Photo of Emma by Phill Taylor.
It’s Birth Trauma Awareness Week (7-14th July 2019) making it the ideal time to publish Dr Emma Svanberg’s vital post on trauma and the fear of birth in subsequent pregnancies. I know how that feels after experiencing birth trauma with my first son but experiencing a positive elective with my second.
Emma is a Clinical Psychologist specialising in the perinatal period; she co-founded Make Birth Better with Dr Rebecca Moore in 2018 to raise awareness of the impact of birth trauma and campaign for improvements to maternity services for both parents and professionals.
Emma has written for The Guardian, RightsInfo, The Early Hour and We are Future Female. She lives in London with her young family. Why Birth Trauma Matters is her first book.
It is an honour to host this important post.
Over to Emma.
When I was pregnant with my first child, a friend of mine gave me Naomi Wolf’s book ‘Misconceptions’ and drew my attention to the African proverb contained within its pages:
‘Being pregnant and giving birth are like crossing a narrow bridge. People can accompany you to the bridge. They can greet you on the other side. But you walk that bridge alone.’
This, to me, is the crux of so many of the stories of trauma we hear following birth. Women who not only cross the bridge alone, but are unaccompanied at either end.
What is Birth Trauma?
There are a variety of factors which can cause a birth to become traumatic – based on not just the birth itself but on your own previous history, the maternity journey and also events following the birth. What comes up in the research literature is the importance of ‘interpersonal factors’.
We know that, no matter what type of birth you have, feeling unsupported will increase the likelihood of later symptoms of trauma. For some women, this may be hostility or violation but for many others this is feeling abandoned or a lack of kindness.
What makes birth so different to other traumatic events is that it is not usually seen as a negative experience – everyone around us tells us that it will be the most joyful day of our life. When it hasn’t gone well, the distress that this can cause is usually dismissed with an ‘at least’…. ‘at least you have a healthy baby!’
We face a reminder of the birth not only with repeated visits from midwives but every year with the birthday of our child. And, unlike any other traumatic event, we may wish to go through it all again.
It’s not surprising that many women delay having another baby, and many choose not to grow their family at all. Again, this can often be met with judgement – yet we would never expect a survivor of abuse to repeat that experience.
Naming the fear of birth
Once we, as parents and as professionals, accept that a fear of birth is not only possible but likely after a traumatic birth, we can start to think about how to reduce it. Research shows (Beck & Watson, 2010) that the majority of women go on to have positive birth experiences after a traumatic birth.
Within the NHS, this fear has been acknowledged by the creation of a tokophobia toolkit, to support women frightened by birth. Many Trusts have implemented pathways to support women and their partners.
On the Make Birth Better website and social media, we often hear from women who had positive and empowered births after trauma – as with Vicki-and we are increasingly hearing from other women who have used these stories to plan their own births.
Resolving feelings of trauma
You may wish to consider treatments or therapies to resolve the feelings of trauma that you are left with. If we consider that a major part of trauma is how trauma symptoms can be triggered by reminders, we can accept that it is likely the experience of birth itself could be a trigger. However, trauma is something that can not only be recovered from but which can even lead to growth (hard to believe when you are in the middle of it).
The main therapies recommended for birth trauma are Cognitive Behavioural Therapy (CBT) or Eye Movement Desensitization Reprogramming (EMDR). These are often available through local talking therapies services– although we are aware at Make Birth Better that therapy provision can be a ‘postcode lottery’. We have lots of information on the Make Birth Better website about healing from trauma.
Planning for a subsequent birth
If you are thinking about whether to give birth again, the first question to ask yourself is ‘do I really want to do this?’ Often our feelings can be so complicated by the judgement of others, and also our own need to prove ourselves, that we don’t think about what we want.
Depending on your local Trust, you may be referred to a specialist mental health midwife who will support you with your anxieties, develop a personalised plan with you and also often offer continuous care. Continuity of carer has often come up as being one of the main factors in a satisfactory birth and has been written into NHS policy as part of Better Births recommendations. If you can’t be offered this by a midwife in your area, you might want to consider hiring a doula or even an independent midwife. There is a cost to this, which can be prohibitive to many, but lots of birth professionals offer reduced rates or payment plans. Or, you could think about someone else who you trust, whether this is a friend or family member. The important element is having someone who you trust and who you know will be supportive and reassuring as well as advocate for you.
Your Birth Squad
You might want to start thinking about others too who could be part of your birth ‘squad’. What felt so difficult last time around – and what would help to counteract that this time? If it was around the type of intervention you received, could you discuss alternatives with your midwife? If it was the way you were spoken to, could you ensure that you have a birth partner who can advocate for you? If it was around your post natal experience, can you add a post natal plan to your birth plan and ensure someone is committed to this? If your trauma was around feeding, is there a local breastfeeding counsellor who can be on hand?
We can often feel really put off making a birth plan when birth has gone badly, however writing a comprehensive plan not only help you think through what you really want but also inform those around you what is important to you. Milli Hill’s ‘The Positive Birth Book’ has a great birth planning section, and she emphasises not only including your ideal scenarios but often what you would like to happen in the event of a plan b, or c, or d!
Thinking carefully about how you wish you had been supported last time, even down to what you wish people had said to you, can make sure you feel well supported this time. Making sure people are accompanying you, not only to the bridge and off it, but over it too.
- Why Birth Trauma Matters, Emma Svanberg
- The Positive Birth Book, Milli Hill
- How to Heal A Bad Birth, Melissa Bruijn, Debby Gould
- The Compassionate Mind Approach to Recovering from Trauma, Deborah Lee