A Year of Holding Space: Reflections from Birth Work in Malta

As the year comes to a close, I find myself reflecting on the families who have trusted me to walk beside them through some of the most intimate and vulnerable moments of their lives. Being invited into the birth space is an incredible honour, and I am deeply grateful to each family who has welcomed me as part of their journey. Thank you for trusting me to support, guide, and advocate for you as you navigated the unknowns of pregnancy and birth.

I also want to take a moment to thank my own family. This work often requires me to step away from important personal events, to be present where I am most needed, and to carry the emotional weight of experiences that are not my own. Your continued support, understanding, and belief in the importance of what I do makes this work possible.

This year, as the past 6 years, I have witnessed the reality of birth in Malta in all its beauty and complexity, and at times, its heartbreak. Obstetric violence, limited birth choices, and a lack of willingness from those in positions of authority to prioritise physiological birth equally alongside surgical interventions remain persistent challenges. Women enter birth well-informed and prepared for various outcomes, yet they continue to face shocking levels of restriction and lack of autonomy over decisions about their own bodies.

The policy of allowing only one support person in Malta’s public hospital continues to force families into impossible choices: do they bring an intact family to witness the birth, or do they prioritise professional doula support to help them achieve their desired birth goals safely? Or do they pay thousands to give birth in the private hospital where they can choose their team, but have no guarantee of not being transferred to the public hospital. It is deeply concerning that families are forced to make such decisions, when we know that the presence of a supportive team is critical to the experience and outcome of birth.

This also includes supporting birth partners in processing their own experience, so they can fully show up for their loved one. Recognising how this can impact their relationship both during the birth and in the months and years that follow is an important part of birth preparation. Birth is not experienced by one person alone, and acknowledging everyone’s experience helps families navigate this life-changing event with connection and understanding.

This year, I have also watched induction and caesarean rates continue to climb, often with limited discussion of the potential short- and long-term impacts on mothers and babies. It is painful to witness fear being used to manipulate decision-making, to see bait-and-switch scenarios, and to hear women being given misleading, incomplete or blatantly false information, all of which has profound emotional consequences in the postpartum period.

Globally, I see midwives being undermined and restricted from providing individualised, holistic care. Many are overworked, undervalued, and unable to practice in the way they know would best serve the families they care for. Witnessing this, alongside the systemic pressures that limit women’s choices, is both heartbreaking and infuriating.

Yet, even amidst these challenges, there is hope. I have seen women courageously share their honest birth stories so that others can learn and feel seen. I have seen families process trauma, validate their experiences, and reclaim a sense of agency and understanding. Positive stories where preparation, support, and autonomy come together shine as beacons of what is possible when women are truly heard and supported. I am grateful to witness this growth and resilience, and to see that fewer voices are dismissing women with the tired refrain of “just be grateful you and your baby are alive.” Survival is no longer the only acceptable outcome — dignity, respect, and autonomy matter.

As I reflect on this year, I recommit to this work. To the families I support, to the midwives and healthcare professionals striving for better care, and to the broader conversation about birth in Malta. I remain committed to holding space, advocating for autonomy, and bearing witness to the experiences of women and families as they navigate pregnancy, birth, and postpartum life.

Thank you for trusting me, for allowing me to hold space for your journeys, and for continuing to remind me why this work matters.

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With gratitude,

Crystal