The trauma few mums talk about

Birth trauma affects one in three Aussie women and can have a lasting impact on their lives. In the second instalment of our two-part feature, the experts look at why so many mothers are left scarred from their birth — and the possible solutions.

“All that matters is a healthy baby.”

“You and baby are safe — why are you complaining?”

“If you insist on doing things that way, your baby will die.”

These are the types of comments women who have experienced birth-related trauma describe hearing from maternity staff.

Some claimed it pushed them towards drugs and interventions they did not want. Some reported that they were lied to in order to coerce them into agreeing to unnecessary interventions which left them feeling like their care providers prioritised their own agenda over their needs.

While it’s often openly talked about that physical injury can happen during childbirth, what’s now emerging are the ways in which women can be left feeling emotionally scarred from the process — effects that can be long lasting and damage a mother’s bond with her child.

And, given suicide is a leading cause of death for women in the first 12 months after birth, some experts are now speaking out to make sure everyone is aware that a traumatic birth can be a contributing factor and that more needs to be done to support women during one of the most vulnerable times in their lives.

One in three Aussie women experiences birth trauma

Research suggests one in three Australian women identifies their birth as traumatic, due to physical injury from the birth and/or the psychological effects from the process.

This can lead to serious mental health problems, including depression and anxiety and even family breakdowns.

In Australia, one in 10 women develops post-traumatic stress disorder (PTSD) from the experience.

Now a leading maternity lobby group is claiming Australia’s maternity services are at crisis point and is calling for them to be overhauled.

Alecia Staines, director of the Maternity Consumer Network (MCN), says too often health professionals make major decisions without proper consultation with the birthing mother, contributing to her trauma, and too many plead ignorance over complaints about inadequate care.

“There seems to be a long-held belief that the experience of birth isn’t important,” Ms Staines says.

“Women have long been told things like ‘As long as you and your baby arrive’, but being alive should be the very minimum a woman expects in her birth.

“We can have live women and babies and also treat them well ... but the evidence is quite clear about the extent of disrespectful and abusive care.”

She says the World Health Organisation (WHO) highlighted the extent of the issue when it found many women worldwide experience disrespectful, abusive or neglectful treatment within maternity services.

To reduce the incidence of birth-related trauma, the WHO recommended in 2018 that maternity services do more to make women feel safe, comfortable and positive about the experience.

Flashbacks, nightmares and crippling anxiety

In last Wednesday’s edition of Today Perth mother Marina Trinidad, 27, revealed she was diagnosed with PTSD after experiencing a traumatic delivery at a WA public hospital in 2019.

She described how staff changeovers meant she was cared for by a revolving door of strangers and how she was kept on her back, with her feet in stirrups, against her wishes.

She suffered months of flashbacks, nightmares, crippling anxiety and hypervigilance, though treatment from her GP and a psychologist is helping.

While the factors contributing to psychological birth-related trauma are varied and complex, researchers who interviewed new mothers with it found almost two thirds blamed it on uncaring and dismissive attitudes from their care providers.

Even women with medically normal births wound up traumatised when they felt like their midwife, nurse or doctor did not care about them, according to the BMC Pregnancy and Childbirth study published in 2017.

The study’s authors concluded the relationship between the care provider and the woman is critical to the birth experience.

And, even if care providers consider their actions and interactions to be routine, the authors noted some women still experienced them as traumatic.

Dr Liza Fowler, an obstetrician at the Wellbeing of Women Centre in Murdoch, says what is traumatising can mean different things to different people.

Patient care might be improved, she adds, if nursing, midwifery and medical students were regularly given opportunities from early on in their studies to listen to real women talk about their experience with caregivers during their births.

“People used to just accept what the doctor said and it didn’t matter how we said it to you — you just listened to them,” Dr Fowler says.

“Now we have managed to get the physical danger aspects of childbirth down and ... we are seeing the psychological effects becoming more important.”

It is her belief that caregivers need to pay closer attention to the emotional experience of birth, in addition to the physical outcomes.

She says research showed women were more prone to feeling ignored, humiliated, disrespected and even violated when there was no opportunity to develop a relationship with a care provider.

By contrast, women who feel supported and included by their caregiver often report a satisfactory birth experience even after a physically difficult delivery.

Since being cared for by different people can lead to breakdowns in communication on both sides, and women feeling powerless, Dr Fowler would like to see extra investment made so that all women have access to a midwifery group practice, which are not presently offered at every public hospital in WA.

“If you can develop a relationship with someone, you accept things easier because you trust them,” she explains.

“A study I looked at took all the women with trauma and only one third were women who felt they had unnecessary interventions or had physical trauma.

“Sixty per cent of them were people who were traumatised by the way they were spoken to and handled by the professional, so it wasn’t even around having unnecessary intervention, it was just that things were never explained

and they felt like they never had a choice in anything and that they were ignored. That actually causes the trauma and this is the next field where we can really improve maternity care.”

Unrealistic expectations can lead to trauma

Consultant obstetrician and gynaecologist Dr Michael Gannon, who is also a spokesperson for the Australian Medical Association WA, agrees there is room for improvement in WA’s maternity sector but says the continuity of care model, though highly desirable, is too expensive and inefficient to replicate in every public hospital.

“We all know continuity of care is extremely popular but the reality is that the (personalised care) private hospital model demands gold-level private health insurance and out-of-pocket expenses ... so it is absolutely routine for the vast majority of women who deliver in the public system to see a whole variety of different people antenatally and a whole variety of people in labour,” he says.

“You don’t have that same ability to build trust and to understand what is happening to you and when it goes wrong, that is trauma — and to call it trauma is no exaggeration.

“Some women are lucky enough to get into the system where this is offered (for example, through King Edward Memorial Hospital) but the reality is the private system does deliver that continuity of care and efforts to replicate that in the public system are even more expensive and actually very inefficient.”

He says what the sector needs to do is provide better antenatal care because one of the main contributing factors to trauma is when expectations of birth do not line up with reality.

It would include making sure important antenatal information is not glossed over or excluded.

“One of the problems we have got is the disconnect between the information women get in the antenatal period from professionals and their peers and then the reality of what their births look like,” Dr Gannon says.

“Part of the trauma is they are inadequately prepared for the difficulties of labour and delivery ... bearing in mind that sometimes in the setting of a labour ward there is less time to fully explain things because sometimes there is urgency in introducing treatments, etc.

“If the baby’s heart rate is sitting on 80 beats per minute then that is not the time to have a detailed conversation about the pros and cons of putting a set of forceps on or waiting to see what happens next.

“But I think for too many women their first exposure to concepts of assisted delivery or emergency caesarean sections or blood transfusions or antibiotics or their baby being admitted to the nursery, is when it is happening to them.

“And yet they are just realities of how women and their babies get looked after. These things are not done lazily - they are done when there is a problem.”