Since I have been sharing glipses of my book, Scars of Gold, some people have asked me the question “what is birth trauma?” From some of the discussions I’ve had with people from various backgrounds, there appears to be a confusion in society between understanding of the experience of pain during birth, and overall birth trauma. An overall traumatic birth experience is when any form of distress that the mother experiences either during and or after childbirth, has an impact on her life.
Some of the impacts include but are not limited to:
• physical disability and/or injury
• difficulty in bonding
• postnatal depression
• relationship breakdown
• financial problems
Many people mistakenly believe that birth traum only relates to a physical injury sustained during the birth, but birth trauma is often a psychological response. For many many mothers, birth trauma has a lot to do with the way they were treated by their care providers. Regardless of the actual outcome of the birth, women who receive respectful care from their maternity care provider are more likely to perceive their birth experience in a positive light, as opposed to those who receive disrespectful care.
My own experience included an unplanned emergency caesarean. After many hours of labour, my CTG trace was telling us that my baby wasnt too happy and that it was time to go to theatres and meet my little boy. When my midwife spoke the word “caesarean,” although my heart sank a little and I shed a few tears for about 30 seconds, I reluctantly accepted this mode of birth, because my midwifery knowledge and training told me we had tried everything for as long as possible. I knew that continuing any longer would only exhaust me and my baby further. In addition to knowing that I neede a caesarean, and the reasons for it, my midwife talked to me through it all, reassured me, and made sure I knew and understood the situation. So we went off to the operating theatre to have the section.This scenario of being wheeled into the operating theatre for an emergency caesarean is not dissimilar to many other women who end up having an unplanned, emergency caesarean, or other interventions.
Having an unplanned, emergency caesarean did not cause trauma for me because I knew what was going on and I received respectful maternity care throughout the labour and birth process. (For me it all sprialled out of control in the postnatal ward.)
But for multitudes of women, having an unplanned, emergency caesarean can cause trauma. Why? I think it has a lot to do with the communication between them and their care providers. Often women are told “if we don’t do a caesarean now, your baby could die.” Then they are whisked away to theatres, not knowing what is going on with their lives, worried about their baby surviving or not.
The fear of not knowing what is happening to them, or their baby, can be very traumatic. And yet this fear, and the subsequent trauma that can develop, can be so easily alleviated, if not completely prevented. In a study of 2192 women in the Netherlands, the authors found that women attributed their traumatic birth experience primarily to a lack and/or loss of control, and poor interaction with caregivers. This included communication/explanation, listening, emotional and practical support.
This study found that the interaction around interventions seemed to be more important to these women than the interventions themselves. Doesnt this show us that its important for women to feel involved in the decision making when it comes to the birth of their child? That they want and need respectful communication throughout? That they want to know what is going on? If we know that respectful maternity care can prevent birth trauma, then wouldn’t it make sense for maternity care providers to make sure women feel in control by keeping them informed? Wouldnt it be better to calmly describe what is going on, especially when a caesarean or other intervention becomes necessary, instead of frightening them that their baby could die if they dont have a caesarean? Is there some other way maternity care providers could communicate the need for medical intervention that doesn’t leave them feeling alone, afraid and out of control?
One in three women are impacted by birth trauma, and they often suffer in silence. The psychological impact of birth trauma can last a life time!!! So it’s important to ask the question “what can be done to prevent birth trauma?” I think we need to make it a priority to ensure every woman receives respectful maternity care. Listening to women, explaining what is going on, and providing emotional and practical support can help women to perceive their overall experience of childbirth as positive, regardless of what actually happened during the event. It’s been made clear, time and time again, that continuity of midwifery care facilitates these elements of respectful care. Women are more likely to feel listened to, feel involved in the decision making process, and receive emotional and practical support when they are provided care by a known and deeply trusted midwife. And having a known and deeply trusted midwife is only possible within a midwifery continuity of care model, not from fragmented care.