation, wrap our body, change the mode of functioning, respond to this situation carefully. Medicating can be simpler than accepting and talking. It's easier to get rid of a problem quickly than to deal with it constructively.

How else do women abuse their bodies?

For example, in puerperium. They often lift heavy baby carriers with children inside, which also affects the pelvic floor muscles.

The postpartum period is the period of mothering mothers. There are cultures in which women take care of women during this time so that they can only look after the new-born. Due to technical reasons, our culture does not give it any chance. Husbands have two weeks off, then women are left alone. They cannot always count on their mother, and sometimes her presence would even cause conflicts. Consequently, they carry loads, and they shouldn't.

What do you say to pregnant women who are ashamed of their bodies or their reactions? What will soothe them and give them a chance to get out of embarrassment?

I tell them that everything they feel is OK, that none of their emotions are subject to my judgement. I let them know that everything is fine for me and that they can show them with a sense of security. I support them and say that this shame is also needed, it protects, it's there for a reason. If it's destructive, I recommend going to a psychotherapist or women's circles.

I say that I see them, and I will do anything to protect what they protect with their shame. I give women the strength to confront their emotions.

 

Ewa Kaleta talks to Barbara Baranowska, PhD

• Barbara Baranowska, PhD - acting head of the Department of Obstetrics of the Medical Centre of Postgraduate Education

Interview published on wysokieobcasy.pl on 12 December 2020.