Birth Trauma - an end to suffering in silence.

We know that advances in medical care have resulted in childbirth being safer now for mum and baby than ever before.  Even where complications arise, specialist obstetric and neonatal care helps to ensure that the vast majority of difficult deliveries result in a happy outcome.  Most women who have a difficult experience of childbirth are able to come to terms with their experiences and very often go on to have more children in the future.

However, for some women, and their partners, the experience of childbirth can be psychologically devastating.  For many women pregnancy and childbirth will be their first significant interaction with the medical profession.  Regardless of how well-informed they are of the physical details of childbirth, many will not feel prepared for their experiences.

Women who have been encouraged to participate in planning the delivery may find that their wishes are ignored or overruled by clinicians.  Some may find that decisions are being made around them, often in an emergency situation, without them being made aware of what is being done and why.

Women who may be struggling to cope with levels of pain may find that they are denied procedures that they believe would help to ease that pain.

Some women who have particular reasons to want a caesarean section or, to avoid forceps, for example, may find that they get a hostile reception.

Even when women perhaps come to terms with the physical aftermath of these issues they may still struggle to process the emotional and psychological impact.  They may suffer from nightmares and flashbacks.  They may feel that they cannot cope with the loss of control they have experienced and then feel a need to avoid the possibility of future pregnancies.  Some will go on to be diagnosed with post-traumatic stress disorder.

Sadly, some will suffer in silence, thinking that they are simply experiencing the inevitable consequence of childbirth.

The Birth Trauma Association has been highlighting the plight of women who experience birth trauma for a number of years.  We are pleased and proud this week to be supporting them in their campaign to raise awareness of birth trauma.

Although it is unclear exactly how many women develop postnatal, post-traumatic stress disorder, because no official data is collected, the best estimate is 4% (based on 2017 systemic review that included 28 studies of postnatal PTSD).  Factors which may help to reduce the level of PTSD postnatally include ensuring that maternity units are properly staffed and that women are not left alone for long periods whilst in labour. 

From working with women who have suffered birth trauma we are also aware that it is critically important that clinicians talk to the expectant mother, explain things and listen to mum's fears and concerns.  Of course in a high-pressure environment where perhaps seconds count in ensuring a safe delivery, it can be challenging for clinicians to find the time to explain and reassure before they take necessary action.  Nevertheless there can be no excuse for ignoring or talking over a patient, or failing to respect their wishes.

It is also critically important that those who spend time with mum after the delivery, including GPs, health visitors and community midwives, understand the potential for PTSD to occur.  Whilst childbirth may be challenging, life changing, traumatic and, often, amazing, it does not have to result in long-term psychological ill-health.  There is help and support available for women who are diagnosed with PTSD and it is important that those who are suffering are encouraged to find the support they require. 

For those with PTSD, suffering in silence is rarely a solution. Women who are struggling with their experiences cannot simply be expected to be grateful that they have a healthy child. We welcome the BTA's campaign and we encourage those who are experiencing problems to seek help and advice. We hope that, by highlighting this important issue, the campaign ensures that childbirth ultimately becomes a safer and happier experience for all.