Birth trauma research is really important.
It is clear from a number of sources that traumatic birth experiences (which are experienced differently from person to person, of course) can significantly affect a mother’s experiences, well being and mental health.
This is the starting point taken by a number of groups of researchers. This blog post contains discussion of some of the key studies on this topic, which I have shared and discussed in my Birth Information Update. These papers contain links to many others for those who would like to explore birth trauma further.
Defining birth trauma
The most recent study that I have written about is an important discussion paper on the topic of developing a woman-centered, inclusive definition of traumatic childbirth experiences.
Published in Birth: Issues in Perinatal Care, Leinweber et al (2022) set out the problem:
“Many women experience giving birth as traumatic. Although women’s subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research.”
The issue of subjectivity
This lack of a clear definition is often an issue when we try to research subjective experiences. And birth is full of subjective experiences. The sensations of labour, our satisfaction (or otherwise) with the care that is offered, the way we feel about giving birth.
It’s important for individuals to be able to have their experiences respected and heard, and for us not to assume that things are the same for everyone. But researchers, service users and clinicians also all need to be able to use terms that we can define, so that we can write about such topics and know what each other are talking about.
This is especially the case with birth trauma, which is thought to be experienced by somewhere between 9% and 50% of women, depending on what research you look at (Leinweber et al 2022). The rate is also variable according to country, care provider, types of birth and several other factors.
The aim of the conversation
So Leinweber et al (2022) set out, “To formulate a woman-centered, inclusive definition of a traumatic childbirth experience.” To do that, they began a quick literature review, which helps get a sense of what is out there already, and they then undertook a five-step process.
“First, a draft definition was created based on interdisciplinary experts’ views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback.” (Leinweber et al 2022)
Unsurprisingly, their research confirmed that a woman-centered and inclusive definition was felt to be important to both the recipients and providers of maternity care.
Their final definition was: “A traumatic childbirth experience refers to a woman’s experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman’s health and wellbeing.” (Leinweber et al 2022)
A few things are important about this definition. As the researchers note, it, “acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth.” (Leinweber et al 2022)
But just naming something can help us to further the conversation. And, while we have been talking and writing about birth trauma for a while, we are still developing the language needed in order to deepen and widen our understanding of this. This paper, which is open access, will help with that. It contains an in-depth discussion of many aspects of birth trauma and reference to more than ninety papers for those who want to explore the issues further. You can read it here.
Women’s experiences of birth trauma
In another important paper, researchers undertook a qualitative study in which they interviewed ten mothers. They wanted to “explore maternal self-perceptions of bonding with their infants and parenting experiences following birth trauma.” (Molloy et al 2020).
I won’t lie about the fact that reading some of these women’s words is harrowing. But this kind of honesty is what we seek in qualitative research. These women’s words remind us that trauma is complex. People experience things differently. There is much talk from some areas of the kind of trauma that derives from intervention or the words and actions of professionals, and that is certainly confirmed in this paper. But in talking about the sources of their feelings, the women also reference being upset by information from outside sources (childbirth education being one example), by their expectations of themselves, by societal pressure. It’s important not to focus only on one area when sources of trauma are multiple, and also individual.
If you’ve heard me speak, either live or online, you might know that one of the things I refer to often is the way that our current approach to maternity care has served to undermine woman’s own knowledge. I’ve written about that as well, most recently in In Your Own Time: how western medicine controls the start of labour and why this needs to stop. When we insist that pregnancy length is fixed and not fluid, when we force women to follow due dates defined by machines and not their own bodies, when we constantly prioritise medical definitions over women’s own instincts, we undermine a vital source of information and a well of trust.
Sadly, this has been further confirmed by this study.
“Women saw the start of their parenting journey as contributing to this emotional disconnect from their infants where their self-knowledge and understanding of their own bodies was dismissed by professionals, which in turn led to them doubting further decision making and knowledge about parenting. They began to mistrust their own instincts. They also felt they couldn’t talk about what they really felt for fear of being branded ‘bad mothers’ or having children removed.” (Molloy et al 2020).
Sadly, the results of the study didn’t surprise those who are involved with birth, which seems these days to be managed and run on a commercial model:
“Women who experienced birth trauma often described disconnection to their infants and lacking confidence in their parental decision making. Many perceived themselves as being ‘not good enough’ mothers. For some women the trauma resulted in memory gaps of the immediate post-partum period which they found distressing, or physical recovery was so overwhelming that it impacted their capabilities to parent the way they had imagined they would. Some women developed health anxiety which resulted in an isolating experience of early parenthood.” (Molloy et al 2020).
The knock-on effects
And the authors conclude that, “Women who have suffered birth trauma may be at risk of increased fear and anxiety around their child’s health and their parenting abilities. Some women may experience this as feeling a lower emotional attachment to their infant. Women who experience birth trauma should be offered support during early parenting. Mother-Infant relationships often improve after the first year.” (Molloy et al 2020).
All studies have limitations. As Molloy et al (2020) acknowledge, the study population in this one were self-selected. All but one of the women described herself as ‘White British’, and the other as ‘Eastern European’. The researchers also acknowledge this, and the fact that this is a rather specific group. That’s especially important when one considers the experiences of Black and Brown women in maternity care and how badly we need to work out how to improve their experiences and outcomes. The authors note a plan to undertake further work to include more diverse populations.
Is there any hope?
The authors do express a bit of hope in their summary. “Other than anecdotally, little is understood or known about a mother’s experience of parenting through PNMH illness. Exploring mothers’ perceptions of their parenting experiences and capabilities may inform the development of services which are there to support parents with PMNH illnesses, and early parenting. This also goes some way to explore the link for women between their birth experience and how they feel able to parent. Those women who struggled to develop a relationship found that this improved over time. This may also give hope to mothers who are struggling with their parenting relationships.”
We can only hope that work like this will help make a difference to those experiencing birth trauma.
The studies in this post were previously featured as the ‘study of the month’ in my Birth Information Update, a monthly newsletter in which I share up-to-date birth-related research and thinking. If you’d like to hear about new research, make sure you’re subscribed to our free newsletter list, which means you’ll get Sara’s monthly Birth Information Update and details of our current projects.
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Leinweber J, Fontein-Kuipers Y, Thomson G et al (2022). Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth. doi:10.1111/birt.12634.
Molloy E, Biggerstaff DL, Sidebotham P (2020). A phenomenological exploration of parenting after birth trauma: Mothers perceptions of the first year. Women and Birth. In press. https://doi.org/10.1016/j.wombi.2020.03.004