Episode 8: When birth doesn't go to plan. A conversation on Birth Trauma.

What is birth trauma really? How do you know if you have experienced it? Is there anything that can be done to prevent it? 

In this episode, we delve into the complexities around the unpredictability and personal/societal expectations around pregnancy, birth and the postpartum period and how this can lead to birth trauma.

Transcript

SPEAKER_02 0:00

Although this podcast is run by experts in the field, the advice given may not apply to your individual situation and should not replace the advice of your doctor or midwife.

SPEAKER_01 0:13

Welcome to both sides of the bump.

SPEAKER_02 0:20

Hi, and welcome back to both sides of the bump. Today we're going to be talking about a very special topic called birth trauma. We really want to kind of understand the experience and work out what we can do to help as health professionals and also I guess give people sort of a bit of direction as to how they can help themselves as well. I guess disclaimer for this episode is that we are probably not experts in this particular topic. So we really just wanted to make this a bit more of an open conversation, just starting the discussion around birth trauma, especially because we've just passed through birth trauma awareness week here in Australia. So yeah, I guess we just wanted to talk about it. We're really open to extending this conversation to another episode if there's anybody that wanted to come on and be a guest and go through their experience. Yeah, what do you reckon, Shavi?

SPEAKER_00 1:24

Yeah, I think um I think I I echo that completely, Steph. I think that it's important that birth trauma is not just something that is discussed in a one 30 to 40 minute episode. Um, and probably it has been in the past, tried to be addressed very rushedly, which is often the reason why um trauma can even occur. Um but we uh we reckon that this episode might at least give you an idea of what you might expect, or even maybe give you some tips on how you can help your friends who might have been through similar situations as well. Um it's been in the media a a lot recently, and birth trauma, I think we're talking about birth trauma specifically, but there are other terms that people have used to describe similar experiences, um like uh obstetric violence, which personally I I think is a terrible term. I hate it. Um I I think birth trauma is a much more uh uh encompassing term and probably a better reflection of of what uh what the intended meaning is. Um so what is birth trauma, Steph?

SPEAKER_02 2:30

So I think part of the problem or has has been a problem for for the past is it is really hard to define because everybody experiences it differently. Um but if you had to sort of put a definition of it, it would be either the physical or psychological injuries or distress that occur during or as a result of childbirth. And it's really important to mention that it can be the birthing mother, but it can also be partners that are affected and even healthcare professionals who witness the birth. And I think working in the industry as long as we have, we've definitely had moments where I I mean, I don't know if I'd specifically say trauma, but certainly things that have stuck with me and I have a very vivid memory of experiences. So maybe it is, you know, and I think we really need to start acknowledging that for healthcare professionals as well.

SPEAKER_00 3:30

I think that's really important that you said that it's about the birth trauma. The birth trauma is about the experience because it doesn't birth trauma doesn't necessarily have to reflect a medical complication or uh or a birth uh like a like a birth injury, physical injury, or even a psychological injury specifically. It's the experience, it's what the what the woman or or the what the person who's experiencing the birth trauma um would be that the woman or her partner or um or even the clinical staff is is how they've experienced that situation. Uh, and I think that's really important in the definition.

SPEAKER_02 4:07

And so it's it's about one in three women that will report their birth as traumatic, which I mean, I don't know where they're getting that number from because are they interviewing every single person that's had a birth? I mean, I I certainly don't ever remember being asked if I if I felt like my birth was traumatic. I don't know.

SPEAKER_00 4:26

This is also the thing, right? Like if you ask somebody, was your birth traumatic, maybe they're more likely to reflect on it and think that maybe it was, as opposed to uh a woman volunteering that she experienced birth trauma. Um, sometimes it takes that question to be asked to be before it's considered to be traumatic. Um, I mean, we we'll talk about types of birth trauma because there are lots of different types, and I think the the really obvious types of birth trauma are the physical types, so things like uh major perineal tearing, um, pelvic floor muscle damage like levata ani injuries in particular, um, prolapse, bladder or bowel injuries, or or bladder continence or bowel incontinence. Um these are the sorts of things that can that are that can cause physical birth trauma. Um, instrumental delivery, caesarean delivery, caesarean wound complications, postpartum hemorrhage, so big bleeds after the birth. These can be particularly traumatic for for women, but also their partners who often witness um a lot of them uh and actually see what goes on when when their partner is bleeding very heavily after a birth. Um so these are the sorts of things that can cause physical birth trauma.

SPEAKER_02 5:42

Yeah, even just you hearing hearing you say that, yeah, the some of the stuff that we see and we are just so, so, so used to. I yeah, coming from a support person perspective, it it can it would be so terrifying if you just saw blood pouring out of your the person you love most in the world, yeah, and being completely helpless to doing anything at all.

SPEAKER_00 6:07

Um the other thing that I've noticed is a lot of the time the partners are the ones who are a bit um neglected in the uh process and the debrief.

SPEAKER_02 6:15

Yeah.

SPEAKER_00 6:15

And so the partner, whereas the the woman herself often isn't really fully aware of what's going on because they can't see things, uh, depending on their positioning and what what the complication is. But let's let's take the bleed as a as an example, postpartum bleed as an example. Um, the partner can see everything. The partner can see the blood on the floor, they can see the faces of all the staff that are coming in, um, they can see all the staff, the number of staff that come in. So it can be quite um scary for a partner, like you said, watching the person they love most in the world, uh, and and I guess not really knowing whether they're going to survive or not. And often the staff may not in the moment have the time to reassure or to explain what's going on, and that also can add to the the trauma for the partner.

SPEAKER_02 7:05

I think we are getting a bit a bit better at it. I think um part of a lot of the recent years of emergency training that I've done has been there's been a really big influence um on setting somebody up to be with just the partner and explaining all the you know the birth support, explaining what's going on, making sure they're sitting down, making sure they all their questions are answered. So yeah, I think we're we're definitely getting a little bit better at that, hopefully. But like you said, sometimes you just don't have the time. You just don't have a spare, spare hand to do it. Yeah.

SPEAKER_00 7:44

And I think that's why we're having this discussion is to try to make sure that even though we don't we may not have time at the time of the incident, um, we should be able to make time. And and I think that if you feel like you haven't had the time made, it's okay to ask for it too. It's okay to have the time, to ask to have the time made to discuss it or to go through it and answer all of your questions or any of the concerns that you might have had around your birth.

SPEAKER_02 8:12

So they're the really probably the physical, obvious things that might happen, but there's just a whole bunch of psychological things or effects that you might have from birth. Um, just you can just feel helpless, you can feel in shock, um, you can just have so much, some some people just hold so much fear around birth, even going into it and then through it and coming out of it. Um, it can manifest as things like anxiety, panic attacks, you can see difficulty bonding with baby, um, even just simple things like not wanting to talk about the birth or avoiding that conversation. Um, and then there's going down the path of post-traumatic stress, depression. It's just it's so broad, which is again why it's so hard to diagnose um and even and manage. Yeah.

SPEAKER_00 9:05

Yeah. I reckon that a lot of birth trauma comes down to um not just what happened, but how what happened is interpreted or experienced by you yourself. So, like I I often give this example to my students or my trainees, which is that let's say we do a forceps birth, a vaginal forceps delivery. And for us, it might be the most straightforward forceps, like we do a small, maybe a small episiotomy. The forceps is very, like very straightforward, you don't have to pull very hard. Um, baby comes out great, screaming, crying, um, there's not much bleeding, uh, everything goes really well. And so to us, we think that's just a very straightforward, beautiful kind of forceps birth. For the woman herself, that may be her only forceps birth, and she may feel like it's the most horrific thing that's ever happened to her. Um, and that discrepancy in the experience of the event might reflect on how the clinician discusses it with the patient. So we see this even with cesareans. Um, so I will make it a point to, no matter how straightforward the Caesar goes, whether it's straightforward or not, I will make it a point to choke talk to the woman straight afterwards initially, just to say, explain exactly what happened, say it was straightforward or not. I'll tell her exactly what it how it went, and then make sure that she's okay and that there's in uh and explain what would happen next, like what the next steps are with their Caesar recovery as an example. Um and I think this is a good, even if it the patient doesn't necessarily hear everything in that first discussion, I think just the fact that you go back and have a chat to them about it um makes a big difference in their long-term recovery as well. Um, and it doesn't have to stop there. So you can keep discussing it with them into the postpartum period as well, which I think will make a big difference.

SPEAKER_02 10:55

Well, I guess they just feel heard by you saying that. And they know that yeah, and they know that they can then bring that conversation up again because you've almost made it okay to talk about straight away.

SPEAKER_00 11:09

Yep. And I think that's really important. I think we and like you said, Steph, I think everybody is getting better at this, like compared to when I was uh when I was a student or a junior trainee, um, everybody's realizing how much of an impact uh birth trauma can have on not just the recovery, but also on the bonding between the mum and the baby and relationships between the mum and her partner. Um and these are things that can be quite easily uh, or not maybe easy is the wrong word, but but but can be prevented by appropriate discussions around and post-delivery. Um and I think that the these days we are also in another uh another era which is different to 20, 30 years ago, which is that now um women are getting information from multiple multiple sources, and uh and the the sources may not always have accurate information. So things like social media, um, even their friends and family. And sometimes the information that they're getting is is uh provides them with either extreme, uh either extreme of either unrealistic expectations of their birth or even the other extreme, which is fear-based misinformation. So they get too much statistics about what can go wrong, and that makes them more afraid of what what might happen in their birth, even though it might not happen. Um and then when when particularly in some systems, when you see one clinician who tells you one thing and then you see in the next visit, you see another clinician who tells you the opposite, it can be very confusing, and that can that can lend towards birth trauma as well. Um, that's just even in the antenatal period.

SPEAKER_02 12:55

And we've like we've talked about that continuity of care before and how important it can be. Just yeah, getting the same information from from the same source that you trust and that is reliable is so important. Um, but yeah, just all that external stuff is just uh it just feels like so much pressure on women to do something like so that they have to do it perfectly, they have to do it really well. Um, and if they don't, it's it's bad, and they're bad, and they haven't started off that journey into motherhood like they wanted to or like they believe they had to. Um it's just yeah, it's so much pressure. And I find it really I what I find really difficult is it sort of explaining to people a happy medium between too much information and not enough information, because not enough information can lead you down the path of not understanding anything and being really fearful of everything, and then too much information can do have the same effect because so there's a definitely a balance point in the middle of that.

SPEAKER_00 14:10

Yep.

SPEAKER_02 14:10

Yeah, which is really hard to to gain to get, I think, as a as a person going into birth, or even just somebody educating and somebody being there along the journey.

SPEAKER_00 14:20

And I and I'll tell you, I'll be honest with you, like I have I get it wrong sometimes. Like sometimes I'll tell a patient too much, too much information, and then I realize uh as her eyes widen and she gets more frightened, I realize, whoops, I'd probably give you just a bit too much. Um and then I'll I'll back down and I'll say, look, I don't uh like if you if I'm telling you too much stuff, we don't have to go to this level. So it and you have to tailor it, and the and it's tricky for the healthcare professional too, because different women need different amounts of information, different women need different discussions tailored to that individual, and it may take a while before the clinician is able to understand how much each individual needs. Yeah. Um I think the the important thing about preventing uh birth trauma is to try to I think to try to help the patient understand what has happened and why it's happened and what could have happened and maybe what they've escaped as well can help. Um and that might help to to make a difference. But then if you tell a patient that she almost died but she didn't, I don't think that would be particularly helpful for to stop her birth trauma. Um even though it may be the truth. Um and so I guess finding that balance can be tricky and it it's harder when you don't know the patient uh very well, like in a public system.

SPEAKER_02 15:52

It is really tricky. So um I know obviously with your private patients, that's something that you would routinely do. You'd chat to them afterwards and probably again later on down the track. Yes. It's not really something, I guess, that's uh offered routinely in a public system, um, unless somebody unless it's recognized that the birth was traumatic by whoever determines that definition. Um or the woman herself says or the the family says, We I would like to come back and have a debrief. But do you reck do you think there could be a way that we could incorporate that somehow postnatally for everybody? I just I just don't know. It it would be, yeah.

SPEAKER_00 16:40

There could be a way, like even in the public system, I think the tricky thing with the public system is um the person who delivers your baby may not ever see you again. Um and probably the person who's best suited to do the clinical debrief would be the person who's involved in whatever's gone on, like whatever's caused the trauma. The other thing is the birth trauma may not be evident straight after the birth either. So, particularly psychological trauma may not happen till six to twelve weeks after sometimes, um, when as everything sinks in and the questions that you have remain unanswered. Um so even a debrief straight after the birth, which is the best time in a in a short-term setting to debrief, uh, may be forgotten by the time that the trauma is setting in. Um so for that you'd need a uh like a postnatal clinic debrief. And ideally, with the person who delivered your baby, that's very difficult to achieve in a public system, at least in the system we've got in Melbourne, um with uh the with funding as it is as well. Um but also uh making sure that you see the same doctor in a public system is it can be very tricky too, because that doctor may be on a rotation, they may never, they may only be at that hospital for three or four months before they move to another hospital. So you may never see, like they may never actually be in contact with that clinic again. And that makes it tricky too.

SPEAKER_02 18:10

And I know that um even in the two public hospitals that I've worked in, they do have really great debriefing clinics, but it is a group of people that run them. So basically you will just see one of those people. So it's it's it is pretty unlikely that that person would have been um involved in your birth. So they're gonna get a lot out of it, absolutely, and they've just been the most incredible thing. But yeah, I agree. I think it I think it's so much more helpful when it is somebody that was there.

SPEAKER_00 18:41

Yeah, and to be fair, the the events of the birth should be very well documented. So the person who is giving that debrief will be able to give you some detail, but they may not necessarily be able to tell uh the the patient what the um what the clinician who was at the delivery was thinking. Um whereas if you were the person at the delivery, you could tell the patient what you were thinking and like your reasoning behind things. Um and that's I think the another difference there too.

SPEAKER_02 19:11

So when we do get the opportunity to debrief with somebody, um, some of the things that we might kind of go through with you is yes, like you said, understanding what happened, talking it through, asking you can ask questions, um, and just kind of trying to reduce that confusion and and fear and even self-blame that sometimes can occur around that when when you don't fully understand what's happened. Um, they'll probably talk about it sort of incorporating some uh emotional or psychological support. So that might be something like counseling, uh support groups, and and how you can get your family and friends involved as well. Obviously, if there's anything medical that needed to be followed up, hopefully it already has, but sometimes things can get missed. So that that might be something that's uh involved as well. Um and then what should really happen is talking about future births and creating plans around that really early on so that uh if that if if we do see another pregnancy, we can we can be prepared, we can go into it knowing exactly what you need particularly and framing that care around it. And hopefully it can have some sort of continuity in it as well is ideal. So I know um a lot of hospitals will have uh particular clinics that are uh for previous trauma, traumatic births, um, or it might be, you know, complications and things like that. But yeah, just having uh some sort of continuity there is is probably quite important, like we've mentioned. Um and then yeah, just giving you all skills, giving you techniques, what you can be doing, understanding your triggers, how to manage them. Um yeah, there's there's just so much that's involved. It it is really uh there's a the specific courses that health professionals really need to take to be able to do those debriefs because it is it is really involved, I think. Yeah.

SPEAKER_00 21:22

With um with trauma, I mean we brushed on it already a little bit before, Steph, but I wanted to delve into it a little bit more, which is this idea of um of misinformation resulting in birth trauma. So or or um uh high expectations or maybe unrealistic. I think unrealistic is maybe unfair because a lot of the time you don't really know what's going to happen. So to call something unrealistic ahead of time is a bit unfair a lot of the time. But um but I wonder whether uh like very high expectations or or thinking that you will be able to do it a certain way or be in control of what happens um with your labour. About your birth, um, I think that that might be a significant contributor to um to birth trauma in in both directions. So like if you if you know a lot of a lot about what could happen and you're determined to avoid some of those things, or vice versa, if you know a lot about what could happen, but you're determined to have or to experience some of those things that that are positive to you, um, when actually you don't actually control it, and and nobody really does. Uh the doctor doesn't, the midwife doesn't. Um and all we really can do as healthcare professionals is to optimize the outcome. Um, but some patients are really um, I guess, determined to have a certain certain birth experience and set themselves up that if they don't have that birth experience, it can be very difficult to come back from that. Uh, what do you think about that?

SPEAKER_02 23:04

Yeah, I think one thing that's changed probably over the last maybe couple of years quite significantly is moving from this idea of birth plan to having birth preferences.

SPEAKER_00 23:18

Yeah.

SPEAKER_02 23:18

Because it is it is great to have the preferences, and I think it's really important for every individual person to acknowledge what they want and what they think will be best. Um, and then for also us as health professionals seeing that written down and going, okay, great, we can work towards that by doing X, Y, Z. Um, but at the end of the day, it is a preference. And if things change and the plan deviates slightly, um, the path, you know, is a little bit little bit off that straight, that straight narrow road. Straight narrow road. Then that's okay. You know, and that's not it's not that something's bad has happened. It's not that um you've done something wrong or we've done something wrong. It's like you said, just that out of it's not in it's not in our control. That's that's all it is.

SPEAKER_00 24:10

It's in I I like how you mentioned the straight road because that's actually the analogy I use for my patients too. I say that your pregnancy will head along a pathway, and as long as it's going well, we just keep going down the same pathway. And then at any point, and it and it can shift really quickly, but at any point it can shift. And when it turns, when the path shifts, we have to turn with it. And it's only when we don't turn with it that we hit the barrier, and that's when things go wrong. So if we shift with it, then everything will be okay. It may end up with a different uh out uh different um experience, but you still will be safe and your baby will be safe too, as long as we shift with those changes. And those changes happen sometimes very unpredictably and sometimes in a very short time frame, like not without enough time to really let it sink in at the time it's happening. Um and this can happen, it's just part of it's just part of birth, I guess. Um and and the way that we describe it to to our patients is also very important so that they know that there's they can still be safe if we shift, but that it it's okay um to shift.

SPEAKER_02 25:22

So it's yeah, knowing these things going into it is is what's important because I think so many people would just go into birth not knowing that it's okay for things to slightly shift and change, you know. Um but yeah, I guess that's where that sort of antenatal education uh comes back into it. Yeah. Um, so if we've kind of had some sort of experience, we're not sure, we we think it might be traumatic, we think it might just be worth a conversation, I guess you could always chat to, yeah, friends and family would be a really good place to go. Um, but there are really great support services set up for birth trauma. So um the main one probably being Birth Trauma Australia, the website. So they have um and I didn't really know, I had to look into this.

SPEAKER_00 26:17

It's a great service, yeah.

SPEAKER_02 26:18

Yeah, yeah, really, really good. Um, so they have just a whole bunch of guides, so downloadable guides that you can read through. Um, they have a 24-7 peer support group, so that's through a Facebook support group that you have to kind of be a part of, so you have to join. Um one thing that actually really surprised me, and we talked about this in the last episode, uh, was the public, yeah, public health physio appointments and how they can sometimes be a bit challenging to access. But this Birth Trauma Australia have a free public floor physio telehealth appointments that you can book. Which I just think is, yeah, how incredible. So they've obviously acknowledged that it is a huge part of birth trauma and it is something that can linger for years and years um and needs to be addressed when it yeah, sooner rather than later. So yeah, that's that's at the top of their the top of their list of the things that they do, which I think is amazing. Um they then also have a whole bunch of resources for health professionals as well. Uh, because like I said, most of us aren't that's not our area of expertise. Like sure, we we've we've got experience and we we can talk to patients, but we don't have that training. So it's so good to know there's some way you can get training. Um and they also do a whole bunch of um a whole lot of information on birth preparation as well. So it it might be stuff that we talked about, you know, having that that preference list, but not necessarily a plan. Yeah, so gr it's so incredible, yeah.

SPEAKER_00 27:53

It's really good.

SPEAKER_02 27:54

So and you can get you can obviously get debriefs like we mentioned through your hospital. So if it's a public hospital, it's hopefully gonna have a debrief program that you can access. Um private obstetrians like yourself, most of the time will be giving that debrief at some point. If not, you can definitely, I would say, make an appointment after the fact.

SPEAKER_00 28:17

We will I think we'd all be very happy to talk about this stuff because if you're if I think if you are happier with your birth, your next birth will be happier as well. Um if you are traumatized by your first birth, um, it can it can definitely lead into your next birth or your next pregnancy, or even make you decide not to have another pregnancy, which is devastating for somebody who was planning one. Um and so those sorts of things we can talk through and we can um help you get through. And uh and that might be it might be all you need um is just a clear discussion about what happened, um maybe even why, and then also whether or not, well, what the likelihood is that something similar would happen again.

SPEAKER_02 29:04

Yeah, I think, and also just acknowledging that it doesn't have to be a label. Like if you don't want to have this label of I have birth trauma, you don't have to. You can go in and just talk to somebody and you can get whatever help you need to just work through whatever's happening in your mind. Um, but also for some people, and I I I purposefully did a little bit of research through through a few people that had had talked about their birth trauma, and actually having that label for those people was helpful because they could say, Oh, there is a reason why I feel like this, and there's something I can do about it. So it can be, it doesn't have to be, but I think just reaching out and talking about it is so important. Doesn't matter how far that goes or how quickly it gets sorted, it's just you have to just ask those questions and you have to reach out for that support.

SPEAKER_00 30:00

I reckon that's great, Steph. I reckon that I really like that. I reckon it's a really good way to wrap up. Um and uh and if anything that you've heard on our podcast today has resonated with you, um again, feel free to let us know on socials uh or uh if you think you might be interested in talking about your birth trauma with on our podcast to just let us know just again. Um and we might be able to to uh get a get a interview going with you. Uh and if you have any uh um needs for resources to discuss your own birth trauma or birth trauma that a friend has experienced, we'll have some resources available on our um on our social media.

SPEAKER_02 30:43

Yeah, we might just pop all those links, I think, in there. Yeah, I think that's a great idea. Yeah.

SPEAKER_00 30:47

Um and uh as always Steph and I are around, so you can always send us a DM if you need to. Um, but uh but good luck with your pregnancy. Um and also uh remember that there are always people to talk about talk to if you need it.

SPEAKER_02 31:04

Thanks, guys.

SPEAKER_01 31:08

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