Shining a light on birth trauma

Shining a light on birth trauma: Is it too little, too late?

The conversation around birth trauma has finally been thrust into the spotlight, but we have to ask—has this come too late to make a real difference?

The past month has been both enlightening and challenging as discussions about birth trauma have taken centre stage. Doula UK recently contributed to the Birth Place Experience Study UK (BESt-UK) and eagerly anticipates the findings, which should be made public mid June.

Doula UK were invited to Parliament for the opening of the APPG Birth Trauma inquiry, led by Theo Clarke MP, which marked a significant moment. We’ve analysed the report from this inquiry and attended the Birth Trauma Summit by Make Birth Better, immersing ourselves in the latest developments and shared experiences. You can find the full report in the resources section below.

Woman medical birth on back CTG — Birth on back with CTG

Harrowing testimonies and urgent recommendations

The Birth Trauma Inquiry brought to light over 1300 gut-wrenching accounts from women and birthing individuals. Stories of neglect, blood-soaked sheets, fear, debilitating injuries, PTSD, and unimaginable suffering were shared repeatedly. The inquiry resulted in 12 key recommendations, including:

1. Staff recruitment and trauma-informed care: Urgent measures to hire and retain staff, with comprehensive trauma training.

2. Universal mental health services: Eradicating disparities in mental health care.

3. Postnatal checks: Separate six-week postnatal check-up's covering both physical and mental health.

4. OASI care bundle: Implementing measures to reduce birth-related injuries.

5. Standardised talking services: Nationwide birth reflections services to foster open dialogue.

6. Informed consent education: Comprehensive antenatal classes on birth choices.

7. Respect for birth choices: Ensuring birthing choices, including pain relief options, are honoured.

8. Support for birth partners: Enhanced communication and support for partners.

9. Continuity of care: Shared digital notes across multidisciplinary teams.

10. Litigation time extension: Extending legal negligence litigation time from three to five years.

11. Addressing inequalities: Targeting disparities, especially for black and Asian individuals, with a focus on interpreters and training.

12. Economic impact research: Investigating the financial ramifications of birth trauma, including the impact on careers.

It has been recommended that a Maternity Commissioner who would report directly to the prime minister, should be employed to implement, and oversee these changes and the development of the UK’s NHS maternity service.

As doulas, we've long been aware of the NHS's shortcomings in protecting families from birth trauma. Sadly I see the impact of this trauma with families getting in touch for doula support after a previous traumatic birth. The recommendations are promising, but one must wonder why it took so long to identify these issues and whether the NHS has the resources or desire to implement real change. My thoughts are echoed in the words I share below…

Voices from social media and the news:

"Lots of talk, but will action be taken?"

"We've known this for years. What's different now?"

"The OASI care bundle is seriously flawed."

"Nothing short of a national tragedy."

"Obstetric nurses, not midwives, are being trained."

"Focus should be on preventing trauma, not just fixing it afterward."

"High induction rates and medicalisation of birth need addressing."

"Good maternity care is the exception rather than the rule."

(quotes above have been amalgamated from many sources sharing similar comments).

Make Birth Better say, "We need to address foundational problems: institutional racism, misogynistic practice, maternity settings which are not culturally safe or inclusive, toxic leadership which silences professionals."

A couple holding a new baby in theatre — Classified as an emergency caesarean birth

The Birth Trauma Summit: A beacon of insight

Following the public inquiry, Kirstie Broughton, Doula UK’s Partnerships Coordinator, attended the 9th annual Make Birth Better Birth Trauma Summit. The event featured a diverse array of speakers and evidence-based insights. Highlights included:

AIMS: Addressing interpreter and BSL needs.
Jo Disney-Spiers: A retired midwife, sharing a grandmother’s perspective on loss.
Jayde Edwards: Her experiences navigating the maternity system at 15 years of age.
Irwin Mitchell: The critical role of communication.
Dr. Rebecca Moore (MBB founder): Celebrating changemakers shifting the dial on perinatal trauma
Dr. Annabel Sowemimo: Decolonizing medicine and maternity care.
Dr. Hazel Keedle: Discussing obstetric violence and the BESt study.
Angela Frazer-Wicks MBE: Trauma-informed care involving children's social care.
Dr. Chrishanthy Jayarajah: Mental health impacts of gender disappointment.
Nikki Wilson (MBB CEO): Public inquiry into birth trauma.

The future of trauma: Change and prevention

The summit reinforced familiar truths: the NHS needs to truly listen to those it serves. Effective communication and personalised care are crucial. The maternity service needs a better working culture, more support for staff, and comprehensive training to retain its midwives. While resources for those who have suffered birth trauma are vital, prevention should be the primary focus, starting with reducing unnecessary interventions (unnecessary induction of labour would be a good place to start!)

It's disheartening that midwives are trained to read CTG monitors, rather than in the physiology of birth. This is leading to defensive practices born from fear of litigation. This, inevitably, contributes to the trauma.

Ultimately, respect for women and birthing individuals, equitable care, and genuine listening are essential. Only time will tell if these recommendations bring real change.

Meanwhile, you can be proud that doulas continue to make a significant impact, enhancing the physical and mental health outcomes for the families we support (see evidence in the section below). As doulas, it is essential to prioritise your own physical and mental wellbeing, especially in this ever-expanding landscape of trauma, including vicarious trauma. Please reach out for support if you feel it would be of benefit.

For further reading and support resources, explore the links below: