What is Birth Trauma? What causes it and can we prevent it? I have been working in the birth field for well over a decade; both in and out of the hospital. The idea of birth trauma was very new when I began my career. I have gratefully seen it become a more recognized and studied topic. On the flip side of that, unfortunately, it has needed to become a more recognized and studied topic. In my first weeks as a new midwife, I experienced two births that have forever cemented birth trauma in my psyche. I share them here to highlight the complexity of this topic.
It was her second baby, she was in a strong labor pattern. I helped her to get into the birth pool. She appeared completely serene and focused. She did not speak much, breathed beautifully and worked with her contractions. I tired to meet her calmness by being present and quiet. I stayed within her line of sight and met her eyes when she looked up. Her labor progressed quickly, soon she started to push and then birthed her sweet baby into her arms. They both transitioned well after that and soon she and babe were tucked into bed and nursing. A little while later, I found her crying and asked what was wrong. She then told me that she felt traumatized; that during her birth she felt alone and isolated, that she had been so quiet because she was scared. She had desperately wanted me to help her, to talk to her and let her know she was ok. We talked for a long time but I was not able to fully repair her experience. Her tears will always remain with me.
It was her first baby. She had worked hard all day and was now working on birthing her babe. She was strong and grounded, her baby’s head emerged and then stopped. She was having a shoulder dystocia and we had to focus intently on releasing it; I talked her through the necessary position changes and was able to assist her baby out. The baby required a little help to get going and the new Mother had a higher than normal blood loss. My nurse and I did what was required to see them both safe and then were able to tuck them into bed. It had been a stressful situation, I left the room to take some breaths, have some water and calm my nerves. I then went back to her room, planning to sit with her, walk her through everything and answer her questions. Upon entering the room, her face blossomed into a huge smile and she said, “That was so much easier than I thought it would be!” We still talked, I still answered all her questions and she was still elated about her birth and her baby.
These two births happened within one week of each other. They have helped me to understand some important issues around this topic. In some cases, of horrible loss, birth trauma may not be avoidable. However, in many cases, we as providers and support people can help to significantly decrease the incidence of it happening. Our actions, our words and also our reactions have the potential for huge impact on our birthing families. Oftentimes, despite the actual events that take place, we can help to ensure that birthing folks feel secure and supported. Birth trauma is often defined as “when the individual (mother, father or other witness) believes the mother’s or her baby’s life was in danger or that a serious threat to the mother’s or her baby’s physical or emotional integrity existed.” The group, Prevention and Treatment of Traumatic Childbirth or PATTCh is a wonderful resource for more information. Another great resource is the midwife, Cheryl Tatano Beck who has been working in this filed of study for years. You can check out a great podcast interview with her here on the Birthful podcast. Current estimates are that up to 1/3 of birthing people experience birth related trauma. I would wager that this may be a low estimate as many cases are not reported.
The two births that I experienced as a provider serve to highlight this fact; the fact that most of the time the root cause of birth trauma lies in our hands. I recently came across a paper published this year in BMC Pregnancy and Childbirth; Women’s descriptions of childbirth trauma relating to care provider actions and interactions by Rachel Reed, Rachael Sharman and Christina Inglis. (you can find the entire article here and I highly recommend checking it out) This article seeks to discuss the common causes of provider related birth trauma and the stories shared by its participants are heartbreaking and powerful. The authors identified 4 key actions and interactions that can have a negative impact on birthing families.
- Prioritizing the care provider’s agenda. This one seems pretty clear and happens when a providers wishes, plans or desires is in conflict with the wishes, plans or desires of the clients and the provider imposes their dominance over the client.
- Disregarding embodied knowledge. This can happen when a pregnant and/or birthing person reports symptoms and they are dismissed by the provider who assumes their knowledge or experience is superior to that of the lived experience of the client.
- Lies and threats. Coercion and scare tactics that are used to intimidate a person into making the decision preferred by the provider.
- Violation. When a clients expressed desires are completely disregarded and procedures are done against their will.
In my mind, a key component to all four of these causes is Informed Consent or rather the lack of Informed Consent. As clearly defined here on a free online medical dictionary, Informed Consent “is the consent of a patient or other recipient of services based on the principles of autonomy and privacy; this has become the requirement at the center of morally valid decision making in health care and research. Seven criteria define informed consent: (1) competence to understand and to decide, (2) voluntary decision making, (3) disclosure of material information, (4) recommendation of a plan, (5) comprehension of terms (3) and (4), (6) decision in favor of a plan,and (7) authorization of the plan. A person gives informed consent only if all of these criteria are met. If all of the criteria are met except that the person rejects the plan, that person makes an informed refusal.” The concepts of autonomy and informed consent are and should be hallmarks of medical care, however, in maternity care they are sometimes side stepped. Cristen Pascucci of Birth Monopoly has been working on the forefront of this topic and will soon be releasing an article that discuses Informed Consent specifically related to maternity care in the United States. Please use this link to sign up fer her newsletter and read the article.
Full disclosure and in complete honesty as a provider myself: offering true Informed Consent is difficult. It requires time, time that many providers in busy practices may not have. It requires providers to be knowledgeable and up to date on the research and information around various topics and to then be able to distill that information down to the most relevant parts and provide unbiased education on it. And then, as the provider you must be able to let go of the final decision. This is the crux of the problem and what can make the process of Informed Consent seem daunting! Clients can and should be able to, after comprehensive education and support, choose an option that you may not recommend or agree with. However, despite all of this, it is imperative upon us as the provider to strive to practice true Informed Consent processes with all of our clients.
What are your experiences with Informed Consent?
Image credit Aubre Tompkins