It’s a painful reality for many of the women making submissions to the current NSW Legislative Council inquiry into birth trauma, and all-too familiar to perinatal psychologist and UNE researcher Lucy Frankham.
Lucy has been following the inquiry closely and regularly treats women through the Centre for Perinatal Psychology who have experienced birth trauma and symptoms consistent with Posttraumatic Stress Disorder (PTSD). Now she has found evidence that those symptoms – thought to accompany at least one-third of births (some 9,000 annually in Australia alone) – significantly predict poorer mother-child relationships.
“A traumatic birth can have serious and long-lasting effects on the physical and mental health of mothers, as well as on the development of their infants,” said Lucy, a PhD candidate. “And this is impacting millions of women each year and possibly more than we think because trauma is not part of routine screening and many women are misdiagnosed with postnatal depression.”
While the NSW inquiry has so far heard testimonies from women describing a lack of consent, inadequate pain relief and clinical incompetence, Lucy said they can be haunted by other, more subjective experiences.
“Obstetric complications and medical interventions like an emergency caesarean are risk factors for birth-related PTSD symptoms, but medical status seems less important than loss of autonomy, control and dignity; perceived support; and fear of birth.
“They are more likely to lead to birth being experienced as traumatic and women going on to develop PTSD symptoms such as intrusive thoughts or images, nightmares and sleep disturbance, extreme distress, avoidance of reminders of the birth – including the baby – and self-blame.”
On a purely practical level, a mother’s distress directly increases the chances of breast-feeding difficulties, and infant sleep and settling problems.
“Some mothers also become over-protective of their baby and socially isolated because they avoid mother’s groups and health-care professionals,” Lucy said. “It can interfere with their mood, cause flashbacks and influence decisions around future conception. This can all cause problems within the couple’s relationship and family discord and stress.”
It is well documented that poor maternal mental health associated with postnatal depression adversely affects an infant’s physical, cognitive, social, behavioural and emotional development. The impacts of birth-related PTSD overlap, suggesting children in these situations are just as prone to the same vulnerabilities, such as an increased likelihood of developing Attention Deficit Hyperactivity Disorder, asthma and respiratory problems, weaker immune systems and neurodevelopmental issues.
Lucy’s study was a meta-analysis that drew on the experiences of 5,572 women who participated in 12 studies internationally. Her measurement of PTSD symptoms in another of her Australian studies, at six weeks and six months after birth, showed they can worsen over time.
“We must keep an eye on these women and their children for months and even years,” Lucy said. “I would also like to see better education for mothers, health workers and policy-makers as part of an integrated response to birth trauma.
“We need to understand why so many women are experiencing birth as traumatic, screen for PTSD symptoms post-birth, and then provide appropriate support and interventions to improve the mother-infant relationship if they do occur. If we can get in there quickly, then hopefully we can buffer women, infants and their families against any potential long-term consequences.”
Lucy is now writing a training program for health-care workers on how best to psychologically support women. Societal attitudes also need to change.
“When a woman puts her hand up to say she has been traumatised or distressed by her child’s birth, the message they often receive is to get on with it,” Lucy said. “The NSW inquiry is highlighting that women have been ignored and not taken seriously; that we need to allow women to be supported and be supportive.
“One woman who made a submission was 24 years post birth. Women don’t forget a traumatic birth. You go into pregnancy, birth and motherhood really hopeful and excited, but many women come out in pieces, unable to sit down or feed or even tolerate their baby. That’s not how it should be.”
The NSW Upper House inquiry into birth trauma is due to complete its public hearings in December and report in February. Lucy’s research has been published in the Journal of Sexual and Reproductive Healthcare.
