As a researcher in perinatal psychiatry (working with women who are pregnant or have recently had a baby), unfortunately I was not surprised to see last month's headlines about the Birth Trauma Inquiry report and the ‘Postcode Lottery on Perinatal Care’. I work in London, but even within boroughs across the city, women tell me of vastly different experiences of perinatal care. I also find that in the majority of moments when I tell people what I do for a living, they are quick to share stories of either their own experience, or the experience of their loved ones. One thing is clear to me – you don’t have to look very far to find a woman who has had a poor perinatal experience.
Birth trauma is complicated, but what we do know is that it can have a profound impact on the woman herself, her family, and the early weeks and months of an infant’s life. Of course, birth trauma is very often coupled with significant physical pain and recovery, which is not to be ignored, but given that I am a researcher in perinatal mental health, this is the aspect on which I will focus here.
According to the Birth Trauma Association, 4-5% women develop post-traumatic stress disorder (PTSD) after giving birth (as well as 1% of birth partners, which is also significant). This is important, because as well as the symptoms being very distressing, postnatal PTSD can also affect parents in other ways, such as how well they feel able to bond with their new baby, as well as how anxious they feel about having another baby in the future. Not only that, but the relationship babies form with their parents can impact their outcomes throughout life, as has been written in this article by my colleague Alessandra, so birth experiences are important for the whole family.
As an example, Louise Thompson (who formerly starred in reality show ‘Made in Chelsea’), recently shared that her poor mental health after her traumatic birth experience impacted her initial connection with her son, saying that “when I did see him, I would hold him at arm’s length. I didn’t want to talk or sing to him.” The report contains the voices of many other women who have experienced birth trauma, but given how upsetting their stories are to read, I will leave readers to decide whether they feel comfortable seeking them out.
Postnatal PTSD can be caused not just by physical trauma, such as difficult or painful labour and delivery, but also by psychological factors, such as feeling a lack of control in their delivery experience, or anger at medical staff who may not have cared for them or listened to them as they would have hoped. Indeed, in stories I have heard from women that I work with, it is clear to me that these psychological factors and a person’s perception of an experience play a large role in their risk for trauma and PTSD. For example, I have met women who, to those around them, would seem to have had a very physically traumatic birth, but who felt in control and cared for, and they suffered fewer symptoms of trauma and PTSD than other women who had an objectively less traumatic birth physically, but felt scared and unheard throughout.
This importance of perception gives me hope that we can truly make experiences much better for women. Even in the best of facilities, with the best staff and circumstances, unfortunately there will still likely be a small minority of women who have unavoidable complications of childbirth which result in physically very traumatic deliveries and post-birth care. However, we have far more power to influence how a woman feels about, and remembers her delivery, based on the level of care that she is provided, both during the labour and delivery itself by the obstetric and midwifery staff, but also by psychology professionals after the experience.
A great example of this that I have heard a handful of times in my work, is the ‘Birth Reflections’ initiative, an opportunity for women to have a debrief a few weeks after their delivery, with the obstetric professionals who cared for them, possibly with the addition of a psychology professional. These meetings are spaces to reflect upon aspects of the delivery that the women felt to be traumatic, and for them to gain further information on the circumstances of certain treatment decisions that were made in a hurry, in order that they can regain some understanding of what happened to them, and a feeling of control of the situation. In many cases, this has made a real difference to the women to whom I have spoken, but unfortunately it does not seem to be offered in every hospital yet.
Of course, it is worth mentioning that not every woman who gives birth will have a bad experience. I work with women who suffer with postnatal depression, and so it is likely that I hear a higher proportion of stories of poor birth experiences than exist within the general population of women who give birth, because we know that perceived birth trauma is a risk factor for postnatal depression. Nevertheless, birth trauma is something that everyone who works with perinatal women and their families should be working to minimise as much as possible, because when it does happen, the effects can be profound and long-term. I was upset to read in the Birth Trauma Inquiry report that “women in their 60s and 70s wrote about how the memory of the birth was still vivid”. It is important for me to say that I do not blame healthcare professionals for much of this, as I know how hard they work and how much they care for their patients, despite staff shortages and often stretched conditions.
The report makes a number of recommendations to improve care for women with respect to birth and trauma, including the recruitment of more staff, ensuring continuity of care, the importance of asking mothers about their own physical and mental health after the birth (not just after the wellbeing of the baby), the rollout of the ‘Birth Reflections’ programme, and efforts to tackle inequalities in care among ethnic minority groups. While small steps in these directions are happening all the time, thanks to the hard work of NHS staff and others, it is imperative that the government takes notice of this report and commits effort and funding to this important area. Only then will we truly be able to improve the experience across the country of women and their families at such a significant time, and make it memorable for all the right reasons.
