“All that matters is a healthy baby.”

We hear that statement all too often and too many of us believe it’s true. I don’t agree. Yes, a healthy baby matters, but it is not all. A healthy mum, physically and emotionally, matters too!

In a previous blog post, I wrote about physical and emotional birth trauma and how it impacts 1 in 3 women in Australia. This number seems to make birth trauma quite common. But common is not normal. Every woman should come out of birth physically and emotionally well.

The good news is that birth trauma can be avoided or at least minimised.

What is birth trauma?

Researchers define trauma “as a perception of ‘actual or threatened injury or death to the mother or her baby,’” though others argue that “the perception of trauma is in the ‘eye of the beholder, and ’should be defined by the woman experiencing it.”

So what do women say who experienced their birth as traumatic?

A study in the Netherlands asked more than 2,000 women who reported having birth trauma to share what they thought caused or contributed to it and how they think it could’ve been prevented.

Examples of lack of emotional or practical support given by women in the free text fields included not being taken seriously in their perception of the speed of labor progression, being left alone during labor, no continuity of care, and a midwife or gynecologist who was too busy to spend time with them.

In a 2017 study with over 900 women conducted by a team of researchers in Australia, a majority of the women (about 66 percent) traced their birth trauma to actions and interactions involving their care providers. They felt that their doctors prioritized their own agendas — such as wanting to get home — over their needs, coerced or lied to them, and dismissed or ignored them altogether. (healthline.com)

Interactions with care providers seem to be a more important factor than medical intervention or the type of birth when it comes to women’s experiences of traumatic birth. For example, a perceived lack of control and involvement in decision-making can contribute to the experience of trauma. All too often, women felt disconnected, helpless and isolated during birth.

So, what could’ve been done to prevent a traumatic birth experience?

The women in the study “believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.”

Some examples of actions mentioned in the free text fields were cesarean section, pain relief, vaginal examinations, and operative vaginal delivery.

“Be assertive”, “express myself”, “remain in charge” and “make different choices in caregiver” were added as well “be better prepared” and “make a birthplan”.

Summary of the studies

The two studies show us that “women attribute the cause of their traumatic birth experience primarily to lack and/or loss of control and issues of communication and practical/emotional support. They believe that in many cases their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for more or fewer interventions.” (NCBI)

So, what can we learn from that?

Preparation

You don’t have to let birth happen to you, you can be actively involved. The thing is that pregnancy and birth are unknown territories for most women. In order to be proactive, you need to know what your options and your preferences are. This is why preparation is so important.

Preparation for birth includes many aspects. One is birth education to understand how birth works and to know what to expect. Another one is creating a birth plan to identify your birth preferences, get to know your options and become educated around the different interventions. Only if you are informed, you are able to ask for or refuse certain actions during birth.

Plan your birth team and birthplace, have conversations with your care provider about your preferences and see if they support those or if you need to change care providers.

Support

Women need continuous emotional, physical and informational support from someone at all times (read more). Without proper care, women can feel alone and helpless. Choose a care provider who supports your birth preferences and a birth space where you feel safe. Create a birth team that will support you continuously and in all the ways you will need to feel heard, safe and cared for during birth.

Communication & Consent

Your birth must be centered around you. You are the most important person in the room and your voice should be heard. Be bold and ask questions if you are unsure about a certain action or process. You have the right to be involved in making decisions about actions in your pregnancy and birth and to informed consent and refusal, from induction, to cervical exams, to cesarean birth.

“Consent is an important legal and ethical principle in health care. For consent to be valid it must be voluntarily and freely given; the person consenting must not be under any undue influence or coercion; and there must be no misrepresentation as to the nature or necessity of the procedure.” (BMC)

You can read more about making informed decisions in this blog post.

Control

The main cause for women to experience their birth as traumatic was that they felt like they lost control. All of the points, from prenatal education to birth plans, continuous support, comfort measures to informed consent or refusal are going to help you feel in control even in circumstances that aren’t exactly controllable.

If you, or someone you know needs help:

PANDA National Helpline: 1300 726 306

Birthtrauma Association

Birthtrauma Consultancy

Sources:

BMC: Reed, R et al. “Women’s descriptions of childbirth trauma relating to care provider actions and interactions.” BMC Pregnancy and Childbirth (2017) 17:21

NCBI: Hollander, M H et al. “Preventing traumatic childbirth experiences: 2192 women's perceptions and views.” Archives of women's mental health vol. 20,4 (2017): 515-523. doi:10.1007/s00737-017-0729-6