sara desperately wants another child but she is still traumatised by the birth of her last one. "When I think about my son's birth I recoil in horror. He was wrenched out of me – there was so much pain and so many stitches. I don't ever remember being consulted about my needs."
Sara also suffers flashbacks – a classic symptom of Post Traumatic Stress Disorder (PTSD), a condition more commonly associated with war veterans. PTSD is the term for a set of normal reactions to a traumatic experience, particularly one that involved the threat of death or serious injury and caused fear, helplessness or horror. Unfortunately this is exactly how childbirth can be experienced if it is handled badly.
According to The Birth Trauma Association, of the 700,000 UK births that occur each year, 10,000 women will develop PTSD. In a recent magazine survey eight out of ten women said they were frightened during labour, 75 per cent found it more painful than expected and over half felt they got poor care.
Birth expert and campaigner, Sheila Kitzinger believes as many as half of all women who give birth in the UK suffer some degree of trauma. At its most extreme this can lead to panic attacks, an inability to go past the hospital where the birth took place and even avoidance of pregnant women. Worryingly, half the women who die after childbirth do so because they commit suicide.
Women at greatest risk are those with a previous psychiatric history, those who had a poorly handled assisted delivery and those who felt unsupported during labour. Other factors include bad post-natal care and a fear for the safety of the new baby.
The condition is common but awareness among health professionals remains low and many women are wrongly diagnosed with post-natal depression.
Coping after a traumatic birth
Often women who have suffered a traumatic birth complain that other people are dismissive. Yet being believed is an important part of recovery. Kate McMaugh, a voluntary counsellor with the Birth Trauma Association, advises traumatised women to contact a support organisation (see help and info) to find an 'empathetic voice'.
Counselling via a voluntary service, your GP or private practitioner can help, especially if the anxiety continues beyond six months. Ms McMaugh says that with counselling, the symptoms associated with PTSD 'can be dealt with and can fade'.
Many women also find it helpful to share their concerns with the health professionals associated with the trauma. This can include writing a letter to the hospital concerned. You can also request more information (including your hospital records) about why certain procedures were carried out, to help piece together what happened to make events so terrible.
Ms McMaugh also recommends exercise, relaxation, a nutritious diet and time away from the baby. "It's important to nurture yourself as well as the baby."
Improving your birth experience
Expectant mums are advised to think through their needs prior to the birth by seeking information about local services, reading about childbirth and attending antenatal classes.
"When you understand what is happening in labour, the intense and unusual sensations are not so frightening," states the National Childbirth Trust.
Basic techniques for coping during labour include:
- Staying upright where possible to let gravity play its part.
- Taking a bath or shower as water reduces pain.
- Being massaged to help with lower back pain.
- Using breathing techniques (which will be taught in antenatal classes) to stay relaxed.
Birth choices
Traumatic births tend to be associated with high levels of intervention and impersonal care. A home birth or one at a 'birth centre' (which attempts to provide a 'home-from-home') may reduce these risks.
Women who choose these approaches report feeling more in control. The procedures are less intrusive (you won't be strapped to machinery) and you can move freely. Birth centres allow partners good access and most provide water pools, birthing stalls, beanbags and birth balls. Pain relief usually includes gas and air and pethidine (or equivalent). However, these options are only appropriate for low-risk pregnancies; they are not available for epidurals or caesareans and you'll need to transfer if complications arise.
Women who opt for a home birth can hire birth pools and most birth centres (and many hospitals) also offer this. The water supports the woman's body making it easier for her to change position and helps to reduce pain. Provided the labour progresses normally and the midwife is adequately trained, the baby can be delivered in water although some women prefer to labour in the pool but deliver on 'dry land'.
Natural birth is just one alternative and most women give birth in hospital where care is shared between midwives and obstetricians. The atmosphere is more clinical and intervention more likely but you'll have access to the full range of pain relief including an epidural, and an obstetrician is on-site to deal with complications.
Another option is an elective caesarean although an Audit Commission study suggests that only one percent of elective c-sections are performed because of maternal request. Where women do choose a caesarean, 'fear of labour' and 'previous bad experience' are often cited. With an elective caesarean you can plan in advance and will not endure the pain of labour. If there is not a medical reason for the caesarean there is no guarantee that you will be offered this on the NHS. You'll need to speak to the obstetrics team at your local hospital.
Caesareans are usually carried out with a spinal block so you remain awake throughout. However, it is major abdominal surgery with associated risks including the possibility of infection. Maternal mortality is extremely low but an elective caesarean carries a three-fold greater risk of death than a vaginal birth, and an emergency caesarean a nine-fold greater risk.
Other options?
Traumatic birth is often linked to poor continuity of care and the inability to access the type of service you want. The government recently published its 'National Service Framework' on maternity services stating:
"NHS maternity care providers and primary care trusts [must] ensure that: The range of antenatal birth and post-birth care services available locally constitutes real choice for women (including home births)."
But often choice is scant and less than three percent of women have a home birth.
According to Mary Newburn of the NCT, women cannot be forced into hospital and most units will be able to provide 'midwife-led care and access to a birth pool – one way or another'. Nonetheless she acknowledges that services will vary and that women may need to be 'fairly assertive' to get their needs met.
An alternative is to book an independent midwife who will support you throughout the labour (average cost £2,500) or to employ a 'doula', a professional birth-partner who can advise on breathing, relaxation and positioning during labour (costing around £300-£600) – see help and info for details.
But if it's an NHS service you want, then now might be the time to start lobbying: your local MP, the chief executive of the maternity units in your area, and your local trust's maternity liaison committee are good places to start.
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Organisations
Active Birth Centre
25 Bickerton Road
London N19 5JT
Tel: 020 7281 6760
E-mail:
mail@activebirthcentre.com
Website:
www.activebirthcentre.com
Quite a commercial website but there are useful articles, recommended reading on the subject, yoga classes for pregnant women and information on how to hire a birthing pool for a water birth at home.
The Association to Improve Maternity Services (AIMS)
Helpline: 0870 765 1433
E-mail:
chair@aims.org.uk
Website:
www.aims.org.uk
Campaigns for improvements in maternity care and produces a wide range of leaflets and booklets that enable parents to make informed decisions concerning every aspect of their maternity care.
Birth Crisis Network
The Manor
Standlake
Witney OX29 7RH
E-mail:
sheila@sheilakitzinger.com
Website:
www.sheilakitzinger.com/Birth%20Crisis.htm
The website was set up in order to offer women the opportunity to talk about a traumatic birth. The site also has links to articles on the subject.
Birth Trauma Association
PO Box 1996
SP1 3RQ
E-mail:
enquries@birthtraumaassociation.org.uk
Website:
www.birthtraumaassociation.org.uk
A voluntary organisation that is working to raise awareness of birth trauma. Provides support and advice to women who have Post Natal Post Traumatic Stress Disorder and to those who are finding it difficult to move on from their childbirth experience. Also provides information for health care professionals.
Doula UK
PO Box 26678
London N14 4WB
Tel: 0871 433 3103 (Mon-Fri 9am-3pm, 8-10pm; Sat 9am-12pm)
E-mail:
info@doula.org.uk
Website:
www.doula.org.uk
A doula is an experienced woman who offers emotional and practical support to a woman (or couple) before, during and after childbirth. Doula UK is a network of doulas, run by doulas. The site has more information about doulas, and you can find a service in your area.
Independent Midwives Association
1 The Great Quarry
Guildford GUI 3XN
Tel: 01483 821104
E-mail:
information@independentmidwives.org.uk
Website:
www.independentmidwives.org.uk
Midwives lobbying for the traditional role of the midwife; its members may be contacted by women seeking advice or information on their pregnancy or birth. Midwives may also be booked in advance should a woman not want an NHS/hospital birth.
National Childbirth Trust
Alexandra House
Oldham Terrace
Acton
London W3 6NH
Enquiry line: 0870 444 8707 (Mon-Thurs 9am-5pm; Fri 9am-4pm)
Breastfeeding support line: 0870 444 8708 (8am-10pm every day)
Website:
www.nctpregnancyandbabycare.com
Information and practical support on all aspects of pregnancy, childcare and early parenthood with antenatal classes and postnatal support groups. Ring enquiry line for details of local services.
Royal College of Midwives
15 Mansfield Street
London W1G 9NH
Tel: 020 7312 3535
E-mail:
info@rcm.org.uk
Website:
www.rcm.org.uk
The only trade union and professional organisation run by midwives for midwives. The website has lots of information and a news section with articles.
Websites
Association for Improvements in the Maternity Services (AIMS)
www.aims.org.uk
Contains articles on the maternity services debate and a good links section. Provides information, support and advice to parents and health professionals on all aspects of maternity care, focusing on maternity services.
The Association of Radical Midwives
www.radmid.demon.co.uk
Set up by midwives in the UK committed to improving maternity care in the NHS. They offer support and information to those having difficulty getting or giving good, personalised midwifery care. There are useful articles on a range of subjects, including the caesarean section debate. The website has a list of contact details dependent upon your type of enquiry.
Birth Choice UK
www.birthchoiceuk.com
Information on maternity services nationwide.
Dr Foster Birth Guide
www.drfoster.co.uk/home/birth2005.asp
Provides information on how maternity care is delivered in the UK and details of what services individual maternity units throughout the country offer.
Homebirth Reference Site
www.homebirth.org.uk
Website run by a woman with four homebirths of her own, this site lists articles and research findings, and covers the more controversial aspects of giving birth at home.
Midwives Information and Resource Service
www.midirs.org
A database of online articles from over 500 journals on all aspects of childbirth. A good resource, with a forum.
Sheila Kitzinger
www.sheilakitzinger.com
Kitzinger offers advice and information on all aspects of pregnancy and birth, including birth choices and current research findings.
Trauma and Birth Stress – PTSD After Childbirth
www.tabs.org.nz
Set up as a support network in New Zealand by women who suffered stressful or traumatic pregnancies and/or births. The site contains a good deal of useful information including publications and articles written by midwives and mothers.
UK Midwives and Consumers Mailing List
http://health.groups.yahoo.com/group/ukmidwifery/
If you join this e-mail discussion group, you can post a question to other mothers and midwives on any issue of pregnancy or childbirth.
Reading
|
Easing Labour Pain: The complete guide to a more comfortable and rewarding birth
by Adrienne Lieberman
(Harvard Common Press, 1992)
Describes labour pain and the physical process of childbirth, and discusses breathing exercises, massage, music, biofeedback, hypnosis, companionship, medication, and the birth environment. |
|
Gentle Birth Choices: A guide to making informed decisions about birthing centres, birth attendants, water birth, home birth, hospital birth
by Barbara Harper
(Inner Traditions, 1994)
A general guide to the range of birth choices available to women. Has very positive reviews on Amazon. |
|
The New Experience of Childbirth
by Sheila Kitzinger
(Orion, 2004)
Written by a well-respected expert in the field, this book explores the emotional as well as the physical elements in childbirth. |
|
Rebounding from Childbirth Toward Emotional Recovery
by Lynn Madsen
(Greenwood Press, 1994)
Focuses exclusively on women's feelings about going through a difficult birth. |
|
Water Birth: A midwife's perspective
by Susanna Napierala
(Greenwood Press, 1994)
Written by a midwife to more than 600 births the author suggests that giving birth in water offers mother and infant the ideal circumstances for beginning their lives together. |
|
Your Pregnancy Week by Week
by Lesley Regan
(Dorling Kindersley, March 2005)
State-of-the-art imagery and specialist up-to-the-minute research and information describes your baby's remarkable progress in the womb. |
None of the Administrators, Moderators, or general users can take any responsibility for the results or consequences of any attempt to use or adopt any of the information presented on this web site. The information given is for a guide and helping hand towards finding accurate information tailored to specific needs by professionals.
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