Excitement, nervousness and a sense of relief are normal feelings during the latter stages of pregnancy. There are baby showers to enjoy and birth plans to consider before the big day arrives.
But what if that day does not go as planned? What if there are traumatic elements that accompany the arrival of your child?
A ‘birth trauma’ can refer to untoward event around giving birth. It might include a birth which is physically traumatic, and births that are experienced as traumatic, even when the delivery is obstetrically straightforward.
According to consultant perinatal psychologist Julianne Boutaleb, birth trauma also includes situations in which mothers and their partners are poorly looked after by the medical staff involved in the birth. This may involve long periods of time without supervision, or a lack of knowledge about their particular needs.
She explained: ‘What we’ve learned in the last few years is that birth trauma can be brought on by what’s going on in the mother’s immediate environment, and her feeling out of control.
‘Being left to go through labour alone is something women often speak about. And people talk about how uncaring the professional care givers have been. There are many brilliant care professionals who provide excellent care of course but that’s not always the case.
‘So birth trauma is very much in the eye of the beholder. For some it may be a medical trauma. For others it may be about being left to their own devices and having nothing explained to them over the course of hours and hours.’
Julianne says that birth trauma can be completely unexpected by mothers-to-be who have done their best to prepare for motherhood – attending antenatal classes and generally being conscientious about looking after themselves.
‘These women are very much in control of other parts of their lives,’ she continues. ‘Then they turn up in labour and they are pulled into this horror story that they absolutely didn’t expect.
‘The shock cannot be underestimated – and the implications for them, and the relationships with their partner and their new baby are quite wide-ranging.’
Julianne, who has been working in perinatal psychology for 20 years, says that a hugely stretched NHS may be one of the reasons behind these lapses in care
She says: ‘At the moment women and their partners are going into hospitals where there are shortages of midwives, and where there are cuts to maternity services.
‘Often the support that used to be there isn’t there anymore, and a lack of resources can easily have an impact on how compassionate midwives can be.
‘This means we are seeing more and more women who feel completely shocked and traumatised by what has happened to them while they were giving birth.’
On a positive note however, Julianne believes that birth trauma being more widely discussed means more can be done to help the women – and their families – who are affected. And this includes well known celebrity mothers.
‘Kiera Knightly has talked about birth trauma, and the horrors she went through giving birth to her daughter,’ says Julianne.
“And Serena Williams has written about birth trauma, because she suffered a pulmonary embolism after giving birth and almost died. High profile women talking about this issue helps a lot.’
She adds: ’Becoming a parent comes with certain expectations of ourselves, particularly as mothers – that we will be able to get pregnant, that we’ll be able to give birth in a particular way, that we can breast feed and feel a connection with our babies.
‘Most women who come through a traumatic birth will say that those things just get lost. They feel that they have failed at giving birth – that they have failed at something that defines them as a woman.’
The long-term effects of birth trauma can include depression, PTSD, and anxiety-related issues such as being fearful of going back to work, or having another baby. Sexual relationships can suffer, and both members of a couple may feel they have lost the connection with one another.
Another side effect can be attachment issues with the baby. The parents may blame the baby for what happened or feel very distant from their child. Birth trauma has been linked to a wide variety of behavioural issues which may not be picked up until months or even years later.
Getting through together
Juliane explains that people like her are trying to improve things by communicating with nurses, midwives and parents.
‘We’re trying to get the message out about birth trauma so health professionals can better understand what’s happening,’ she says.
‘The shortage of midwives that I mentioned earlier is one of the biggest problems. Women see midwives less often during their pregnancy, and the old idea of having the same midwife throughout labour just doesn’t happen anymore.
‘But what we know from research is that having a continued, supportive relationship with a midwife makes women and their partners feel really well supported.’
Julianne believes that finding the right support, including meeting with a therapist with specialised knowledge, can really turn things around after a trauma has occurred.
‘We often use a mix of trauma focused CBT and mindfulness,’ she says. ‘We work with the couple on their relationship with each other, and to help with their attachment with the baby.
‘The wonderful thing is that with birth trauma, it might be a difficult beginning, but what’s really important to hold on to, is that it’s rarely the end of the story.
‘And if you can see the signs and symptoms early on and get the help you need, there is real hope that parents can get through it.’