Birth trauma: action

[Verso]

To give some context: in April 2005 I had a very traumatic delivery which is still very fresh in my mind despite postnatal counselling and debriefing sessions. Over time, I have also read about or heard many stories of traumatic births and poor postnatal care which have angered and upset me. I really think things have to change.

I have been in contact with the Birth Trauma Association and they are soon going to the Health Select Committee at the House of Commons on this issue (I don't yet have a date but will post it when I do). They have suggested we contact our MPs on the subject of birth trauma and also lobby the media (exact details of what this entails will also follow).

I am not usually an 'activist' type of person, but I feel so very strongly about this - and even five minutes of reading on some of the birth trauma threads on here can make almost anyone want to do something to prevent the appalling treatment some women have experienced being repeated.

If anyone is interested in joining in please post here and I will co-ordinate a response.

just wanted to say sorry you had such a dreadful time that is clearly still fresh in your mind. i think it's frankly dreadful that women have to endure ANYTHING other than a great experience when having a baby! for me, i was lucky and had a fantastic birth in the RAH Paisley despite emc, but i am well aware that many women (including a friend in London) have a terrrible time.
good luck with your post, hope you get good response.

definately am interest....my 3rd childs birth had a positive outcome, as in lifebirth and heathy....but I was most definitely still traumatised....

I'm really sorry to hear that, FreakyLady. I am hoping that if a few of us make a co-ordinated response to raise awareness of the issue, perhaps things could change and at least some cases could be prevented.

Lib76 thanks for your message and sympathy. I didn't mean this thread to be about me - just wanted to say right away that I have a vested interest in the issue - but thanks anyway - and I'm glad you had a good experience.

yep, i volunteer for the BTA and suffered birth trauma myself. I did an article on it recently for teh local NCT newsletter... have you been in touch with AIMS too?

No I haven't - that's a great suggestion and I'll follow it up this week. Would you be ok to send me the article, lulumama? I'd really like to read it. Are you on CAT? I'll send you my email address if so.

yes, am on CAT , i would be happy to send it to you..

Hi - I would be interested too.

Thanks to all of you for your replies. I've received an email this morning from the BTA with more details in it of their plans:

"...We are going to the Select Committee on November 24th but we have got a meeting with one of the opposition parties on 5th November (what a night to be in the House of Commons!). We also being invited to the Safer Births Initiative on the 26th of this month ? also in the House of Commons.

Regarding lobbying the media, I mean just writing to journalists both local and national. We discovered journalists just love little pieces that are ready written for them ? if you can include a quote from somebody and think of a nice punchy headline, that is usually very effective. Local newspapers can also be very good."

What qualifies as a birth trauma - I had a very difficult labour as it was extremely painful, I was on my back with wires and monitors all over me and was not given pain relief when I begged for it despite being on syntocin. I had nightmares about it for months afterwards (and felt I had to work through what had happened over and over in my head (including alot of crying) before I finally made peace with the situation). What I never really figured out was whether the interventions that I had - including syntocin despite going into labour naturally - were actually necessary. I am pg again and must admit that I am very nervous about labour in a way that I was not for my first (which imo would normally be the most nervous you can get because it is an unknown).

Sorry, that was a question. "What qualifies as a birth trauma?"

a birth that gives you nightmares, flashbacks, leaves you feeling frightened/ violated/ out of control.. anything that leaves you traumatised basically..feelings of having to talk about and relive the birth over and over,feeling weepy and tearful talking about it etc..

verso - good for you for trying to improve things. However, as a midwife, I firmly believe that there are many reasons for birth trauma, most of which will not be resolved by any government inquiry or false promises.

And Lib76 - 'i think it's frankly dreadful that women have to endure ANYTHING other than a great experience when having a baby!'

• sorry but you are either naive or deluded if you believe this as childbirth is as unpredictable as it is beautiful!

With the best care in the world, it is possible for women to be traumatised by birth for many reasons. I list a few below

• labour not going according to plan
• unrealistic expectations due to unrealistic antenatal classes
• unexpected emergencies
• induction
• pain
• fetal distress / flat baby
• poor communication with medical / m/w staff
• horrible midwife
• understaffed or very busy ward
• other emergencies meaning the anaesthetist is not available for instant epidural
• birth centre full / pool busy - leading to t/f to labour ward and medicalisation of the process
• poor practice / incompetence by staff
• poor recall of events by patients and staff

....the list really is endless.

Some of these can be remedied, unfortunately most really cant. Some are unavoidable, some are down to staff or patient expectations, and others are just bad luck.

I recently asked a group of labour ward midwives, young and old, 'do you love delivering babies?' and I was shocked to hear about a third of them say 'no, not really' or 'its my job'
How can you deal with that kind of attitude? These midwives would never understand about birth trauma, let alone change their attitude due to the government saying that they should.

Likewise, I had a woman transfered recently from the birth centre to labour ward as she was stuck in labour and needed syntocinon to speed things up, and she was really upset and when I asked her why, she replied that in the NCT class, transfer to labour ward was known as 'taking the lift of shame', and she had failed! FFS - theres a birth trauma waiting to happen!

The other thing I want to say is that while I cringe and am mortified by some of the birth trauma stories on here, and the way some of you have been treated, in a lot of the clinical type stories, there are always 2 sides to the story, and we are only ever hearing one side. It would be interesting to get a reply from some of the clinicians involved, as in some of my previous management jobs investigating patient complaints, I have learned that things are seldom as they seem at first sight!

Anyway I could ramble on about this all day, but I wont. Sorry if I have offended anyone
and my rant is now officially over!

All the best Verso and Lulumama, please let us know how things go.

fwiw, i have a foot in both camps. have experienced birth trauma (at the RAH Paisley lol, completely the opposite to Lib76's experinece at the same hospital )
this does tend to lend credence to mintpurple's suggestion that there is very little that can alter many of the situations. although we are currently investigating our situation legally, one of the most difficult decisions was whether to put the midwife/ team involved through an investigation when it is perfectly possible that their actions were either in accordance with guidelines or unavoidable given the situation.

mint, thank you so much for posting.. in my view one woman/one midwife would be a huge step in reducing the risk of birth trauma, in as much as the woman and her midwife would have a good relationship and the one to one/continuity of care is a really positive thing and i think it is something we need to continue lobbying the government about

i am sorry that some of your colleagues see it as 'just a job', but am so delighted that there are wonderful, empathetic midwives like you who keep the faith, as it were !

am also really , really disappointed and sorry to hear that the NCT contributed in some way to a negative experience.. anything that makes women feel like they have failed is just not acceptable.

and gives the NCT a bad name., again.

agree that we only ever hear one side here, and i am always encouraging women who have been traumatised to take things back to the hospital they delivered in, to get closure and to get to the bottom of things.. as sometimes as you say, it is not as it seems.

i think though as wards are stretched further and furtehr and midwives are spread thinner and thinner, these sad stories will keep coming up again and again

thanks for giving your thoughts , it is good to hear it from the coal face!

Thanks, lulumama and mint. I was not so much upset that things had not gone according to plan, it was just that a lot of things were done with what I consider an inadequate explanation during the labour. For instance, I was told, "we think that the baby may be in some distress, we need to give you syntocin to speed things up",

I asked what that would mean and the midwife said that it was a intravenous drip to help my contractions. At no point did she mention that this did not just "speed things up" it made your contractions way more intense and therefore way more painful. If she had stated that, I think I would have stated that I wanted an epidural then and there (something my gp agreed with, when I went over the birth with him later). So I endured 5 hours of excruciating contractions, I was literally begging for an epi 2 hours before ds was born which I did not get. It was the unbearable level of pain that I think traumatised me. It gave me nightmares, I would wake up in tears in the night thinking about it, and I was fearful of another pregnancy for a long time and I actually generally have a high pain threshold. I remember thinking at one point during my labour, in all seriousness, death would be a relief from this pain (and I am usually neither dramatic nor suicidal in any way)

I agree with you lulumama regarding the one midwife thing. I had 4 different midwifes looking after me during my labour and I had never met any of them during my association with the hospital during my pregnancy - in other words none of them were not the same people that I had dealt with through my pregnancy. I also think that it can only impact on the consistency of the labour experience because inevitable each different midwife will have a slightly different approach, manner and personality. As a patient, it is hard to adapt during labour and gives the whole experience a confused, disjointed feeling. None of my midwives were "bad" (well except for one who came in and informed me that the baby was back to back and the labour was going to be really painful - I was a bit shocked as it was the first that I had heard of it and then it transpired that she was LOOKING AT SOMEONE ELSES CHARTS!!!!) for the most they were professional and practical. Still it depersonalised and medicalised the experience - I am having my first baby, the most life-changing event of my life - and they are going on and off shifts like it is going out of fashion.

Radio 4 now ladies.

mintpurple - as a doctor I salute you! you sound like the type of midwife I used to love working with

I do feel that unrealistic expectations of pregnancy, birth, breastfeeding and parenting is a huge problem as our society changes away from supportive family networks. That doesn't take anything away from the experiences people have had (my own antenatal and labour care was awful).

Ummadam, I agree that often people have unrealistic expectations, but I also think that that problems is aggravated by an underfunded NHS.

A (slightly cynical) part of me wonders if we are all directed towards "natural" birth right from the start (ie everyone discusses the "dangers of intervention, but I never had anyone discuss the "dangers" of non-intervention and why it is right and good to be open to the possibility of interventions and that often pain relief is the better option when intervention is necessary - fortunately my mother was a pediatric nurse for over 30 years so I think I had a more realistic idea of what could go wrong than many people) because a managed birth is frankly more expensive.

I live on the continent now and I am pregnant with my second child. I have my own ob-gyn (of my choosing)as well as midwives helping me through my pregnancy. My ob-gyn is supportive of a natural birth, but we have discussed what happens if there is a need for medical intervention and I feel that, whilst I am under no illusions that it is all under my control, he is treating me as an individual DESPITE the fact that in his line of work childbirth is obviously an every day occurence. He intends to be at the birth for every mother on his books, even if he is just there at the end (if all goes ok with the midwives and I am able to progress with a natural labour). I already feel that this pregnancy is being better managed because of the consistency of care that I am receiving from one person and his team. I also know that I will be in a room with no more than one other person and may even have a private room. The food is reputed to be very good and the hospital has a policy of keeping new mothers in for 5-7 days to help with all aspects of post-natal care, from breastfeeding to monitoring the mother's condition, giving her a chance to rest (which they can because they are not on a ward with 6 other mothers and their screaming newborns).

Btw, the post-natal care that I received by the midwives and then my health visitor in the UK was wonderful! Consistent and helpful with breastfeeding. Personally cannot find any fault with that in my area.

I agree completely Bluebutterfly and I'm glad to hear you are having a good experience this time around. With the knowledge I have I went into my pregnancy with the attitude that anything where my child and I were alive at the end was fine but not guaranteed and anything else was a bonus. I had midwife led antenatal care and didn't see a doctor until my friends came to visit after the birth. Ok the midwives nearly killed my son and didn't believe I was in labour until 30min before he was born and I will be asking to be under medical care instead next time but I was intervention free or , still not entirely sure 9 months down the line.

Out of interest (and you do not have to answer obviously) how is your current antenatal care and subsequent care in labour being funded?

The NHS in general is woefully underfunded but a lot of the problem is the DOH and trust level attitude that throwing a few more managers at the problem to beat us into shape will solve the problem. Many more doctors, nurses, midwives, cleaners, porters, radiographers, cooks etc are needed instead and most of us can't work faster or harder than we do no matter how many managers stand behind us tutting and writing on their clipboards.

Rant over

I live in Luxembourg and the Caisse de Maladie system is fairly complicated. It is a national health system with a minimum standard of care available to everyone. I think that this site sums up the system better than I can:

here

Yup, I agree with you there too ummadam - my mother retired from the nhs 4 years ago so I certainly heard about many of the serious problems that were not being solved (and were in fact being aggravated) by investment in "management" rather than in the people who have traditionally managed health care.

Mint thank you for posting from your perspective. I agree that it would be woefully unrealistic to expect to change everything - and that was never the intention. But I don't think we should automatically assume as a result that we can't change anything.

From your list, and your experience (and that of the other medically-trained people on this thread), which key things do you think could be usefully challenged and/or improved?

• labour not going according to plan
• unrealistic expectations due to unrealistic antenatal classes
• unexpected emergencies
• induction
• pain
• fetal distress / flat baby
• poor communication with medical / m/w staff
• horrible midwife
• understaffed or very busy ward
• other emergencies meaning the anaesthetist is not available for instant epidural
• birth centre full / pool busy - leading to t/f to labour ward and medicalisation of the process
• poor practice / incompetence by staff
• poor recall of events by patients and staff

II'm sure my friend won't mind me posting this, but she had a horrific experience.

Booked into midwife led stand alone birthing centre, first child, no complications.
She got a taxi there at 2am and they were full, so they told her to go home as it was very early stages.
At this point she called her mum, (her birth partner) and told her to come over.
Her contactions suddenly increased, she called the birth centre and they arranged and ambulance. The ambulance technician!? decided as she was asking for pain relief she had to go into hospital.
She was alone and terrified in A&E in a hospital she'd never visited whilst they put her details through the computer, then taken to the labour ward and frequently left alone again for over half an hour at one point. She was strapped to monitors and still wearing a big jumper but could barely move to take it off.

In the meantime her mum had gone to her house, found her not there, gone to the birth centre who told her they'd seen her earlier but she hadn't returned, (or had the hospital let them know she was there) creating panic all round.

She says she was so scared and upset she couldn't focus on labouring and after 2 hours of pushing had an episiotomy , all the while doctors talking about a 'crash caesarian'. right in front of her.

She has since had to have reconstructive surgery and the mental trauma is something she may never fully deal with.

One of the things I would very much like to see changed is the attitude towards inductions and the 'procedures' around birth.

DS was induced at 15 days over and we were very much coerced into having the induction. Once we were on the induction conveyor belt there was no deviating from it no matter what we said or wanted.

For example, my labour started with the pessaries but did not get going fully, so I was told they would need to break the waters. I was resistant, my doula was against the idea, but we were bullied into it with no good reasons given for why it was necessary. The only reason the doctor could give us was 'it's how induction works and you signed up for induction so you have to' and 'you're not in established labour yet so it's the only option'. No medical reasons, no evidence, I was treated like the dimmest child rather than an intelligent woman. I was even threatened with being sent back up to the main ward in disgrace if I wouldn't 'co-operate'.

They took advantage of my doula being elsewhere to convince me, they broke the waters, and surprise surprise given my emotional state, labour ceased completely.

Yes, there may be a recommended process to induction, but how on earth is coercing a woman in this way going to produce a positive and productive labour?

I'm still about it 2.5 years later.

I think that there are certain things that could be changed that would make the whole experiance a lot better.
When I had ds I was only 19. I was frightened and very unsure what labour would entail. All I knew was that it was going to be painful lol. The NHS anti-natal classes were the biggest waste of time in the world and when labour began I felt totally un-prepared.
To cut a long story short when I was giving birth the midwife told me that they needed to do an episiotomy (sp?) at that point i couldnt have cared less if they had wanted to chop my legs off, I just wanted the baby out. Ds was delivered and I was overjoyed with my beautiful baby boy. Midwife then breaks the news that I had a third degree tear. I didnt have a clue what this was I think someone gave me a brief description but I was told that it would need to be repaired in theater. What I didnt realise was that I would have to spend ages away from my baby. Ds stayed with his dad whilst I had my bits sewn back together. I found this quite destressing and upsetting as I wanted to be with my new baby.
I had nmanaged the whole labour with gas and air so having a spinal block felt a bit like a kick in the teeth. I was nummbed up and my legs put in stirrups (sp?) and left in the operating theatre to wait for the doc to sort me out. I kid you not this room was more like a corridoor than an operating theatre. There were people constantly passing through and at least a douzen people must have seen me in this far from glamerous position. I know this would be scary for anyone but I had hoped that they would take my age into account and perhaps be a little bit more tactful.

Anyhow they couldnt get rid of me out of the hospital quick enough. I was home the next day and spent the following months in agony. I found going to the loo difficult and it made me think twice about having more children.

All Im trying to say is that I wish someone had taken me aside and been kind and understanding and explained why the whole thing had happened. It was an awful thing to go through but had someone explained why I think I might have been able to deal with it a little better.
Dd was born the same time the following summer. Her birth was totally different and actually an manageable experiance. I went to NCT classes which I though were amazing especially for the breathing techniques we were taught. They made my labour a lot easier and I was able to cope with the pain a lot better. My midwaife at the hospital was a wonderful lady. My sister told her about the previous birth and how I was frightened and she said she reassured me that she wasnt going to let it happen again. Dd was born quickly and I only sustained a superficial tear. She was a lovely lady and was very supportive and kind to me when I was upset about exps behaviour. She took me down to the ward and just seemed to actually be interested in me as a person. I was on a different ward and instead of being in a room with a zillion other women i had a room with 3 other women and our own bathroom. The nurses were extreemly supportive even though they were totally over stretched. They helped me with breatfeeding and let me stay for 4 days to rest and try and get it established. It also felt a lot cleaner on this ward. I can not stress how totally different both of the births were. the first totally put me off having children ever again and was a horrible horrible experiance that I never ever want to go through again. The second was pleasent and makes me feel like I could have a million more babies. The second actually made me feel empowered and pretty good about myself. the first made me feel like a faliure... I guessing you can see the gist of it. Anywho just thought I would contribute my experiances.

I never did get an explanation as to why I tore so badly. I still get a lot of problems now from it.

sorry if I rambled.