The way we treat birth reflects the way we treat life | Eva Placzek | TEDxBerlin Salon

Key Concepts

• Postpartum Depression (PPD): A mental health condition affecting up to 17% of mothers globally.
• Obstetric Violence/Mistreatment in Childbirth: Disrespectful, abusive, or negligent treatment of women during labor and delivery.
• Christella Maneuver: A now-discredited practice involving forceful pressure on the uterus, often experienced as violent by patients.
• Trauma-Informed Maternity Care: An approach to childbirth that recognizes the potential for trauma and prioritizes emotional and psychological safety.
• Respect & Consent-Based Care: Maternity care centered around the woman’s autonomy, informed consent, and respectful treatment.

The Hidden Epidemic: How Disrespect and Violence in Childbirth Fuel Postpartum Depression

The global rate of postpartum depression (PPD) stands at a staggering 17%, affecting approximately one in six mothers. This isn’t simply a biological consequence of childbirth; the speaker argues a significant contributing factor is often overlooked: disrespect and violence experienced during labor and delivery. The speaker emphasizes that for many women, the roots of PPD aren’t post-birth, but begin during the birthing process itself.

The Link Between Mistreatment and Mental Health

Research indicates that a mother’s risk of PPD increases by 50-60% when she experiences disrespect or violence during childbirth. This is particularly alarming given that 30-50% of women globally report some form of mistreatment, neglect, or obstetric violence during labor. This isn’t limited to under-resourced settings; it occurs even within the wealthiest healthcare systems. The speaker frames this not as isolated incidents, but as a systemic failure within maternity care cultures that often treat women as “passive bodies” rather than active participants in their own care.

Examples of Harmful Practices & Personal Testimony

The Christella maneuver is presented as a prime example of a harmful practice. Described as strong pressure on the upper uterus to force the baby down, it’s often perceived as violent by patients. Critically, the speaker points out that the World Health Organization (WHO) does not recommend this practice, and performing it without consent constitutes a violation.

The speaker shares a deeply personal account of her own experience as a newly trained midwife. She witnessed shouting, rushing, ignoring patients, and procedures performed without explanation. She specifically recalls the routine use of the Christella maneuver and episiotomies (surgical cuts to widen the vaginal opening) without consent. This experience led her to leave the profession, realizing that staying meant perpetuating harmful routines. She explicitly states, “Staying meant becoming one of them, repeating harmful routines until they felt normal.”

A Shift in Perspective: From Survival to Holistic Care

Upon returning to midwifery after a period of healing, the speaker sought a different hospital environment. This time, she focused on reshaping the system rather than simply surviving it. She prioritized slowing down, explaining procedures, listening to patients, and centering the woman’s experience. This led to a crucial realization: “When we protect the mother, we protect the baby.” She argues that honoring a mother’s dignity strengthens her mental health, respecting her choices empowers her, and listening to her begins to heal generational trauma.

The Scale of the Problem: Statistics and Global Impact

The speaker highlights the widespread nature of traumatic birth experiences. Across Europe, North America, and Australia, up to one in three women describe their birth as traumatic, and up to 43% report experiencing moments of disrespect and violence in obstetric care. She emphatically states, “This is not a statistic. This is millions of women,” and insists on naming this experience as “abuse in childbirth” to facilitate change. The consequences extend beyond the mother’s immediate well-being, impacting the newborn who is placed in the arms of a mother feeling alone, frightened, and ashamed, often leading to PPD.

Four Pillars for Transformative Change

The speaker proposes four essential pillars for transforming maternity care:

1. Respect and Consent-Based Care: Consent must be more than just paperwork; it’s a fundamental protection. No intervention should occur without full understanding and agreement.
2. Retiring Harmful Practices: Outdated, harmful, or unproven interventions, like the Christella maneuver, should be discontinued.
3. Trauma-Informed Maternity Care: Training must incorporate empathy, communication, and shared decision-making to address the emotional and psychological aspects of birth.
4. Postpartum Mental Health as Standard Care: Screening, support, and stigma removal for PPD must be mandatory, not optional, given the prevalence of the condition.

A Vision for the Future of Birth

The speaker envisions a birth room where the first question is, “How would you like to be supported today? What do you need to feel safe?” She advocates for a maternity ward where the woman’s voice is the most important monitor, and where legal guidelines represent a minimum standard of care. She believes mothers should leave not only healthy but whole, and that babies should enter the world surrounded by calm, dignity, and respect.

She concludes with a powerful call to action directed at governments, health ministers, and hospital leaders: “Change birth, and we can change everything that follows.” She asserts that improving maternity care is fundamental to building healthier societies, resilient families, and achieving equity and better outcomes for all.