Experience is different to Outcomes
Clinican’s understanding of the birth experience & why minimising trauma in the perinatal period is essential
Childbirth is a profound and significant life event for many women. Sometimes the focus on obstetric and birth outcomes can be to the exclusion of the birth experience. Women may experience trauma during the perinatal period due to pregnancy or childbirth complications, obstetric interventions or poor outcomes for themselves or their babies. One of the strongest predictors for the development of PTSD symptoms following childbirth are interpersonal factors and a woman’s negative perception of interactions with her care givers. Critically important to women’s wellbeing and optimal experiences are choice, control and shared or involvement in decision making. Effective communication is central to good interactions with women and can influence women’s appraisal of difficult birth events or experiences. Communication skill development for HCPs should not only be provided at undergraduate level but should be required for all those working providing maternity care….
Trauma informed care
Trauma is complex and can be brought about by a wide range of individual experiences across the lifespan and can be associated with transgenerational and or systemic relationships. Despite the evidence of the link between trauma and mental distress, healthcare professionals may be unaware of the traumatic sequlae on women’s lives and the negative consequences of maternity care practices. It is vital that healthcare professionals utilise a trauma informed approach to their interactions with women during the perinatal period. The Five Guiding Principles of trauma informed care are; safety, choice, collaboration, trustworthiness and empowerment. Ensuring that the physical and emotional safety of a woman is addressed is the first important step to providing Trauma-Informed Care.
Exposure to Trauma can Affect Health Care Providers
HCPs & Secondary Traumatic Stress:
Healthcare professionals can experience and witness difficult childbirth events. As witnesses or participants in caring they are exposed to such harmful events including disrespectful or poor care, coercive or indifferent interpersonal communication or high levels of obstetric intervention. Observing women’s trauma may result in fear and guilt with such emotions more likely when witnessing interpersonal care-related trauma. A normal response to witnessing trauma, particularly to multiple episodes is for midwives to experience Secondary Traumatic Stress (STS). This increases their risk of full PTSD.
Midwives can develop close relationships with women that are comforting for both, but may challenge normal professional/client boundaries. This strong emotional involvement often means midwives open themselves and put aside their own needs. So, when a traumatic event occurs they can feel unprepared, unsupported, and overwhelmed, with a sense of failure and personal bereavement. Witnessing women experiencing potentially traumatic birth events may compromise midwives’ and doctors’ abilities to maintain positive interactions with women.
Midwives describe feeling powerless to protect women during traumatic birth events and also feeling a burden of responsibility. Organisational demands and culture may leave midwives/doctors unable to provide compassionate care and feeling complicit in poor care which creates shame, blame and further guilt that hurts these clinicians. These issues are often heightened by personal stresses and prior traumas. Yet, the pressured environment means midwives are unable to disengage and process these emotions, leaving them very vulnerable to STS and PTSD. Midwives can experience STS and PTSD from witnessing traumatic birth events or poor interpersonal care of women, or from conflict between models of midwifery care and working within a toxic culture.
STS and PTSD negatively impact on midwives’ lives and wellbeing and their abilities to provide positive compassionate interactions with women. Women’s negative perceptions of their interactions with midwives is a significant factor in the development of PTSD in women following childbirth. A non-judgmental organisational culture is required to acknowledge and respond to HCPs needs. Destructive workplace cultures must be recognised and addressed. Improving the workplace culture and addressing clinicians’ needs will improve not only their working lives, but their interactions with women, and in turn, women’s mental health outcomes.