“Birth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians” Beck, C (2004).

Birth Trauma is a negative and disempowering physiological & emotional response to a birth. It can happen to any woman whether it is her first birth or tenth birth. It can happen following an emergency caesarean or a ‘natural’ vaginal birth, whether mother & baby are considered physically healthy or are physically struggling, whether there was forceps or scented candles or whether senior consulting obstetricians or trainee doulas were in attendance.

One of the most important research outcomes to have been conducted in the field of Birth Trauma is that women who have previously experienced a perceived or actual loss of control (such as sexual abuse) will be more vulnerable to Post Traumatic Stress Disorder (PTSD) following birth if they have inadequate support and care during the birth (3-6).

Broadly speaking, women are more likely to experience Birth Trauma if they have an emergency caesarean or assisted delivery (forceps or ventouse), procedures which do not occus in a home setting. However, women who have a vaginal birth are still at risk (5, 7). Most importantly, women who feel out of control during birth or who have poor care and support from their carers are more likely to get PTSD (4, 6). This is regardless of pain thresholds, length of labour, previous responses to traumatic situations, blood loss or venue.

Approximate figures suggest that between 1.5%-6% of women report symptoms of PTSD following birth (1), however, the figure could be as high as nearer 8-10% as often Birth Trauma goes unreported or is misdiagnosed as PND (Postnatal Depression) (2).

When should a woman suspect that she has Birth Trauma as opposed to Post Natal Depression?

When she:

• experiences an event perceived by her to be traumatic

• experiences flashbacks of the event, with vivid & sudden memories

• has nightmares of the event

• finds an inability to recall an important aspect of the event

• has an exaggerated startle response, constantly living “on edge”, ‘flight or fight’ syndrome, is hyper vigilant, constantly looking around for trouble or stressors

• notices herself avoiding all reminders of the traumatic event

• experiences intense psychological stress at exposure to events that resemble or remind her of the trauma

• has physiological reactivity on exposure to events resembling the traumatic event, such as panic attacks, sweating, palpitations

• is plagued by fantasies of retaliation

• finds herself to be uncharacteristically experiencing cynicism and distrust of authority figures and public institutions

• may be hypersensitive to injustice

Does planning a homebirth mean you can avoid Birth Trauma?

Your ability to have a wonderful and natural birth free from trauma is dependent on other things besides your choice of birth venue. It can also be dependent on your choice of birth partners (midwife, doula, obstetrician, life partner, sister, mother, friend) and how they support you – this includes what experience and confidence they contribute to the birth space. But most importantly it can depend on how your birth journey pans out and if you feel supported, heard and respected by your carers whilst you are on that journey. A birthing woman will find it hard to utilise her strength, determination, knowledge and trust in her birthing body (all necessary factors to achieving a trauma-free birth) if she isn’t feeling safe, supported, heard & nurtured by her caregivers within her chosen environment, where ever that might be.

A home birth is not a guarantee to ensuring a trauma-free birth. However, the research suggests that the less medicalised a birth is and the more appropriate and informed support a woman receives during birth and in the first 24 hours following birth the lower the potential of developing Birth Trauma is. This infers that that the combination of less medicalisation and appropriate support is more likely to occur within a home type setting and with care givers/supporters chosen by the birthing woman or with whom she has a strong & trusting rapport with.

I am struggling with Birth Trauma, what should I do?

If you feel that you may be suffering from PTSD following your birth there are a number of paths you can take from seeking emotional support to heal to practical solutions for finding answers.

Create an empathic ally:
If you can try and talk to your partner, a family member, close friend or doula about your feelings and responses. Often having someone close who understands what you are going through means you have the close support you need. If need be show them the checklist (above) and talk it through with them. You may need to explain that the feelings you have are different to postnatal depression and that the support you require may also be different.

Obtain information:
You may wish to obtain a copy of your birth notes from your hospital trust or midwife. The cost is dependent on your local health trust/hospitals fees but can range from £10 to £50 (£50 is currently the maximum that can be charged for obtaining medical records in England). Be sure to ask for both the notes for yourself and your baby and to include any print outs of readings, scans, blood tests etc. When you receive them you may choose to read them or put them aside until you are ready to read the contents. Don’t be disappointed though if you are unable to understand wholly what happened as the bulk of your notes may well be in medical shorthand or use medical acronyms.

Seek clarification:
If and when you are ready you may choose to have a midwife go through your notes with you in order for you to obtain answers to your potential questions-this is called a ‘de-brief’. Having Birth Trauma can often mean that you don’t understand what happened to you, why it happened, when it happened or how it happened (confusion can be part of the traumatic response to a situation or where you experienced ‘disassociation’). Often sufferers find they have a large list of questions that they feel they need answering as part of their individual healing process. Your local hospital trust may arrange this for you or alternatively you may choose to use an independent or private midwife to provide a third party opinion or to avoid having to re-visit a hospital. Write all your questions down before hand as often emotional responses to situations can make even the most ‘together’ person flustered and forget things. If it helps ask for assistance drawing up a simple timeline of events to help clarification and don’t be afraid to keep asking for straight answers. If possible take your chosen ‘ally’ with you.

Seek professional support:
Although Birth Trauma isn’t always well recognised there are a number of professional organisations and counsellors who specialise in supporting women with Birth Trauma. From free helplines such as Sheila Kitzinger’s ‘Birth Crisis’ to private therapists to online or face to face support groups. Always check that whoever you have enlisted to support you isn’t still suffering from Birth Trauma themselves and do professionally consider themselves ‘post-trauma healed’ or ‘survivors’.

Currently effective trauma therapies include Human Givens ‘Rewind Technique’, EFT (Emotional Freedom Technique) and EMDR (Eye Movement Desensitisation & Reprocessing). Try and avoid therapies that aim to psychoanalyse or prolong healing by going over your trauma repeatedly. These styles of therapy are great for other emotional responses but are of little help for people suffering from PTSD.

Reassure yourself:
Please do reassure yourself on a number of different factors. You are not alone as Birth Trauma is sadly more common than you think, your responses are due to a physiological response to a traumatic situation and are not indicative of you being a bad or unfit mother, you won’t always feel like this/it’s not a life sentence and you are still ‘you’.

LifeBoostUKPerhaps most importantly reassure yourself that you have every reason to know that should you wish to be pregnant again and give birth again that it’s highly unlikely you would go through the same situation again. You have every right to a better birth and most women who have suffered and survived Birth Trauma are so acutely attuned to what is right and what is wrong for them personally that they opt to birth differently next time and look to bring in the support network that is right for them.

Lori is a mum of two wonderful children and a Birth Trauma survivor. She now works as a Birth Trauma & PND psychotherapist supporting women in the UK, UAE & Scandinavia.

References

1) Beck.C. Birth Trauma: in the eye of the beholder Nurs Res. 2004 Jan-Feb;53(1):28-35.
2) Horsch, Antje. “Post-Traumatic Stress Disorder following Childbirth and Pregnancy Loss.” Clinical Psychology in Practice (2009): 274.
3) Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: A cross sectional study. Journal of Anxiety Disorders. 1997;11(6):587-97.
4) Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 2000;39:35-51.
5) Ayers S, Harris R, Sawyer A, Parfitt Y, Ford E. Posttraumatic stress disorder after childbirth: Analysis of symptom presentation and sampling. Journal of Affective Disorders. 2009;119:200-4.
6) Ford E, Ayers S. Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology and Health.
7) Soet J, Brack G, Dilorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth. 2003;30:36-46.
8) Cigoli V, Gilli G, Saita E. Relational factors in psychopathological responses to childbirth. Journal of Psychosomatic Obstetrics and Gynecology. 2006 Jun;27(2):91-7.