pregnancy

Birth Trauma: As a doctor, here's what I've learned.

She lay in the hospital bed paralysed by shock.

She was a young, healthy first time mum who was two weeks before her due date. 

She didn’t quite understand how things had escalated so quickly. Why was she actually been induced early? Why had her obstetrician hastily booked her in before the weekend when at their last appointment she was happy to wait for a repeat ultrasound? 

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Nonetheless, she re-grouped and re-framed. 

Her obstetrician promised her that once she had artificially broke her waters, she would give her a few hours to establish labour naturally. 

She held tight to this promise. In these few hours she would be able to put into play the teachings from her intensive birthing course she had dragged her reluctant partner to, to the positive affirmations she had written down, to the mantra she had been meditating on over the last 30 weeks to trust in her body’s primal ability to birth this baby.

But when her obstetrician broke her waters she coolly commented that she would need to start the Syntocinon infusion earlier than expected. 

By the time she thought to ask why, her doctor had left the room and a cannula was being inserted into her arm. The drip began and she lay still. 

She had envisioned herself empowered, fiercely roaring through labour but here she was, a passive patient, feeling robbed of her partnership in the labour and birth of her own baby. She was scared and unsure. She was in pain. Things felt too rushed. If only she could have had one more appointment with her obstetrician to understand everything at play. 

Ten hours later her beautiful daughter lay warmly on her chest. And yet, despite the overwhelming love and gratitude that gripped her, despite the successful outcome, she would always look back on her birthing experience as disempowering and confusing. 

What makes a good birth? 

An obstetrician or midwife may leave a room feeling satisfied with patient outcomes, namely a healthy mother and baby. Yet, the reality for many women can be much different. 

Whilst thrilled for having survived childbirth and grateful for their baby, feelings of confusion, loss of control and powerlessness can be overwhelming and even traumatizing.

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As both a doctor who works with women who are giving birth and as a mother who has given birth myself, I’ve thought a lot about birth trauma and if there’s anything we can do as mothers and support persons to actively prevent it. 

Discrimination, physical or verbal abuse, procedures without consent and non-supportive care constitutes mistreatment during childbirth. 

For doctors in training there is more conversation being had about this mistreatment and what we can do to prevent it. Patient autonomy, shared decision making and respectful and dignified care are all crucial ingredients in creating positive birth experiences.

Up to 7% of women perceive their birth as negative.

Some of these women even meet the diagnostic criteria for Posttraumatic Stress Disorder (PTSD). 

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A negative birth experience doesn’t merely remain a bad memory but studies have shown it informs future outcomes, such as being associated with requesting for a cesarean section in subsequent pregnancies as well as depression during and after a subsequent pregnancy.  

Factors that are associated with a higher chance of developing PTSD after childbirth include a loss of control, obstetric emergencies, emergency caesarean section, instrumental delivery, pain and a lack of support from staff or partners.

Not surprisingly, having support from your partner or care provider is proven to have a positive effect on one’s experience of childbirth. 

Continuity of care including meeting the midwife or doctor prior to labour as well as having a homelike birth setting also found positive effects on a mother’s satisfaction with care.  

And surprise, surprise… how you’re treated is an important factor. 

Studies show that attentiveness to your and your partner’s needs is important. Additionally, when carers inform women about labour progress and involve women within decision-making they are less likely to have a negative birth experience. 

When women assess their own childbirth experience, we know that both the quality and quantity of caregiver support and involvement in decision-making play a more influential role than age, socioeconomic background, ethnicity, labour education and the physical birth environment itself.

It can feel almost impossible to have any sense of control during labour and birth, however, here are some very practical things you can do to safeguard a positive birth experience.

1. During pregnancy

Educating and preparing yourself for birth and being aware beforehand of the reality that birth plans can change is significantly helpful. 

Whether that means asking your midwife or doctor to sit down with you and walk you through the labour and birth and/or enrolling in evidence based antenatal education courses. 

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Find a midwife or doctor who will listen and discuss your fears, perceptions, personal beliefs and expectations. 

Discussing any differing opinions between yourself and your carer during pregnancy will allow you the time to find common ground and create a mutually acceptable plan together. 

If the differences between your plans and that of your carer are too great then you can have the time to make another arrangement before your birth. 

2. During labour 

A sense of loss of control and perceived lack of support can be hard to avoid in emergency situations, which are sometimes an unavoidable reality of childbirth. 

During obstetric emergencies, staff will be focused on ensuring a healthy mother and baby. Having a support person with you be it a partner, parent, friend and/or a doula to advocate and provide additional support makes a world of difference. 

Don’t be afraid to remind your midwife or doctor that you want to be involved in decision making and to keep you up to date as much as possible during the labour process. 

Usually, there is a point in which an emergency caesarean or instrumental delivery becomes a likely possibility. 

It’s at that point where you and your support person should be made aware of this possibility and included in the decision-making process rather than being withheld information until a sudden change in the birth plan has to be made. 

3. After birth

The importance of postpartum care and debriefing is underestimated. 

Every woman should be offered the opportunity to discuss her birth and perceived experience. 

This should be offered by your midwife, obstetrician, GP and partner but can also be offered by friends and family. 

Feeling supported and heard will help reduce the development of PTSD symptoms. It also gives you an opportunity to ask your midwife or doctor why certain things happened so that you don’t walk away from the birthplace with unanswered questions. 

For traumatic births, this closure is essential to the healing process. 

We don’t have control over every aspect of our birthing story. But we do have the ability to be proactive in protecting our right to a positive birth experience.

And if or when we encounter unexpected outcomes, we have control over our response to it. 

If you would like to discuss this further please reach out to your GP or to a psychologist or psychiatrist with an interest in perinatal mental health.

Feature Image: Getty.

If you think you or someone you know may be suffering from depression, contact PANDA – Post and Antenatal Depression Association. You can find their website here or call their helpline – 1300 726 306.