Traumatized by being a size 4

Many natural childbirth advocates who don’t have the unmedicated vaginal delivery they planned mourn the loss of “their” ideal birth. Is that appropriate? Is it appropriate for them to be “traumatized” by a C-section? Or is idealizing a vaginal delivery like idealizing a specific weight or size, a cultural stereotype that we should question, not a universal standard?

Professional NCB advocates like Penny Simkin have been stung by accusations that the NCB movement ignores or even celebrates women’s pain. They’ve developed a novel excuse theory. Pain isn’t important; “suffering” is important.

… “[S]uffering,” can be distinguished from pain, in that by definition, it describes negative emotional reactions, and includes any of these: perceived threat to body and/or psyche; helplessness and loss of control; distress; inability to cope with the distressing situation; fear of death of mother or baby. If we think about it, one can have pain without suffering and suffering without pain.

To Simkin, suffering is a hop, skip and a jump from “trauma,” a recognized psychiatric entity.

According to the American Psychiatric Association, the definition of trauma comes very close to the definition of suffering.

And using what passes for “logic” in the world of NCB, Simkin concludes that reducing birth “trauma” is infinitely more important than reducing labor pain. What causes birth “trauma”? You guessed it; “trauma” is caused by not achieving the NCB approved “ideal” of birth.

Simkin never asks the obvious question: Is failing to reach the NCB “ideal” a legitimate reason to be traumatized. Simkin insists that even asking the question is forbidden:

One’s perception of the event is what defines it as traumatic or not. As it pertains to childbirth, “Birth trauma is in the eye of the beholder,” and whether others would agree is irrelevant to the diagnosis.


Many American women are “traumatized” by being unable to meet an idealized weight and dress size. Just like there are some women who think that an unmedicated vaginal delivery is an “achievement”, there are other women who think that wearing a size 2 is an achievement. We live in a society that venerates women who wear a size 2, looks down on a woman who is a size 12, and despises and feels sorry for women who are a size 22.

But women’s feelings about weight are not objectively “true.” They are a product of cultural stereotypes, and as such, should be questioned. Similarly, women’s feelings of “trauma” over a C-section are not objetively “true,” either. They are also a product of cultural stereotypes, in this case the stereotypes created by NCB advocates.

Women who are a size 2 aren’t inherently better or superior in any way to women who are not. While the individual woman may have bought into the cultural stereotype of what a woman “should” look like, and while she may diet obsessively to get there and stay that way, and while she may feel “empowered” and happy because she is a size 2, that does not mean the rest of us should agree with her. It also does not mean that the rest of us should aim to be a size 2, should feel empowered by being a size 2 or should sympathize with her over the disappointment of having to wear a size 4.

Women who have an unmedicated vaginal birth aren’t inherently better or superior in any way to women who don’t. While the individual woman may have bought into the NCB stereotype of how a woman “should” give birth, and while she may plan obsessively to follow the stereotype, and while she may feel “empowered” and happy because she has an unmedicated vaginal birth, that does not mean the rest of us should agree with her. It also does not mean that the rest of us should aim to have an unmedicated vaginal birth, should feel empowered by having an unmedicated vaginal birth or should offer sympathy over the “disappointment” of having a C-section.

There are many, many women who are depressed about their weight. I would guess, in fact, that there are far more women depressed about their weight than their birth experience. That’s not surprising, because the obsession with being thin reflects the values of the dominant culture, while obsession with unmedicated childbirth reflects the values of a small subculture.

What is the appropriate response to a woman who feels depressed about her weight? Is being depressed the appropriate response to being a size 4 or 6 or 8?

If a woman sought psychotherapy for being a size 4 or 6 or 8, should the therapist counsel her that the disappointment of being size 6 instead of size 2 is a reasonable response, that her sense of self worth should be dependent on her weight and that the best thing to do would be to make determined efforts to become a size 2 in the future?

Or might the therapist suggest instead exploring what being thin “means” to this woman? Might the therapist suggest questioning the cultural stereotype that thin=good woman? Might the therapist might suggest that the depression over being a size 4 or 6 or 8 is actually not about weight, but about feelings of low self esteem that affect the woman’s entire life, but are currently expressed through disappointment about weight?

What is the difference between being “traumatized” about not matching the cultural ideal of being a size 2 vs. not matching the subcultural ideal of having a unmedicated vaginal delivery? The woman who is depressed about being a size 4 has “chosen” to adopt the value of being thin every bit as much as the woman who has “chosen” to adopt the value of venerating unmedicated childbirth. It is based on what she has seen, what she has read, what she believes is important.

Does that mean that if we do not sympathize with her all too real feelings of self doubt or even “trauma” that we are mean people who trivialize other people’s feelings? Or does it mean that we are demonstrating an appropriate response to obsession with cultural stereotypes that have no objective validity and ought to be questioned?

Adapted from a post that appeared on Homebirth Debate in January 2008.