having to bear it: when childbirth is traumatic

by Jo Carlowe

when childbirth is traumatic | help and info

Sara desperately wants another child but she is still traumatised by the birth of her last one. "When I think about my son's birth I recoil in horror. He was wrenched out of me – there was so much pain and so many stitches. I don't ever remember being consulted about my needs."

© Getty

Sara also suffers flashbacks – a classic symptom of Post Traumatic Stress Disorder (PTSD), a condition more commonly associated with war veterans. PTSD is the term for a set of normal reactions to a traumatic experience, particularly one that involved the threat of death or serious injury and caused fear, helplessness or horror. Unfortunately this is exactly how childbirth can be experienced if it is handled badly.

According to The Birth Trauma Association, of the 700,000 UK births that occur each year, 10,000 women will develop PTSD. In a recent magazine survey eight out of ten women said they were frightened during labour, 75 per cent found it more painful than expected and over half felt they got poor care.

Birth expert and campaigner, Sheila Kitzinger believes as many as half of all women who give birth in the UK suffer some degree of trauma. At its most extreme this can lead to panic attacks, an inability to go past the hospital where the birth took place and even avoidance of pregnant women. Worryingly, half the women who die after childbirth do so because they commit suicide.

Women at greatest risk are those with a previous psychiatric history, those who had a poorly handled assisted delivery and those who felt unsupported during labour. Other factors include bad post-natal care and a fear for the safety of the new baby.

The condition is common but awareness among health professionals remains low and many women are wrongly diagnosed with post-natal depression.

coping after a traumatic birth

Often women who have suffered a traumatic birth complain that other people are dismissive. Yet being believed is an important part of recovery. Kate McMaugh, a voluntary counsellor with the Birth Trauma Association, advises traumatised women to contact a support organisation (see help and info) to find an 'empathetic voice'.

Counselling via a voluntary service, your GP or private practitioner can help, especially if the anxiety continues beyond six months. Ms McMaugh says that with counselling, the symptoms associated with PTSD 'can be dealt with and can fade'.

Many women also find it helpful to share their concerns with the health professionals associated with the trauma. This can include writing a letter to the hospital concerned. You can also request more information (including your hospital records) about why certain procedures were carried out, to help piece together what happened to make events so terrible.

Ms McMaugh also recommends exercise, relaxation, a nutritious diet and time away from the baby. "It's important to nurture yourself as well as the baby."

improving your birth experience

Expectant mums are advised to think through their needs prior to the birth by seeking information about local services, reading about childbirth and attending antenatal classes.

"When you understand what is happening in labour, the intense and unusual sensations are not so frightening," states the National Childbirth Trust.

Basic techniques for coping during labour include:

• Staying upright where possible to let gravity play its part.
• Taking a bath or shower as water reduces pain.
• Being massaged to help with lower back pain.
• Using breathing techniques (which will be taught in antenatal classes) to stay relaxed.

birth choices

Traumatic births tend to be associated with high levels of intervention and impersonal care. A home birth or one at a 'birth centre' (which attempts to provide a 'home-from-home') may reduce these risks.

Women who choose these approaches report feeling more in control. The procedures are less intrusive (you won't be strapped to machinery) and you can move freely. Birth centres allow partners good access and most provide water pools, birthing stalls, beanbags and birth balls. Pain relief usually includes gas and air and pethidine (or equivalent). However, these options are only appropriate for low-risk pregnancies; they are not available for epidurals or caesareans and you'll need to transfer if complications arise.

Women who opt for a home birth can hire birth pools and most birth centres (and many hospitals) also offer this. The water supports the woman's body making it easier for her to change position and helps to reduce pain. Provided the labour progresses normally and the midwife is adequately trained, the baby can be delivered in water although some women prefer to labour in the pool but deliver on 'dry land'.

Natural birth is just one alternative and most women give birth in hospital where care is shared between midwives and obstetricians. The atmosphere is more clinical and intervention more likely but you'll have access to the full range of pain relief including an epidural, and an obstetrician is on-site to deal with complications.

Another option is an elective caesarean although an Audit Commission study suggests that only one percent of elective c-sections are performed because of maternal request. Where women do choose a caesarean, 'fear of labour' and 'previous bad experience' are often cited. With an elective caesarean you can plan in advance and will not endure the pain of labour. If there is not a medical reason for the caesarean there is no guarantee that you will be offered this on the NHS. You'll need to speak to the obstetrics team at your local hospital.

Caesareans are usually carried out with a spinal block so you remain awake throughout. However, it is major abdominal surgery with associated risks including the possibility of infection. Maternal mortality is extremely low but an elective caesarean carries a three-fold greater risk of death than a vaginal birth, and an emergency caesarean a nine-fold greater risk.

other options?

Traumatic birth is often linked to poor continuity of care and the inability to access the type of service you want. The government recently published its 'National Service Framework' on maternity services stating:

"NHS maternity care providers and primary care trusts [must] ensure that: The range of antenatal birth and post-birth care services available locally constitutes real choice for women (including home births)."

But often choice is scant and less than three percent of women have a home birth.

According to Mary Newburn of the NCT, women cannot be forced into hospital and most units will be able to provide 'midwife-led care and access to a birth pool – one way or another'. Nonetheless she acknowledges that services will vary and that women may need to be 'fairly assertive' to get their needs met.

An alternative is to book an independent midwife who will support you throughout the labour (average cost £2,500) or to employ a 'doula', a professional birth-partner who can advise on breathing, relaxation and positioning during labour (costing around £300-£600) – see help and info for details.

But if it's an NHS service you want, then now might be the time to start lobbying: your local MP, the chief executive of the maternity units in your area, and your local trust's maternity liaison committee are good places to start.

(January 2005)

Read on for details of relevant organisations, websites and reading.