Imagine being able to look into a crystal ball or hop into a time machine and see how your labor is likely to go and be reassured knowing that you’ll have an absolute angel of a nurse/midwife to take care of you. You’ll manage labor really well and so will your baby. If things get too much you can avail of so many options to keep us comfortable. And if you saw anything in that crystal ball that you didn’t like, you could prepare for what’s ahead in a different way and maybe make different decisions. It’s the unpredictability of labor that’s often the most mentally challenging especially when it’s your first baby.

The reality is we can only prepare so much - because we don’t know what’s going to happen - at least not in this amount of detail above - but there are ways you can reduce your chances of experiencing birth trauma or even just a very stressful birth experience.

What is Birth Trauma?

According to the UK Birth Trauma Association

Birth trauma is a shorthand phrase for post-traumatic stress disorder (PTSD) after childbirth. We also use it for women who have some symptoms of PTSD, but not enough for a full diagnosis.

People can experience birth trauma due to unexpected complications, staff interactions, perceptions of support in labour, medical interventions or a devastating outcome

What Steps Can You Take To Reduce Your Chances of Experiencing Birth Trauma?

• Hire a doula - having 1:1 continuous support from someone not hired by the hospital or our close friends/family is associated with improved outcomes for women and babies. Doulas are providing virtual support via Facetime - don’t dismiss the benefit of having the 1:1 support simply because it’s virtual.

• If you encounter a staff member that is not respectful, kind and compassionate ask for a new nurse/midwife.

• Choose your hypnobirthing class carefully - traditional hypnobirthing (Mongan Method) seems to be associated with more birth trauma. At a minimum supplement your learning with additional resources.

• Consider an out of hospital birth - birth center, midwife led unit or homebirth so you will know your midwife or small team of midwives. It’s not unusual for laboring parents in US hospitals to be left alone as your nurse will usually have at least 1 other family to take care of.

• Women who experience prenatal depression and have high levels of fear around birth are at higher risk. Talk to your careprovider, seek counselling and keep up your daily GentleBirth app practice. Meditation (not hypnosis) is shown to be effective as reducing depression changing certain brain regions that are specifically linked with depression. If meditation isn’t part of your birth prep you can add some practice sessions easily with the GentleBirth App.

• Learn about common labor practices at your place of birth and have written birth preferences to give you more of a sense of control including epidural birth preferences.

• Build your muscle of emotional resilience (resilience is the ability to bounce back from stressful events). Mindfulness training provides a practical means of enhancing resilience, optimism and self compassion. One study on PTSD for combat veterans suggested the practice of compassion reduced the risk of PTSD. The study findings suggest that self-compassion may influence the course of PTSD symptoms.

• A new study suggests that whether certain genes are expressed -- turned on or off - may play a role in a persons chances of developing post-traumatic stress disorder (PTSD). Data from research participants showed those with PTSD tended to have lower expression of a gene called SNRNP35 in the brain and higher expression of a gene called ZNF140 in the blood. I have no idea if that gene is ‘switched on’ for me - and I’m sure you don’t know either. I’m not even sure how you’d find out. But growing research suggests mindfulness changes gene expression. Every so often I’ll get a birth story from a mom that seems very traumatic on paper but time and time again they have bounced back from the events with a compassionate and optimistic perspective that humbles me.

Let’s talk about staff…

“I wish I’d known I could ask for a different nurse”

I’ve lost count the number of times I’ve heard this from parents who wish they’d had an opportunity to get a new nurse - compared to those parents who did know and followed through and felt very very glad they did.

Unfortunately another one of the strongest predictors for experiencing birth trauma is how the mother was cared for during labor. It is almost unimaginable to consider that in your most vulnerable moments a careprovider could be anything other than compassionate and kind but that’s not always what women experience. In some cases staff themselves are experiencing secondary traumatic stress themselves so they shut down to protect themselves. It’s not easy for midwives and nurses to provide sensitive midwifery care within a very medicalised system.

One recent study found four common themes in women’s experiences of trauma as it relates to staff interactions.

• Prioritising the care provider’s agenda

• Disregarding embodied knowledge

• Lies and threats

• Violation

I’ve added a link to this study below if you’d like to read more.

What I want you to take away from this aspect is that at any point during your labor you can request a new care provider. You have one opportunity to birth your baby - your nurse may not remember your name tomorrow. Talk to your partner ahead of time so that in the event that you meet staff that are not being respectful and kind your partner can facilitate to have a replacement. But do give them the benefit of the doubt - maybe they’ve just come from a very difficult birth…or have been up with a teething baby themselves all night…we all have bad days. But if you’ve given them an opportunity to make it work and things aren’t improving you partner can simply walk out to the main desk and ask for a replacement.

I hope these tips are helpful for you as you continue to stack the odds in your favor of having a wonderful, positive birth.

Tracy

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Traumatized Midwives - Traumatized Women

Risk Factors for Birth Trauma

Leinweber J, Rowe HJ. The costs of 'being with the woman': secondary traumatic stress in midwifery. Midwifery. 2010;26(1):76-87

https://self-compassion.org/wp-content/uploads/2015/04/Hiraoka_Meyer_etal_SelfCompassionPredictsPTSD_JTS15.pdf