Childbirth Trauma: care provider actions and interactions

A big THANK YOU  to all the women and men who shared their experiences of traumatic childbirth for Christian Inglis’ Honours study. There was so much data that Christian chose to focus on paternal mental health for his thesis and publication. Later we analysed the women’s descriptions of trauma and have recently published these findings in an open access journal. A summary of the findings is provided below:

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

(You can access the full journal article free from BMC Pregnancy and Childbirth)

FINDINGS: Four themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.

CONCLUSION: Care provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

Thematic Map

Thematic Map

 

Paternal mental health following perceived traumatic childbirth

(Unfortunately this article is not open access – you can find the full abstract and publication details here)

RESULTS: Thematic analysis of qualitative survey data and interviews found a global theme ‘standing on the sideline’ which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes.

CONCLUSIONS: According to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support.

Thematic Map

Thematic Map

 

 

 

 

 

 

 

 

 

 

Conclusion

It is probably no surprise to readers that the actions and interactions of care providers influence the experience of childbirth trauma. Analysing this data was difficult and at times distressing. However, it is vitally important that we shine a light on the abusive and disrespectful ‘care’ some women experience. We need to see the monster and acknowledge that we (care providers) are the monster in order to shift the culture of birth (thanks Jessie for your monster theory 😉 ). There are no excuses. I will leave you with a quote from one of the participants:

“…The most terrifying part of whole ordeal was being held down by 4 people and my genitals being touched and probed repeatedly without permission and no say in the matter, this is called rape, except when you are giving birth. My daughter’s birth was more sexually traumatising than the childhood abuse I’d experienced…”

If you have experienced birth trauma please seek support (you can find links at the bottom of this post).

About midwifethinking

Midwife and Senior Lecturer
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17 Responses to Childbirth Trauma: care provider actions and interactions

  1. Jessie says:

    Thank you for sharing these women’s stories

  2. This is so wrong. Had a discussion this week with a woman who had experienced treatment like this.

  3. Annie Choate says:

    Thank you for this research and its findings, It closes the gap between known childbirth trauma and the often resulting Postpartum Mood and Anxiety Disorders by giving responsibility to the care providers for their role in the trauma and resulting disorders.

  4. Jenny Patterson says:

    Thank you for this work. I am in the middle of a PhD looking specifically at the experience of the care provider interaction from the perspective of women PTSD following childbirth and midwives. I am doing in-depth qualitative research using Interpretative Phenomenological Analysis. So I hope to add to the above work.

  5. Liz Ford says:

    This is such a powerful study, Thanks for publishing it.
    So much work needs to be done to change the culture on labour wards where this is happening – stories like these tell of obstetric violence and assault. What are RCM, ACM, RCOG and RANZCOG going to do about it?
    Could you do a press release to the newspapers? They might pick up on a study like this.

    • This is not the only study. There have been quite a few. To be honest I don’t think care providers (generally) want to hear/read this. When I present the findings there is often a big of reluctance to accept the situation ie. try and turn it back onto the women and their expectations. I am very wary of media and don’t engage with press if I can help it. I think the first step is calling it out. And we can do this as individual care providers and find our our critical mass. We need to stop being bystanders.

  6. CornishDoula says:

    Thank you for undertaking such an important study and sharing the resulting information. This is not new to those who work within the world of birth… It is shocking, needs to be discussed openly… hopefully allowing women to move forward from their experiences.
    Substandard and inhumane treatment of pregnant, birthing women and their families needs to end.
    Thanks again. Much appreciated!

  7. Mavis Kirkham says:

    Thank you for a really useful piece of research which adds to our knowledge. For midwives, It is particularly important in the light of the work Doreen Kenworthy and I did which shows that giving really good care and reciprocity in our relationships with women at times of tragedy provides great consolation and lessens the trauma for the midwife as well as the mother..

  8. Mo says:

    Thought the following article was relevant. Thank you for all you do. I’m expecting my second child and have devoured all of the content on your blog. Can’t wait to hear more from you!

    https://theconversation.com/rise-in-freebirthing-suggests-women-feel-midwives-and-doctors-are-ignoring-their-needs-65813

    • Thanks for the link. Our research also found that women who had experienced trauma altered their plans for subsequent births – including planning to freebirth to avoid further trauma.

      • Jenny Patterson says:

        Thanks for this link. As an independent midwife for many years I recognise the subsequent choices women make as very important and telling. However most distressing is the fact that many women choose not to have further children as a result of their experiences, or delay longer than they would have otherwise chosen.

        • We also found this. Particularly in the father’s data. Men stating that they wouldn’t have any more children after seeing what their partner went through. As an IM a lot of my clients were looking for something different to their previous traumatic experience.

  9. BekH says:

    You write a lot about choosing your care provider carefully but what about women who cannot afford to pick and choose due to low income? I’m in Australia and going through the public system. I am at the mercy of whoever happens to be on staff at the hospital in my catchment area. I have managed to find a doula who will take me on at an extremely low cost, but how can I avoid all the extra interventions, especially as I am unlikely to have met either my ob or midwife? I cannot birth in the birth center attached to the hospital as I am a vbac, and even if I could, at 25 weeks pregnant it is too late to try and get into there now, or a midwifery program. I am ok if I end up with a c-section due to medical necessity, but I absolutely do not want one because of the cascade of interventions, or because the ob is looking for pathology in what is most likely to be a normal birth.

    • If you are unable to choose your care provider then you need to do some additional preparation. (I was unable to choose my care providers for my own babies BTW).

      I suggest have a very clear written birth plan… including a statement about decision making. I give examples of statements in the ‘birth plan’ chapter of my new book: https://www.capersbookstore.com.au/product/why-induction-matters/

      Statement example:
      “I understand that it is the role of health professionals to share relevant, evidence-based information with me to assist in my decision making, and to gain consent for procedures. I also understand that my decisions, and any outcomes resulting from my decisions are my own responsibility.”

      Statement example:
      “I understand that this birth plan, and my preferences might change, and I will inform my care provider if I want to make any changes. If my care provider recommends any changes to my birth plan I would like information about:
      • the benefits and risks of the suggested change
      • whether I need to make the decision immediately
      • what may happen if I choose not to follow the recommendation.
      Before making my decision I would like to be left alone to discuss my options with my support person/s.”

      Then I suggest having someone there specifically to advocate for you and the preferences documented in your birth plan (you will be too busy birthing). A doula is a great option.

      Also – if you are unhappy with the care provider looking after you, you can ask for another. The hospital will accommodate this.

      You can have a positive experience in the public hospital system. You just need to plan a bit more and take control… and remember you have legal rights within the system.

      • BekH says:

        Thank you for this, it is very helpful! I was beginning to think that my lack of options automatically put me on the wrong footing for the birth I would (in ideal circumstances) like to have. And thank you for all the articles on the blog; they have helped to shape my understanding, appreciation of and desire for a physiological birth.

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