Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Abstract

BackgroundMany women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.MethodsAs part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.ResultsFour themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.ConclusionCare provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

Can respectful maternity care save and improve lives?

“…Studies cross-referencing these issues were published only within the past 2-3 years, [14][15][16]25 which indicates that until recently, there has been little exchange of information by researchers on the relationship between disrespectful maternity care, PTSD, and postpartum PTSD. 28 yielded very few cross-references between these phenomena.…”

“…28 yielded very few cross-references between these phenomena. Studies cross-referencing these issues were published only within the past 2-3 years, [14][15][16]25 which indicates that until recently, there has been little exchange of information by researchers on the relationship between disrespectful maternity care, PTSD, and postpartum PTSD. Making the connection between respectful maternity care and postpartum PTSD is important, because many labor events and caregiver actions during traumatic births contribute to persons developing postpartum PTSD (ie, believing that they or the baby were (and may have been) in danger of serious injury or death).…”

“…[14][15][16] Other types of disrespectful maternity care may include the absence of translation services; withholding or distorting information; coercion and unfounded threats of harm to baby to gain consent for unwanted procedures; and lack of informed consent. In some countries, disrespectful maternity care consists of physical or sexual abuse in the form of hitting; unnecessary restraints; exposure of the woman's sexual parts; rough vaginal examinations; and other abusive treatment.…”

“…More commonly, birthing persons are subjected to harsh, rude, or judgmental language that may lead to worse care or neglectful care consisting of leaving laboring people alone; withholding food and drink; limited mobility; or generally, a lack of kindness. [14][15][16] Other types of disrespectful maternity care may include the absence of translation services; withholding or distorting information; coercion and unfounded threats of harm to baby to gain consent for unwanted procedures; and lack of informed consent. 14,17 These actions and care processes may be due to several complex and interdependent factors: structural, institutional, and individual racism, structural violence such as armed conflict, economic crises, and violence against women.…”

Health Care with Indigenous Women: Respectful Partnerships

“…Conceptualizations of 'risk' can be western-medical or Indigenous, however they are not necessarily the same thing. Women from racially and culturally marginalized groups commonly report cultural insensitivity to them in childbirth, both within policy and within individual patient-provider interactions [20] [21].…”