Dr Andy Mayers is a Principal Academic at Bournemouth University, where he teaches clinical psychology and mental health. Beyond the university, he is a perinatal mental health campaigner, educator, and support group ambassador. He works with several national organisations including the Maternal Mental Health Alliance, Perinatal Mental Health Partnership, and this Birth Trauma Network. He is a Trustee for the new Dorset-based charity DorPIP, who provide therapeutic intervention for parent-infant relationships and support for perinatal mental health. You can read about some of his work at andrewmayers.info.
Andy has campaigned for many years to raise awareness of birth trauma
in dads. Here he shares his knowledge as a researcher (as well as a
father and grandfather) with us at Make Birth Better:
What about fathers / birth partners?
Other resources on this website may focus on reducing the incidence of birth trauma by driving changes in antenatal and postnatal care. Here, I want to focus on the impact of birth trauma on the entire family. Ultimately, experiencing (or witnessing) birth trauma can lead to developing post-traumatic stress disorder (PTSD). I was shocked at how little we know about that link. Public perceptions don’t help. I was recently invited to give an interview on BBC Radio Solent about birth trauma. I spoke about PTSD. The presenter said that most people might think that PTSD only applies to members of the armed forces who have been in war zones. How wrong they are! Officially (according to DSM-5, the diagnostic manual for mental health conditions), PTSD is diagnosed as a reaction to ANY event (experienced or witnessed) that may lead to death, threatened death, actual or threatened serious injury (or be perceived to be threatening). Of course that includes birth trauma. In this sense, a ‘trauma’ could indeed relate to potential death or serious injury (including significant loss of blood), but it could also be due to a sudden change in the birth plan (such as unplanned caesarean). But what is the impact of birth trauma, not just for the mother but also for the father, and indeed the infant too?
BIRTH TRAUMA AND PTSD
While that trauma may relate to medical complications, an otherwise ‘normal’ birth might be perceived as traumatic when there has been “loss of control, perceived threat or physical harm to self or baby, or negative attitudes of healthcare professionals involved in the birth.” Around 4% of women are diagnosed with PTSD, following a traumatic birth. Clearly not everyone who experiences trauma will go on to develop PTSD, but we do know some of the risk factors that may make that more likely.
Typically, PTSD (in any population) is a greater risk when someone exhibits one or more of the following: they do not have social support; they feel that their beliefs and assumptions about life have been shattered; they have lost ‘control’ over their own environment; they have prior history of mental health challenges; or they engage in 'negative coping styles' (e.g. using alcohol and/or drugs, becoming self-isolated, or engage in dissociation) and avoid positive ones (e.g. making sense of the trauma). In birth trauma, additional factors (such as poor interaction with health professionals) can also play a part. Recently, it was shown that most mothers were resilient to the effects of birth trauma (62%), while those who were not went on to develop PTSD. A further 18% recovered, but 20% experienced chronic or delayed PTSD. It was found that poor satisfaction with health professionals ‘predicted’ those mothers whose PTSD symptoms were chronic or delayed. Those without social support were less likely to recover and more likely to experience chronic or delayed PTSD.
That research told us a lot about the risk factors for becoming mentally unwell following birth trauma, but little about what mothers (and fathers) actually perceive about the trauma experienced, the information they received, and the support they got (at the time of trauma and in the ensuing months). I have started some work in that area. Our preliminary (as yet unpublished) work at Bournemouth University has uncovered potentially important findings.
Sampling from a larger cohort over 270 mothers who had experienced birth trauma, we thoroughly examined perceptions of 44 of these using thematic analysis. We found that mothers reported concerns about the birth experience (including inconsistent care and lack of support), distress immediately after the birth (including separation from their baby, feelings of failure, needing to seek own help, and recurring memories), life in the ensuing months (especially symptoms of PTSD), and they talked about the need for more support (including the need to learn about mental health and risk factors much earlier and about having access to more check-ups postnatally).
It goes without saying that we need more understanding, information and support for mothers following birth trauma but, for fathers, there is almost no support. Given that fathers are almost always present in the birthing room these days, this is perhaps shocking. Fathers are potentially watching their wife and/or baby die in front of them and, yet, they are often completely ignored.
We have also undertaken some very preliminary research with dads who have witnessed birth trauma. Using thematic analysis, we examined the perceptions of 25 fathers who had witnessed their wife/partner’s birth trauma.
We found that fathers were disturbed by the perceived gap between the support they received compared to what they wanted. They also expressed concern around their understanding of the trauma (including a lack of information provided, loss of control, poor relationship with health professionals, and being a male in a female environment). Much of that concern focused on being dismissed by health professionals as a secondary participant, at best. Fathers were also shocked by events following the traumatic birth (including reporting PTSD symptoms and other mental health problems, and the relationship with their partner and children).
SAME SEX COUPLES
By the same token, we also need to consider members of the LGBT community. Same-sex partners who have witnessed a traumatic or difficult birth may find it even more challenging to seek support. We need to ensure that our support systems account for them too (see below).
We already know that maternal mental illness has a significant impact on the bonding and attachment with their baby. This can be distressing, but we also know that there are serious consequences of poor attachment on the child’s emotional, social, and educational development. Those children are also more likely to develop health and mental health problems. Similar outcomes have been found with fathers who experience mental health problems during the pregnancy and postnatal period. What we know little about is the impact of birth trauma on attachment and bonding, for either parent. I am starting some work on that this year. Also, I will be supporting DorPIP in their work to provide resources and intervention for parent-infant relationships (which may well have been affected by the parental experience of birth trauma). While this can be an uncomfortable thought for parents who have had a difficult birth, we also know that babies are very adaptable and - if we can get parents the help they need - this bond can be protected.
We need to learn a lot more about the impact of birth trauma on mothers, fathers, and families. We also need to use evidence about this to persuade governments and commissioners that we need to improve clinical practices and provide more support to families. In the meantime, I would like to finish by signposting to where there is support for birth trauma. Some these links can also be found on my website for mothers and fathers (and it’s often worth checking back there to see if there are any updates).
Or use our resources page to find local and national services and advice.