What health professionals don’t know about postnatal PTSD

In her work as a journalist and as CEO of the Birth Trauma Association, Kim Thomas has read and listened to the stories of hundreds of women describing their traumatic birth experiences. What shocked Kim early in her work, about a decade ago, was the disjuncture between these accounts of birth trauma and the healthcare professionals’ understanding of the condition. Luckily it looks like times are changing.

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Back in 2013, I published a book on birth trauma, aimed at supporting women who developed PTSD after giving birth. I wanted the book to reflect lived experience as much as possible, so I interviewed 12 women who’d had traumatic births. I also interviewed some midwives.

What took me aback was the disjuncture between these women’s accounts of birth trauma and the midwives’ understanding of the condition. The women’s stories were deeply harrowing, but when I spoke to the midwives, they didn’t seem to have any understanding of how badly a traumatic birth affected women. In the end, I only included one of the midwife interviews in the book.

Heartfelt stories
There were two women, Nina and Emma, whose stories particularly affected me. In both cases, the interviews took more than an hour as the women poured out their heartfelt accounts of their traumatic births and the impact it had on them. Nina had been through an extremely lengthy and painful labour, in which she was repeatedly denied an epidural for apparently arbitrary reasons. She had blacked out parts of the experience but later her husband told her she had threatened to throw herself out of the hospital window. At one point the baby’s heartbeat appeared to stop and they thought it had died. Afterwards, she became depressed and angry, and was obsessively anxious about the baby. Her relationship with her husband deteriorated. Going for a smear test, she shook so much with fear, she nearly fell off the bed.

“For three months Emma was too ill to care for her baby, and was consumed with guilt”

‘Like something from a horror film’
Emma had a long and exhausting birth. After the baby was born, some of the placenta remained inside her. The consultant walked into the room and, barely acknowledging Emma, attempted a manual removal, which Emma described as ‘the most painful thing’ she’d ever experienced. Despite Emma’s screams, and the midwife urging the consultant to stop, she continued. Then Emma started to haemorrhage (her husband told her it was ‘like something from a horror film’) and had to be rushed to theatre. She also experienced a third-degree tear and remained in hospital for several days. For three months she was too ill to care for her baby, and was consumed with guilt. Physical problems resulting from her tear went undiagnosed by several doctors until she was eventually given a correct diagnosis and treated. She and her husband made the decision to have no more children.

A slow change
It's 10 years since I spoke to Nina and Emma but I still think about them a lot. One of the things I realised is that health professionals often have no idea of the profound and lasting psychological damage that a traumatic birth can cause. Once someone leaves the hospital with their newborn, the doctors and midwives may never see them again.

Two years after publishing the book, I began working part-time for the Birth Trauma Association. During that time, I’ve read and listened to the stories of hundreds of women. Although they vary in the detail, the central theme – an objectively difficult birth compounded by poor or even negligent care – is common to most of them.

I’ve also been fortunate enough to be asked to give talks to midwives and other health professionals about birth trauma. Slowly, I’ve noticed a change – whereas once health professionals were unaware that the problem existed, many now are keen to hear about women’s experiences and to find out how they can make things better.

“Postnatal PTSD is not an inevitable outcome of a difficult birth”

Closing the gap
So when I was offered the chance to write a book about postnatal PTSD aimed at health professionals, I seized it with both hands. The book, which launched in April, explains what postnatal PTSD is and the devastating effect it can have on people’s lives (there is also a chapter on postnatal PTSD in partners). Although the book makes use of academic research, once again I interviewed numerous women about their own traumatic births. Many had shocking stories to tell, from invasive procedures being performed without consent to serious conditions going undiagnosed. I have a chapter that looks at the distress caused by physical injuries, and another that discusses the particular ways in which people from Black, Brown and other underrepresented Ethnicities are let down in maternity care. The final chapter recognises the many stresses maternity services are under and looks at the importance of midwives’ own mental health.

What does it look like?
But I also talk about how things might be improved. My co-author, an NHS Grampian midwife called Shona McCann, runs a clinic to support pregnant women who have undergone trauma (often, but not always, a previous traumatic birth). The care she provides enables them to approach birth feeling confident and supported. If a woman wants a planned caesarean, for example, Shona may make an appointment for her to meet a consultant who can then put her on their list to ensure continuity of care. If a woman is frightened of returning to the hospital where she gave birth before, Shona can accompany her to the maternity unit beforehand so she can feel better prepared emotionally.  

Postnatal PTSD is not an inevitable outcome of a difficult birth. Midwives and obstetricians have a huge role to play in providing compassionate care that acknowledges someone’s distress and helps to reduce it. My fervent hope is that this book will, in a small way, help them to recognise that.

You can buy Postnatal PTSD: a Guide for Health Professionals here.