Maternity Services review Submission-Birth Healing
Introduction
It
is stated in the discussion paper “Improving Maternity Services in
Australia” that Australia is one of the safest countries in the world
to give birth, for both maternal and infant survival rates .
This is a fantastic record and one that many women are reassured by and grateful of.
Given
this standing as a strong foundation, there are many calling for
reforms to be made to the maternity system in this country to expand
our understanding of safety to include that of wider physical safety
(that is, not undertaking obstetric and surgical interventions unless
medically indicated, and understanding the risks involved in these
choices) and psychological safety during childbirth. In other words, we
need to address birth trauma, which many women will experience.
Many
women, when telling others about their traumatic birthing experience,
will be told: “At least you had a healthy baby.” Whilst this statement
is well intentioned, it is insensitive to the needs and emotions that
birth trauma can entail. Of course, as mothers, we are overjoyed that
our babies are healthy (as they are in a large proportion of traumatic
births, although sadly some are not). However, what many women who have
sustained birth trauma come to realise, and what wider society also
needs to realise, is that is possible to feel very differently about
the birth (the process) and the baby (the outcome).
What we
feel needs addressing is ensuring that the process of birthing- the
psychological component of becoming a mother- is given the attention it
deserves, along with the attention given to physical outcomes of birth.
This submission is made on behalf of Birth Healing. The
emphasis of the submission will be birth trauma, and how the maternity
system effects, and can be reviewed, to address the issue of birth
trauma. This issue is one of importance, which is sadly hugely
underestimated and misunderstood by many.
Birth Healing is an
online forum for support, healing, growth and action after birth
trauma. It has been running since January this year, when the site
administrator experienced birth trauma and found there were very few
services targeted at people who have experienced birth trauma. Whilst
it is a relatively new site, plans for the future include forming an
incorporated organisation, holding face to face support meetings in
various areas around Australia, and counselling services; all in aid of
closing the gap where it comes to services for people recovering from
birth trauma, and preventing birth trauma from occurring in the first
place.
The Birth Healing website can be found at http://birthhealing.forummotion.com/
Background Information
Birth
Trauma is a general term for a range of undesirable psychological
consequences following childbirth- this may include Post Traumatic
Stress Disorder or the symptoms thereof . The birth process, whilst
natural, can often be traumatic, through the unpredictability of the
event, deviations from what is considered to be a ‘normal’ birth are
common, and some births may be life threatening to mother and/or baby .
Cheryl
Beck, Nursing Professor at the University of Connecticut states: “Birth
trauma is an event that occurs during any phase of the childbearing
process than involves actual or threatened serious injury or death to
the mother or her infant. The trauma can be classified as a negative
outcome, such as a postpartum haemorrhage, or psychological distress.
Experiencing this extremely traumatic stressor, a woman’s response can
be intense fear, helplessness, loss of control, and horror.”
Post
traumatic stress disorder (PTSD) is one condition linked with birth
trauma. PTSD is an anxiety disorder which is developed after exposure
to a traumatic event where horror, fear and/or helplessness are
experienced. Symptoms and effects can include nightmares and
flashbacks, intrusive thoughts, emotional numbing and character
restriction, psychological distress in response to internal or external
cues that symbolise the event, physiological reactivity to these cues,
avoidance of stimuli associated with the trauma, detachment, sense of a
shortened future, hyper vigilance and other symptoms . Obviously, this
creates many problems for the new mother.
In one study
(Alcorn, 2006), 45.5% of women had traumatic birth events as classified
by the DSM-IV (a diagnostic tool for psychological conditions)-that is,
partial PTSD, and 53.8% reported their birth as traumatic when asked
“Was your birth traumatic?” This study also found that 6.3% of women
had full PTSD at 3 months post partum .
Another study (White, Matthey, Boyd and Barnett, 2006), found that co morbidity of PTSD and post natal depression is high .
Maternal
distress following childbirth can affect the effectiveness of the
functioning of the maternal role, depression and anxiety, adaptation to
motherhood, self perceptions, lifestyle, and quality of personal
relationships, among other things .
Predictors of birth trauma
and PTSD symptomology include low levels of support from staff and
partner, low control of birth and interventions, patterns of blame,
previous mental health difficulties, trait anxiety ; a high level of
obstetric intervention, dissatisfaction with intrapartum care ;
premature birth, birth of babies then placed in a neonatal intensive
care unit, birth of a baby with an illness or disability, women who
experienced a medical complication during or soon after birth, or whose
baby experienced a medical complication during or soon after birth,
women who sustained an injury during the birthing process, women who
had their labours induced, those who had caesarean, forceps or vacuum
extraction deliveries, who had an episitomy and those who experienced
still birth or neonatal death of their baby .
Anecdotal
evidence from the Birth Healing website reveals that common themes in
birth trauma include loss of control, birth and health care
professionals who lack adequate listening skills, post partum
haemorrhage, induction of labour, caesarean, forceps or vacuum
delivery, episiotomy, frequent and/or forceful vaginal examinations,
artificial rupture of membranes, being isolated from support people and
loved ones, a lack of support and attentive health care post natally,
and a lack of dignity afforded to the birthing woman.
Samantha Cambray is the owner of Birth Healing, a forum community for support, healing, growth and action after birth trauma