I often find myself in conversations about maternity services where frustrations surface—about mistakes made, about unnecessary interventions, or sometimes about moments where action was needed but delayed. It’s easy to see why emotions run high when we talk about birth and the care women receive. For many, it feels personal because it is personal. But this isn’t about making excuses for midwives, obstetricians, or anyone else working in maternity care. It’s about digging deeper to understand why things are the way they are. Because without understanding, we can’t hope to change anything.

At the heart of it all lies a troubling truth: the way maternity care is currently structured often sets professionals up to fail. They are tasked with navigating complex situations under extraordinary pressure, with the constant fear of mistakes hanging over their heads. What’s particularly fascinating—and heart-breaking—is that the very act of focusing on not making mistakes can make mistakes more likely. This isn’t conjecture or anecdote; it’s how the brain works.

Let’s take a closer look at the psychology behind this. The human brain, brilliant as it is, operates in ways that are sometimes counterintuitive. When you tell yourself, “Don’t make a mistake” what your brain hears loudest isn’t the “don’t”—it’s “make a mistake”. This phenomenon is well-documented in psychology and is often explored in Neuro-Linguistic Programming (NLP). The subconscious mind struggles to process negatives. If I say to you, “Don’t imagine a blue tree” chances are you’ve already pictured one, even though the instruction was to avoid it. The brain latches onto the key image or idea, and in doing so, inadvertently amplifies it.

Research supports this. Studies on cognitive function under stress show that negative self-talk can impair focus and decision-making, particularly in high-pressure situations. For example, a study published in ScienceDirect, the researchers found that individuals who engage in negative self-talk experience increased anxiety and decreased working memory capacity, leading to impaired decision-making and performance.

Now imagine being a midwife in the birth room or an obstetrician handling a complex situation. They’re under pressure, perhaps recalling a past incident where something went wrong, and their internal dialogue is a loop of, “Don’t mess this up”. Their focus is so fixed on avoiding error that their ability to think clearly and respond flexibly is compromised. Anxiety spikes, decision-making narrows, and what they feared most becomes more likely.

This isn’t just theoretical. Studies have shown that stress impairs cognitive performance, especially when combined with fear-based thinking. In high-pressure environments like maternity care, where every decision carries weight, the stakes are even higher. It’s not just about individual moments of doubt or hesitation—it’s about the cumulative impact of working in a system that reinforces this kind of fear.

But the problem doesn’t stop at the mental strain caused by negative thinking. There’s another layer: the emotional toll of the job itself. Midwives and obstetricians witness trauma more often than we might like to admit. They see births go wrong, hear heart-stopping alarms, and sometimes, despite their best efforts, lose mothers or babies. Even when things go right, the ever-present anticipation of disaster takes a toll. Over time, this constant exposure to stress and trauma leaves scars—ones that can manifest as PTSD, burnout, or even physical health issues.

PTSD among maternity care providers is a growing concern. Research highlights that midwives and obstetricians are at significantly higher risk of PTSD compared to other healthcare professionals. A study published in The European Journal of Midwifery in 2021, found that midwives who witnessed traumatic births were significantly emotionally affected, often losing self-confidence and considering leaving the profession. Unlike other medical professionals, maternity staff are not only responsible for health outcomes but are also deeply entwined in one of the most emotional moments of a family’s life. The stakes feel deeply personal for everyone involved, and that weight is hard to carry.

What happens when professionals are overwhelmed by stress and trauma? They become more likely to either overreact or underreact in critical moments. Fear of litigation or being blamed for poor outcomes often drives unnecessary interventions, such as inductions or caesareans that might not be needed. On the flip side, the same fear can cause paralysis—delaying decisions when swift action is necessary. It’s not a lack of skill or competence but the sheer weight of the circumstances they’re operating under.

Adding to this complexity is the tendency to assign blame. It doesn’t help to blame mothers for their outcomes, as was highlighted in a recent BBC investigation into maternity care. Nor does it help to scapegoat other professionals like doulas or independent midwives. Data has shown that doulas were present in less than 1% of neonatal deaths, despite recent attempts to link them to poor outcomes. In other words, the overwhelming majority of tragic cases involve other factors and other professionals. Blame distracts from the bigger picture—the structural failings and systemic pressures that shape every decision and outcome. Instead of pointing fingers, we need to focus on building a system where collaboration and accountability go hand in hand.

When mistakes happen, there’s little room for grace, for understanding, or for addressing the deeper issues at play. In many maternity settings, the culture around error is one of shame and fear rather than learning and growth. Professionals know that a single mistake could define their career, and this creates an atmosphere where no one wants to speak up or ask for help. It’s not just damaging for the individuals involved; it’s a missed opportunity for the entire system to improve.

If we want to create meaningful change in maternity care, we need to start with the people providing the care. We need to understand that their mistakes are not just theirs—they are the result of a system that doesn’t support them properly. This isn’t about excusing errors but about creating an environment where fewer errors happen in the first place.

One way to start is by rethinking how we talk about mistakes. The constant drumbeat of “don’t mess this up” must be replaced with something more constructive. Imagine a culture where midwives and obstetricians felt safe to say, “This is where I struggled”, or “Here’s a mistake I made and what I learned from it”. Normalising these conversations would help to break down the fear of failure and turn it into a learning experience. It would also reduce the internal pressure that makes errors more likely.

But we can’t stop at changing the narrative. Maternity care providers need tangible, practical support for their mental health. This means offering regular access to counselling, not just after traumatic births but as an ongoing resource. It means building peer networks where midwives and obstetricians can talk openly with others who understand their challenges. And it means creating workplaces where asking for help is seen as a strength, not a weakness.

Of course, none of this will succeed if we don’t address the structural issues. Chronic understaffing, long shifts, and inadequate resources are all too common in maternity care, and they exacerbate every other problem. A burnt-out midwife who hasn’t slept properly in days is more likely to make mistakes, no matter how well-trained or experienced they are. The system needs to prioritise sustainable staffing levels and workloads—not just for the sake of professionals but for the families they care for.

Trauma-informed care is another piece of the puzzle. This concept is often discussed in the context of patients, but it applies just as much to those providing the care. Trauma-informed workplaces recognise that many professionals carry their own emotional scars and ensure that policies and practices reflect this understanding. A trauma-informed approach might include debriefing after difficult births, offering flexibility for those struggling with burnout, or simply fostering a culture of compassion rather than criticism.

The language we use matters, too. Not just in how maternity professionals talk to themselves but in how the wider system communicates with them. Too often, the focus is on what went wrong, rather than celebrating what went right. Imagine how much more empowered midwives and obstetricians would feel if their good work was regularly acknowledged—if they were reminded of the many lives they’ve touched and the countless moments they’ve made better.

Maternity care is about more than clinical outcomes. It’s about creating an environment where mothers, babies, and families feel safe and supported. But that’s impossible if the people providing the care don’t feel safe and supported themselves. This isn’t just a matter of fairness or kindness; it’s a practical necessity. The better we take care of obstetricians and midwives, the better care they can provide.

We’re quick to criticise when things go wrong, and of course, accountability matters. But if we don’t also examine the system that allowed those mistakes to happen, we’re missing the point. This is about more than finding fault. It’s about asking better questions: How do we create a maternity care system where mistakes are less likely? How do we support professionals so they can make clear, confident decisions? And how do we build a culture where everyone involved feels valued, respected, and understood?

There are no quick fixes, but that doesn’t mean we should settle for the way things are. Obstetricians and midwives enter this work because they care deeply about mothers and babies. They want to make a difference, to be a positive presence at one of life’s most transformative moments. If we give them the tools, the support, and the understanding they need, they can do exactly that. And that’s a change worth fighting for.

My response to the article "Rise of the doula: a helping hand or a danger to mothers?"

Dear Rosie,
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I read your article "Rise of the Doula" with great interest. However, I noticed several points that seemed to lack balance and omitted crucial information necessary for a well-rounded discussion on childbirth options.

Firstly, it's important to acknowledge that complications can and do happen in all birth settings, including hospitals. Babies die in hospitals too, despite the presence of highly trained staff and advanced medical facilities. For example, in England and Wales, the neonatal mortality rate was 2.9 deaths per 1,000 live births in 2022. This equates to 0.29%, showing how very rare these occurrences are. Highlighting only the negative outcomes of home births without mentioning the risks associated with hospital births provides an incomplete picture.

Moreover, the focus on freebirthing and radical birthkeepers could lead readers to believe that non-hospital births are inherently dangerous. However, it's worth noting that many women successfully have safe and fulfilling home births, especially when supported by trained midwives and doulas. These professionals often provide continuous care, proven beneficial for maternal and neonatal outcomes. Research shows that for low-risk pregnancies, home births attended by certified midwives are just as safe as hospital births, with no significant difference in perinatal mortality.

Additionally, the claim that biting on an umbilical cord or placenta can stop a haemorrhage is often dismissed by obstetricians. However, there is some evidence and anecdotal support for traditional practices. The power of the placenta in preventing postpartum haemorrhage has been discussed in various traditional and natural birth communities​ ​. When obstetricians dismiss these practices, it is fair to ask for proof or scientific studies that explicitly disprove their effectiveness, instead of outright dismissal of traditional knowledge. The human race has survived for millions of years without obstetricians, which suggests that childbirth, in its natural state, is generally safe. Therefore, traditional practices should not be dismissed outright but rather studied and understood within the context of modern medicine.

Regarding financial aspects, obstetricians in the UK can earn an average of £82,000 annually, while midwives earn around £34,000. In contrast, doulas, who provide essential non-medical support, typically earn between £1,000 and £2,000 per birth package and usually if working on their own have around 10-15 births per year. These figures illustrate families' significant investment in securing personalised, supportive care during childbirth. Interestingly, it always appears that women in the caring industry seem to be more heavily highlighted. This hidden misogyny reveals how the patriarchal view is embedded in our society. There is an overriding feeling that these women should be ashamed of asking for money, which overlooks the immense value and care they provide, crucial for the well-being of mothers and babies.

Doulas play a crucial role by offering emotional and practical support, helping mothers navigate their birthing options, and advocating for their preferences. This support can be invaluable in a healthcare system where midwives are overworked, and continuity of care is often lacking. The presence of a doula during childbirth has been shown to significantly improve birth outcomes. Research indicates that women who have continuous support from a doula are:

- 39% less likely to have a caesarean section.
- 15% more likely to have a spontaneous vaginal birth.
- 10% less likely to use any pain medication.
- 31% less likely to use synthetic oxytocin to speed up labour.
- 34% less likely to rate their childbirth experience negatively.

These statistics highlight the positive impact of doula support on reducing medical interventions and enhancing the overall birth experience.

Your article mentions the tragic outcomes of some home births but does not provide context about the high rates of interventions in hospitals. Interventions like inductions, epidurals, and caesarean sections, while sometimes necessary, can also lead to complications such as increased postpartum haemorrhage and higher rates of maternal mortality and morbidity. Not to mention the number of women who are left traumatised and experience postnatal depression as a direct result of how they were treated during childbirth.

In conclusion, while it is vital to discuss the potential risks of home births and the importance of medical intervention when necessary, it is equally important to present a balanced view. Recognising the benefits of doula support and the successful outcomes many women experience with home births can help expectant mothers make informed decisions that align with their personal circumstances and values.

Best regards,
Kicki Hansard
Certified Birth and Postnatal Doula
Founder, The BirthBliss Academy

Full article from The Times here.

In today’s globalised world, cultures constantly cross paths, intertwining in increasingly complex patterns. Advanced technology and migration trends have accelerated this interchange, painting a vivid mosaic of traditions, norms, and behaviours. You'd think this cosmopolitan era would nurture greater understanding and acceptance. Yet, regrettably, the tapestry of human interaction remains marred by clashes, one of which is ‘cultural discrimination’. Intrigued? Let’s delve into this paradox.

Life is full of unexpected twists and turns, and betrayal is one of the most disorienting of them all. It's like a sucker punch to the gut, leaving you winded and disoriented. But what happens when your friends or colleagues, the people you thought had your back, don't distance themselves from the person who betrayed you? It's a complex and emotionally charged situation that many of us find difficult to navigate. So, let's roll up our sleeves and delve into this intricate emotional landscape.

The Sting of Betrayal: A Closer Look
Betrayal is a loaded term, often evoking images of dramatic confrontations and tearful goodbyes. But in reality, betrayal can be subtle, creeping into your life almost unnoticed until the damage is done. Whether it's a friend sharing your confidential information or a colleague taking credit for your work, betrayal always boils down to a breach of trust. And trust, once broken, is incredibly hard to rebuild.

The Social Web: Why Friends Don't Always Take Sides
Friendships and professional relationships are complex webs of interactions, loyalties, and unspoken rules. Your friends or colleagues may have various reasons for not distancing themselves from the person who betrayed you. It could be ignorance, fear of confrontation, or even self-interest. Understanding this complexity is the first step in navigating the emotional maze you find yourself in.

Step 1: Take Stock of the Situation
Before you react, take a moment to assess the betrayal's impact. Is it a minor setback, or has it fundamentally altered your relationship with the person? Your next steps will depend on this evaluation. Create a 'Betrayal Impact Scale' for yourself, rating the betrayal from 1 to 10. This will give you a clearer perspective on how to proceed.

Action Guide: 

• Write down the facts of the betrayal.
• Rate its impact on a scale of 1 to 10.
• List the emotional and practical consequences.

Step 2: Open Up the Dialogue
If you're comfortable, consider having a candid conversation with your friends or colleagues. Sometimes people are simply unaware of the emotional toll their actions—or lack thereof—have taken on you. A straightforward discussion can sometimes clear the air and even garner you some support.

Action Guide:

• Choose a neutral setting for the conversation.
• Use "I" statements to express your feelings.
• Be open but also prepared for any response, even if it's not what you hope for.

Step 3: Establish Boundaries
You can't control others, but you can certainly control your own actions and reactions. Clearly define your boundaries moving forward. If your friends or colleagues continue to engage with the person who betrayed you, you may need to distance yourself for your own emotional well-being.

Action Guide:

• Clearly articulate your boundaries to your friends or colleagues.
• Decide what actions you'll take if your boundaries are not respected.
• Stick to your boundaries, even if it's difficult.

Step 4: Re-evaluate Your Relationships
This experience serves as a reality check for your friendships and professional relationships. If your circle chooses to remain neutral or even side with the betrayer, it's time to question the depth of these relationships.

Action Guide:

• Make a list of relationships that are truly supportive.
• Consider distancing yourself from relationships that are not beneficial.
• Invest time and energy in relationships that bring you joy and support.

Step 5: Seek Alternative Support
If your current social circle isn't providing the emotional support you need, look elsewhere. Engage in new activities, join clubs, or participate in online communities that align with your values.

Action Guide:

• Research clubs or groups that interest you.
• Join online forums or social media groups that align with your values.
• Make an effort to form new friendships.

Step 6: Focus on Personal Growth
Use this experience as a catalyst for personal development. Whether it's picking up a new hobby, focusing on your career, or simply spending quality time with loved ones, make sure to invest in yourself.

Action Guide:

• Identify areas for personal or professional growth.
• Set achievable goals.
• Take actionable steps towards achieving these goals.

Step 7: The Art of Letting Go
Holding onto resentment is a self-destructive act. As challenging as it may be, strive to let go of your negative emotions. This doesn't mean you forgive and forget; it means you're choosing your own peace over emotional turmoil.

Action Guide:

• Practice mindfulness techniques to manage your emotions.
• Consider writing a 'letting go' letter to the person who betrayed you (you don't have to send it).
• Engage in activities that bring you peace and happiness.

Step 8: Seek Professional Guidance
If the emotional toll of the betrayal is too heavy to bear alone, consider seeking professional help. Therapists can provide valuable coping mechanisms that friends, however well-intentioned, cannot.

Action Guide:

• Research therapists who specialize in betrayal or relationship issues.
• Schedule an initial consultation to see if it's a good fit.
• Commit to regular therapy sessions for ongoing support.

The Road Ahead: Finding Your New Normal
Betrayal is a life-altering experience, but it's also an opportunity for growth. Your social circle may shrink, but it will also become more authentic. So, take a deep breath, square your shoulders, and walk through this emotional storm. On the other side, you'll find a stronger, more resilient you. And that, my friend, is something to look forward to.

Volunteering is often seen as a noble endeavour, a way to give back to the community and make a difference. However, when it comes to women, the narrative takes a slightly different turn. While women are more likely to volunteer than men, this generosity often comes at a cost, both personally and professionally.

The Gender Gap in Volunteering
According to a Statista report, 52% of women in England participated in voluntary activities in 2021/22, highlighting a gender disparity in volunteering. This is corroborated by research from the University of Melbourne, which showed that women were nearly 50% more likely to volunteer than men.

The Economic Impact
Volunteering is not just a social good; it has a tangible economic impact as well. A report reveals that volunteers contributed £4 billion to the UK's economy in just three years. Another study found that the socio-economic value of volunteering and donating is worth a staggering £18.7 billion to the UK economy.

The Caregiving Conundrum
Women in caregiving industries often face an added layer of complexity. Society expects them to provide these services out of goodwill, as if the emotional labour involved doesn't warrant financial compensation. This expectation not only devalues the work but also adds an unnecessary burden on women who are already juggling multiple roles.

The Unpaid Labour of Volunteering
Women frequently volunteer their time and skills for valuable jobs and receive nothing in return. Whether it's organising events, serving on committees, or providing expert advice, this unpaid labour is often overlooked. While volunteering can be fulfilling, it's crucial to recognise the value of your time and expertise.

The Dark Side of Volunteering
While volunteering has its merits, it's essential to consider its potential drawbacks, especially for women:

1. Career Stagnation: Volunteering often involves tasks that don't lead to promotions or career advancement. This can result in career stagnation, especially for women who already face numerous obstacles in the professional sphere.
2. Time Drain: The time spent volunteering is time not spent on other career-advancing activities. This can be particularly detrimental for women, who often have less leisure time due to domestic responsibilities.
3. Perception of Lower Value: Excessive volunteering can sometimes lead to a perception that your professional skills are of lower value, making it harder to negotiate for better job opportunities or higher pay.

Navigating the Volunteering Conundrum
While volunteering can be a fulfilling experience, it's essential to approach it strategically, especially as a woman. Here are some practical tips to navigate the volunteering conundrum:

• Prioritise Skill-Building Opportunities: When choosing a volunteering opportunity, look for roles that allow you to build or enhance skills relevant to your career. This way, you're not just giving back to the community; you're also investing in your professional development.
• Set Boundaries: It's easy to get caught up in the spirit of giving and overcommit. Be clear about how much time you can realistically dedicate to volunteering without compromising your career or personal life. Setting boundaries helps you manage your time effectively and prevents burnout.
• Leverage Your Network: Use your volunteering experience as an opportunity to network with professionals in your field. A strong network can open doors and offer career opportunities that you might not have access to otherwise.
• Know Your Worth: While the work you do as a volunteer is invaluable, it's crucial to know your worth in the professional world. If you find that your volunteering efforts are overshadowing your career, it might be time to reassess. Don't hesitate to seek paid opportunities that recognise the value you bring.
• Be Strategic About Your Commitments: Before committing to a volunteering role, consider its impact on your career and personal life. If a volunteering opportunity aligns with your career goals and offers a chance for skill-building, it's likely a good fit. On the other hand, if the role doesn't offer any professional benefits and takes up a significant amount of your time, you might want to reconsider.

By approaching volunteering with a strategic mindset, you can enjoy the benefits of giving back to the community while also advancing your career. It's all about finding the right balance and making choices that align with both your personal and professional goals.
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Volunteering is a commendable act, but like anything in life, it comes with its own set of challenges and implications. For women, especially, the act of volunteering is a double-edged sword that can both empower and hinder. As we navigate the complex landscape of gender, work, and societal expectations, it's crucial to strike a balance that serves not just the community but also ourselves.

We've all heard the saying, "Sisters are doing it for themselves." But what happens when those sisters find themselves in conflict? All-female spaces, be it a book club, a workplace, or a support group, are often seen as sanctuaries of support and understanding. Yet, sometimes, they can become anything but. Let's take a heartfelt look at why this might happen.

The Pressure Cooker of Expectations
Women are often expected to be everything to everyone. We're supposed to be strong yet gentle, assertive yet nurturing. These conflicting expectations can create a pressure cooker environment in all-female spaces. We might feel the need to be the "perfect woman," and when others don't meet our expectations (or we don't meet theirs), tensions can rise.

The Spice of Life: Diversity
We women are a diverse bunch, and that's what makes us beautiful. But it can also lead to misunderstandings. In an all-female space, we might find ourselves with women from different walks of life, different cultures, and different beliefs. It's a rich tapestry, but if we're not careful, those differences can lead to clashes rather than connections.

The Shadow of Competition
It's a tough world out there, and sometimes, competition gets the best of us. Even in spaces meant for support, we might find ourselves comparing our lives, our achievements, our looks. It's a slippery slope, and before we know it, we might feel more like rivals than sisters.

The Art of Communication
We all know that communication is key, but it's easier said than done. In all-female spaces, we might hold back our true feelings to keep the peace, or we might speak without thinking and hurt someone's feelings. It's a delicate dance, and it takes practice to get it right.

The Power of Leadership
A ship needs a captain, and an all-female space needs strong and compassionate leadership. If the leaders are not setting the right tone, the whole space can feel off-kilter. It's a big responsibility, and it requires a careful balance of strength and empathy.

A Sisterhood Worth Fighting For
All-female spaces are not always easy, but they are worth fighting for. They can be places of growth, understanding, and true sisterhood. But like any relationship, they require work, patience, and a whole lot of love.
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So, let's celebrate our differences, let go of unrealistic expectations, and communicate with honesty and compassion. Let's be the sisters we all need and deserve.