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