Podcast: Healing and Preventing Birth Trauma with Guest, Consultant Perinatal Psychiatrist Dr Rebecca Moore

Healing and Preventing Birth Trauma with Guest, Consultant Perinatal Psychiatrist Dr Rebecca Moore

Season 1, Episode 9

The focus of the episode is on healing from trauma and preventing it and you may well still find it useful to listen to during pregnancy. No specific traumatic birth stories are referenced. However if you would prefer not to listen to it, or you find it triggering to listen to, please consider your own emotional health first and switch off if needbe!

This week I’m joined by Dr Rebecca Moore, Consultant Perinatal Psychiatrist and co-founder of Make Birth Better. Up to 1 in 3 women would describe their birth or the perinatal period as ‘traumatic’, which can impact their mental health, parenting and future family plans.

We discuss what can be done to prevent birth trauma- both from a parent and healthcare provider perspective. And, for women and families who have experienced trauma, what can be done to help manage and heal from this. We discuss the work of ‘Make Birth Better’ who help prevent trauma within the healthcare system itself, and also work directly with women and parents following birth.

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TRANSCRIPTION

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I know right now you have no idea what to expect from birth, what it's going to feel like, how it's going to pan out.

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Welcome to the birth-ed podcast, where we open up conversations about all aspects of pregnancy, birth, and parenthood, so you feel fully informed, confident, and positive about what this journey might entail.

I'm Megan Rossiter, founder of birth-ed, and your host here at the birth-ed podcast.

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We offer in-person courses in the UK and an online course which is accessible worldwide.

The Birth-Ed course is totally unique in that it offers both a comprehensive antinatal preparation, so covering everything, all your birth choices, possible interventions, decision-making tools, your pain relief options, your birthplace choices, optimal positioning, kind of everything that you might want to know about having a baby.

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OK, so welcome back to the next episode of the Birth-ed podcast.

I'm joined today by Dr Rebecca Moore.

Rebecca is a consultant perinatal psychiatrist working privately in London and co-founder of Make Birth Better.

Rebecca, welcome.

Thanks so much for joining us today.

Pleasure to be here.

So in this episode and an area of Dr Moore's kind of speciality, we're going to be talking about birth trauma.

So Rebecca, for a bit of context, can you describe what do we mean when we talk about birth trauma?

Yeah, of course.

So essentially, when we talk about birth trauma, we're thinking about some aspect of a woman's birth that to them felt really, really difficult and really, really frightening and out of control.

And what that does then is sits with them in their mind or with a particular set of symptoms that can last for hours, weeks, months, years after birth.

And we know that about a third of women find some part of their birth traumatic or difficult.

And we also know that that can be due to things that happen in pregnancy, during birth, or even postnatally, or a mixture of those things, and that just as often, it's not medical events necessarily.

It might be, so it might be that you had an unexpected bleed or you feared that you were going to die or your baby was going to die.

But just as often for women, it's actually about how they're made to feel cared for during birth.

It's those interpersonal factors of the person that is with you.

So feeling alone, feeling unheard, feeling a lack of kindness.

So those things are equally as important, and both of those things can be a source of trauma for women.

And throughout your kind of experience working in this area, do you see that this is something that is growing, that is falling?

Or is it the same?

I think that's really difficult because I think there's probably lots of different factors at play.

Yeah, so I think we're more aware of birth as being potentially a traumatic event.

So until the 1980s, birth wasn't really considered something that could be a cause of trauma.

So it's a relatively new thing for us to be potentially seeing birth as traumatic.

I think that we talk about it more, perhaps know a little bit more about it.

So perhaps we're identifying cases where previously women would have struggled and suffered in silence or been misdiagnosed as having depression.

So I think it's talked about more.

And I think that probably it is slightly increasing.

So there's a big study that came out very recently where it was 40% of women were finding some aspect of their birth traumatic.

And I think that reflects probably women coming into systems at the moment that are unbelievably pressured and traumatized as well.

The pressure on the NHS is higher probably than it ever has been before.

Women are having pregnancies that are perhaps more complex and bring with them more anxiety and coming in towards the understaffed with lots of agency stuff.

So I think there's a whole mixture of factors that perhaps mean that women and men are more vulnerable to finding birth difficult than it has been historically.

And you kind of touched on this already, but do we know what causes birth trauma?

Is it one thing more than another?

So there are a group of women that are more vulnerable to finding birth traumatic.

So they have much higher rates of PTSD, postnatally due to birth.

Women with a history of prior sexual abuse or sexual assault or prior history of depression and anxiety are much more likely to find birth traumatic.

But then actually in the moment, in birth, it's just as likely to be an obstetric event as it is an interpersonal event.

When we look at the big studies, actually the causes are equal.

So it can be because of something medically, but often it's not.

So you might look at it on paper and say this woman had a really quick, uncomplicated vaginal birth, but to her it might feel really, really traumatic.

It doesn't matter what it looks like medically, it's how it feels.

And I always think that's a really important thing to point out to women is that, well, actually you can have an induction and an instrumental birth and it not be a traumatic experience to feel very positive about it.

Equally, like you say, women could have what on paper looks like a really straightforward kind of birth that people would want for themselves.

And for some people that causes trauma for one reason or other.

So if a woman thinks that perhaps she looks back on her birth and thinks that maybe actually it's causing trauma for her or that it was a traumatic experience, what are the kind of steps that she should think about taking to sort of acknowledge that, to kind of manage it, to overcome it?

What do you do and at what point?

So dependent on how you're feeling, I think that's really hard for women, particularly if it's your first pregnancy and baby and you're tired and there's so much going on, it can take a little while to sort of shift and for you to actually think about, I'm not quite sure if this is normal or not.

So I think the first thing is just recognising that something's not quite right.

And really, after a difficult birth, what that means is that probably you feel you just cannot get over your birth.

So it is with you all the time, either you're thinking about it all the time, you're having nightmares about it, you can't stop talking about it, or you don't want to talk about it at all.

You perhaps don't want to go near the hospital, you don't trust professionals.

So if your birth feels like it's sitting with you in a way that is making you feel distressed, and that's with you most of the time, beyond a month after having baby, then perhaps that is a sign that there is something about your birth experience that's been difficult for you.

I think for women, often the concept of the word trauma sometimes can be difficult because we can feel like, I can't be traumatized by birth, isn't that meant to be the sort of greatest thing?

Yeah, particularly if you're at home and you've got a healthy baby and you've got everything you ever wanted.

So it can be very hard to voice that, and it can be very hard to hold in your mind that you're really grieving and mourning your birth experience whilst loving your baby very, very much.

And I think sometimes women feel ashamed to talk about it or feel they can't complain.

And I think that particularly goes for dads, because they feel like I didn't have to give birth, so I really can't complain.

But if you're having those feelings and distress, then the first step is to try and tell somebody how you feel.

And usually, for most people in the UK, that's going to mean speaking to your health visitor, your midwife if they're still involved, or your GP.

Now we know that the response that people get is hugely variable.

Sometimes it's wonderful, sometimes it's not good at all.

So it's about trying to go with somebody, have somebody there to advocate for you.

If you don't feel it was good enough, then perhaps plucking up the courage to go and see a different GP, a different health visitor.

There's also a tonne of stuff on the Make Birth Better website where we've got stories from women which perhaps you might resonate with you, you might think, gosh, that sounds like my experience.

But there's also some free downloadable crib sheets that half are for parents and half are for professionals, which can map out for you some of the things that you might be feeling.

And then we hope that they are a really useful tool because you can tick them off and take them to your GP and say, look, this, this, and this is happening for me.

Because a common story that we hear is often people are told they're depressed and given a prescription when they know they're not depressed, but they can't quite name what it is.

So we hope those will be really, really helpful to help women to be able to identify what's going on for them.

And then it's about getting the treatment and the support that's right for you.

So everybody's experience will be hugely different.

And for some women, it can fade quite quickly, but it's not uncommon to meet women 20 years later who are still traumatized by their birth.

So it's about thinking about what you might need to add in.

And for a lot of people, a really good starting point is therapy.

So it's whether you have access to self-refer to your local IAPT service, which again, sometimes there can be waiting lists that are very, very long, or a lot of women actually end up sourcing private care, which they shouldn't have to.

But unfortunately, you know, can be the only option available.

Sometimes it's about medication, not always.

Sometimes people want to take medication.

And there are a ton of other trauma resources that can be really, really helpful.

So exercise, apps, there are some really great apps.

So it's about what you want is to have somebody explain to you all the different sources of support that are available.

And again, on the Make Birth Better website, we've got a map of local practitioners where you can put in your postcode and find out who's around for you.

And also where we go through all the different types of treatments that you might use, because there's no one way to heal.

You know, you have to pick what feels right for you, and each woman will usually pick a mixture that's really, really different.

And then try something and it might help or it might not.

Exactly.

And, you know, there's no time frame that these things can take a while to heal.

It might involve doing work with the baby or doing work as a couple, because often there can be a huge impact sexually for women, or their marital relationship can be really impacted by trauma.

So, it's about thinking for that individual person.

What symptoms have they got?

What might feel helpful?

Yeah.

What don't they want to do?

And then, you know, making a plan together.

Yeah.

You've kind of touched on a couple of things, but talking about if, you know, the birth trauma is the event that kind of happens, what do we see as some of the kind of common impacts?

Does it lead to things like postnatal depression and anxiety?

Does it often have a physical impact, what kind of relationships with babies and partners?

So, it can be all of those things.

So, obviously, it can lead to a formal post-traumatic stress disorder.

Yeah.

It probably does in around sort of 4% to 8% of women, but about 19% of that high-risk group that have anxiety and depression beforehand.

Women can go on to develop anxiety disorders, depression, obsessive-compulsive disorders are really common after trauma, so often with trauma, it's that you've lost control.

Yeah.

So, then if you can check or count or clean or be very ordered, it gives you some of that control back.

So, a lot of women will have new onset obsessive-type behaviours.

There can be a massive impact on relationships in general, just not wanting to see people or feeling that you can't talk to anybody in your NCT group because your experience is very different and you don't feel you can see them because you don't want to talk about it.

Sexually, often for women, they don't want to have sex because they might get pregnant again and then you might have to have another birth experience.

And often women who've had a birth trauma delay having a second pregnancy for much longer than the average woman who hasn't had a birth trauma.

And there can be huge difficulties in a relationship because one of the common symptoms of trauma is anger and irritability, and usually the people we live with bear the brunt of that because they're with us all the time.

And for some women, it can impact their parenting.

So typically, I suppose you get two routes.

It's the one that women find they feel very, very overprotective of baby because something bad has happened to them.

So they worry that something bad is going to happen again.

So having baby with them all the time, checking baby a lot, or sometimes you can have difficulty to connect with a baby because they're a very small, potent reminder of your trauma.

So in that case, it might be that the thing that's needed is some specific parent-infant work to help create that bond.

So it can affect...

I think the important thing is that it really needs to be properly assessed and treated.

It's very treatable, and the prognosis is really, really good, but leaving trauma sitting there unhealed can ripple out to mum, to her career, to her relationship, to her parenting.

It can have a huge impact for the whole family.

So we really need to get this right for women.

Yeah, absolutely.

So we've kind of touched on partners there as well.

And I suppose it goes without saying that partners can experience birth trauma, but is it likely to be in a kind of very different way to mums?

Can they experience it and mums not experience it?

Like, how does that kind of sit?

So we don't know as much about the rating partners and fathers, particular, say, as we do women.

There's definitely a lot of evidence growing that, of course, anybody in that space, in that room, can be affected, and that includes the health care professionals as well.

So we know that dads can be traumatized by birth, and absolutely, sometimes you may have mum not being traumatized because, actually, she's not seeing it, whereas dad is watching and spectating.

And I think that part of it can be really, really difficult for dads because they feel like everything unfolds in front of them, and they see their most loved person in pain and potentially worrying they're going to be seriously unwell.

And they feel absolutely powerless to do anything to help at that moment.

And men tend to display all the similar symptoms as women, really.

I think perhaps for men, there is sometimes more irritability and anger, perhaps, than women.

And often, we know that men probably don't seek help for mental health issues at a rate that women do full stop.

So I think we know that they're less likely to come forward and talk about their mental health.

And again, I think that is probably the fault of the system in that actually we don't really involve partners as well as we should.

And particularly postnatally, I would really like to see us thinking about supporting the family rather than just mum, because actually then we would capture everything that was going on from mum, partner, and baby.

And it's not just mum, it is a family.

So for us to just look at mum kind of doesn't really make any sense.

And, you know, how often do we see dads at six-week checks or, I mean, virtually never.

But if they were actually included and invited, that would be a really nice way to screen men and women, to just check in and see how they are.

Yeah, absolutely.

I always think that, you know, even the kind of two-weeks paternity leave, you're going, they've just become a parent for like the very, very first time.

Two weeks is not.

So yeah, and particularly if you've experienced trauma and then you've got to go, you know, you expected to go back to day-to-day life kind of pretty much immediately.

Well, think about, you know, commonly where babies end up having to go into neonatal intensive care.

And so instead of coming home and having this time to connect and bond, you know, by the end of that, mum and dad are invariably exhausted.

Babies who need NICU care, that's another massive risk factor for PTSD for both parents.

And then you have dads trying to go back to work when babies not even potentially come home yet.

So to not be thinking about partners and including them is just not the right way to be doing things.

We need to be much better at doing that.

You kind of touched on there something as well, which is probably kind of worth mentioning, is that trauma doesn't necessarily just come from birth itself, but that kind of whole perinatal period, say, from kind of experiences in pregnancy, or the way I suffered with hyperemesis.

And that was an incredibly traumatic kind of experience.

And right through into that kind of period after the kind of postnatal period as well.

So hyperemesis, particularly, is a huge risk factor for PTSD.

And all the literature from this year shows that about 20% of women with hyperemesis go on to develop a formal PTSD.

And I think, in essence, what we need to do is have a trauma-informed system and really assume that we all come into pregnancy with layers of trauma at different times in our life.

Virtually nobody has no trauma in their life.

So I think if we were just trauma-informed and assumed that people are coming in with their own stories of different events and providing care that was trauma-aware to everyone, then the experience would be so much better for people.

What do you mean when you say trauma-informed?

Well, I think, first of all, recognizing that people come with trauma of all different kinds and that some of those traumas make women more likely to find birth difficult.

So then we know then that the things that help women to be less traumatized are things like continuity of care, having somebody that they can have really in-depth conversations with over multiple timeframes to explore alternately what birth might look like so that it's less shocking and overwhelming in the moment, that we're ensuring that women have really good communication, really good kindness, that consent is properly thought about and maybe even planned as an advance-ish thing, rather than in the midst of labour, because consent is something that often is a factor in birth trauma, where women feel that they haven't consented and then procedures feel like an assault almost to some women.

So I think it's just about embedding that in the care that we give to women and being really sensitive to women from the very beginning.

And a lot of it, we could do so much better antinatially in terms of how we talk to women about birth, because often for women, there's a narrative of that they can choose the birth they want or they're led to believe that they can choose the birth they want.

And of course, sometimes that happens and that's brilliant.

But what's lacking from that, I think, is any sort of nuanced discussion around the what ifs of if this happens, what will make you still feel in control, empowered.

And actually, those conversations are really easy to have, but they need time and space.

And say if we're thinking about the sexual abuse group who are 12 times more likely to find birth traumatic, so really vulnerable group.

If we expect them to disclose to a midwife that they see once, it's highly unlikely.

But if we have a continual midwife that sees that person all the way through their pregnancy, has time and space, and they develop trust, they're much more likely to be able to talk about that, and they're much more likely to be prepared, and less likely to be traumatized.

So it's just thinking about that as something that should be vital, and really to me on par with any physical health issue.

Because the consequences are far less manageable if they're not properly treated.

And I think that the important thing to note there is that the two are not mutually exclusive.

Like if you are cared for emotionally and mentally, then it has a direct impact on what is happening from a physiological perspective.

So actually, the three things are very, very closely interlinked.

And what you mentioned about being aware of the what-if situations in pregnancy rather than them appearing.

And this is a big area that I focus on with the antenatal teaching that we do.

I actually had a birth story came through from a family that I worked with earlier this year who had...

They were planning for a home birth.

It was, you know, their thinking about birth and their understanding of the physiology and what their body needed, what they needed to do, was sort of like absolutely perfect, bang on.

And then they came to the course, and I started talking about, you know, well, this can happen, and this can happen.

And it doesn't...

In the right circumstances, these things can be kind of life-saving interventions, and they can be very helpful.

And actually, for this family, some medical things came up that ended up meaning that they gave birth with an induction kind of in the hospital, and they got this birth during.

It was like the most positive, wonderful story, and you just think if people don't have that information and those conversations, and understand importantly their rights and things around giving birth, then that, you know, that can leave people feeling like, oh, fine, I didn't get anything that I wanted, and it was all awful because it wasn't what I was kind of hoping for.

But if we can present this information to people in a way that puts them at the center of the decision making, that ensures it's only ever happening when it's truly needed, and we're not kind of jumping the gun or the kind of too much too soon approach that we talk about, and then supporting them emotionally and mentally, even in situations where things are becoming potentially more medical, then in a lot of, I reckon a lot of cases where trauma has happened, actually it didn't need to have that, like you said, had all of that kind of happened.

And so many women will say to me, I never even considered that I might have to go to theatre.

Yeah.

And my thought is always, we as a system should have made you think about that in a way that empowers you, not to scare, but to inform.

And we do women a great disservice by somehow assuming that they're not capable of knowing these things or making an informed choice, but actually to deny them the knowledge means that of course they can't make an informed choice because nobody's ever spoken to them about it.

Yeah.

And it's perfectly possible to have those kinds of discussions.

And I think we need to be so much better about consent and how we talk about that with women.

I think there's a lot of assuming of consent sometimes for some women.

So silence does not mean consent.

And I also think we need to give women the tools and their partners to challenge healthcare professionals more often, to feel that you're not being a nuisance, you're not being awkward.

You are perfectly entitled to ask, why are you doing that?

Why are you doing it now?

Can you explain it to me?

And a good healthcare professional will not mind being asked that at all, and should be readily able to explain to you in a way that you feel like.

Go and find somebody that can.

Exactly.

So I think we need to enable women to feel that they can ask all the questions they would like to.

But again, that takes having that discussion and I think again, that comes back to partners because a common theme, I suppose I would see is that women feel angry that their partners didn't advocate for them in the way that they expected them to.

But then actually when you ask them, they've never had a conversation about how they wanted their partners to advocate for them.

So whilst I can completely understand their frustration and hurt and distress, it's again about saying you need to be having those conversations together.

So that if I'm in pain and tired and exhausted and I'm not able to ask questions in the way that I normally would, can you please do that for me?

And what might I want you to ask?

So that then everybody feels able in that space.

And these are all things we can do and should be doing.

And I think that's what's so distressing is that for a lot of women, their trauma is completely preventable in so many ways.

Sometimes, of course, you can't predict medical things and how each woman will respond to that.

But actually, usually what makes the difference for that woman is whoever's with her in the space.

So I can see women who've had a chain of things happen to them, but they had the most amazing support on the day and walk away feeling relatively okay.

There was somebody, again, that has a very straightforward birth on paper, but feels completely alone and feels totally bereft from that.

That leads us on to another conversation that's probably quite helpful to have.

If there's any women listening to this episode who haven't experienced birth trauma, maybe they're expecting their first baby, maybe a subsequent pregnancy, what can we be doing as women to protect ourselves as much as we can from experiencing birth trauma?

And you mentioned one thing, having conversations with your partner about what you want from that experience, what you want them to do, to be for you.

Is there anything else that we could be thinking about or considering as pregnant women?

So that's hard, isn't it?

Because I feel like the owner shouldn't solely be on women.

It needs to be a mixture of women and the system, of course.

But I think it's all the things we've discussed with you.

So to know the range of births that can exist, to have thought about all of them at least.

Of course, of course, of course, you can have your preferences.

But maybe think of it as preferences rather than plans.

Try to be as fluid as you can.

If you have tools that work for you around breathing and techniques, fabulous.

And build all of those in that you can.

And know what the options might be and what it might look like.

You know, have really thought about that together as a couple as much as you can.

You know, I think the other thing that I say to people, and probably there'll be loads of people cursing me as I say this, but you know, if you get into a space early in labour, who's going to be with you as your midwife usually for most women is really important.

So if you have the luxury of a doula, brilliant.

That can be absolutely game changing for a lot of people.

But if you get there and you feel immediately unhappy with the care that you're being given or you don't click or this person isn't communicating with you, ask to change.

It is possible.

And that person, for you, is vital because you can have prepared brilliantly and be informed and know how to challenge people.

But if you don't feel instinctively and often women will just say, and I just felt from the moment this person came in the room that they weren't really there for me or they weren't looking at me or they seemed cross or they seemed fed up.

And I know that feels really difficult to actually say, hang on.

But you can ask for somebody else.

And I think we need to be better at allowing women to do that.

I think people always say to me, but the NHS is free.

I don't know about you, but I pay my taxes.

So the NHS is not a free service.

It's something that we all contribute and pay to, pay for.

And if you're in a situation where you went to your GP and you thought actually maybe I need a second opinion, you would go and seek out a second opinion.

And the same can play into birth.

If you're not feeling supported or looked after, then you can ask potentially to try it with somebody else.

I think absolutely.

And I think don't worry about seeming difficult.

And I think people are inherently lovely and nice.

They want to be nice and they don't want to offend, but you're not offending.

So if you just feel there's something not quite right there, you can always ask for somebody different to be there.

And I think the rest of it is really about preparing sort of mentally as best you can, which is very difficult because it's preparing mentally for something that is inherently unpredictable.

So that's two difficult things to hold together.

But I think knowing the range of birth options that might happen and having just had a thought, think about what you might like or not like, if possible.

Having a really open dialogue with your partner.

If you've got continuity of care, amazing, because that can make a huge difference for you as well.

And just not being afraid to challenge people in labour and to ask why things are being done or to ask for things to be, say, what are the risks to do nothing and wait?

And instinct, trust your gut.

So many people have such powerful gut instincts about what they do or do not want.

And there's a lot of literature around that.

Yeah, it's amazing.

And I think if you're able to tap into that, don't let it be silenced, trust your instincts, go with it.

I would say there's sometimes, like, your body and your baby sometimes have a weird way of communicating with you, even if you can't necessarily put your finger on exactly what it is.

And that can go in both ways.

That can go into actually feel like I'm being pushed into something that doesn't feel quite right.

But it can equally go to actually, do you know what, something just feels off and I don't know what it is, but I think I want to be doing something.

And so yeah, absolutely, that's a really, really important thing.

And so don't, I would always say, don't underestimate that kind of internal state.

I mean, if you're able to tap into it, I think it can be really helpful and really powerful.

And don't let anybody silence that.

Yeah, absolutely.

Cool.

So kind of moving on a little bit then, I suppose we've kind of been talking about this kind of throughout, but is there anything else that you would add?

Because like we said, we don't want the responsibility of experiencing birth trauma absolutely should not fall just on the shoulders of women giving birth themselves.

There are things that we can do like making sure we've kind of accessed information, like ensuring that we've had conversations with partners and things.

But ultimately, the bulk of it's got to fall on the system that we are giving birth within.

I know that that is kind of a big focus of some of the work that you do with Birth Better.

Do you want to tell me a little bit about, for the people that don't know what Make Birth Better is, do you want to kind of explain what that is first and then we'll touch on that?

So Make Birth Better is a collaborative of parents and professionals all across the UK and actually all across the world increasingly.

Our aim is to reduce birth trauma, and we do that via campaigning, training, research.

We set up around two years ago, and we've grown really exponentially financially and have a very active platform on Instagram in particular, where lots of parents with lived experience, I think, find that a very supportive platform.

We've worked really hard to be very inclusive, because I think sometimes what can happen in the birth world is it can get very polarised camps who are very pro one thing, and can sometimes perhaps get a bit shouty at each other.

And then what happens is that people get lost in the middle of that.

So we've worked very hard to be a sort of platform where all views and voices are to be heard and respected.

And I think people following us can really feel that.

And I suppose what also makes us slightly different is that we see a key part of our work is recognising that trauma is not just for families, but is also a key part of the problem is that the trauma is in the system that's providing the care.

And then you get a vicious circle of trauma for women.

So we very much want to address both things because we feel that without looking at both, things aren't going to change enough for women.

Yeah.

And so let's touch, I know that there are some kind of healthcare professionals that listen to this as well.

So let's touch on that, that trauma that midwives, obstetricians, anybody kind of working in that system itself, that they experience and the impact that that might have on their practice.

So this year in particular, there's just been a huge amount of new studies, and I think unfortunately what they've shown us is that people working in the system are very, very stressed.

So we have the WELM study, the Indigo study, where massive rates of midwives are suffering from depression and anxiety and PTSD.

And the Indigo study, one in ten obstetricians were working with an undiagnosed PTSD.

So you've got people there day in, day out, and we know how hard they work.

They work really long hours, often with no gaps in between, that are seeing a lot of trauma day in, day out, and then becoming traumatised themselves, understandably.

And what then happens is that people become burnt out and really haven't got the emotional resources to give to women coming on to the birthing unit.

So what you have is stuff that, and I think we can all think about this, that's perhaps happened to us, that are there in the room, just about, but not really giving anything more.

So they're going through the motions, but emotionally they're not really giving us very much.

They're competent, they're not particularly kind or compassionate.

And then we know that that kind of care is much more likely to make women feel traumatised.

And so then you just have this whole loop of trauma going on.

And what we really need is for a recognition of that, for how hard teams work and for how many are traumatised.

And we need spaces for teams to have meaningful, proper supervision and reflective practice.

So we're about to launch a report at Make Birth Better where we had a survey of over 5000 women and healthcare professionals.

And the one thing that all healthcare professionals are saying is we just need some support and supervision and a space to reflect.

Because what we do is we come into work, we work really hard, it's like do, do, do, do, do.

And then nothing within that is a space for us individually or as a team to process what we're seeing.

And so it's completely understandable that people would feel traumatised.

Of course, it can never, never, never excuse poor care to women.

That goes without saying.

But we need to be really looking after our frontline team because we know that there are record numbers of midwives, for example, leaving, that people are leaving sooner in their careers, that people aren't coming into the system.

And we need to protect our teams and really value them.

And that would be part of systems being trauma-informed is that that would also include the staff.

So there's some places, particularly in the States now, where they work on a whole trauma-informed model and have regular groups and supervision for everybody in the space to process events that they're going through.

Because if you think about a 12-hour shift, there might be a stillbirth, then there might be a medical emergency, and then you go home and then you're back on again for another 12 hours, not 12 days.

That would be too much.

And these are really amazing people that want to provide care, but they're just being hurt by the system themselves.

Yeah, nobody goes into a caring profession because they want to do anything other than look after people and care for them.

I always found that those 12-hour shifts, particularly if you've got three or four in a row, you can kind of run out of caring.

Like, you can run out of...

I would get home, and if anybody asked me for anything, you'd be like, no, that's it.

Like, I've cared as much as, like, I don't care anymore.

And so, yeah, you do need that...

You need that time off.

You need the conversations.

You need to be looked after yourself in order to be able to give because caring takes a lot of energy out of somebody.

And also, we want...

You know, we want the NHS to provide the best care.

So to be able to do that, we need to prioritise the health of the people working within the NHS on par with the people being treated by the NHS, in my opinion.

And if you look then at the impact of not doing that, you know, lots of agency staff, no continuity.

They don't know how the system works, so you get even poorer care provided to women coming into units.

So actually, it just needs to be shifted, and the whole system needs to change in how it looks after its teams as well.

Okay, so kind of the final thing, I suppose, to talk about would be if women have experienced birth trauma or trauma of any kind to do with their pregnancy or the postnatal period, and at some point, they're thinking, you know, I want my family to be bigger than it is now, approaching kind of a secondary subsequent pregnancy.

I know for me, that's been something that we've put off for years with the kind of fear of experiencing pregnancy in the same way that I did the first time, and I imagine that my experience is probably fairly low level in comparison to what a lot of women kind of are taking with them going into that.

And we kind of, I suppose a lot of it will be making sure that they've accessed that support to kind of process what happened the first time.

But is there anything else that you would say to women who are either pregnant now and thinking, God, I've got to give birth again and I'm really frightened, or people that aren't quite at that point yet, but are thinking at some point in the future, I would, you know, want to have another baby?

So, yeah, the first part is absolutely having had the right treatment initially, so rapid access to trauma specialist care, hopefully, so they're able to process the first birth.

Yeah.

And then it's very...

Well, just on that.

Yes.

I know that something that a lot of hospitals offer is something called a birth reflections meeting.

Can you explain what that is, what your experience of that is, if people find it helpful?

So, typically, what it is is going back to the hospital and seeing a consultant midwife or an obstetrician, not necessarily anybody that was present at your birth.

They would have your notes, and you would have time to ask questions and go through what happened at your birth.

I think the evidence for it is very mixed.

So it very much depends who's doing it and how they're doing it and where they're doing it.

For some women, asking them to go back to the same unit after you've been traumatized, they can't even get out the car park because it's too overwhelming to be back there again.

So I think we need to be more clever about how we offer that to those group of women.

And sometimes it's helpful for women because perhaps they want to know chronologically what happened.

They perhaps have gaps in their memory, and perhaps it's very helpful for them to realize why things happened at a particular time.

I think for others, it doesn't feel helpful.

It feels more like a sort of defensive practice of we did everything right.

And that understandably feels really silencing.

So variable, I would say.

It is definitely a thing that is offered most routinely to women.

I think it's something like two-thirds of all trusts now offer it.

So I think it's about thinking about whether you feel it might be helpful for you.

If you feel there are gaps and you would like to know, then perhaps yes.

Go with your partner, take a list of questions, ask for a written summary.

That can be really helpful.

If it's more about you feeling traumatized by the whole experience, sometimes it's helpful, sometimes it's not.

Going forward into second pregnancy, it's invariably hugely anxiety-provoking for women because, of course it is, because you're asking yourself to put yourself back into the same traumatic experience.

A lot of trusts now will offer a specialist birth-planning meeting with a consultant midwife where you can talk through what happened last time and think about what you might want to do differently.

And I often say to women, it's sometimes about what you don't want to happen again, rather than what you do.

That can sometimes be a good way to think about it.

A lot of women will want to have a planned caesarean because they feel that that is what would give them more control.

And it's to know that you can absolutely ask for that.

It's within the NICE guidelines.

I think, unfortunately, a lot of women are still made to jump through a lot of hoops in order to get that agreed.

But there are a lot of places that are very good in agreeing with that.

Sometimes women might have more therapy in the pregnancy to just re-manage their anxiety, think about their birth, think about what they want to happen.

Sometimes women want to have a home birth because they never want to go tough at all.

And actually, something that I always talk through, is sometimes, I don't know if you've found, but it's sometimes quite helpful to think of it like, I'm either going to go very holistic home birth, really, really focus in on the physiology and the support and all of that, or women find it kind of helpful to go, I'm going to have a planter's area, it's going to be calm, I'm going to know what's happening.

And so either of those can potentially be quite helpful.

I think both of those are common pathways and can feel really healing.

So I think it's just, again, same thing, loads of conversations with your partner about what happened last time, for both of you, how it felt.

What might feel better this time, and what might that look like, and can that be achieved?

Is that having somebody different in the space to support you, a different family member, a doula?

Where might that be?

It might be just swapping to a different hospital feels better, or pushing for a caseloading team so that you see the same person every single time.

Or it might be about pain.

Sometimes it's often about pain, choices and options that women feel they weren't offered.

Could you have a very early epidural?

Would that feel better?

Or do you not want to go down that route again?

So it's just having really in-depth conversations about it.

Again, on the Make Birth Better website, there are loads of stories from women about positive second birth experiences after trauma, which I think for some women can be really, really helpful because it can just feel like something that can never happen for you.

So it's really good to hear people's stories where it did happen, even after very difficult first experiences.

Or not even first, maybe second or third.

So I think it's knowing that it is possible.

It takes a lot of courage, and it probably will feel really scary at some point.

But build in as much support as you can and as you need to make it feel better for you.

Yeah, fantastic.

Okay, so is there anything else that you think we've kind of missed or skipped over or...

Oh gosh, we could keep talking.

We could keep going for hours.

I think I just want to, you know, encourage people to feel able to speak up if they are still really stuck about their birth and to not feel guilty about that, to not feel ashamed about talking about that in any way, and to know that there's loads of different ways to heal and find support.

A lot of people would never come and see a healthcare professional, so they might do it all online, or peer groups, or Twitter, and that is brilliant.

I think there's a lot of power in that sometimes, because you can be anonymous, nobody knows who you are, where you live, and you can say things more freely that perhaps you would never say to me.

And that's totally fine.

You do whatever works for you.

Yeah, absolutely.

So the final question, then, that I ask to everybody who's a guest on the podcast, is if you could gift any pregnant or birthing person one thing, what would it be?

Such a hard question.

It can be a real thing, or it can be a totally abstract.

So I want to give everybody, this is not a real thing, but I hope it will come, a trauma-informed, trained midwife that goes with them through their whole journey, and that means birth as well.

So they have this person, Antonata Lee, at birth and post-natally, because I think for a lot of women, that would be quite magical in what it could do.

I can't tell you the amount of guests that we've had on the podcast, but that has been their gift, and I think that just goes to show how much of a difference that can make.

And it is something that the NHS are kind of trying to set out to achieve.

Is it fine?

Well, they're trying to achieve it, but again, when we surveyed it, actually a lot of people weren't having continuity of care at all.

And I think what's missing from the continuity of care that is going well is that women have it antenatal and postnatal, but not in birth, not in labour.

And that's actually when you really need it most.

You just want that person there, don't you?

When you're at your most vulnerable, to have somebody there that you've already built a relationship with and knows all about your hopes and wishes and fears is just what you need at that moment.

Yeah.

So here's hoping in a few years.

It's fantastic.

Well, I think that was a really informative episode, and I sort of...

I worry that it might be really triggering for people, but I think that that's all been really quite helpful.

So thank you very much.

Yeah, I mean, I think we...

We want to talk about birth trauma because we want people to know that potentially parts of their birth can feel difficult.

Yeah.

And that's, again, not to scare people.

It's just to know that if that was the case, there are lots of ways that you can seek support and heal.

And again, it's about just giving women all the options and choices and knowledge about how birth might be.

Of course, for loads and loads of women, birth isn't traumatic, but I think actually for most of us, it's probably somewhere in between.

You know, there are bits that are fabulous, bits that are painful, and bits that we wish hadn't quite gone the way we hoped.

It's a gray area, isn't it?

So I think the more we know about how that might feel or be, then the better we can reflect on that and heal from that.

Yeah, amazing.

Well, thank you so much for joining me.

Thank you.

Thank you so much for listening to this week's episode.

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