When postnatal debriefing silences women: A critique through the lens of set and setting

Abstract

Postnatal debriefing is often framed as a therapeutic conversation that helps women make sense of their birth experience and prevent psychological distress. However, emerging research reveals that debriefing can have highly variable effects, particularly for women who experienced trauma. This commentary offers a theoretical critique of postnatal debriefing through the lens of "set and setting," a framework adapted from consciousness studies. Drawing on a personal encounter and recent empirical studies, we argue that when debriefing focuses solely on women's expectations (set) while ignoring the institutional and relational context of the birth (setting), it can become a form of subtle coercion. In some cases, it risks shifting responsibility for trauma away from systemic failures and onto the individual woman, thereby reinforcing dynamics of gaslighting and epistemic injustice. We propose that debriefing should not be viewed as a neutral or purely technical task, but as an ethically charged relational act. A set and setting-informed approach to postnatal debriefing may foster deeper validation, accountability, and healing. This critique invites a rethinking of who conducts debriefing, how it is done, and in what context-especially when the institution providing care is also the site of potential harm.

Keywords: Birth trauma; Gaslighting; Maternal mental health; Obstetric violence; Postnatal debriefing; Set and setting.