Birth Trauma

We all want mothers and babies to come through birth feeling healthy and emotionally complete. But, when a birth is not a healthy or positive experience or a mother does not feel supported or safe, it can have devastating results. These births may be disappointing, negative, or even traumatic. Birth trauma is real. It affects a large number of women every year. Birth trauma is often not talked about or not recognised. Mums are told to pull yourself together or look at your lovely healthy baby, that is all that matters. Women who experience birth trauma are often believed to be depressed, when in fact, it is something very different. Birth trauma is also known as Post Traumatic Stress Disorder following childbirth.

Birth trauma can be measured in two ways:

1.full clinical diagnosis; or
2.women who have some or many of the symptoms of PTSD but do not meet the full criteria for clinical diagnosis.

Birth trauma is defined as:
•the woman felt threatened or in danger of injury
•the woman felt threatened or in danger of death
•the woman felt threatened or in danger that her baby was at risk of injury
•the woman felt threatened or in danger that her baby was at risk of death
•the woman felt helpless, out of control or alone
•the woman was not treated in a supported or kind manner
•the woman did not feel listened to
•lack of information – withholding of information
•not being part of the decision making process
•the type of labour – long, painful – short, sharp – inadequate pain relief, highly medicalised, or she feels she was left to suffer

Diagnosis of Birth Trauma is based on the woman’s feelings about her birth, whether the health care providers agree or not. Birth Trauma can occur with or without physical injury to the mother or baby; in all types of birth. As one research study concluded:

“Birth Trauma lies in the eye of the beholder” University of Connecticut School of Nursing 2004

Clinically diagnosed Post-traumatic Stress Disorder (PTSD) following childbirth has been shown to range from 5.6% (Creedy, Shochet, & Horsfall, 2000) to 9% (Beck, Gable, Sakala & Declercq, 2011). The rates of women who have symptoms of post-traumatic stress, but do not meet full diagnosis of PTSD, have been shown to be up to 18% (Beck, et al. 2011).

Four themes emerged that described the essence of women’s experiences of birth trauma:

To care for me: Was that too much too ask?
To communicate with me: Why was this neglected?
To provide safe care: You betrayed my trust and I felt powerless, and
The end justifies the means: At whose expense? At what price? (1)

PTSD following childbirth is thought to be under-reported and misdiagnosed. Many women with PTSD are diagnosed as having Post Natal Depression (PND), and, therefore, they do not get the treatment they need. While women experiencing PTSD may also experience depression, the symptoms are very different.

“Trauma survivors have symptoms instead of memories” Harvey, 1990

Women experiencing birth trauma often experience strong symptoms. She will experience nightmares or flashbacks, often reliving the trauma over and over. These nightmares and flashbacks are often very vivid. Women contacting AIMS Ireland often find that they have ‘triggers’ which can bring them right back to the event – sounds, smells, images, places.

“Every night for over a year I would wake drenched in sweat after nightmares of my daughter’s birth. I could feel their hands on me, hear the machines, feel my heart racing in fear. I regularly awoke to my own crying out. There was no escaping it. The daytime was even worse, it was then I had to confront reality. A baby to care for that reminded me of my trauma. A husband who said he understood but didn’t want to talk about it. I felt so ashamed I let them do that to me. I should have been stronger, louder. It was my somehow my fault. I was so angry at my husband for not helping me. It wasn’t his fault but I hated him for it. I felt so much shame. I used to cry all the time. It consumed me. My anxiety was through the roof and I developed a fear of confined spaces and panic attacks. I finally sought help after I had to go into the hospital for something unrelated … I walked past the antenatal clinic and the sounds and smells hit me like a force I’ve never felt before. I ran to the toilets and threw up. Its been 5 years since my birth…. it never goes completely away but its no longer a trauma I relive. ” ~ A woman in contact with AIMS Ireland Birth Trauma Support

Women may also feel strong anxiety, panic, or feelings of fear. She may have difficulty coping and bonding with her baby. She may feel guilt, shame, or worthlessness.

What PTSD looks like:
•re-occurring flashbacks, nightmares, “play-by-play” reel of the birth playing over and over
•you may feel distressed, panicked, or anxious around things that remind you of your birth
•you may avoid things that remind you of your birth
•you may feel unattached or have a hard time bonding with your baby
•you may feel anger at those who were in the room with you (birth partner)
•you may feel violated
•you may feel grief, anger, or numb
•you may become obsessive with details of your birth
•you may avoid speaking of or thinking about your birth
•you may fear or make a decision to never give birth again
•you may want to get pregnant straight away – “make things different”
•you may experience problems in your relationship if your partner doesn’t understand or you have sexual problems
•you may experience sleep difficulties

Speaking about Birth Trauma

If you are having a difficult time recovering from a difficult or traumatic birth, it is important to recognise how you are feeling. Don’t just hope that your feelings with go away or that how you are feeling is not valid or important.

Sharing your feelings with supportive people is important. You might not want to at first, but a lot of mums feel relieved once they do.

You can find support through:

• your partner
•a close friend or relative
•a midwife
•a counsellor
•your GP
•a debriefing service through your maternity unit
•peer support, from other women who are healing from birth trauma. Some counselling services run support groups for birth trauma.
•AIMS Ireland support services
•AIMS Ireland closed online Birth Healing Support Group
•The Birth Trauma Association in the UK

Not everyone you speak to may understand birth related PTSD, may health care professionals are not very familiar with it yet. It may help to print this out and show it to your partner or GP. If you find a health care provider isn’t supporting you, there are other supports available through counselling and support groups, listed below.

Counselling Services:

There are many reasons why women, and, sometimes their partners, may benefit from counselling after the birth of a baby.

There are no ‘right’ or ‘wrong’ reasons for seeking counselling.

It is important that if you feel like you need to speak to someone, that you find the support you need to feel better.

Counselling and Support Resources

Nurture is a charity which offers national counselling services for pnd and ptsd in a wide range of services from group support and individual counselling in person or via Skype http://nurturepnd.org/

The accredited list of counsellors can be found here: http://www.irish-counselling.ie/

The accredited list of counselling or clinical psychologist ( panic or anxiety or PTSD) can be found here – OR – can be arranged via a referral through a GP or this site: http://www.psychologicalsociety.ie/find-a-psychologist/
Family Resource Centres also offer counselling liaison services. Find your nearest Family Resource Centre here: http://www.tusla.ie/services/family-community-support/family-resource-centres/find-family-resource-centre

AIMSI Birth Healing support group: A closed group for women whom have experienced a difficult or traumatic childbirth offering a safe place to share stories and provide peer support. If you are interested in this group, please contact AIMS Ireland. support@aimsireland.com or via messages. You will be required to provide an email address to be added.

Requesting Your Birth Notes

If you have had a difficult or traumatic birth, you may have many unanswered questions. Reviewing your birth notes can help provide answers, fill in gaps, and give the hospital’s account of your birth.

Every woman is entitled to a copy of her maternity notes.

You do not need to give a reason as to why you want a copy of your maternity notes.

To request a copy of your maternity records, contact your local maternity hospital’s patient services department and they will give walk you through the process. Alternatively, you can request a copy of your notes from Freedom of Information.

You will need to make a formal request in writing providing details of identification. These include:
•Your Name
•Your Date of Birth
•Your Baby’s Name and Date of Birth
•Your Address and Contact Number
•Photocopy of Identification

Once your request is received, the patient services or FOI Officer will process your request. The patient services or FOI Officer will pull your chart and photocopy the information inside. This should include your antenatal, labour and birth, and postnatal records. It should also include any tests, procedures or scans. Once all the information is collected and photocopied, the patient services or FOI Officer will send them to you via registered post or arrange for their collection. As personal health records are legal documents, you are the only person who may sign for the notes. The notes should be with you in 2–6 weeks.

Making a Complaint

If you are unhappy with any aspect of your maternity care you may decide to write a letter of complaint. Complaint letters are a way to highlight issues of concern from your experiences. Hospital management and carers (midwives, doctors) are supportive of complaint letters as they are often the only way that problem areas can be identified and addressed. It is very important that women write complaint letters so that improvements to services can be made. Also for women who had negative experiences, many find that writing a complaint letter gives them a sense of closure.

Women often ask what warrants a complaint letter; there is no specific answer to this question. Women write letters on a variety of issues which concern them; there is no issue which is too big or too small. Complaint letters may be in relation to issues which occurred during antenatal care (pregnancy), during labour, during the birth or during the postnatal period. Complaints can be made to highlight a general issue or to raise concerns on a specific policy. You may also raise concerns relating to a specific individual—their manner, the way they treated you or a procedure they may have performed.

There are a number of ways in which you may lodge a complaint.

•directly to your health care provider – private obstetrician or midwife
•to your local maternity unit – Head Consultant and Director of Midwifery
•to the HSE, Your Service, Your Say
•to the Office of the Ombudsman

To make a complaint against a specific individual:

* Obstetrician or another doctor – Irish Medical Council

* Midwife or Nurse – The Nursing and Midwifery Board of Ireland

Complaints should be respectful and clear, highlighting the key points you would like to make, providing examples, details, and any relevant evidence which will help illustrate your points.

Written complaints must be acknowledged within 7 days and a written reply provided within 30 working days of receipt.

Following your complaint, your maternity unit will:
•Review your birth notes (this is why it is important to have your own copy of your birth records).
•Send a reply which explains or responds to the points raised in your letter.
•Possibly invite you to attend a meeting to discuss your letter further.

If you receive a reply in response to your letter and feel it needs further clarification, you may request a meeting or may alternatively send another letter highlighting your issues with their response.

If at any time you require research, information or support on issues pertaining to your complaint/query, please contact AIMSI at support@aimsireland.com

If you have been invited to attend a meeting to discuss your complaint, AIMS Ireland recommend that your birth partner/husband/family member goes along with you. Some women have found these meetings to bring on strong emotions and it is best to have someone there to support you. It may also feel less intimidating to have someone with you.

Finally, AIMS Ireland would again like to highlight how important your letter is to the maternity system. Hospitals can only change what they know; the more women communicate, the more likely improvements will be made. It is a difficult decision to make a complaint. Many women, AIMS Ireland representatives included, have commented on how difficult it can be to write and then send their complaint letters. You are not alone; we are here to support you in any way we can.

There are many reasons why women, and, sometimes their partners, may benefit from counselling after the birth of a baby. There are no ‘right’ or ‘wrong’ reasons for seeking counselling.

Contact Details for Complaints:

1) HSE – Your Service Your say: http://www.hse.ie/eng/services/yourhealthservice/feedback/

 Please note, there is a time compliance with HSE complaints services. A written acknowledgement should be received immediately and complaints officers will look into your complaint within 30 days of the date of acknowledgement. If your complaint will take longer than 30 days for a reply, the complaints officer must acknowledge this within the 30 day reply timeframe and an update will be provided every 20 days. If the HSE does not comply to these terms, please contact AIMS Ireland at support@aimsireland.com

2) To make a complaint about a midwife or nurse – An Bord Altranais: http://www.nursingboard.ie/en/complaints_process.aspx

3) To make a complaint about a doctor – Medical Council: http://www.medicalcouncil.ie/Public-Information/Making-a-Complaint-/
4) Contact your local TD with your experience or what you would like to see from Irish maternity services

5) Create a local consumer group with women using your local maternity unit – Birth Matters in Drogheda and Cavan are consumer groups made up of women like YOU who work with their local maternity unit to better services for women, babies, and families. Why not start your own group?

6) Contact the Minister for Health, Simon Harris TD

7) Share your story publicly on AIMS Ireland blog or in the media.

8) Legal support

Support Services Contact Information

AIMS Ireland Support Services or to be added to the Birth Healing Peer Support Group: support@aimsireland.com

References:

1) Beck, C. T. (2004a). Birth trauma: In the eye of the beholder. Nursing Research, 53(1), 28-35.

2) Creedy, D. K., Shochet, I. M., & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth, 27, 104-111.

3.) Beck, C. T., Gable, R. K., Sakala, C. & Declercq, E. R. (2011). Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey. Birth, 38: 216–227.doi:10.1111/j.1523-536X.2011.00475.x