1093424

research-article2022
QIXXXX10.1177/10778004221093424Qualitative InquiryKeedle and Willo

Research Article
Qualitative Inquiry

A Poetic Inquiry of Traumatic Birth

2022, Vol. 28(8-9) 938­–945
© The Author(s) 2022
Article reuse guidelines:
Through Bearing Witness sagepub.com/journals-permissions
DOI: 10.1177/10778004221093424
https://doi.org/10.1177/10778004221093424
journals.sagepub.com/home/qix

Hazel Keedle1 and Pixie Willo2

Abstract
In collaboration between a researcher and poet, we have used poetry inquiry to create a collection of found poems from
open-ended survey data. Found poems were created using the written responses from the Australian Birth Experience
Study survey and the poems highlighted women’s experiences of traumatic birth. Analysis was undertaken through reflexive
poetry from the poet and through reflection by the researcher. The poems display themes of lack of control and consent.
These poems illuminate the voices of the women who shared their traumatic birthing stories to gain understanding and
raise awareness in the community on aspects of birth trauma.

Keywords
investigative poetry, methods of inquiry, feminist methodologies, methodologies, qualitative health research, qualitative
research methodologies

Introduction/Background obtained through the Western Sydney University Human

Pregnancy, birth, and early parenting are a challenging but
transformational period for individuals and families. The
experience of birth can be positive or negative. It is esti-
mated a third of women will identify as having birth trauma
(Beck, 2013) which can rise as high as two thirds for women
who have a cesarean (Keedle et al., 2020). Birth trauma can
be described as an experience of distress or psychological
disturbance during the birth or cesarean which continues
into the postnatal period (Greenfield et al., 2016) or as Beck
(2004) describes “birth trauma lies in the eye of the
beholder” (p. 35). Women who experience birth trauma
often describe feelings of loss of control and experience
negative interactions with health care providers during their
birthing experience (Reed et al., 2017; Watson et al., 2021).
Experiencing birth trauma can lead to psychological issues
such as post-traumatic stress disorder (PTSD), postnatal
depression (PND), and anxiety disorders (Alcorn et al.,
2010; Bell & Andersson, 2016; Simpson et al., 2018;
Williamson et al., 2021). Partners who witness a traumatic
birth can also experience a loss of control and ongoing rela-
tionship issues as well as mental health issues (Daniels
et al., 2020; Elmir & Schmied, 2021).
BESt Survey
Ethics Board, approval number: H14260. The online survey
of 133 questions was developed using validated measure-
ments such as the Mothers Autonomy in Decision Making
(MADM; Vedam et al., 2017a)/ Mothers on Respect index
(MORi; Vedam et al., 2017b) and The Mistreatment Index
(MIST) (Vedam et al., 2019), demographic information and
consisted of both open- and closed-questions developed by
the research team. The survey became the largest birth
experience survey conducted in Australia with over 12,000
partial and 8,804 completed responses.
The collaboration of researcher and poet started through
a social conversation into poetic inquiry. The researcher
(HK) and poet (PW) had shared experiences of friendship
and mothering for many years, and this led to a joint vision
of using poetry as part of the feminist methodologies of the
BESt project. The use of poetry to explore the findings was
planned for during the development stage of the study and
included in the ethics and grant applications. As poetry was
a new research methodology for myself (HK), I came across
the area of poetic inquiry and the use of found poetry in
academic publications. I realized this related to the process
PW and I were exploring.
1
Western Sydney University, Penrith, New South Wales, Australia
2
The University of Melbourne, Victoria, Australia

Corresponding Author:
The Birth Experience Study (BESt) was an Australian
Hazel Keedle, Lecturer of Nursing & Midwifery, School of Nursing and
national survey that aimed to explore the experiences of Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW
women who had a baby in the previous 5 years and was live 2751, Australia.
from March 2021 to December 2021. Ethical approval was Email: h.keedle@westernsydney.edu.au
Keedle and Willo 939
Poetry Inquiry
The mode of poetry, the act of writing poems or analysing
through poems, is represented in the literature as a way to expand
perspectives on human experience (Vincent, 2018, p. 51)
Poetic inquiry is an expansion from traditional forms of
qualitative data analysis. Instead of creating meaning from
organizing data into themes or categories, poems are created
that express the emotions and feelings from participants’
words and experiences. Readers not only gain understand-
ing of the phenomenon studied, but readers are also invited
to have an emotional connection with the data through the
poet’s interpretation.
Faulkner (2018) identifies how the use of poetry in femi-
nist research can show embodiment and reflexivity and as a
movement for social change. “Poetic inquiry and feminist
poetry are examples of how we can engage in embodied
inquiry to emphasize the importance of storytelling and nar-
rative in the representation of knowledge and everyday
experience” (Faulkner, 2018, p. 5).
The theoretical framework underpinning the BESt proj-
ect is feminism and feminist research principles. Therefore,
the extrapolation of these principles into the field of poetic
enquiry allows us to highlight the impact of the hegemonic
maternity system on pregnant and birthing women.
Feminist research using poetry inquiry has explored issues
such as relationships and identity (Faulkner, 2018), media
reports (Faulkner, 2020), domestic abuse (Breckenridge,
2016), demonstrating rigor in research (Ohito & Nyachae,
2019), breast cancer (Reilly et al., 2018), reproductive tourism
(Walmsley et al., 2015), and abortion (Shaw & Haney, 2017).
Fontein-Kuipers et al. (2018) used the form of I-poems
to create four poems from “I” statements taken from inter-
views held with Dutch women who experienced a traumatic
birth. Their themes identified the negative emotions felt, the
interactions with health care providers, and the impact of
the environment to their experiences of birth trauma
(Fontein-Kuipers et al., 2018).
Poetry inquiry can include different poetry methodolo-
gies. Found poetry was used as the methodology for this
poetry inquiry. Found poems are created from written texts
or conversations and the poet writes poems focusing on the
lines, spaces, voice, and feeling (Faulkner, 2016). The writ-
ten comments from survey participants were used by PW to
create this poetry.
The aim of this article is to demonstrate the process of
poetry inquiry in giving voice to women’s experiences of
birth trauma. Bearing witness is a form of trauma informed
practice.
Methodology
The answers to open-ended questions were downloaded
from Qualtrics and shared with PW through password
protected cloud-based file sharing. Although the surveys
were anonymous any identifying information such as names
and places were removed during poetry creation.
My (PW) journey of creating found poetry through the
BESt survey data began by searching for words in the
dataset such as “experience” “doctor,” “midwife,”
“trauma,” and “consent.” Stories that included these words
and elicited a strong emotive pull became a catalyst for
each poem. I pondered each unstructured, frank, and heart-
breakingly powerful narrative of birthing in all forms as a
lived experience, searching for specific words with a
shared commonality. This process consisted of discover-
ing lines along the same theme woven into a description,
then experimenting with form to highlight and emphasize
meaning without losing the integrity of each mother’s
voice. But instead, letting the data flow into an under-
standable palatable and powerful narrative. The intention
through poetic intuition and self-awareness of voice that
emerges from the essence of the data, captures the emo-
tions of the moment, defining a story through interpreta-
tion of voice, simultaneously highlighting the significance,
while maintaining meaning. Through these poems, I aimed
to give power to these women’s voices.
The poem “bearing witness” is a reflexive poem describ-
ing my experience of reading through the data and absorb-
ing the stories when starting to compose the poetry.
Giving Voice to Birthing Women—Bearing Witness
Each story poured into my heart
My pen
Aching to be written
Mother’s voices crying out to be heard
Their words, determinedly
Writing themselves
As they birthed
onto the page
I, a mere observer
Gathered them up like a
Bundled blanket
Each indeterminable earnest thread
Ironclad in its unwavering
Tapestry, truth weaving
Between warp and weft
I sett the boundless honouring
Of nothing left unsaid
Analysis Through Reflexive Poetry
Out of thousands of birth stories, there were many echoed
traumatic narratives repeated during their birth experiences. I
(PW) felt the need to convey each mother’s loss of identity or
autonomy to consciously verbalize their needs during the
birth process. Often, I was so overcome by these powerful yet
triggering stories that I would be moved to tears. I had a
940 Qualitative Inquiry 28(8-9)
foreboding thought that these women were not heard or seen.
I hope that through these poems their voices have been heard.
The process of creating poetry from the written voices of
women was often formulaic and restrictive. As poets are
generally beings who experience the world through a lens
of emotive thought expressed into words, it was impossible
for me as the poet to remain methodical and detached from
this process. Each poem that grew out of the BESt data gen-
erated a personal emotional and unprompted response. I
expressed these feelings in another poem of my own words;
a reflexive poem which is presented after each woman’s
poem. These reflexive poems were a form of analysis and
creation where I could make sense of their journeys, while
simultaneously freeing my own voice.
Findings
The majority of birthing stories within the data seemed to
express an incredible lack of connection with the care pro-
viders (doctors and midwives) and most were in hospital
settings. Although there were some positive responses,
many of these stories depicted birth trauma.
This is shown in the poetry created below. A variety of
poetry styles were used, these include tanka poetry, free
verse, using end-jams, quatrains, and shaped verse.
The first poem is a slightly adapted tanka, two tankas
with a repeating seven (much like a coda in music) followed
by a haiku. Tanka poetry dates back to 7th-century Japan
and, in current literature, has been used in social activism
(Breckenridge, 2016). The limitation of words in this style
of poetry opens to a more vocal and evocative message.
Screaming out to Stop
My Dreams crushed, hearing
Baby’s heartbeat in distress
Told “stop worrying”
Labelled a “broken mother”
Still feels so fresh, eyes well up
“She keeps screaming out to stop”
“Still screaming to stop”
just ignore her—keep going -
We are on the clock
Betrayed, and violated
Frivolously dismissive
my expectations “too high”
In a fragile state
Still feel heavy with regrets
“Why haven’t you pushed him out?”
Yet?
************
Poets’ reflexive response to Screaming out to Stop
All eyes
Behind the tarnished mirror
Behind the tubes and Kilner jars
White coated heroes in formaldehyde
Ether Laudanum
heartbeating the strange
And invisibly voiceless
Anatomically labelled
Straining
Wild &
flailing feral
Acts cascading the
Inhumane
Free Verse
This is an entire birth story from one mother that has been
adjusted ever so slightly to fit within a poetic form.
Mother Guilt
By the time I reached the pushing stage, I. . . was coached to
hold my breath. . . . . . and pushing mid contraction. . . I had a
time limit. . . the baby had to be out within the hour. . .
Eventually, the doctor said. . . the vacuum is. . . our best option.
. . for proceeding. . . which filled my heart with dread. . . I did
not have time to answer. . . or consider my options as. . . Baby
at an angle. . . putting pressure on my hips. . . caused. . . a
painful contraction. . . Without consent, the doctor. . . . . . began
the vacuum process. . . It felt like a hundred strangers. . . had
swarmed into the room. . . all here for the freak show. . . My
screaming continued. . . my partner crying as. . . he watched on
helplessly. . . They moved onto forceps. . . I was yelling to my
partner. . . “This is wrong!.” . . “This is wrong!”. . . Everything
about this was wrong. . . The pain. . . At one point. . . was. . .
Unbearable. . . I thought I was dying. . . I just needed. . . a
break. . . to. . . catch my breath. . . so. . . . . . I started yelling . .
. “Stop! Stop! Please stop!.” . . My cries ignored. . . they did not
stop. . . they did not pause. . . When my baby came out. . . her
fraught cries. . . like mine. . . like. . . she was in agony. . . That
will haunt me forever. . . my first words to her. . . were. . . sorry.
. . for how wrong it all was. . . how she deserved better. . . how
I had failed. . . to protect her. . . in the jaws. . . of a. . . Humanless
system. . .
Reflexive poem to Mother Guilt
Quite often,
Our breath, our connected stillness
This expanse we feel
Lies in the space
And weight
Inbetween our words
Folded into each pause
We find,
Left hanging
The spaces in the silence
Held in the quietest corners of our minds
In the lull of the waves
Keedle and Willo 941
The breath between the contractions
Gathering the push
The composure of time
This is where our power lies.
The emphasis and repetition of the words He and Nobody
heard in the poem below are used to emphasize the weight
of the violence. Words repeated through point, through
rhythm:
Obstetric violence
The Dr entered the room
the sight of him caused
me to burst into tears
everything became
A terrifying blur
He
Awakened my fears
He
brutally took away all control
my plan not respected
completely shattering my world,
my innate intuition.
Completely ignored.
He
put his fingers inside me
Without
My
Consent
I don’t believe I consented
scared and vulnerable
Scared for my baby
they pulled me from the water,
Nobody heard
The words I was screaming
from the very beginning
Nobody heard
Reflexive response to Obstetric violence
Sweat—What is sweat?
A bead of perspiration drips—glistening
Dangling—my hopes
Shifting, power, dismissing
What is power?
Tension, rearing, ego, sweat
weeping from a shiny head
Musk, testosterone, the ticking of a Rolex
Time, seething, sheets, frantic, hands
Grabbing
Twisting me
Twisting me like clay
Below is a found poem inspired by Sylvia Plath’s method
of using end-jams, creating a hinge-like effect, emphasized
by this method to evoke the experience of an interrupted
or disconnected thought. The empty significance of things
through loss, through heavy metaphor (Perloff, 1970), that
emotions and words are almost too much to bear.
Loss
Pushing on my back, looking back
Feeling an unnatural compromise, my
Cries through labour, discouraging my
Trust my breath vapours
Pouring down my neck I
Sweat, too heavily, my body under attack
Insisting they obtain permission
Frustrated from the start
No warning for induction
Disruption to my birthing
Syncing midwives
Rotating hips in dystocial rhythm
Pacing patterns across the room
The CTG beeps of losing her when
Moving syntocinon on hands and knees
Plunged from an intimate delicate setting
Wearing off hazy disconnected topped
Up with stronger stuff memories
Swelling as my fever rose pitching
Lower-level care inflicted wailing softly
Tangled, sobbing crying out in fear,
Restricting chords of tiny incomplete
Clamping wishes unfulfilled unfinished
My voice a shutdown instrument
Ideas floating inevitable defeat
Techniques c-sections, an offering of different things
The difficulty of fitting fingers into my torn vagina
Muslin draped across her face; anguish mirrored mine
Her hand hanging limp to the side the
Cot cold on my baby swaddled
Deteriorating in a donated keep sake box
Lost in trauma my pain breaking free to be
942 Qualitative Inquiry 28(8-9)

Witnessed in my grief, Reflexive response to Coercive Quatrain

Still holding space, the
In time
Finality etched indelibly I The edges of plagued memories, curl in sepia, then fade
Lament our brief connection to In time
My ears swarmed with hazing bubbles, begin to ebb away
In time
This wound that will not heal
Our faces will paint a happy picture, betrayed, my body will
This hole that will not close
deny
In time
This love that I still feel I’ll release the waves of tin foil butterflies, that nullify my
disguise.
(This poem requires no reflexive response) In time
We can try once more again
Coercive Quatrain
The following poems have placed sentences to visually illicit an
My obstetrician was going away impact.

Sensed that inducing suited only him Because

“Inductions rarely progress, they, delay”
Pressured, I declined my waters breaking, I learned       of the trauma
Because
I could be       strong
“May as well opt for having a Caesar
Because
“You know, your baby will die if you don’t.”
You just can’t       go with the flow
Time, running out in severe measures Because
As though—deciding the right, to impart As women       
We can say no
Their authority, without consulting Because
Because of our inherent trust in Them It’s what we’re       socialised to do
Influencing, decisions, disrupting Because
Felt upset, and scared. controlled, overwhelmed Our choice       to minimise drama
Was one
As though—I had no voice—as though I’d disappeared we never really knew

The Baby did not fit

One doctor
made me feel I
had no choice
It
was
traumatic
I felt . . .
out of control
misinformed,
Distressed
the  baby  did
not  fit
Poets’ reflexive response to shaped poetry (Because and the Baby did not fit):
Drowning. . .

We. . .
are
all
drowning. . .
Drowning
in
our
own
Keedle and Willo 943
words. . .
Words
that
refuse
Reflection and Analysis
Poetry is often utilized as a means of inquiry—that is, the
process of writing research poems helps the authors develop
new insights. (Furman et al., 2016, p. 304)
As a midwife and midwifery researcher, I (HK) have lis-
tened to and read countless stories of birth trauma and I
frequently feel frustrated and saddened by the trauma expe-
rienced. However, interacting with these poems affected
me on a deeper level. The lack of control and consent is a
dominant experience in these poems. A lack of control is
often felt by women who experience birth trauma (Keedle
et al., 2019, 2020).
In the poem “Mother Guilt,” the words “how I had failed
to protect her in the jaws of a humanless system” spoke to
me. Too often women blame themselves for a traumatic
birthing experience yet when reading this poem, you are
drawn into how “out of control” the women felt. Starting
with being coached in second stage, progressing to not
being asked consent for using a vacuum on the baby and
having strangers observing her birth. Yet, even when she
had no control or dignity, she still blamed herself and not
the humanless system that she had become victim to.
The lack of consent, especially in relation to internal
vaginal examinations, is an example of obstetric violence.
Obstetric violence refers to violence and harassment that
happens during childbirth (Garcia, 2020). The poem
“Obstetric violence” emphasizes the blurring between treat-
ment and assault. Consent should precede all physical
examinations, yet women often report experiences where
they know they did not give consent. This can leave women
in a tenuous position questioning whether the outcome of
having a healthy baby was enough to negate the assault. It
is not. However, many women are unaware of how to make
a complaint or even if their complaints regarding these situ-
ations will be taken seriously or fall upon deaf ears.
Reading the poems and the subsequent reflexive poetry
stirs up a passion in me to fight for all women who continue
to experience obstetric violence and birth trauma, both
those that speak out against it and for those that remain
silent. These emotions motivate me to write the papers and
present the findings of our studies, regardless of how
uncomfortable they are for both academics and
point-blank
to
be
Heard
health professionals to hear and read. To prevent obstetric
violence, we first need to understand and recognize it from
the women’s perspective.
The aim of this poetry inquiry was to give women who
shared their story in the BESt survey a voice. The seven
poems shared in this article and the reflexive poetry
responses have provided a platform for their voices to be
heard as well as providing a window into the raw emotions
and experiences of these brave women.
Conclusion
The collaboration between researcher and poet has resulted
in the creation, analysis, and reflection of a series of found
poems from the stories of women who completed the
Australian BESt survey in 2021. The poems evoke a variety
of powerful emotions, and this can be used to bring the
experience of birth trauma to a wider audience.
Feminist research methodologies identify the impor-
tance that the research should be of benefit to the commu-
nity of women who shared their stories (Lafrance &
Wigginton, 2019). Sharing these stories of birth trauma
through poetry gives voice to the stories in a way that can
evoke change and shed light on what has often remained a
private trauma. As researchers, it is our responsibility to
give the findings back to the community in a variety of
methods and poetry is one such method.
A collection of poems from the BESt survey data will be
published and made available to academics and the com-
munity as part of the delivery of findings. Future poetry
readings at community events and conferences are also
planned. It is hoped that this collection of experiences
expressed through the poetic medium can positively influ-
ence and bring about change at both personal, professional,
policy, and political levels for future women’s birthing
experiences.
“Poetry is political. Writing, performing, and publishing
poetry is important political activity” (Faulkner, 2017,
p. 89).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
944 Qualitative Inquiry 28(8-9)
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Hazel Keedle https://orcid.org/0000-0003-1083-7843
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Author Biographies
Hazel Keedle, PhD, is a Lecturer of Midwifery at Western Sydney
University. Hazel’s research interests are vaginal birth after cesar-
ean, birth trauma, and maternity experiences explored primarily
using feminist mixed methodologies. She has published in BMC
Pregnancy and Childbirth, Women and Birth, Journal of Nursing
Scholarship, as well as writing a chapter in Birthing Outside the
System (Routledge) and a book for women based on her PhD find-
ings Birth after Caesarean; your journey to a better birth
(Praeclarus Press).
Pixie Willo is currently studying for a Master of Creative Arts
Therapy (Drama Therapy) at University of Melbourne. She has
completed a Graduate Certificate of Creative Therapies at Charles
Darwin University and holds a BA Theatre, Performance and
Creative Writing from the University of New England. Much of
Pixie’s work is written for performance. Her work is deeply per-
sonal and autobiographical, chronicling her journey as a mother,
feminist and queer writer. Pixie’s first work of poetry was pub-
lished in April 2021 in Clarity’s absence (2021) (Girls on Key
Press).