Supporting families after a difficult and traumatic birth of course is so important but we need to address how we can prevent trauma from a difficult birth in the first place.
So how can we support preventing birth trauma?
There are four main areas that are crucial to preventing birth trauma.
These areas are;
- Raising awareness of birth trauma and its impact on families.
- The importance of kind, compassionate and respectful care.
- Supporting families to make evidence informed choices around their birth.
- Reducing Birth Trauma by improving maternity care and services
Why are these areas important? How can we as communities and individuals support these areas and work towards improving them for families?
Raising awareness of birth trauma and its impact
Sadly birth trauma is still little acknowledged or understood. Many women don’t even know that the feelings they are struggling with about their baby’s birth could be birth trauma. Even within the birthing community birth trauma is often not recognised. Healthcare professionals too may miss the signs. Even when it is very clear that a woman or her partner are struggling, birth trauma is often not thought to be the cause, instead it can be put down to suffering from postnatal depression or other mental health conditions.
By raising awareness of birth trauma and it’s impact we can help families to access support when it is desperately needed. Awareness of the signs of birth trauma allows those caring for families to notice when they are struggling and ask if support is needed. More awareness helps women to understand why they may be struggling with their experience and encourage them to speak out and ask for help. This is important because it means support can be given sooner and enable the trauma to resolved before another pregnancy.
It is important that women are able to talk about the birth of their babies in a safe place where they feel listened to and not judged. It is also important that any woman or partner that is struggling after the birth of their baby is asked about their birth experience. If a birth is traumatic the result can be postnatal depression, perinatal anxiety or PTSD. However, if awareness is lacking chances are that this will be missed and that can result in an escalation of symptoms.
We can all help raise awareness. We can talk about our own experiences, we can listen to the experiences of others. We can also learn more about birth trauma and how it impacts those affected. Education means understanding, and when we understand, we are able to help. Especially if we work supporting families during pregnancy and beyond.
The importance of kind and compassionate care
The way a woman is cared for during her pregnancy and birth can have a profound effect upon her and her partner. Sadly a lot of trauma in birth is caused by unkind words and/or actions, by lack of compassion for a woman’s needs or circumstances, and by not respecting choices, or beliefs. It is also the case that trauma is caused by neglect and poor care.
Even in emergency situations trauma can be greatly reduced by the kind of care given, kindness and compassion as well as respecting the woman and her partner, by still offering choice can help prevent or reduce trauma. Language and the way we communicate with families can also either increase or reduce trauma. When supporting families lack of clear, honest and respectful communication is often the thing that is said to have caused more trauma. Sometimes even the medical terminology used can cause distress, such things as ‘failure to progress’, ‘incompetent cervix’, or ‘poor maternal effort’ are just some of the words that can leave women feeling like they are to blame for a traumatic birth.
After a difficult birth it’s important that any healthcare professionals who support a woman and her partner LISTEN. This is the single most important thing we can offer a woman who is suffering. Listening enables you to truly know what they have been through, how they are feeling and what is important to them. Listening will enable you to know if the woman or her partner are likely to be suffering from birth trauma and thus enable you to get them the support they need. This is listening that embraces empathy. Sadly many women have told me how upon opening up to healthcare professionals they have been met with defensive, unkind words that have made their trauma worse.
Care that is kind and compassionate does not minimise a woman’s feelings or experience. Instead it will move those caring for her to do everything in their power to support and protect her. We must not underestimate how birth trauma can be greatly reduced by kind, compassionate, respectful care.
Sharing our experiences of both good and poor care can help those who are supporting women in pregnancy and birth know what makes care kind and compassionate. We can open up about what respect means and how this can impact on us. By working together we can help improve birth and also reduce trauma even in the most difficult of circumstances. One way we can do this is by being involved in our local Maternity Voices Partnership, working with maternity staff to improve care for all. Also by getting involved in the #MatExp grassroots movement to make sure your voice is heard.h
Supporting families to make evidence based informed choices
When it comes to birth, families have a right to know what choices are available to them and then make choices that are right for them.
Much comes into play for a family when weighing up the right choice for the birth of their baby. Everyone has unique situations, family backgrounds, personalities, life experiences and beliefs, these maybe cultural, personal or religious. These can all affect the choices they make. It can also mean that the choices they do make may not be the choice that is seemly right for them ‘on paper’. A difficult childhood, a previous loss of a baby, fear or a mental health condition may mean that the choice they make is based on not only what they as a family would like but also their situation, a previous experience, or out of a need to manage a current problem. Preventing birth trauma means understanding the individuality of each person and then respecting the choices they make.
How can families be helped to make informed choices?
Firstly it is important that they are given information that is evidence based. It is also important though that this is given in way that does not become a controlling influence. What does this mean? Information given can be given in such a way that it leans towards a ‘preferred’ option, sometimes the risks can be dwelt on, but the benefits skimmed over. Or it can be the case that information given is tailored to suit the needs of those providing care, rather than allowing an unbiased approach that enables more individualised care.
Families need to be given accurate, up to date, evidence based information that enables them to discuss with care providers the risks and benefits of the choice they are considering. Any families planning for birth need to take the time to find out their options and look at the evidence, weighing this up with their own personal circumstances. Never should women feel coerced into any choice, or procedure.
Even in emergency situations, by giving choices, regardless of how small they are, we allow women and their partners to still feel in control of their care. Often trauma can result from feeling that the experience somehow happened to them, with little choice and that a they had a loss of control at such a vulnerable time.
It can be especially challenging if families wish to make choices that seem to go against the ‘recommended’ advice. If you care for women and families it can be hard to support choices that you personally may feel are unwise or that you would handle a different way. However if the information you have given is accurate, evidence-based and given in the right manner, and a family are clear about what may happen as a result of their choice, then it is important to support the choice made to the best of your ability. Our helping families to make informed choices and then supporting those choices goes a long way in preventing birth being traumatic.
Reducing Birth Trauma by improving maternity care
Our maternity services are under pressure. Funding, staffing and how care should be provided are greatly debated issues. We value all the hardworking staff that support families during pregnancy and birth everyday often in difficult circumstances. However we also acknowledge that there is much to be done to improve services and the care given. Many of the women I support share that they have felt let down by those in place to care for them. Many have been left traumatised and broken by their birth experience.
So what can help prevent birth trauma?
- Acknowledgement that care is sometimes not what it should be.
- Helping all staff to have awareness of birth trauma and its impact.
- Co-working with families to build/improve services.
- Support and training for all staff around birth trauma.
- Cultures in maternity units that are women centred and supportive of staff.
- Help and support for those who work within maternity services who have witnessed difficult births.
- Specialist midwives (PNMH, bereavement)
- Policy, governance and guidelines to protect women and staff.
- Clear processes for investigations when things go wrong.
- Ways for families to feedback their experiences.
- Really listening to families and their experiences.
Maternity units must nurture a culture that acknowledges the emotional needs of families a being just as important as keeping women medically safe. Some units have specialist perinatal mental health midwives and bereavement midwives to provide value support. All staff that care for women and families in birth should also be supported with perinatal mental health and bereavement training. Most units will also offer birth reflection or listening services as well as debrief sessions for those who wish to access.
Improving maternity services is a vital part of reducing birth trauma. We cannot just address when trauma has happened, but instead must seek ways to support staff and families preventing birth trauma in the first place.
Perinatal mental health and birth trauma
We can do much to prevent birth trauma, however in some cases it will still occur despite our best efforts. Its is vital therefore that support is in place to help those affected recover.
Experiencing a traumatic birth can greatly impact perinatal mental health. Women may go on to develop postnatal depression, psychosis, perinatal anxiety or post traumatic stress disorder. Women who already have mental health conditions such as depression, anxiety or OCD may find their symptoms worsen or they may have a relapse with managing their condition. This applies to for partners who may witness a traumatic birth.
Studies also show that those who have had a baby in a neonatal unit are very likely to show symptoms of PTSD or even develop full PTSD*. We can also imagine the impact of the loss of a baby on a family and the implications this has on mental health. Then of course loss of a wanted experience, maternal injury or illness in a mother or her baby all impact on the emotional wellbeing of the whole family.
Finding support with perinatal mental health can be hard, finding support for a difficult birth even harder. Yet this is crucial for a family. Struggling with a difficult birth experience can greatly increase anxiety about having a new baby, it can impact bonding, feeding and relationships with partners and other children in the family. Support with feelings around a difficult or traumatic birth experience means families being able to open up about their feelings and find comfort and understanding.
Often it has been noted that women who later go on to present with a perinatal mental health issue are rarely asked about their baby’s birth and if this has contributed to them feeling anxious or depressed.
Postnatal care is invaluable and midwives, health visitors, support workers, GPs and all those who women come in contact with are vital links for families. Continuity of care allows for relationships built on trust which serve as a firm foundation to see that someone may be struggling and need support. Being aware of local services that offer support means being able to signpost families to the help they need. Most of all women should be asked about their birth experience and be given the time and space to talk about how they are feeling.
Campaigning for services that specialise in perinatal mental health including birth trauma support must also continue. Awareness is the first step, but there must then be services to provide the help and treatment when needed. Often with birth trauma providing a safe place for talking about the experience and having the trauma acknowledged goes a long way to reducing its impact.
Also sharing of families stories allows us to see what can help support families better, lived experience shared as part of training in perinatal mental health services can have a profound impact on those who attend.
Unfold Your Wings hopes that one day women and families will have maternity experiences that are individualised, respectful, gives dignity and allows for informed choice. That put a woman, her baby, her family and their needs first. That support birth experiences that do not result in trauma but that even under difficult circumstances will help a woman to feel loved, protected and supported. We hope, that the voices of women everywhere will be heard, no matter who they are, what they do, or what choices they make.
Why is this so important, because a woman’s birth experience stays with her, it can have a profound effect on her and her family as they start on their journey as parents.
All women, babies and families are special and deserving of the best maternity care possible.
*Shaw RJ, et al.(2009). The relationship between acute stress disorder and post traumatic stress disorder in the neonatal intensive care unit. Psychosomatics. 50(2):131-7https://www.ncbi.nlm.nih.gov/pubmed/19377021