Birth Trauma

The 17th to 23rd July 2023 was ‘Birth Trauma Awareness’ week. I’ve been unsure whether I wanted to do a blog post on the subject, as it’s a very personal matter for most people, but I decided that it’s an important topic to cover.

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To give you a bit of background, the Birth Trauma Association UK use the term ‘birth trauma’ as a shorthand phrase for PTSD after childbirth, and for women who have some symptoms of PTSD, but not enough for a full diagnosis. They state that ‘4-5% of people can develop PTSD after giving birth’.

PTSD was first identified amongst soldiers returning from the Vietnam war, but PTSD can follow any traumatic event and also affect people who have witnessed a traumatic event. For this reason, PTSD can affect birth partners too. It also doesn’t have to be related to a specific traumatic event. It can be due to feelings of loss of control or loss of dignity, external pressures and absence of informed consent to name but a few. Research shows that there are certain factors which make birth trauma more likely. These include:

- Long labour

- Very painful labour (!!)

- Induction

- Poor pain management

- Feelings of loss of control

- High levels of medical intervention

- Assisted delivery such as forceps

- Emergency caesarean

- Impersonal treatment

- Poor staff attitude

- Not being listened to

- Lack of information

- Lack of privacy and dignity

- Fear for baby/mother’s safety

- Stillbirth

- Birth of a baby with a disability resulting from a traumatic birth

- Baby requiring medical intervention/admission to the Neonatal Unit

- Poor post-natal care

- Previous trauma

- Witnessing loved one’s trauma

For the sake of this blog, when I talk about ‘birth trauma’, I’m referring to parental mental health concerns caused as a direct result of childbirth.

I’m going to make the assumption that most people reading this will either be pregnant or a parent. In which case, I’m sure all of you will have had multiple interactions with people telling you their own birth stories.

I remember when I was pregnant with my first baby… suddenly, I was inundated with women telling me their birth stories. Yes, there were a couple who re-told their positive experiences, but the majority, and the most detailed examples, were always the ‘traumatic’ births. It came across that the likelihood of having a positive birth experience was few and far between! I’m sure it is well meaning, but not wholly helpful for the pregnant mummy! As you’ve just read above, fear can predispose us to birth trauma, so I find myself wondering, who is this helping? Is sharing birth experiences actually a means of de-briefing from previous trauma? Equally, we do also need to be realistic. Birth is an unknown entity, and we all naturally have some level of fear of the unknown, but knowledge is power!

When it comes to my work, I come across so many women whose symptoms fit the spectrum of ‘birth trauma’. Maybe not full PTSD, but symptoms of it. I am a prime example. I made a playlist for the birth of my son. Things didn’t go smoothly, and for months afterwards, I couldn’t listen to certain songs on that playlist without breaking down in tears. Luckily for me, these symptoms subsided with time and a solid support network. But the point is, irrelevant of the severity of symptoms, it was a birth-related trauma, and I think this level of trauma is really common.

I also come across a lot of mothers (me being one of them) who experience feelings of guilt and failure following a birth that didn’t go as hoped. I was promised that labour was a ‘natural process’ and that my body would ‘know what to do’, but what if it doesn’t for whatever reason? I know now that this absolutely does not mean that I’d ‘failed’, but I struggled with that one for a while, and I’m positive that I’m not the only one.

This is where antenatal preparation comes in.

I am all for positive birth preparation, but it also needs to be realistic, evidence-based and factual. If we are not fully informed about our options, how can we make informed decisions? Some birth preparation classes can appear biased to a certain ‘type’ of birth and therefore, focus predominantly on that. Some don’t even cover potentially ‘traumatic’ options, so not to scare people. Our antenatal classes were on zoom (due to covid), but I remember actually walking out of one of our antenatal classes, as something that they taught was factually wrong.

So, when it comes to antenatal classes, look for an evidence-based, factual class. Ask to see the content before committing. Look for a breadth of subjects, covering all birthing options (location, delivery type, pharmacology options, assistive devices etc). If your birthing centre offers antenatal classes, which most do, go to these. The NHS classes generally cover all eventualities. Also, inform yourself, do your own research, make your own informed decisions.

Finally, I’ll just touch on birth plans.

Using the term ‘birth preferences’ rather than ‘birth plans’, is a powerful means of changing our expectations around birth. In order to have a preference for something, you have to know what the alternative options are. Birth ‘preferences’ encourages more knowledge, and allows for more flexibility, rather than a set plan of how things will go. You may be lucky, and your birth goes to ‘plan’, but if it doesn’t, you’re setting yourself up to fail and predisposing yourself to birth trauma.

The thoughts around birth plans are slowly changing, but more often than not, you will get towards the end of your pregnancy and be asked ‘have you made your birth plan?’ Just changing the language and using the term ‘preferences’ prompts us to explore options in addition to our ideal scenario.

And this is the other big issue with a birth ‘plan’. When planning, lots of parents come up with their ideal scenario but fail to consider, or at least adequately consider, any other possible scenarios. Without due consideration of all the options, you cannot then make an informed decision should these options appear during labour. Preferences also allow us not only to specify our preferred options, but also to identify specific things that we absolutely do not consent to.

I created the ‘Traffic Light System’ birth preferences which I use with my antenatal families. This allows parents to document all their ‘preferences’ into categories depending on the item and the situation. It encourages exploration of all the birthing options/scenarios and is also very helpful for birth partners to follow and advocate for Mummy during labour. These templates can be found on the website under 'resources'. Click the button below to view.

'Traffic Light System'

In summary, some take home messages: if you had a difficult birth, think twice before you share the gory details with other expectant mothers. It’s unlikely to be helpful for them to know what you went through. If you feel that you need to share your experience in more detail, seek support, or speak to other mothers, friends and family about your experience. If asked about your birth story, instead of going into what may be perceived as traumatic events, try saying, ‘it didn’t go as I’d hoped’ and then give helpful, practical advice such as ‘make sure you explore all your birth options’, ‘try not to be too ‘set’ in your expectations’, ‘make preferences for different scenarios’, ‘be open minded, but equally know what you don’t consent to’ etc.

If you or someone you know has experienced or is experiencing any form of birth trauma, irrelevant of the extent of the issue, its vital to seek support. It doesn’t have to be formally through a professional if that’s not what you need, but from partners, friends and family. Most birthing units now offer everyone a ‘birth afterthoughts’ appointment. You can do this whenever you are ready. The opportunity for an appointment never expires, no matter how far down the line after birth. It may be called something different in your birthing unit, but they are all fundamentally the same thing. A chance for you to debrief, gain information you may be missing, and also a chance for you to feedback to them on your experience. You may also receive an invitation to give feedback to your birthing unit, and I implore you to do this. We can only make services better for you if we know where we’re going wrong, so be brave and be honest!

Reach out if you have any questions, and if you need more information, look up the Birth Trauma Association UK and the Maternal Mental Health Alliance. They both have great resources and lots more info on their websites.

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Some excerpts from The Birth Trauma Association website (2023).