How you can help women avoid birth trauma and PTSD

Posted by: on Jul 1, 2018 | No Comments

What causes birth trauma?

According to the Birth Trauma Association, it’s caused by a number of things:

  • Lengthy labour or short and very painful labour
  • Induction
  • Poor pain relief
  • Feelings of loss of control
  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section
  • Impersonal treatment or problems with the staff attitudes
  • Not being listened to
  • Lack of information or explanation
  • Lack of privacy and dignity
  • Fear for baby’s safety
  • Stillbirth
  • Birth of a damaged baby (a disability resulting from birth trauma)
  • Baby’s stay in SCBU/NICU
  • Poor postnatal care
  • Previous trauma (for example, in childhood, with a previous birth or domestic violence)

There are some things we really can’t do much about, that as we say, are in the lap of the gods.

But whenever and wherever we can make things even a little nicer, easier, and less traumatic we really should be collectively striving for that. No matter how tired, exhausted, overworked a health professional might be, some things should be a reflex, inbuilt into our behaviour. No-one’s perfect, and we can learn from mistakes – it’s never too late to do better for our next client or service user!

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10 ways to help avoid / minimise birth trauma

1)  Point out what the protocols of your hospital are, but do not use coercive or bullying language EVER.

Make it clear what they are but always make sure women are aware that

- mothers-to-be are not legally bound to follow protocols

- there are sometimes several schools of thought around an area and that it would be wise for them to do their own research beyond the NHS leaflets to make an informed decision

- that protocols are designed for the general public, not each woman specifically or idiosyncratically

- she will often have several pathways available, some of which are not recommended but she is free to choose if she wishes, presented without emotion or persuasion – not just one you want to push on her because of your own preference.

2)  Acknowledge when you don’t know enough about a subject rather than pretending you do.

Signpost to robust, evidence-based sources and up-to-date information. Ask the mother how she is feeling and what her intuition is telling her to explore and research more closely. Instead of trying to look infallible, just admit ‘ this is outside of my knowledge’ and then point them towards someone more expert than you. Make a point of being open to learning things that are new and out of your current knowledge, so you can give women only what you know to be truly accurate information.

3)  Never dismiss a mother’s intuition.

If a woman has a strong feeling about something – trust her. While collecting birth stories for Birthplace Matters, I heard from so many women who had very accurate knowledge or intuition about how their baby was doing, either that everything was fine or that something was wrong, or how close they were to pushing their babies out, which was ignored. One example I hear a lot are stories from women in relation to dilation and pushing. I recently talked with a doula friend who had supported a woman who went from 6cm to having a baby in her arms in just 15 minutes. It can honestly happen.  So don’t shout at a woman not to push because she isn’t dilating according to the Friedman curve.

4)  Support women’s informed decisions

If she chooses a pathway that is outside of guidelines, try and find it in your heart to support it, without badgering her and bullying her over and over to get her to co-operate in an ‘our way or the highway’ campaign. Acknowledge she is going outside of recommendations and give her your care and loving support anyway. She is a fully grown adult not a silly child – don’t treat her like one. Her parenting right to make decisions for her baby doesn’t begin once she leaves the hospital and sets foot across the threshold of her own front door – that responsibility is hers NOW already. Make it clear to her that you understand that, without tutting, frowning, and making snide remarks please.

5)  Give statistics responsibly and talk about benefits as well as risks

Simply saying, for example that your baby’s risk of abc doubles if xyz happens is a terrifying prospect to any mother. However, if you tell her her babies risk of something doubles from 0.05 percent to 0.1 it gives woman a more realistic sense and is more helpful in making them make truly aware so they can arrive at their own carefully weighed up decisions – if there are risks to something, women need to know using maths not misleading language designed to scare them. Let them weigh up the benefits and risks of a particular pathway – NEVER make decisions for them by omission – if you are only presenting them with one option when you know damn well there might be 2, 3 or 4 options then you are forcing a pathway that isn’t chosen freely.

6)  Advocate for them even if you don’t agree with their choices and defend their human and maternal rights regardless.

Refer women to others with specialisations in supporting whatever the woman herself wants to choose, and don’t take her non-compliance as a reason to take it personally or be nasty. It’s not about you.

7)  CONSENT!

You should not be doing anything to a woman without her consent, and in order to make sure you have gained her consent, you must explain fully what you are doing or what a recommendation is. And remember it is just that – a recommendation, or suggestion.  You can’t put your gloved hand inside a woman and get consent as it is going in. You cannot break her waters without her consent. You cannot do anything at all to her or her baby, unless she gives her consent. Even if you think it’s in the best interests of the mother and/or baby. This is not your baby, your birth, or your body. She will live with the consequences of your actions so make sure she said yes and understood first!

8)  Read the birthplan

It’s completely reasonable for women to express their wishes and when something is written in black and white it should be read by staff. You are public servants to her, not vice versa. She is not there to grease the wheels and make your shift easier. Her taxes pay for you to be there assisting her and she may only give birth once or twice in her lifetime. This may be everyday work for you, but for her, this is one of the most important days of her life

9)  Gentleness costs nothing

No matter how many times you’ve stitched a vulva today, or put in an IV drip or cannula, or catheter, no matter how busy, rushed or tired you are – please remind yourself of the human in front of you who may walk away with PTSD because of your actions – this woman is not a piece of meat but a living, breathing, feeling, person with dreams, future memories, and rights.

gentleness

10)  Remember why you joined this profession

If you think you can’t offer gentle care anymore, consider moving on to another career path. It doesn’t make you a bad person to admit that. It makes you a caring one who won’t let women suffer because of traumatic practices which are ingrained into the people working around you which have become so normalised they’re not even seen clearly for what they are any more..

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The links below are from the Birth Trauma Association website:   http://www.birthtraumaassociation.org.uk/about-the-bta/research

Allen, S (1998). A Qualitative Analysis of the Process, Mediating Variables and Impact of Traumatic ChildbirthJournal of Reproductive and Infact Psychology, 16: 107 – 131.

Allen S North N and Elliott P (2005) An investigation of the relationship between PTSD and PND symptoms and factors mediating the development of PTSD following traumatic labour experiences ( Paper available from Sarah Sllen Department of Psychology Southampton University SP17 1 BJ)

Andreucci CB1,2, Bussadori JC3, Pacagnella RC4, Chou D5, Filippi V6, Say L7, Cecatti JG8;Sexual life and dysfunction after maternal morbidity: a systematic review. Brazilian COMMAG Study Group; WHO Maternal Morbidity Working Group.

Ayers S Eagle A Waring H (2006) The effects of childbirth related PTSD on women and their relationship : a qualitative study. Psychol Health Med 2006 Nov 11 (4) 389-98

Ayers, S, Bond, R, Bertullies, S and Wijma, K (2016) The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46 (6). pp. 1121-34. ISSN 1469-8978

Ayers, S. & Ford, E. (2012). PTSD following childbirth. In: C. R. Martin (Ed.), Perinatal mental health: a clinical guide. (pp. 155-164). M&k Update. ISBN 1905539495

Alvarado R Perucca E Rojas M Monades J Olea E Neves E Vera A (1993) Gyneco obstetric aspects in women developing postpartum depression. Obstet Ginecol 1993;58 (3) 239-4

Ayers, S and Pickering A.D. (2001) Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence. Birth. 28 (2): 111 – 118

Ayers S Thoughts and emotions during childbirth: a qualitative study. Birth 2007 Sep 34 (3) 253-63

Ballard, C. G. et al (1995) Post-Traumatic Stress Disorder (PTSD) after Childbirth. British Journal of Psychiatry. 166: 525 – 528

Beck, C. T. (2004) Birth Trauma – In the Eye of The Beholder. Nursing Research. 53(1): 28 – 35

Beck, C.T. (2004) Post-Traumatic Stress Disorder Due To Childbirth – The Aftermath. Nursing Research. 53 (4): 216 – 224

Beck CT (2006) The anniversary of birth trauma; failure to rescue Nurs Res 2006 Nov-Dec 55(6) 381-90

Born L , Soares (2006) CN, Phillips SD, Jung M, Steiner M Women and reproductive related trauma Annexe NY Acad Sci 2006 Jul 1071:491-4

Boudou M Sejourne N Chabrol H Childbirth pain, perinatal dissociation and perinatal distress as predictors of PTS symptoms Gynec Obstet Fertili 2007 Nov 7

Callahan JL, Hynan MT Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the perinatal post traumatic stress disorder questionnaire J Pernatol 2002 Sept 22 (6) 448-54

Church, S and Scanlan, M (2002) Post-traumatic Stress Disorder After Childbirth. The Practising Midwife. 5 (6): 10 -13

Cohen et al (2004) Posttraumatic Stress Disorder after Pregnancy, Labor and Delivery, Journal of Women’s Health, 13(3): 315 – 324

Creedy, D. K (2000) Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors. Birth. 27(2): 104 – 111

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth. British Journal of Midwifery. 4 (6): 290 – 294

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth: 2, British Journal of Midwifery, 4 (7): 354 – 373

Czarnocka, J and Slade, P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 39: 35-51.

DeMier R.L. (1996) Perinatal Stressors as Predictors of Symptoms of Posttraumatic Stress in Mothers of Infants at High Risk Journal of Perinatology. 16 (4): 276 – 280

Emerson, W. R. (1998) Birth Trauma: The Psychological Effects of Obstetrical Interventions, Journal of Prenatal and Perinatal Psychology & Health”, 13 (1): 11 – 44

N. Goutaudier , N. Séjourné , C. Rousset , C. Lami  & H. Chabrol Octogone Negative emotions, childbirth pain, perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Gamble, J.A. et al (2002) A Review of the Literature on Debriefing or Non-Directive Counselling to Prevent Postpartum Emotional Distress. Midwifery. 18: 72-79

Holditch-Davis, D et al (2003) Posttraumatic Stress Symptoms in Mothers of Premature Infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), 32 (2): 161 – 171

Hynan, M. T. (1998). The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ). In R. W. Wood and C. P. Zalaquette (eds.) Evaluating stress: A handbook of resources, 2: 193-199. Lanham, MD: Scarecrow Press.

Joseph S Bailham D (2006) Traumatic childbirth: what we know and what we can do. RCM Midwives 2004 Jun 7 (6) 258-61

Kennedy, H.P. (2002) Altered Consciousness During Childbirth: Potential Clues to Post Traumatic Stress Disorder? Journal of Midwifery & Women’s Health. 47 (5): 380 – 382.

Menage, J. (1993) Post-Traumatic Stress Disorder in Women Who Have Undergone Obstetric and/or Gynaecological Procedures. Journal of Reproductive and Infant Psychology. 11: 221-228

Nicholls K Ayers S (2007) Chilbirth related post traumatic stress disorder in couples; a qualitative study. Br J Health Psychology Nov 2007 12 Pt 4 491-509

Parfitt, Y. & Ayers, S. (2009). The effect of postnatal symptoms of post-traumatic stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology,stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology, 27(2), pp. 127-142. doi: 10.1080/02646830802350831

Priest SR Henderson J Evans SF Hagan R (2003) Stress debriefing after childbirth: a randomised controlled trial. Med J Aust 2003 Jun 2 178(11) 542-5

Reynolds, J.L. (1997) Post-Traumatic Stress Disorder After Childbirth: the Phenomenon of Traumatic Birth. Canadian Medical Association Journal. 156 (6): 831 – 834

Rowan, C. Bick, D. Basots, M.H. Postnatal debriefing interventions to prevent maternal mental health problems after birth; exploring the gap between the evidence and UK policy and practice. World views Evid Based Nurs 2007 3 (2) 97-195

Sandstrom M, Wiberg B, Wikman M, Willman AK, Hogbierg U. A pilot study of EMDR for PTSD after childbirth Midwifery 2007 Jan 12 th

Soderquist J Wijma K Wijma B Traumatic stress in late pregnancy J Anxiety Disorders 2004 18(2) 127-42

Soderquist J Wijma K Wijma B Traumatic stress after childbirth; the role of obstetric variables. J Psychom Obstet Gynaecol 2002 Mar:23 (1) 31-9

Soet, J. E et al (2003) Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth. Birth.30 (1) 36 -46

Turton, P. et al (2001) Incidence, Correlates and Predictors of Post-Traumatic Stress Disorder in the Pregnancy After StillbirthThe British Journal of Psychiatry. 178: 556-560

Vaiva et al (2003) Immediate Treatment with Propranolol Decreases Posttraumatic Stress Disorder Two Months after Trauma, Biological Psychiatry, 54: 947 – 949

Van Pampas MG, Wolf H, Weijmar Schultz WC, Neeleman J, Aarnoudse JG

Post traumatic stress disorder following pre eclampsia and HELLP syndrome J Psychosom Obstet Gynaecol 2004 Sept – Dec 25 (3-4) 183-7

Wijma, K. et al (1997) Posttraumatic Stress Disorder After Childbirth: A Cross Sectional Study. Journal of Anxiety Disorders. 11 (6): 587 – 597