Expect the Worst

There once was a dream that women would find motherhood a natural and empowering experience. That dream of natural maternity started with childbirth. For instance, in the first edition of the women's health handbook Our Bodies, Ourselves, which was published over 30 years ago, women were encouraged to see childbirth as "a dignified and creative act". Inspired by charming illustrations of relaxed women squatting on the floor, they could feel part of the "humanness, naturalness and continuity of childbearing".

The reality for many mothers in Britain today could hardly be further from that ideal. A recent report from psychologists at Warwick University found that one in 20 mothers suffered what they called post-traumatic stress disorder after giving birth, and many others experienced nightmares and scary flashbacks. I don't find this report terribly surprising. As soon as you have given birth - indeed, as soon as you are pregnant - you are admitted to a club of women who tell and retell stories about childbirth. So many of those stories centre on pain and confusion, and an anger that seems to take the women themselves by surprise.

No doubt the ideal that all women should be able to experience a wonderfully joyful childbirth was never realistic. For many women, labour is just too painful or even dangerous to feel anything but unnaturally nasty. But you don't have to subscribe to some vision of giving birth to whale music in a lavender-scented bath to believe that mothers should not have an experience that leads to post-traumatic stress disorder. And this seems to be just the tip of an iceberg of unnecessary misery. More than half of the women who were questioned in another survey published last year said that they found childbirth "far more shocking" than they had expected.

One cause isn't hard to find. After all, the more support a woman gets from an experienced midwife during childbirth, the less likely she is to find the whole experience traumatic. But within our health service, vacancies for midwives are currently at record levels, with 90% of maternity units in England understaffed. That means that midwives tend to be working in impossible conditions; popping in and out of three or four labour rooms and filling out endless forms while women yell for them.

This crisis in midwifery correlates with an inexorable rise in medical intervention. Recent figures from the Department of Health show that natural childbirth has, for the first time, become a minority activity in Britain. Fewer than half of new mothers now have a spontaneous labour and delivery, while the majority have medical interventions ranging from induction to caesareans. Interventions don't necessarily add up to a horrible birth experience - indeed, a lot of women would argue that an epidural is a necessity for a decent one - but, hardly surprisingly, women who have an emergency caesarean are most likely to say they feel miserable about the birth.

One response of the government to the growing crisis in maternity services has been an announcement that they will offer new mothers more "information" in the shape of "maternity guides" that will give them all the data they need to "help women decide how they would give birth". This is patronising nonsense, since women confronting childbirth are already awash with information. They have checked out the maternity wards, read books of advice and admonition, attended antenatal classes, done their yoga, drunk their raspberry leaf tea, and talked endlessly to their partner about what to expect.

But once they go through the hospital door, too many women lose all control, confronted by a chaotic, creaking system where they are passed from one harassed midwife to another. The Department of Health says that in more than 90% of hospitals continuous care is delivered 60% of the time. But that still means that in about half of births women do not get one midwife who is able to pay them continuous attention. To be sure, a mother today will be allowed various choices that women 30 years ago couldn't necessarily make - she will be allowed to bring her own beanbags, she can squat on the ground rather than being told to lie on a high bed, she can have her partner by her side. But unless she pays for the privilege, she will not be sure that she will have, throughout labour, the presence of an experienced midwife offering her one-to-one support.

The conflict between the ideal of natural maternity and a harsher reality persists after the birth. Feminists of my mother's generation celebrated putting away the bottle and breastfeeding whenever and wherever they wanted. They believed that they were making a choice that would benefit women as well as babies, by trusting their own bodies rather than the products of the babymilk firms.

But when the government recently advised that babies should be solely breastfed for the first six months, it didn't sound encouraging or empowering. On the contrary, it sounded bullying. Typical of those Whitehall mandarins to tell ordinary women that they should spend their days and nights in such a demanding role when they are provided with so little support.

After all, maternity wards - where a mother usually begins to breastfeed - are now such pressured places that it is the luck of the draw if a calm midwife with enough time on her hands is there to show you how to get the whole process off the ground. And once mothers go home, they are often effectively alone with their child, since even with the regulations introduced last month, fathers are still only entitled to two weeks' paid paternity leave. Being alone with a baby who depends solely on you for her sustenance is an exhausting business - no wonder so many women decide they need help in the form of a bottle.

British women are often told, disapprovingly, that in Scandinavian countries many more women manage to breastfeed for much longer, as though it was our fault that we can't keep up with the Norwegians. But Norwegian women have a lot of other things in their favour, such as partners who can take extended parental leave, and the right to a year's maternity leave on 80% of full pay. Women in Britain get just six months' paid leave - most of that on a measly £100 a week. This, surely, at least partly accounts for the fact that 80% of Norwegian women are still breastfeeding at six months, compared with 23% of British women?

The government would have us believe that the timing of getting back to work is neither here nor there, since breast milk can be expressed at work. But once women are back in their offices, shops or call centres, the pressure is on to hold the line against anything as potentially disruptive as family life. Spending hours every week in the loo with pumps attached to your breasts is not as easy, in the modern workplace, as politicians seem to think. Although women may be encouraged to be earth mothers while at home, they know that they are not going to be rewarded for continuing that role once they come back into the working world.

Many women hold an ideal of natural maternity somewhere in their hearts. The dream of the dignified and creative mother has not died, but it isn't something that women can achieve all on their own. Individual women are often left to feel as if they have personally failed when they cannot live up to these dreams. But they haven't failed. Rather, social reality is failing them.