Illiyin Morrison (aka @mixing.up.motherhood) is a mama-of-two, midwife and birth debrief facilitator who specialises in birth advocacy and birth trauma. She has just released her first book ‘The Birth Debrief’.

With a passion for empowering women during pregnancy and childbirth, Illiyin believes good antenatal education can make a huge difference to the birth experience. Her experience of trauma during her daughter’s birth led her to appreciate the need for greater understanding of what took place and why, so she began to offer birth debriefs and has extended this work into her first book.

Here, she explains what gaslighting in maternity is, how to recognise if it’s happening to you, and what you can do about it.

Gaslighting means ‘psychological manipulation of a person… that causes the victim to question the validity of their own thoughts, perception of reality, or memories’. A victim of gaslighting typically experiences confusion, loss of confidence and self-esteem. They might have difficulty making decisions or expressing their own opinions, and may constantly second-guess themselves. Gaslighting takes its name from the 1944 film Gaslight, in which a greedy, manipulative man tries to convince his wife that she is going insane by (among other things) turning down the gas lamps in their home and telling her, when she comments on the flickering lights, that she is imagining things. By manipulating his wife to doubt her reality, he hopes to have her committed to an asylum so he can steal her inheritance. Gaslighting can occur in any relationship where there is an imbalance of power, and unfortunately, this can extend to the relationship between an expectant mother and those entrusted with her medical care.

One US study on the prevalence of gaslighting in obstetric care identified the incidences of this form of abuse – because it is abuse – as falling into one or more of four categories. It involved healthcare providers belittling, minimising or denying the mothers’ humanity, calling their judgement into question, refusing to validate their knowledge, and dismissing or minimising their feelings.

What does this look like in practice? Some examples include:

• Undermining your perception of your symptoms.
• Mocking your perception of events or of medical decisions you have made.
• Dismissing your concerns, or suggesting you are emotionally unstable for raising concerns.
• Preventing or dissuading you from seeking further help.
• Refusing to recommend/prescribe any tests or investigations without a valid reason for refusing.

The doctor–patient relationship is not supposed to be authoritarian or dictatorial in nature; it is a consensual relationship based on trust, understanding, knowledge, and working together. So how does gaslighting rear its head in maternity care?

How it happens

When you are pregnant, it can literally feel like you’re handing your body over to others. It’s as if, suddenly, your ability to reason and speak up for yourself count for nothing. When you are pregnant, you may have many meetings and appointments with healthcare professionals, and it can seem as though a barrage of experts and others are telling you what to do or making decisions for you, leaving you a passive bystander in your own life. One reason this happens is that in the West, we generally view childbirth as a medical event that requires intervention, so we tend to treat pregnant women and birthing people like patients who are unwell. This idea encourages many of us to doubt our own agency and to think we need to be told what to do with our bodies and our babies. This creates fertile ground where gaslighting can thrive.

It is important to note that women have been carrying and birthing babies for millennia. When pregnancy is low-risk and we are successfully carrying our babies, we should be supported to feel empowered by this strength rather than feeling we can only birth when we are reliant on a medical system. So why do we shrink away from our inner strength and wisdom at a time when we should feel at our most powerful?

Please understand that I am certainly not anti-medicine or anti-science. It would be wrong and irresponsible of me to ignore the many times when medical intervention and guidance are not only necessary but are lifesaving. There is no doubt that Western medicine has an important role to play in maternity care – when it is used correctly, consensually and in a necessary capacity.

But we also need to acknowledge that this medicalised way of managing birth has led to many women feeling like they don’t have a say in what happens to them. We take it as gospel, practically from our first doctor’s appointment, that we know nothing, the medical professionals know everything, and they, not we, should have the final say on what happens to our bodies. But this couldn’t be further from the truth. Doctors are there to help and advise, but they are not the ultimate authority over your and your child’s wellbeing – you are. This is why I continue to advocate for all women and birthing people everywhere to feel empowered in pregnancy.

Gaslighting and defensive practice

Defensive practice may make some people who raise questions about their care in NHS debriefing sessions vulnerable to being gaslighted. Defensive practice is when medical staff deviate from sound practice ‘primarily to reduce one’s risk of liability rather than to benefit the patient’. In such cases, concerns reported by the person receiving the debrief may be dismissed as ‘normal practice’ or met with a response such as ‘No, I’m sure that’s not what actually happened’. Staff may make an attempt to normalise things that they know are not actually normal or commonplace.

All sorts of high- and low-risk variables are at play during a medicalised birth, and sometimes – whether because of negligence, or despite everyone’s best efforts – things go wrong and complaints are made. I can definitely empathise with feeling defensive when your practice is called into question – no one likes to be criticised or have their level of care disputed. But if defensive practice is allowed to influence a person’s medical care, especially when they were harmed, it may mean that they are denied the space and time to process their experience during the birth debrief, causing them further harm.

Gaslighting and gender bias

The number of women and birthing people who report being gaslighted when dealing with healthcare professionals is significantly higher than the number of men who report the same issue. This is often because of biases about women’s ability to understand their own pain – this is reported anecdotally and backed by research. Women’s pain has historically been believed to be influenced by their emotions. Despite advances in medicine, these stereotypes still exist and continue to influence the care that women and birthing people receive. Being gaslighted in maternity makes you question yourself, your sanity and your knowledge of your own body – the opposite of what you should be doing. A victim of gaslighting may find it difficult to reach out for help when they most need it, which can lay the foundation for a traumatic birth.

My story

I was gaslighted a surprisingly high number of times throughout my first pregnancy, and it contributed to my birth trauma. At the time, I was so angry. Even with all my knowledge and professional experience, I felt undermined and ridiculed. Even though I was a qualified midwife, the gaslighting led me to doubt myself, my knowledge and my abilities – and in one instance to question the legitimate, informed choice that I’d made to have a home birth, not because I no longer wanted it, but because I suddenly felt silly for having made the choice. It also made me question whether I was putting my child’s life at risk.

From many conversations with other women and birthing people, I know that I am not alone in this. We are so conditioned to be submissive when it comes to interactions with healthcare professionals that even during birth – a time when we should be listening to our bodies – we often make choices that are detrimental to us, but which mean we avoid going against ‘authority’. Again, this isn’t about discounting the expertise of medical professionals, or their advice. It’s about ensuring that your concerns and requests are taken seriously and you are treated with the respect and dignity you deserve as a human being. By all means, do all you can to educate yourself about what is happening in your body as your pregnancy advances – and, yes, respect the expertise of your doctor and midwife. But if something is important to you, you are not ‘silly’ or ‘overreacting’ if you have questions about it and seek to be heard, respected and understood. Gaslighting is never OK. I’ve shared my experience in the hope that you will see how easily gaslighting can happen when you are pregnant, how to recognise if it happens to you, and how to prevent it and/or halt it in its tracks.

Have you ever been gaslighted?

Most, if not all, of us have at some point. Gaslighting is never your fault; it is always based on abuse of power.

To strengthen your mindset around this, try these affirmations:

• I know my own mind and I trust myself.
• I am worthy of respect and care.
• I am strong and capable, and can make my own decisions.

Recognising when gaslighting is happening is one thing; taking steps to call it out and get your needs met is another. Here are a few suggestions for what to do if you feel like you have been gaslighted over symptoms you have reported, which you don’t think are being taken seriously:

• Check in with your body. Are the symptoms persisting? If so, note them down.
• Are you satisfied that everything is OK? If not, speak up.
• Ensure that the conversation and action plan have been documented. If the medical professional has declined to do tests or
investigations, ask that their decision be documented, along with their reason for declining them.
• Ask to see another medical professional for a second opinion. Continue to remind yourself that you have the right to be heard. Your thoughts, feelings and instincts are always valid.

The Birth Debrief by Illiyin Morrison is published by Quercus and is out now.