Thursday, March 26, 2015

Birth-Shame and Empathy

This post (slightly different version) was originally published as an article in Birthing (Calgary) in October 2013.

Birth-Shame and Empathy
Birth and shame aren’t ideas that usually go together. When we think of shame, we may wince or feel repulsed. We have all experienced shame at some time and thinking of it may cause an uncomfortable visceral reaction. Birth, on the other hand, although often misrepresented and oversimplified as a miracle, a battle survived or both, can immediately bring up a varied and emotional reaction in us. Our culture’s simplistic view of birth does not represent the multi-dimensional experience of most women. Birth fundamentally changes our sense of self. Many women would identify the first birth experience as the marker of changing from maiden to mother. And this transformative process can be as glorious as it is shame-triggering.

Dr. Brene Brown is a shame and vulnerability researcher and author from the University of Houston. She has written three books: I thought it was just me, but it isn’t (2007); The Gifts of Imperfection (2010) and Daring Greatly (2012). Brown has also recorded two TED talks: The Power of Vulnerability (2010) and Listening to Shame (2010). Her work provides a lens through which to understand birth-shame in our culture. Relying on my first birth experience and using the shame-resilience work of Dr. Brene Brown, I am going to offer a view of a different facet of birth, including strategies for how to help a woman through birth-shame.

(I could start a birth-shame meeting.) Hello. My name is Heather and I have shame about my birth. (Cough, sputter, choke!) I have had three children in two births. My first birth started as the ever important: “Midwife-Assisted Home Birth with Birthing Pool” (I’m awesome!) and more than 40 hours later was renamed: “Hospital Transfer with Epidural” (Epic failure?) The result of that process was my beautiful daughter, Isabelle, and the most extreme mixed emotions I have ever experienced:

I felt like I was in-love for the first time!
I was angry and upset about why the birth didn’t go ‘right’.
I felt broken as a woman that I couldn’t have the birth I wanted.
I felt alone and frustrated when people said: “But look what you have- a healthy beautiful baby!”

In the midst of this post-partum emotional storm and an inhumane lack of sleep, I struggled through the early days of breastfeeding. The emotional roller coaster rivaled nothing I had ever experienced and the underlying message of all my thoughts in those early weeks were: “I love this baby more than anything in the world” and “What the #*%@ is wrong with me?”

Understanding Shame
Brown describes shame as “the full-contact emotion” that may include physical symptoms such as knots in the stomach, nausea, shaking, flushing and wincing (Brown, 2007) Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of acceptance and belonging” (Brown, 2007, 30). Shame says: I am not ____________enough. Fill-in the blank: good, worthy, deserving, healthy, informed, rich, skinny and so on (Brown, 2012).

Shame and guilt are very different although both are very uncomfortable feelings. Whereas guilt says: I did something bad, shame says: I am bad.  Guilt can be productive and keep our relationships in check. In guilt, we hold up our behavior against our values and self-evaluate. Guilt is adaptive and helps us to change our behaviour (Brown, 2007). We can grow and change for the better from a place of feeling we have done something that isn’t in line with our beliefs and values.

Shame, on the other hand, is the intensely painful belief that we are flawed- I am bad- and therefore unworthy of love and acceptance (Brown, 2007). It’s a feeling of being broken in a way that can’t be fixed. Shame is highly correlated with addiction, depression, violence and eating disorders. Brown says the three things to know about shame are: 1) it’s universal, we all experience it (except for sociopaths); 2) no one likes to talk about it; and 3) the less we talk about it, the more we experience it (Brown, 2012). Shame is felt the same for both men and women, but it is organized and understood differently by gender. According to Brown’s research, men’s experience of shame is about being perceived as weak or a failure. Men can feel forced to stay in a narrow box of what is considered masculine in our culture. Vulnerability and authentic emotional expression is misunderstood as weakness (Brown, 2012).

For women, shame is understood as a web of competing and conflicting expectations. Shame comes from being perceived as anything less than perfect in multiple and often conflicting areas of our life. For example, a woman can’t be the perfect employee and the perfect mother in the same moment and shame is the feeling she is left with: I’m not good enough. I can’t do it all (Brown, 2012).

The symptoms of shame sound like post-partum sleep deprivation and hormone overload: nausea, stomach ache, shakiness. How can I separate out all the emotional and physical feelings? But, “I’m not good enough as a mom”—that was the feeling I had after Isabelle was born! I didn’t recognize it then, but if I couldn’t even birth her like I intended, how could I be good enough as her mother?

Birth Preparation in a Culture of Scarcity
Brown describes the culture of scarcity as fuelling our ‘never_____ enough’ thinking. The components of a culture of scarcity include fear, comparison, shame and subsequent disengagement to protect ourselves from feeling vulnerable (Brown, 2012). We compare ourselves to others and are compared by others. When we feel we ‘aren’t _____ enough’, we are fearful of rejection and so disengage to protect our self from feeling vulnerable. When we are afraid to be vulnerable because the culture is one of harsh comparison and shame, we don’t take risks. We don’t act real and we don’t offer all we may have to offer. Brown asserts that this struggle with shame and avoiding vulnerability is shaping the culture we live in (Brown, 2012). There is less creativity and innovation and instead people keep up the status quo and try not to be noticed. This is true for our larger society as well as our smaller institutions of work, school, community and family (Brown, 2012).

Consider a girl who is raised in a culture of scarcity. She will develop vulnerability shields to protect herself from feeling fear, shame and disconnection. Perfectionism is one such vulnerability shield (Brown, 2012). Appearing perfect, or close to it, is an adaptive response and for a young woman to demonstrate her worthiness of belonging. Brown also refers to this as the “hustle for worthiness”. Racheal Simons, in her book, The Curse of the Good Girl  states, "Many of the most accomplished girls are disconnecting from the truest parts of themselves, sacrificing essential self-knowledge to the pressure of who they think they ought to be" (p. 28). The culture of scarcity feeds the good-girl/ gold-star thinking. For example, a young girl in school may not feel good enough or worthy of belonging (shame) and so she performs at an extraordinary level (appears perfect) in order to get the accolades (gold stars, approval and acceptance) which allow her to feel worthy. This is the good-girl’s modus operandi for the demonstration of her value and assured acceptance.

Now consider this girl-as-a-woman 6 months pregnant and preparing to give birth.

In this culture of scarcity, when a woman is pregnant and considering birth options, the message of ‘never_______ enough’ will inform her: “You will not be safe enough. You will not know enough. You/ your body are not trustworthy enough.” From this place, a woman may be fearful and disengaged and allow decisions to be made solely by health care providers. A woman may forfeit her right to autonomy over her body and be disconnected from her own self-knowledge. The culture of scarcity questions a woman’s capacity to have her own wisdom or any input. This is illustrated in the Monty Python movie, The Meaning of Life: The woman is on a table about to give birth and asks the doctor, “What do I do?” The response is, “Nothing, dear. You’re not qualified.” The message: you don’t know enough.

What about a woman who is able to move past this never enough thinking? Brown states that when we are able to get out of scarcity thinking and choose to push into new areas, shame runs another tape: Who do you think you are?  This is shame saying: stay small; don’t get too big for your britches. When a woman chooses non-normative circumstances for her birth, her decision may be viewed as subversive and upsetting to those around her. This may be reflected by messages from family and friends. Although their love and concern is genuine, their message is often well-steeped in the scarcity culture of never enough thinking.

When good-girl/ gold-star thinking is applied to an upcoming birth, the self-talk goes something like this: “I am going to research birth and choose the best way to birth. I am going to make sure that this birth is safest or most natural or most medically attended there has ever been. I will be great at this. I’ve read the most highly recommended books. I’ve got the best doctor/ midwife/ doula and I’ve done all the best birthing classes.”

Hmmmm…the culture of scarcity fits. I know these messages. I had been a pretty classic ‘good-girl’ through my younger years. I hate admitting it, but I probably took all that passion to achieve and do it ‘perfectly’ into my pregnancy. When I wasn’t feeling fearful, making comparisons and worried about being good enough, I might have been looking for the way to make my birth the most natural, relaxed, fear-less A+ gold-star birth that I could.

A midwife once told me that a woman in labor is a woman in labor. It doesn’t matter what she does in her daily life- artist, accountant or nurse- it’s all the same in labor. This is very bad news for the woman with good girl/ gold star thinking. The labyrinth path of labor is about letting go and trusting. It’s impossible to be perfect and vulnerable at the same time; to hear the whispers of ‘never enough’ and let go.

In the early post-partum days, I thought: I should have stayed home longer. I should have spoken up more. My body betrayed me. I wasn’t mentally strong enough or physically fit enough. I didn’t let go enough. I didn’t go inside enough. I wasn’t fearless enough.

Elements of Shame Resilience
Dr. Brown’s shame resilience model has four elements: 1) Recognizing shame and understanding triggers; 2) practicing critical awareness; 3) reaching out; and 4) speaking shame (Brown, 2007). It is not a linear process and we move back and forth between elements when sorting out shame (Brown, 2012).

The first element is to recognize shame. That is, to know when we are in it and what it feels like in our bodies (Brown, 2007). When we feel shame, can we recognize it and see what messages triggered it? Brown identifies twelve categories of shame triggers: appearance and body image, motherhood/ fatherhood, family, parenting, money and work, mental and physical health, sex, aging, religion, being stereotyped, speaking out and surviving trauma (Brown, 2007). Pregnancy and birth is a minefield of shame triggers. Body image, sex, mothering are all potential areas of shame triggers. Indeed, any of these categories of shame triggers could come up for a woman during pregnancy and birth.

The second element, practicing critical awareness, refers to stepping back and seeing from a bigger perspective (Brown, 2007. It’s a process of reality-checking. Are the messages that are driving our shame realistic? Did the messages originate in the culture of scarcity and come to us via our family of origin or the media? Related to birthing, especially changing birth plans or increased birth interventions, it’s important to understand the bigger picture of the culture in which we birth. It’s also important to know the facts of each of our specific situations and the multitude of factors that contribute to the birth process.

The third element of shame resilience, reaching out, refers to seeking out someone who has earned the right to hear our story and who will be able to respond with empathy (Brown, 2007). Briefly, empathy is a skill set that involves taking another person’s perspective, staying out of judgement and communicating an understanding of the underlying emotion (Brown, 2007 citing Wiseman 1162). Empathy is the antidote to shame and reaching out means reaching out to someone who can do that for us.

This fourth element, speaking shame, means that we call shame by its name when we recognize it. Shame is not guilt, embarrassment or humiliation. It is not depression, anger or anxiety. Shame relies on being kept secret and it grows in silence (Brown, 2007). However, when we can call shame by its name, it withers (Brown, 2012). The tricky part is you can’t meet another person’s shame head on. It can cause more shame. Instead you can help a person sort out their feelings and when you hear ‘not____ enough’ thoughts and feelings, you can help to name it. Empathy is the key to this process (Brown, 2007).

I had lots of feelings after the birth, but the feeling that I hadn’t birthed well enough and therefore wasn’t good enough as a mom was shame. It would have been helpful for me to be able to name it then. I wouldn’t have wanted someone else to point it out explicitly, but that was the core of my struggle. Critical awareness came after the fact, when I confirmed that Isabelle’s fetal position was associated with long hard labors. It wasn’t just me! I wasn’t the only factor in the messy process of labor and birth. Having a bigger perspective of understanding the culture of scarcity or even reflecting on the birth films I watched during pregnancy, helped me see that there were messages about labor and birth expectations that fueled my post-partum shame.

Shame withers when it is named and shrinks to nothing when it is met with empathy (Brown, 2007). The elements, reaching out and speaking shame require another person who is able to provide an empathetic response. Empathy is a skill set and it is often not our first response (Brown, 2007). To understand empathy, consider the following responses[1]:

Mother/ MIL/ Aunt/Grandma: You shouldn’t have tried to labor at home. It certainly was better that you ended up at the hospital and you were safe. I would hate to think what could have happened.

Friend who just had home water birth with triplets while riding a unicycle: I’m so sorry that you had to have those interventions; you poor thing.

Sister/Cousin/Helpful friend: It was hard, but at least you have a beautiful baby now and that’s the main thing.

The first response is judgement. The second response is sympathy where the person is feeling bad for you, but not with you (Brown, 2007). The third response, Brown refers to as, “at least”  and it discounts and jumps over the feeling of shame. All of these responses are about the other person’s own discomfort with shame. Judgement is super-powered by the culture of scarcity. We make comparisons so that we may feel better about our self. We judge in areas where we feel inadequate. The discomfort of not feeling good enough can be partially discharged through judging another. The thinking is: “I may not feel good enough, but compared to her (right now), I’m great!” The difficulty is that this only further feeds into the culture of scarcity.

Sympathy is different from empathy. Sympathy can actually feed feelings of shame. Sympathy is about standing far away from the pain of the other person and saying: I feel bad that you are way over there. (And I am definitely not over there with you.) Sympathy then leaves the person in shame feeling even more alone and unworthy of love and acceptance (Brown, 2007).

The third response, ‘at least’, is a form of flood lighting where the person shines a bright light on all that is good and pretends there is no shame. This is a very popular post-partum response to mothers. It can also fuel shame because the new mother now has the shame of not being grateful enough and a further feeling of: “What’s wrong with me? I’m supposed to be happy.” None of the above responses are helpful because they don’t acknowledge the underlying emotion.

Here is an empathic response:
I know you really wanted to birth at home and things didn’t go as you expected. That’s hard. It sounds like you are feeling disappointed and defeated.

A conversation can go on from there as a listener asks questions about what the woman feels or what she thinks could have been different. Empathy doesn’t require that you have had the exact same experience (Brown, 2007). The key is to look under the incident that triggered shame and to identify the emotions. As an empathetic listener, you may not have even given birth, but you know what it’s like to feel disappointed or defeated because those are universal feelings. You can convey your understanding of those feelings. You can be very helpful by facilitating the woman’s exploration of her emotions. Emotional logic, especially as it relates to shame, has its own rules. Emotional logic is not logical. Although a woman may need help with critical awareness and gaining perspective, she first needs to feel understood.

Empathy also doesn’t have to be a rehearsed set of words. Empathy might be conveyed in a knowing glance or with a hug (Brown, 2007). Perhaps the only thing a friend can say is: “I know you’re having a hard time. I don’t know what to say, but I want you to know that I’m here for you. We’ll get through this.” Brown says that if you have one or two friends to whom you can reach out, share a shame story and receive a genuine emphatic response you’re fortunate (Brown, 2007). This is the inner sanctum of your emotional world and it isn’t likely that there are many who have earned the right to hear your most vulnerable feelings and who can meet them with empathy.

After Isabelle’s birth I felt terrible, but I was also confused about what I was feeling.  I had two close friends who could listen and help. One male friend offered that in transferring before I was ready, I missed out on the female equivalent of ‘slaying the lion to prove I’m a man’. I totally felt like that! I felt like I dropped out of the marathon before I was ready and I was profoundly disappointed. It was a relief to have that reflected back to me.

My closest female friend understood my convoluted feelings well and easily conveyed that. She agreed that I probably could have stayed home longer, but it was a hard call for all of us. She reminded me of the facts: dehydrated with no more IV bags at home, ROP fetal position, 30 hours of labor before we transferred, political push and pulls of the day. I knew she understood my feelings and further she gave me perspective in reflecting back the ambiguity of the situation. It was a relief to have facts in the middle of my birth-shame storm.

Wrapping up
Feeling unworthy is the crux of shame. It is relayed to us through messages from the culture of scarcity and internalized as self-deprecating thoughts (Brown, 2012). When we become a mother for the first time and stare into those beautiful eyes, every imperfect part of our self is reflected back. In that reflection, it is easy to think we aren’t worthy enough of the great love we feel. However, we need to find a way[2] to feel worthy of this love because this is the way we show our child the same:  I love you, not in spite of your imperfection, but because of it. Your imperfection is what makes you who you are. You are always worthy of my love. You are always worthy of belonging to me.

If we teach our children to believe they are worthy of love and belonging we might change the world. But we can only do this by letting them see that we too, believe that we are worthy of great love and belonging[3].

[1] Fortunately I didn’t hear most of these after Isabelle’s birth. These are illustrative.
[2] For more information, see Brown’s book, The Gifts of Imperfection.
[3] See Neff (2003) for more about self-compassion.

Heather Mackay is a provisional clinical social worker in private practice in Edmonton, Alberta. You can read more about her at: or reach her at
This article originally appeared in Birthing Magazine. 

Works Cited
Brown, Brene. Daring Greatly. New York: Gotham Books, 2012. Print.
---. I thought it was just me, but it isn’t. New York: Gotham Books, 2007. Print.
---. Listening to shame. TED2012. Long Beach, CA. Filmed March 2012.
---. The Gifts of Imperfection. Centre City, MN:  Hazelden,  2010. Print.
---. “The power of vulnerability.” TEDxHuston. Huston, TX. Filmed June 2010.
Neff, Kirstin. “Self-compassion: An alternative conceptualization of healthy attitude
toward oneself.” Self and Identity, 2003: 85-101.
Simmons, Rachel. The Curse of the Good Girl. London: The Penguin Press, 2009. Print.
The Meaning of Life. Dir. Terry Gilliam. Terry Jones. Perf. John Cleese. The Monty Python
Partnership, 1983. Film.
Wiseman, Teresa. “A concept analysis of empathy.” Journal of Advanced Nursing, June 1996:1162-1167. Print.

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