Associate Professor Angela Ballantyne1, Dr Alicia Coram2
1University Of Otago, 2Trinity College Pathways School, Melbourne University
We analyze women’s experience of birth trauma using the concepts of hermeneutical injustice, testimonial injustice (Fricker 2007) and wrongful depathologisation (Spencer and Carel 2021) to help explain its lack of recognition and undertreatment. We provide an innovative account of epistemic harm in relation to birth that has been neglected in the bioethics and medical literature.
Experiences of birth trauma are widespread, however there is no social or medical consensus regarding its definition, suggesting a case of hermeneutical injustice. It is variously referred to as negative birth experience; birth injury; perinatal distress and PTSD (as per DSM5). Until recently, the medical literature on birth trauma focused exclusively on trauma to the infant, ignoring potential harm to the mother; and much birth trauma is still wrongfully treated as depression. Further, women’s reported experiences of traumatic birth indicate testimonial injustice – seen in common themes such as not being heard or believed, disempowerment, and unconsented treatment.
Finally, we propose that birth trauma involves unique forms of epistemic marginalisation which are, surprisingly, a result of the commonality of birth. For example, the DSM5 classification of PTSD only recognized traumatic events as those “outside the range of usual human experience” until 1990, thereby excluding birth. Wrongful depathologization, whereby epistemic harm occurs when a psychiatric disorder is simultaneously stigmatized and trivialized, is used to help understand this form of epistemic injustice.
Our analysis grounds birth trauma in a feminist bioethics framework and points to potential interventions to address these epistemic and material harms experienced by women.
Biography:
Angela Ballantyne teaches medical ethics at the University of Otago, Wellington. Her research focuses on research ethics, exploitation, vulnerability, ethics of pregnancy and reproductive technologies, and data ethics. She has served as the President of the International Association of Bioethics and a member of the Covid Immunisation Implementation Advisory Group, HDEC (research ethics) and ECART (reproductive technologies) committees in New Zealand.