Written by: Cassandra Sundaraja
Giving birth to a child – bringing forth new life into the world – is an amazing feat a human body (with a uterus) is capable of achieving. It sounds so heroic and powerful. However, going through the process of labour and delivery in a hospital setting, I was struck by the stark contrast of how pregnant, labouring and post-partum women are made to feel instead – powerless and without agency.
Instead of a celebration of this physiological, emotional, and even spiritual, life transition, almost half the Australian birthing population report having had a traumatic birth experience (Alcorn et al., 2010). Initially limited to physical injury during the birthing process, today birth trauma is understood as “a woman’s experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions, leading to short and/or long-term negative impacts on a woman’s health and wellbeing” (Leinweber et al., 2022, p.691)
Despite the fact that people have been giving birth since the beginning of time, birth trauma has been relatively under-researched. In 2023, the Parliament of New South Wales (Australia) launched an inquiry into birth trauma following numerous reports of the alarming rates of post-traumatic sequalae in postpartum mothers. The impacts of birth trauma reverberate beyond the person giving birth, and extend to the child born, the partner, and essentially the entire family unit. There are plenty of research studies that link traumatic childbirth experiences to postpartum posttraumatic stress disorder (PTSD), depression and anxiety (Ahmadpour et al., 2023; Bartal et al., 2023; Beck & Casavant, 2019; McKelvin et al., 2021; Waller et al., 2022; Yildiz et al., 2017). This can in turn have adverse flow-on effects on mother-infant bonding (Dozio et al., 2020; Molloy et al., 2021) and breastfeeding (Tzitiridou-Chatzopoulou et al., 2023), that further feed into anxiety and feelings of distress, creating a vicious cycle.
While some births are in-fact high-risk, complicated and do require medical interventions (all of which could prove to be traumatic, but not necessarily if handled sensitively and appropriately within a trauma-informed care model), there is a reasonable amount of preventable trauma that results from a lack of continuity of care in the public health system (where perinatal care is offered by different obstetric professionals each appointment), inadequate informed consent practices (where patient decisions take on a flavour of being coerced), increase in rates of medical interventions including the induction of labour, which often follows a pattern of having a cascade of additional interventions, staffing shortages in maternity wards, refusal to offer pain relief to the labouring person, and discrimination on the basis of ethnicity, religious or cultural practices, age, sexual orientation, and language (New South Wales. Parliament. Legislative Council. Select Committee on Birth Trauma. Report no. 1. Birth Trauma, 2024).
Populations in regional areas experience a unique vulnerability to birth trauma due to the shortages in maternity facilities and workforce (midwives and obstetricians) and are also less likely to receive the mental health support they require after, due to a dearth in mental health professionals available. Currently, postpartum women are able to access some free mental health services through Perinatal Anxiety & Depression Australia (PANDA), but this is only until 12 months postpartum. The government provision for healthcare support (Medicare) offers ten rebated sessions, which clinicians unanimously agree are grossly inadequate, and still require substantial out-of-pocket costs for new parents. Our research team is hoping to fill this gap by offering a telehealth-group early intervention for postpartum women who have experienced birth trauma, in one of the regional local health districts in NSW. In order to counter the disempowerment and reduced sense of agency that predominates tales of birth trauma, the intervention is narrative-informed (White & Epston, 1990), with the view of giving that power back to the birthing women through the shaping of their stories of resilience, while at the same time building a sense of community. If successful (and we should know by the end of this year if it is), such an early intervention would provide the much-needed mental health services these vulnerable women require, in a timely, accessible, and cost-effective manner, as versus them spending months on end on waitlists as they await an appointment with a psychologist.
Finally, if we are to bring about a real, long-lasting difference, there needs to be system-driven changes that enable all maternity services to have the resources needed, as well as trained trauma-informed obstetric professionals to provide sensitive care and support with the view of minimizing birth trauma, and the special committee has made recommendations to the NSW government to this regard (New South Wales. Parliament. Legislative Council. Select Committee on Birth Trauma. Report no. 1. Birth Trauma, 2024). Until then, we need to work to offer antenatal and postpartum support to those who are literally responsible for the future of our species.
About the Author
Dr. Cassandra Sundaraja is a lecturer, researcher and clinical psychologist working at the University of New England in the regional picturesque town of Armidale, in New South Wales, Australia. Having trained and worked in both India and Australia, she brings with her a unique cross-cultural perspective. Cassandra is passionate about improving mental health outcomes for pregnant and postpartum people and is also concerned with the mental health impacts of climate change. Apart from teaching, researching and practicing psychology, Cassandra and her partner have their hands full parenting a toddler and two large fur babies – Theo and Dora.
References
Ahmadpour, P., Faroughi, F., & Mirghafourvand, M. (2023). The relationship of childbirth experience with postpartum depression and anxiety: a cross-sectional study. BMC Psychology, 11(1). https://doi.org/10.1186/s40359-023-01105-6
Alcorn, K. L., O’Donovan, A., Patrick, J. C., Creedy, D., & Devilly, G. J. (2010). A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine, 40(11), 1849-1859. https://doi.org/10.1017/S0033291709992224
Bartal, A., Jagodnik, K. M., Chan, S. J., Babu, M. S., & Dekel, S. (2023). Identifying women with postdelivery posttraumatic stress disorder using natural language processing of personal childbirth narratives. American journal of obstetrics & gynecology MFM, 5(3), 100834-100834. https://doi.org/10.1016/j.ajogmf.2022.100834
Beck, C. T., & Casavant, S. (2019). Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(4), 385-397. https://doi.org/https://doi.org/10.1016/j.jogn.2019.02.004
Leinweber, J., Fontein‐Kuipers, Y., Thomson, G., Karlsdottir, S. I., Nilsson, C., Ekström‐Bergström, A., Olza, I., Hadjigeorgiou, E., & Stramrood, C. (2022). Developing a woman‐centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth, 49(4), 687-696. https://doi.org/10.1111/birt.12634
McKelvin, G., Thomson, G., & Downe, S. (2021). The childbirth experience: A systematic review of predictors and outcomes. Women and Birth, 34(5), 407-416. https://doi.org/https://doi.org/10.1016/j.wombi.2020.09.021
New South Wales. Parliament. Legislative Council. Select Committee on Birth Trauma. Report no. 1. Birth Trauma. (2024). https://www.parliament.nsw.gov.au/lcdocs/inquiries/2965/FINAL%20Birth%20Trauma%20Report%20-%2029%20April%202024.pdf
Tzitiridou-Chatzopoulou, M., Orovou, E., Skoura, R., Eskitzis, P., Dagla, M., Iliadou, M., Palaska, E., & Antoniou, E. (2023). Traumatic Birth Experience and Breastfeeding Ineffectiveness – a Literature Review. Mater Sociomed, 35(4), 325-333. https://doi.org/10.5455/msm.2023.35.325-333
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White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. W.W. Norton & Company Inc.
Yildiz, P. D., Ayers, S., & Phillips, L. (2017). The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of affective disorders, 208, 634-645. https://doi.org/https://doi.org/10.1016/j.jad.2016.10.009