Can preparation for birth – prevent Birth Trauma?

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Recently there has been a lot of talk about how if we prepare women for birth we prevent birth trauma. As a trained doula I know how important it is that women are helped to understand the physiology of birth, how they can work with, and trust their bodies, to birth their baby and are given support to have a positive birth experience. However does this and other techniques such as hypno-birthing prevent women experiencing birth trauma?

Preparation for birth matters, this we can not doubt. It supports women to make informed choices, it helps them build trust with those who will care for them, it should also hope prepare them for if things don’t go to plan, or situations arise that mean a change to a birth plan or wishes.

Preparation for birth may take many forms, it may be antenatal education, hypno-birthing classes, self-education or support in the form of a doula. Preparation should be individual and tailored to families needs and circumstances. For instant preparation will be different for a woman who plans a water birth to a woman that is having a planned C section due to choice or medical reasons. It is important that both a supported, understand the birth they have planned and how this may impact them afterwards. But is this enough to then prevent a woman feeling traumatised from a birth experience?

Trauma felt after birth is very individual. It can be the case that a woman has a birth that has many interventions, or becomes an emergency situation or results in maternal/infant damage, trauma being an understandable result. For others however their birth may to others seem a good experience, it may not have had any interventions, or an emergency situation and yet a woman may still feel traumatised. Why?

Because birth is individual to each women. Every experience we go through in life will affect us differently and we may react to it differently to someone else who has had a similar experience. What matters is how ‘that’ women feels about ‘her’ birth experience.

So what about the claim that preparing a woman for birth prevents birth trauma?

The question is can we truly prepare for something that we don’t yet know how it will affect us? Of course not. We can do everything possible to make sure we do what we can to be ready to face situations in life, but sadly life including birth is unpredictable. With all the best preparation in the world when thrown into an emergency, when confronted by a situation that places us or our loved ones in danger, the effects on us and those around us can be profound and life changing.

Also by saying that women can prepare to prevent being traumatised we put the onus on women, we say that they are responsible for something that they often cannot control. How so? A women no matter how prepared cannot prepare for when trauma is caused by poor care, cruel language or medical neglect. This is out of her control. Preparing a woman for birth should never mean that she is accepting of care that is damaging to her or her baby. Rather care given should be protective of women and their partners so that even the most difficult of situations  support for them is possible. Also nothing can prepare families for the physical damage that may result from a difficult birth to a woman or her baby, the time spent in a neonatal unit or sadly if a woman loses her baby.

Also by claiming that preparation before birth prevents birth trauma we then induce guilt and silence those that do feel traumatised. Blame is a huge part of feeling traumatised. If a women feels she didn’t do enough to prepare, if she feels that something she did or didn’t do could have prevented her feeling traumatised then we place blame at her feet. This only perpetuates the cycle of guilt and the belief that a woman some how caused her trauma or that she should have been stronger, more resilient or more accepting to what she has been through. Of the many many women I have met, spoken to or supported who have suffered from birth trauma it is very clear that they are often the strongest, most resilient, brave and courageous people I have ever met. Despite their experiences, the pain often physical as well as emotional, despite having little in the way of support or understanding, they fight everyday to care for their families, go to work and cope with the impact birth trauma has thrust upon them.

It is also said that some women are more predisposed than other women due to previous trauma such as rape or child abuse. For women for whom this may be the case support and understanding, care that is respectful and maintains dignity and making sure that emotional support is provided both during pregnancy, birth and after is what will help reduce the possibility of re- traumatising that woman during birth.

So what can help us reduce birth trauma for women and their partners?

  • Helping parents to be prepared for birth is important, but it is also important that they are supported by those around them if things don’t go to plan.
  • Care given women should be kind, compassionate, respectful and protect dignity. It should be individual and take into account their history and personal circumstances.
  • Allowing for and respecting of choice, even in emergency situations, so that women can feel that they are still in control and part of their care.
  • That emotional support is given just as much emphasis as physical care postnatally.
  • Communication that is respectful and clear, and allows women to make informed choices about their care.
  • The validation of a woman’s feelings around her birth, regardless of how her birth may appear to others.
  • That women and their partners are able to freely discuss their birth experiences and how they feel about them.
  • That support is given for families that suffer maternal or infant damage, have a baby in a neonatal unit or lose their babies.
  • That women who may be predisposed to trauma are given the individual care they need.

Preparation has its place in helping families in birth, but along with this there must also be good care, compassion and the acceptance that while birth can be unpredictable with the right support we can lessen the impact of birth trauma on families by helping them feel safe, supported, cared for and loved.

 

7 comments

  1. Jane Fallon says:

    I believe that the preparation should instill realistic expectations. In my role I meet many women and their birth partners who have attended birth preparation classes and, what a high proportion will report, is that they felt ‘let down’ by their facilitator. That the focus was almost entirely on ‘normality’ so that when their labour took a different path they were ill-prepared.They then interpret this as a failure and find the experience even more traumatic as they had believed they were well prepared, well informed.

    • Nicola says:

      I’m coming to this a year later but I just wanted to say that I absolutely agree with this comment and also particularly what you say in the post about feelings being validated. I went back to my antenatal education (hypno type course) and was repeatedly told that I couldn’t possibly feel like I failed if I did their course properly, that I “picked and I chose” what to take from the course so instead of getting the closure that I hoped for I feel blamed for what happened. I’m trying to find a way to make sure that this course cannot influence another woman’s feelings about their birth as negitavely as it did mine. Thanks for writing this, I’m sure it’s helped thousands of women make sense of things.

      • Emma Jane says:

        I’m so sorry Nicola that you have been treated this way. Birth is unpredictable and no amount of preparation can prevent the effects that this can have. Your not to blame. Be kind to your self. You could also visit beyondbirthtrauma.com.

  2. Tracy Donegan says:

    Great article. Birth (like parenting) is a lived experience and unfortunately for many it is far from the peak life experience it could be. I think we need to look further than traditional birth preparation. Relaxation skills are helpful for many but unexpected events or unsympathetic staff makes mental/emotional preparation a must. Resilience training is an area that is lacking in antenatal education. It shouldn’t be necessary but it is. Emerging research suggests that mindfulness improves emotional resilience and changes the brain in ways that buffer participants from PTSD (seen in military studies). In my experience women who do experience birth trauma recover emotionally far sooner with mindfulness training than those who don’t.

  3. francoise freedman says:

    Thank you Emma Jane for turning the birth trauma inflicted on you into support for women pre and postnatally as a Doula and Infant Feeding professional, and thank you for your eloquent posts. I agree with Tracy that traditional birth preparation needs to be reconsidered and this is why I started Birthlight, with a programme that is yoga-based and includes resilience training as well as relaxation, breath awareness and birthing muscles awareness. It saddens me that yoga for pregnancy and postnatal yoga have become postures on yoga mats in studios. More and more in Birthlight we incorporate what I learnt from Amazonian women and midwives, who are models of body-based emotional resilience supported by their local communities. I would be happy to start a dialogue with you in a spirit of supporting the wonderful work you are doing, as effective birth preparation has been my passion since the birth of my first child in…1975

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