My PhD research seeks to explore the implications of the “good” birth which, since the Western feminist revival in the 1970s, has been conflated with the natural, unassisted birth. I argue that this conclusion is reductive, and instead I will provide a comprehensive and nuanced understanding of the deep-rooted cultural and psychological ideologies that contribute to the conceptual ambiguity surrounding childbirth. To do this, I examine the lived experience of birth shame, the moral permissibility of shaming others (both as a form of coercion and more generally), and the refusal of medical interventions during the intrapartum period.
I support several philosophers in arguing that women are more shame-prone than men, however I argue that pregnant people occupy an intersectional position that compounds their susceptibility to shame because of how pregnancy destabilises one’s sense of self. When contextualising this subset of gendered shame alongside the empirical literature that examines the lived experience of maternity care, it becomes evident that this vulnerability can be exploited by clinicians and contribute to trauma. Testimonials suggest that lingering ideologies surrounding self-sacrificial motherhood and “hysteria” remain pervasive. This is at odds with UK guidance and policy that pledges to deliver care that upholds dignity and autonomous decision making. The evident discord between policy and experiences of care ought to represent an inflection point in how we both deliver perinatal care and support victims of birth trauma.
Shame and Identity
Contemporary theories of shame often suggest that it is the result of failing to live up to an ideal. Disciplines disagree on whether this is a personal or public ideal, and whether the ideals are necessarily moral. I disagree that shame is the result of an inability to exemplify a value. Instead, I support an alternative account[1] that frames shame as the dissonance we experience when we feel defined by some aspect of ourselves. On this view, when we feel ashamed, we experience a tension between how we see ourselves and what something else suggests about us. This can lead to alienation, disembodiment and an overall debased sense of self-worth. Moreover, philosophers such as Sandra Bartky[2] argue that women experience shame more than men due to their subordinated place within society. Anne Drapkin-Lyerly[3] (2003) has developed on Bartky’s theory, arguing that childbirth, being something only those with a uterus can do, is revelatory to the understanding of women’s shame. This line of thought is also adopted by a paper from Sara Cohen Shabot and Keshet Korem[4], who claim that gendered shame manifests in childbirth in two ways. Firstly, the transformative gaze of others objectifying labouring bodies as dirty, sexual and unfeminine. Secondly, the tendency to essentialise labouring women as prospective mothers to reinforce the expectation of self-sacrifice that “good” motherhood demands. I contend that childbirth is not merely another location for gendered shame to occur; instead, pregnancy (and consequently, childbirth) compounds gendered shame. To understand this, we must turn our attention to the unique metaphysical relationship between the pregnant subject and fetus and how it challenges traditional assumptions of the identity. To illustrate, consider the following quote from Iris Marion Young[5] (2005, p.46-47)
The pregnant subject, I suggest, is decentered, split, or doubled in several ways. She experiences her body as herself and not herself. Its inner movements belong to another being, yet they are not other, because her body boundaries shift and because her bodily self-location is focused on her trunk in addition to her head.
In other words, the biological connectedness of the pregnant subject and fetus fissures the unity of her selfhood. This dynamic can effectively destabilise her sense of self, rendering the subject more shame prone than they otherwise were. On my view, pregnant people occupy an intersectional position of gendered shame which, as I argue, leaves the subject especially vulnerable to even subtle coercion that they may otherwise (when not pregnant) resist.
Shame and Birth Trauma
Within clinical practice, shame is often classified as a symptom of birth trauma and post-traumatic stress disorder (PTSD). The most severe cases can meet the diagnostic criteria for PTSD, nonetheless, those who do not qualify can still have debilitating symptoms. The Birth Trauma Report (2024) states that the word “shame” came up repeatedly in personal submissions. Moreover, testimonials often allude to shaming practices employed by clinicians. For example, following a traumatic birth, a woman was told to “stop being a baby” and that it was “time to grow up.” (p.20). Another account states:
“I tore, and as I was being stitched up, the doctor said, ‘I’ll stitch you up so you’ll never do this again.’” I thought the doctor told me this because I was young and my baby was of mixed heritage. I thought I probably deserved it.” (p.61)
The above are just two examples that demonstrate how women are infantilised and dehumanised at their most vulnerable. The latter also suggests that women may not recognise shaming behavior and internalise the abuse as a valid attack. One paper detailing the experiences of pregnant women who chose to refuse recommended medical care reports women being patronised and repetitively threatened with stillbirth (often referred to as “shroud waving”). Shroud waving becomes another way of provoking shame in pregnant people by projecting the Western notion of maternal self-sacrifice. At a minimum, these accounts demonstrate the potency of historical ideologies that women (particularly when pregnant) are irrational, hysterical and require moral education.
When considering the phenomenon of pregnancy and birth shame, if one accepts that women are more shame-prone than men then it is conceivable that pregnant and birthing people are even more liable to its fallout. Once we accept this, it is unsurprising that shame is a cardinal symptom of birth trauma. Maternity care ought to address the impact of shame susceptibility for the pregnant subject and how clinicians knowingly and unknowingly weaponise shame to perpetuate harmful ideologies.
[1] Thomason, K. 2023. The Dark Side of Shame and Moral Life – Naked. New York: Oxford University Press.
[2] Bartky, S. 1990. Femininity and Domination: Studies in the Phenomenology of Oppression. New York: Routledge.
[3] Lyerly, AD. 2006. Shame, Gender, Birth. Hypatia. 21(1), pp. 101-118.
[4] Shabot, S.C. and Korem, K. 2018. Domesticating Bodies: The Role of Shame in Obstetric Violence. Hypatia. 33(3), pp. 384–401.
[5] Young, IM. 2005. On Female Body Experience: Throwing Like a Girl and Other Essays. Oxford: Oxford University Press.
Amelia Tibbott, PhD Candidate, The University of Leeds
8th September 2025
