Support Options for Birth Trauma
Introduction
While most people feel their experience of giving birth is positive overall, some feel their birth was particularly difficult or traumatic and this can have a negative effect on their emotional wellbeing.
A physically or emotionally traumatic birth can lead to Post-Traumatic Stress Disorder (PTSD). This is the term for a set of understandable reactions to a traumatic, scary or bad experience.
PTSD often results from:
- An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby)
- A response of intense fear, helplessness or horror to an experience
Common Symptoms of PTSD include:
- The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares
- Feeling distressed, anxious or panicky when exposed to things which remind you of the event
- Avoidance of anything that reminds you of the trauma (this may include talking about it)
- Upsetting memories of the event
- An urge to avoid any reminders of the event
- Difficulties with sleeping and concentrating.
- Feeling more angry, irritable and jumpy or on edge
The following are some of the experiences that can increase the likelihood of birth being traumatic:
- Very long, very short or very painful labour
- Induction
- Poor pain relief
- Feelings of being out of control
- Traumatic or emergency birth
- Impersonal treatment or problems with the staff attitudes
- Not being listened to
- Lack of information or explanation
- Lack of privacy and dignity
- Baby’s stay in Neonatal Intensive Care (NICU) or Special Care Baby Unit (SCBU)
- Poor postnatal care
- Previous trauma e.g. in childhood, with a previous birth or domestic violence
Research has suggested that around 5% of women are diagnosed with traumatic stress after childbirth. There are also many more women who suffer some of the symptoms of PTSD but who do not have all of the symptoms that would lead to a diagnosis. Some women’s traumatic distress can be mis-diagnosed as postnatal depression.
Treatment options for birth trauma:
Following an assessment, if your symptoms meet the full criteria for PTSD, this is best treated by Talking Therapies. Currently, the two recommended therapies are Trauma Focused Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). Both therapies are based on the observation that when people have PTSD, distressing events remain in the short-term memory part of the brain that is active in fight-flight responses and emotions. This means memories and distress are frequently triggered and people experience reliving the event.
Talking therapies can help people process their memories in a way that they move to long term memory so are less easily triggered and cause less distress. CBT and EMDR do this in different ways but both therapies take place in a safe and supportive environment and can be effective in helping people recover from the effects of trauma.
CBT is a structured therapy where you go over the traumatic events, look at your perceptions and thought processes, and use strategies to try to create a safe environment in which you can consider and process particularly difficult or traumatic aspects of your birth. It usually involves 6-12 sessions of up to an hour over two or three months
EMDR involves thinking about the trauma while following a moving object, such as a finger, with your eye. Alternatively, you can listen to taps and tones through headphones, played alternately in each ear, whilst thinking about the trauma. The treatment follows a set structure, and a typical course consists of 6-12 one-hour sessions.
Your midwife, GP or health visitor can help with a referral on for these treatments or you can self-refer to your local NHS talking therapies service (known as IAPT – Improving Access to Psychological Therapies).
Rewind Intervention:
At Chelsea and Westminster Hospital NHS Foundation Trust we are also able to offer a Rewind intervention to women who are extremely nervous about giving birth again, because of a previous negative birth experience, but who do not necessarily require the Talking Therapies outlined above or who do not wish to access Talking Therapies.
Rewind is a non-intrusive, gentle and brief psychologically informed intervention aimed at reducing the trauma symptoms people can experience. It is performed once a person is in a state of deep relaxation. When a person is fully relaxed, they are encouraged to recall their birth events and then are calmed down again by being guided to recall or imagine a place where they feel totally safe and at ease. This takes place during a single appointment lasting at least an hour, with a follow up appointment (by phone or in person) 1-2 weeks later.
The process:
- The midwife will want to understand how your last birth is still affecting you now on a day to day basis and will take a clinical history of your current symptoms and assess the severity of these by using a self-report assessment trauma scale. The midwife will also want to know how you would like to feel without these symptoms.
- A guided relaxation session will allow you to feel calm and at ease.
- You will then be guided to remember your birth and to watch or feel it play backwards (Rewind) in three ways whilst remaining in a very relaxed state.
- By feeling calmer following the Rewind intervention, you can begin to plan positively for the birth you would like to experience next time. An experienced midwife can help you put together a personalised birth plan that can assist with this.
Rewind is a relatively new intervention and, as such, does not yet have a proven evidence base. We have been offering this intervention at Chelsea and Westminster Hospital NHS Foundation Trust since 2016. During this time we have asked women about their experience of it and 93% of women report it improved or significantly improved their distress symptoms.
No women have reported to us that they have felt harmed by the intervention. Rewind is not currently included in the NICE PTSD guidelines due to the lack of large scale research trials.
The mental health specialist midwife will be able to answer any questions you have, so please take as much time as you need and discuss any concerns. Importantly, as with any therapeutic intervention, it is your choice whether to proceed.
Further information and links:
The Birth Trauma Association (BTA):