We often hear birth talked about as the best day (or days) of our life. But what happens when it’s not? What happens when birth does not happen as we hoped?
Over the past two years there has been a remarkable increase in our understanding of birth trauma. But still, when we put those two words – ‘birth’ and ‘trauma’ – together, it can sit uncomfortably. Trauma is what happens to people who have come out of war zones, isn’t it? Yet 1 in 25 women develop PTSD around birth, and 1 in 3 feel that some aspect of their birth was traumatic.
If you’re reading this and you’re pregnant with your first child, this might be the point when you want to stop reading. But talking about what causes birth trauma can be helpful when you are planning a birth, in considering how to prevent it. And if you are reading this after having given birth and it resonates, then please know that there are many others who feel the same way, and that it is possible to recover from a difficult birth.
So what defines birth trauma? The most important thing to say is that it doesn’t matter what ‘type’ of birth you had – what matters is how you felt during that birth. You might have had a birth with unexpected or emergency intervention, or you might have had what looked like a straightforward delivery. Some people feel traumatised not by the birth experience itself but by experiences during pregnancy, their journey to getting pregnant, how they were treated postnatally, their experiences of feeding. What’s key is that, at some point, you felt that you were unsafe – that your life or the life of your baby or loved one was at risk. We can even become traumatised by fearing for someone else (so partners can suffer too, and often are given next to no support), by witnessing a traumatic birth (so healthcare professionals can also be affected) or even by hearing a traumatic story (so family members and friends can feel the impact too). In many ways, as a society we’re all a little traumatised about birth. The predominant story we hear is about how difficult birth is, with positive stories available but often derided as unachievable or unrealistic.
But maybe it’s time for a different story – one in which the mum (or birthing person), her partner, other family members who want to be involved, healthcare professionals and others work collaboratively to support a positive birth experience. A year ago, I co-founded Make Birth Better with my colleague Dr Rebecca Moore, dedicated to reducing the impact of birth trauma. What we found in talking to parents and professionals was that many people feel unsupported during their whole maternity journey. This is borne out by the research too – which suggests that interpersonal factors are one of the main reasons people are left with symptoms of trauma, and in particular that feeling abandoned is one of the most common factors.
What can we do with this information? During pregnancy, we can think about how to galvanise as much support as possible during our birth experience. Talking openly to your birth partner and your healthcare professionals about what you need from them to feel reassured can make sure they know exactly how to keep you feeling safe (we will have lots of resources for parents and professionals on the Make Birth Better website in the coming weeks to help you talk about what you might find helpful). After birth, if you are left feeling that your birth experience has stayed with you, hearing others’ stories can be so useful in ensuring you don’t feel alone – and identifying what you felt left you feeling unsafe during your birth experience can bring you a step closer to moving forward from it. This might be a process that you feel able to do alone, but many people find additional support from a midwife or psychological therapy service can be beneficial. In both circumstances, you will be encouraged to think through your birth experience and talk about why things happened the way they did. With psychological therapy, you will be supported to consider what has felt so traumatic about that experience for you, and reframe it in a way that helps it to feel less powerful. As a professional, understanding what makes birth traumatic for the people in your care, and how you can also be affected by birth, enables us to work together to make birth better.
Birth can be a positive experience, and it can be a challenging one – often both at the same time. No matter what happens, we know birth will always be life changing.
To learn more about trauma in birth, Emma’s new book ‘Why Birth Trauma Matters’ is published by Pinter & Martin on 11th July 2019.
If you have felt affected by this article, please take a look at the Make Birth Better website or visit the Birth Trauma Association where you can find access to support as well as information on making a complaint.