Guest post: “When we hear about birth we often hear two very distinct stories”

[MumsnetGuestPosts]

If you’ve had a difficult birth in the past, or are preparing to give birth at the moment, you may want to read this post with someone you feel able to talk to about any feelings that arise.

When we hear about birth we often hear two very distinct stories – that it’s either terrible, or wonderful. People talk about birth ‘horror stories’ that leave women and their families suffering, or they talk about the beautiful empowering experience of birth. When we talk in such dichotomies, there’s little room for those in the middle whose experience is often a little bit terrible and a little bit wonderful (and sometimes a little bit exciting and a little bit terrifying and at times even pretty boring). This can leave many people feeling unable to talk openly about their experiences – and whether birth is terrible, wonderful, or somewhere in the middle, we know that it can leave a huge impact on us. It’s the entryway into our parenting experience, and if we come out feeling that it hasn’t gone the way we had hoped, it can mean the start of that journey is complicated.

A year ago, I set up an organisation called Make Birth Better with my colleague psychiatrist Dr Rebecca Moore. We’d noticed this black and white way of talking about birth and wanted to provide a platform to showcase the wide variety of stories and experiences that exist around birth – from both parents, healthcare and birth professionals. We also noticed how few birth stories exist from people who, research shows, might face additional stigma from maternity services such as Black and Minority Ethnic women, same sex couples, trans individuals, non gender conforming people, those with physical or learning disabilities, women living with disadvantages. It’s only by showing how varied birth can be that we can start to speak about every kind of birth story.

Over the past year, we’ve met with women, partners and professionals to ask them what they felt could make birth better. While often antenatal education and stories about birth focus on the women or birthing person’s responsibility to educate and empower themselves, we heard stories about how ineffective preparation can feel when you enter a system which is, in itself, traumatised. Overstretched and overstressed maternity services can feel like they are reactive, rather than proactive, with midwives often dealing with more than one person in labour simultaneously, without time for a loo break let alone to learn about a person’s birth plans.

We’ve started to create a new story around birth. One which includes not only the woman or birthing person and her partner, but also the staff who will travel that journey with a family. And if we’re to include staff, we also need to include the systems that exist around them – the teams which support them, the organisations which treat them with either kindness or blame. If we begin to see birth not as a solo affair but a collaboration between all of these different layers of the system, then we can create a new narrative. That includes all of us too, of course. So that we not only share the different and varied birth experiences that we have (being mindful of any parts that could be emotive), but we ask to hear others’ experiences too. Then we can hear about births that are neither horror stories or fairytales, neither black or white, but full of colour.

If you’re reading this currently preparing for birth, do take a look at the online resources at //www.makebirthbetter.org and take a look at the Positive Birth Movement, Association for Improvements in Maternity Services & Birthrights. If you’re reading this and you think you might have some symptoms of trauma following your birth, do take a look at those resources too as well as the Birth Trauma Association who have an active peer support group on Facebook.

Emma’s new book ‘Why Birth Trauma Matters’ (Pinter & Martin) is published on 11 July.

EDITED BY MNHQ Emma will now be coming back on Thursday at midday

[DrEmmaSvanberg]

Hi all

Thanks to Mumsnet for inviting me to answer questions related to my post, and to all of you for engaging with the different areas and topics that were raised. Rather than answer each question individually, I thought I’d pick out what seemed to be the main themes and I’ll be here for the next hour if I missed anything or you had any follow up questions.

Thanks to those of you who shared your own experiences with trauma during or around birth. I was truly sorry to read of those experiences. There are lots of resources on the website //www.makebirthbetter.org and we have just added some new cribsheets if you would like to read more. Can I caveat this conversation by saying that, if you do have your own experience of trauma, do tread carefully and take a break if you need to.

Before I do answer some of the comments, I just wanted to note that the definition of birth trauma isn’t just PTSD related to the birth itself, but also encompasses symptoms of trauma which may not meet the criteria for a diagnosis, and may be related not just to the birth but the pregnancy and fertility journey, the post natal period, feeding experiences and so on.

Firstly, the issue around use of ‘birthing person’ in my post. We at Make Birth Better have agreed to quite deliberately use the phrases ‘women and birthing people’ or ‘woman or birthing person’. We, also quite deliberately, have chosen not to use catch-all phrases such as ‘birthing person’ alone or ‘parents-to-be’. Our aim is to include women and others who give birth who don’t identify as women.

We are a collaborative of both parents and professionals, and our aim is to be inclusive. As many of you said, language really matters and ideally we should be using the pronouns preferred by each individual – simply moving away from the universal ‘ladies’ and being acknowledged by our first names would be a great start in many services.

One of our goals, as outlined in my original post, is to expand on the current narratives around birth – not just in conversations with families but in the mainstream media – so that different representations of birth are seen. With that in mind, we have chosen to use language to include all who give birth. But we have consciously chosen to make that an addition to ‘women’ as, as many of you have pointed out, there are particular issues around women’s experience, misogyny in both maternity services and wider society that make the particular experience of women central. This isn’t just an issue of women and others, there are also particular issues within women’s experience too which we have tried to highlight – the specific disadvantages for BAME women who have a 5 x higher risk of mortality during birth, the stigma for same sex couples using maternity services, the increased likelihood of trauma for women who have had a previous history of abuse, the greater risk of trauma for women with a lack of social support. We are looking at issues which affect all people who come into contact with maternity services – not just as patients but for staff too.

Generally speaking, our approach is a systemic one which brings in all the different ‘layers’ of the people and organisations involved in birth – not just women, but others who give birth, their partners, other family members and friends, staff members, the service as a whole, wider organisations and society. You can read more about it here. The emphasis for preventing birth trauma, we feel, is often placed firmly on women’s shoulders, when we are encouraged to educate ourselves for birth and then walk into a system which is traumatising.

Our approach encourages people to widen that gaze and look at the cultural shifts that are required throughout those layers to prevent birth trauma – which is experienced by a third of women. But birth trauma, in my eyes, is a problem for everyone. It impacts not only on women and other people who give birth, but it also impacts on our babies, our relationships and other family members.

Secondly, do we have funding and what are we trying to do?

No, we don’t have any funding at present although we are now thinking about applying for some. This is a project born mainly out of the frustration of me and my colleague Dr Rebecca Moore. We have worked with families in the perinatal period – me for 10 years and Becca for 20 – and see rates of trauma increasing not decreasing, and services not only causing trauma but frequently then making it worse with poor post natal care. There are pockets of excellence but what we tend to hear from our clients is that they cannot access the support they need throughout the perinatal period.

While much has improved in the increased funding for perinatal mental health services, this has come at the same time as early intervention and preventative services have been vastly diminished. Many women and others who experience birth trauma (or any perinatal mental health problem) now find that they cannot access support unless their problems become severe. This is something we have recently been researching with a survey looking at access to support, and the skills professionals feel they need to prevent, manage and treat birth trauma.


From a small meeting of 8 people, we didn’t have any idea a year ago that the organisation would become so large so quickly. We now have a core team of 5 (all volunteers and including parents with their own experience of trauma), an active Network of 150 parents and professionals, as well as over 7,000 people who follow us on social media. While our main aim remains to raise awareness of birth trauma and provide a platform to share a diverse range of stories, what we heard from those people was that there is a need for change within maternity services, as many of you have outlined. I think it’s important to note we are not just trying to create a new narrative, this was just the focus for this post ☺

We also… provide lots of free resources on our website. We have begun to provide evidence-based training in collaboration with the parents in the Network (to ensure their voices remain central to our organisation) and consultation to services. We also try and raise awareness of best practice to counter some of the misinformation that exists around trauma. We are involved in research to demonstrate the wide reaching impact of birth trauma. We are beginning to explore how to improve wellbeing in staff. But essentially what we are hoping for is to be part of a growing groundswell calling for a shift in the culture of maternity care.

Are things getting worse?

In many ways, it does seem that they are – although coinciding with #metoo many women are also challenging what have historically been accepted practices. But more women falling into ‘high risk’ categories, and the increase in interventions would suggest that birth trauma is increasing. We don’t have the stats for this as the birth trauma literature itself is so new. Birth was only acknowledged by the NICE guidelines as a possible source of trauma as recently as 2014.

C-section rates are increasing, and while this in itself may not be a cause of trauma, some researchers have suggested that emergency C sections could be classed as a traumatic event (a traumatic event can be defined as an event during which you felt that you or a loved one were in grave danger). Third and fourth degree tears are increasing – the reasons given for this tend to focus on induction and augmented labour rather than episiotomy as far as I’m aware? Physical injury of course would increase one’s likelihood of having symptoms of trauma afterwards. @blahblahblahnanana I’m sure you know more about this than I do.

What seems to be crucial is the role of ‘interpersonal factors’ from antenatal, during birth and in the postnatal period. This is where we believe it may be possible to prevent some incidences of birth trauma. The research shows time and time again that the way people were treated in their pregnancy, birth and postnatal experience are related to how they feel afterwards. In such overstretched services, there is a growing sense of ‘compassion fatigue’, so that professionals are often simply too burned out to offer the support which is needed. The Better Births recommendations are being followed in some trusts but not others – continuity of carer, for example, has been shown to improve birth outcomes but is proving very difficult to implement.

Think that just about covers it! Will be here until 1pm if people have any follow up questions or ideas. I think it’s also helpful to remember that we are all people behind these screens and that we all bring our own experiences so please can we remain respectful.


Emma

[SarahAndQuack]

Thanks, this is really interesting.

Can you say any more about the term 'stories' that you're using? If I'm understanding you rightly, you're interested not just in making experiences better, but in giving people a better set of narratives to relate to as they go through birth?

[DrEmmaSvanberg]

Hi - thanks for your question. One aspect of the work we see as essential is that we have a much wider range of 'birth stories' available. I use that term as this is generally how they are described on websites and books related to birth and birth planning (Particularly in the hypnobirthing world where people are encouraged to read birth stories). This is also a term we might use in Trauma Focused Cognitive Behavioural Therapy, in encouraging people to go through their own story (their own narrative entirely as they remember it, in their own words) when they feel safe enough to do so.

I think that if we have more varied narratives of birth, that in itself would change outcomes for some people. Many people come out of birth feeling a sense of failure and shame, often because they have felt let down by professionals in some way. Then to be told 'well you've got a healthy baby' and have their own experiences minimised - meaning they are much less likely to discuss their feelings with anyone. This is a wider issue too - there were a lot of stories in the news last year discouraging women from sharing their birth experiences in case they frightened others. If we can normalise the wide range of experiences people have of birth, then we can challenge some of those ideals that exist about how birth should be. That is a very small part of the puzzle, though, in my eyes! But you can just look at the way Meghan Markle's pregnancy and birth was portrayed to think about how pressured these narratives often are.

@SarahAndQuack

Thanks, this is really interesting.

Can you say any more about the term 'stories' that you're using? If I'm understanding you rightly, you're interested not just in making experiences better, but in giving people a better set of narratives to relate to as they go through birth?

[SarahAndQuack]

That's really useful and makes a lot of sense, thank you.

[DrEmmaSvanberg]

:) would love you to come and join the mission! We're most active on Instagram @birthbetter

@SarahAndQuack

That's really useful and makes a lot of sense, thank you.

[DrEmmaSvanberg]

Bye for now - do let us know if you have any further questions at [email protected]

Emma