Birth Trauma Week 2020
This week as we move through Birth Trauma Week 2020 (Sept 6 – 12) the rhetoric online has bothered me more than ever. In these troubled times we seem to judge each other now far more than ever and that makes it even more difficult for people to communicate openly and honestly about this difficult subject.
Birth Trauma is not difficult to define, it is simply whatever a woman considers traumatic in her birth. Given the system in which most women experience their labour and birth care is made up predominantly of strangers in a very intimate time, it is no wonder that positive reflections on birth are few and far between. Women will also often initially reflect that unexpectedly harder than they thought or where things haven’t been as they wished or planned is also ‘traumatic’. This too is fraught - the inability to unpack the experience which may need to occur repeatedly to make sense of it - is not afforded many women as the strangers who were present often then disappear and the woman has very limited opportunity to debrief.
Birth Trauma Week recognises a physical level of trauma along with the emotional trauma. However it is clear that the insidious nature of psychological trauma is the area of most difficulty -that which sees less than 1 in every 10 women now diagnosed with PTSD in the wake of their birth. This is a mind boggling statistic, particularly when added to the fact that maternal suicide is a leading cause of death in Australia in the year after birth.
So what can and should we do? We cannot resolve unexpected situations in birth. But we can help with how they feel to the woman and her partner. The most valuable element, that piece of gold that resolves so much, is the depth of relational care with those involved in the pregnancy, birth and post birth period. Midwifery continuity of care provides the relational care needed. True relational care requires partnership and reciprocity – the woman must be in control of who is with her and who provides her care, who. It is no surprise that midwife means “with woman”. Midwives are best placed to provide care to the same woman from early pregnancy, in labour, at birth and for six weeks after as the woman transforms to mothering, for the first or many children she has. This model of care is pivotal to the system wide change that is needed.
Midwifery continuity of care eludes most women – they are not told that it exist, or offered a way to find it, or it isn’t available, or it is available but it is not established in such a way that is truly relational. To be in a relationship in this case a partnership, both partners have areas to bring – the woman experience in herself, her baby, her knowledge and depth of understanding about her individual needs, the midwife experience in the birthing continuum, in normal birth, in normal pregnancy and mothering.
If every woman had someone providing their care truly advocating for them, who had their best interests first (rather than their own or following their employer and institutions pathways) birth trauma would still exist, but it would be different. Where things went wrong those involved would talk through the grief, women would go into the space knowing their options and expecting to receive individualized care. The most tragic element of all this is that cost is usually touted as the reason for midwifery continuity of care not being available and the tragedy is that this model is repeatedly demonstrated in evidence to be cheaper, massively less expensive.
For the woman going into birth – consider the implications of having strangers watching you and consider the difference you will feel if the people with you all the way love and care for you in a professional relationship. For those who have experienced trauma – consider your debrief and unpacking it all, consider your next options, seek those who can love and care for you to help you heal. For society – we need to really look at this, as with lots of things in life, and do it better.