Why Birth Trauma Matters

"Yes, we know that birth trauma isn’t necessarily correlated to mode of delivery, or to blood loss, or to whatever pain relief you used. It’s very much about your internal locus of control and sense of agency, and also about being treated with kindness and compassion. We know that if you have a history of trauma , whether it’s sexual abuse or some other kinds of trauma, that can very easily and totally innocently be reactivated by events, speech, and attitudes during birth. Get the weekly Five Books newsletter We’re only recently beginning to recognise birth trauma as a valid and prevalent phenomenon in and of itself and that it’s distinct from post-traumatic stress disorder, or PTSD. Unlike with PTSD, you can’t just move on or distance yourself from the person or event that triggered the trauma. When you give birth, most of the time, you’ll go on seeing your baby all day, every day and be reminded of that event, and many people will go on to give birth again and encounter that environment and situation again. As a result, birth trauma is a different phenomenon, with it’s own characteristics and we are only just beginning to recognise this and develop effective treatments for it. What the book also covers, which I think is increasingly important, is the secondary trauma endured by maternity staff and partners and other people who are sort of adjacent to the birthing person themselves. There’s a great study by an Edinburgh midwife called Jenny Patterson who found that midwives are at incredibly high risk of witnessing distressing events—for example, certain kinds of treatment or behaviour—that can predispose them to secondary trauma. I could definitely see that happening pre-pandemic, and it has just been exacerbated during Covid because many of us had to look after women in situations that were far from ideal: women being separated from their partners, women being given bad news on their own and even women being critically ill or, sadly, dying with Covid. We’ve had to cope with these things and provide care in an environment that is not psychologically safe for us. I’ve written a lot about the huge numbers of midwives who are leaving or thinking of leaving the profession. The same goes for obstetrics and gynaecology staff, who have some of the highest rates of burnout in all medicine. I think that’s an important part of birth trauma that will have to be addressed. We think of trauma very much in the context of people who have been in the military or been in accidents or assaulted or harmed in other ways. But the triggers for trauma are much wider than that. There’s a cliched description of trauma as anything that’s too much, too fast, too soon. Or a slightly more nuanced definition is that any time you feel that you or someone close to you is at risk of serious harm or death, even that feeling of being close to mortality, can trigger trauma. But because we think: ‘birth is joyful, your baby’s healthy, everything is fine,’ we discount the fact that there’s this whole other physical, emotional, spiritual, sexual event that you have endured that actually has very little to do with this infant you have produced."