this synthesis reveals how a traumatic birth experience can lead to women being drawn into a turmoil of devastating emotions that have long-term, negative repercussions on self-identity and relationships. Professionals require training, awareness and skill development to prevent against trauma and to enable them to identify and sensitively respond to women's psychosocial concerns. Further insights and research into the timing and type of interventions to resolve postnatal morbidity following a traumatic birth are needed.

Objective: To explore and identify women's use of defence mechanisms in the aftermath of a traumatic birth. Background: Following childbirth-related trauma, women adopt a range of unconsciously mediated functional and dysfunctional responses in their attempts to 'cope' with their complex emotions. Methods: A secondary analysis was undertaken on existing qualitative research (n = 13) that considered women's psychosocial responses following a traumatic birth, using Valliant's (1992) framework of Freudian defence mechanisms as a conceptual lens. Extracted findings from the studies were mapped against the framework until saturation and consensual validation occurred. Results: Ten defence mechanisms were identified to resonate with women's trauma-related responses. Women tried to 'repress' and 'supress' their memories of childbirth and used 'avoidance' to protect themselves from reminders. 'Sublimation' and 'undoing' were adopted in attempts to convert their negative emotions into more constructive responses and to present themselves as good mothers. However, the pervasive impact of a traumatic birth was evident through 'displacement', 'somatisation', 'reaction formation', 'turning against the self' and 'regression', with women expressing anger and hostility towards themselves, their infants, partners and others. Conclusion: Training and context-related screening processes to identify defence-related responses are needed. Raising awareness of defence mechanisms could provide reassurance of the 'normality' of women's psychological responses in the short term. Recognition of how long-term adoption is indicative of undesirable and unhealthy behaviours may also promote and encourage access to suitable psychological support.

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