Birth trauma not uncommon: How you — and others — can help

Birth trauma is surprisingly common, but too often overlooked in maternity care. A just-released report by the Kem C. Gardner Policy Institute and the Utah Department of Health and Human Services cites national estimates showing as many as 4 in 10 moms may experience some form of pregnancy-related trauma.

Many of the findings for the report, “Hearing the Mother’s Voice: Birth Trauma in Utah,” are based on in-depth interviews with several dozen women, providing insight into the range of birth trauma experiences and also how they are processed and dealt with — or aren’t.

The goal of the report is to educate people about birth trauma so that the causes and impacts can be more openly addressed using evidence-based approaches, said Melanie Beagley, a Gardner senior health research analyst and the lead author. She told Deseret News the hope is women who are struggling will speak up — and find support not just from health care providers, but also from friends, family and colleagues.

What is birth trauma?

Beagley describes birth trauma as what happens “when unexpected childbirth experiences cause really traumatizing physical or emotional pain, resulting in lasting distress regardless of clinical outcome.”

The two needed components are the distressing or overwhelming experience and some lasting kind of psychological impact. Birth trauma, according to the department’s website, “can cause post-traumatic stress disorder, intense anxiety or depression or obsessive-compulsive disorder. It can affect anyone — you, your partner or other family and friends who may have been with you during the birth.”

National estimates say between 9% and 44% of moms report experiencing trauma related to their childbirth.

A miscarriage, unexpected Cesarean delivery, medical complications, death of the baby or very difficult delivery are birth traumas that are pretty easy to recognize and name. But communication breakdowns with the care team, separation from the newborn and simply feeling like nothing was in your control or the care provider didn’t listen to you are also examples of birth trauma.

The range of things that can happen to create a negative experience can vary and so does the time period, which isn’t just while giving birth itself, but encompasses the prenatal and some of the postnatal period.

The impact is also as individualized as the people experiencing birth trauma. Some people can shrug things off, while for others traumas can create mental health challenges, distrust of health care, reluctance to get pregnant again and even trouble bonding with the baby. Grief or postpartum depression can accompany such trauma.

How the report came about

The report built on and sprang from work done by Utah Health and Human Service’s Family Division team that had focused on maternal and infant health. They work on quality collaboratives with providers and health systems, “so they’re very invested in moms and babies in Utah,” Beagley said, adding they’d been interviewing women who experienced birth trauma in great detail, hoping to both understand and reduce occurrences.

The Gardner institute was more than happy to analyze the interviews and code responses to create an assessment.

What did the interviews reveal?

The women told their stories. They talked about what hurt them and what helped them, the resources they found and the ones they needed that were lacking.

It is admittedly a convenience sampling, Beagley said, with the stories of women who opted into telling their experience. They put a call out on social media channels, talked about it on a podcast and invited providers to help spread the word. And people who had experienced birth trauma — including family and friends — told people they knew who might want to tell their own stories.

One of the clear desires revealed in the in-depth interviews is a longing to feel listened to by health care providers throughout the pregnancy and postnatal period. Many of the women felt their concerns or feelings were ignored or dismissed outright.

And when something like a miscarriage or medical complication occurred, the women said a debrief — candid information about what went wrong — could have changed things for them.

That debrief could also address not just what happened, but whether it could happen again. Knowing is a tool that helps parents make good decisions related to childbirth and even whether to get pregnant again. It could provide courage to the hesitant.

“When communication was good, when information was good, when they were validated for feeling the way they felt — ‘this is a challenging experience; it’s OK if you feel a certain way’ — that helped them and then the inverse is true when those things didn’t exist in their care," Beagley said.

Many also said that mental health education for themselves and their care providers would have been a positive. They suggest mental health checks before they’re sent home from the hospital, as well as postpartum checkups. Childbirth is a process, they said, that would benefit from more maternal mental health specialists and from more training of those who deliver babies and otherwise provide care during a very complex and important time.

One of the oft-mentioned impacts is fear.

“There’s a consistent theme of fear especially for a new mother or a mother of young children admitting that they might be dealing with some mental health challenges. Fear of having a child taken away. Fear of being seen as an unfit mother,” Beagley said. ”When we can validate and educate parents, providers, the public, friends, I think that lessens that fear, which is a significant barrier for people accessing care."

Help is not just from professionals

Women leave the hospital or birthing center to live in the real world and that’s where much of the needed support can be provided. Peer support and a public that is better educated on maternal mental health could do a lot to help those who experienced birth trauma. As the institute noted in background material, there’s a need to “reduce barriers to seeking mental health care (such as cost, stigma and childcare).” That would not only improve awareness, but could reduce isolation and address practical barriers that affect access.

“It’s also for the general public to raise awareness and say, ‘Let’s just check on each other,’” Beagley said. “And for the provider community.”

The report said one of the best helps for someone who struggles is those nearby providing understanding and validation.

The report is online. Beagley recommends reading to the bottom of it, because there are lots of resources listed.