A Guide to Birth Trauma

Birth trauma is a serious topic that up until now has largely remained hidden and unspoken about, but more recently is getting the attention it rightly deserves. Here at Conscious Birth Hub, we would like to discuss this sensitive topic to help mothers understand what can contribute to birth trauma, in order that they can do their best to avoid it. Our intention is to approach the topic with evidence and balanced reason, to avoid inducing fear or anxiety, as we truly believe that prior education, and intuitive insight through the labour process, can minimise the potential for trauma..

The UK Parliamentary Birth Trauma Inquiry

In light of the investigations of the first Parliamentary Birth Trauma Inquiry in the UK in 2024, chaired by the former MP Theo Clarke, we believe that talking about the report is an important step in birth understanding, as British women who have previously been suffering in silence are finally being given a voice to tell their stories. In fact, some stories date back 50 + years. For many women who share their story, this will undoubtedly be a cathartic process that helps to release unresolved trauma and support their healing process, and therefore the inquiry should be applauded for this alone.

The inquiry aims to understand the causes of birth-related trauma, identify gaps in care, and recommend improvements to ensure safer and more compassionate maternity services. The report highlights the importance of better support for mothers, communication between mothers and caregivers, and training for healthcare professionals to prevent and address birth trauma effectively.

Global birth trauma rates

In the UK, studies suggest that approximately 1 in 10 women (around 10%) may experience some form of birth trauma, which can include physical injuries or emotional trauma. Globally, the rates can differ widely due to differences in healthcare systems, reporting practices, and definitions, but estimates often range from about 10% to 30% of women experiencing some form of birth-related trauma.

A Parliamentary Birth Trauma Inquiry set up in Australia in 2024, further highlights obstetric violence and PTSD (post traumatic stress disorder) post- birth, as a global issue. Many European countries are also invested in tackling this issue by conducting research into birth trauma, such as the Babies Born Better Survey. Read more about it here.

In January 2021, the International Survey of Childbirth-Related Trauma (INTERSECT) study was launched, surveying women 6-12 weeks after birth, reaching over 18,000 women in over 40 countries to date. The study is an international collaboration between researchers located across the world, investigating childbirth-related PTSD, and with a particular emphasis on working with under-represented countries in South America, Asia and Africa. The study found that birth trauma globally was as high as 20-40%, and birth PTSD was around 4%.

Other studies show that psychological birth trauma and childbirth-related posttraumatic stress disorder (PTSD) represent a substantial burden with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year.

The different types of birth trauma experienced

Birth trauma can be physical or psychological, or a combination of both. The type of physical injury that can occur during birth include pelvic floor incontinence, nerve damage, and, OASI which is also known as ‘obstetric anal sphincter injury’, more commonly known as a third and fourth-degree tear. This tear affects the perineum and extends into the anal sphyincter muscle, involving a vaginal wall, perineum, and the muscle that controls the back passage (anal sphincter). When women are subjected to medicalised interventions such as episiotomy, forceps, or ventouse, the risk of these injuries is increased. Some women do experience this type of tear with natural vaginal delivery too, but this is much rarer and tends to be caused by precipitous (rapid) labour or prolonged labour.

Other physical traumas can include hematomas (often linked to episiotomy) and uterine rupture, which is a potential complication with induction during vaginal birth, due to the induction drugs overstimulating the uterus to push the baby out. It’s very rare for uterine rupture to happen with normal physiological birth. Trauma relating to caesarean is also common, particularly due to the extreme pain during recovery from this surgical procedure.

Unsurprisingly, if a woman undergoes a physical birth trauma of any sort, they can also experience emotional damage with low self esteem and depression, or they may struggle to care for their infants as easily, and many are left unable to work. If the physical trauma, i.e OASI, is not quickly recognised by health care professionals and managed, and/or if recovery isn’t prioritised, women can experience long-term effects including anal incontinence, perineal pain and dyspareunia (pain during sex).

In terms of psychological birth trauma (PBT), this can vary from painful emotional experiences that women go through during childbirth, such as intense fear, hopelessness, and a sense of losing control; to neglect, psychological abuse, or negligence from medical professionals. Every woman's experience is subjective, originating in the labour process, with effects continuing into the postpartum period. This study in China found that the prevalence of PBT varies from 20% to 68.6% worldwide, depending on which aspects were factors, and demonstrates why we at Conscious Birth Hub are so focussed on supporting mothers to address fear and better understand the birth process and their rights, so that they can advocate for themselves.

Other traumas can arise from psychological discomfort caused by delivering with others, use of epidural anesthesia, complications during birth, and the feeling that the mother has made a wrong choice that negatively impacted her baby.

I also want to add here that Group B Strep is also getting a lot of coverage through the UK Birth Trauma Inquiry, something which is extremely encouraging due to the severity of its implications on babies. Group B Streptococcus (GBS) is a type of bacteria that is commonly found in the intestines, lower genital tract, and rectum of many healthy adults. While it usually doesn't cause any symptoms or health problems in adults, it can be inadvertently passed to newborns during childbirth. GBS can sometimes cause serious infections such as pneumonia, meningitis, or sepsis, and can even cause long-term disability or death. To help prevent these infections, pregnant women are often tested for GBS during late pregnancy, and if they test positive, they may receive antibiotics during labour to reduce the risk of passing it to their baby.

The test for GBS is not offered routinely through the UK National Health Service which is why I tested privately with both my pregnancies. This gave me a greater sense of security when making choices to do with my births. However, there are some conflicting views about the accuracy of the results as testing is time sensitive, and not all babies born with GBS will get sick. As explained in Sara Wickam’s book and blog on the subject:

“We can screen women/babies to decide who might be at higher risk, but the rarity of GBS disease and the bluntness of the current screening methods mean that we end up offering unnecessary and potentially harmful treatment (in this case intravenous antibiotics during labour) to hundreds of thousands of women/babies.

We don’t have good evidence that antibiotics are beneficial”.

This is cited as a main reason for why GBS testing isn’t routinely offered in Britain. The risks that come with GBS should be made aware to everyone though, so families can make up their own minds on the matter. Certainly in the UK there’s ​​a ‘postcode lottery’ in terms of how many families will hear about GBS.

Key findings from global reports about birth trauma

The general theme encompassing birth trauma reports worldwide, is that women are not being listened to when they feel something is wrong, they are often mocked or shouted at, and are denied basic needs, including pain relief when they request it.

However, the findings from worldwide birth reports are that women from marginalised groups -particularly marginalised ethnic groups - experience particularly poor maternal care and often racism during their pregnancies and birth. The report ‘Systemic Racism, not broken bodies’ was undertaken in 2022 by Birthrights UK, and highlights the systemic racism in the maternity system with black and brown women feeling ignored, unsafe and deprived of basic choice, or the means to give consent to things happening to them during their pregnancies and births. More on this report here.

Other reports show how even birth partners can suffer trauma due to poor maternal care, which illustrates the severity of the issues occurring. And the fact that the term ‘obstetric violence’ is part of maternity vernacular, shows how prevalent trauma-causing practices are.

Meanwhile, a systematic review (meaning rigorously searched-for scientific evidence on a topic and combined findings of relevant studies) of the impact of childbirth trauma on midwives (whether this was trauma they witnessed, or trauma they had experienced themselves through their own births) found that ‘midwives were the forgotten victims’.

The midwives expressed feelings of shock, fear, responsibility, and powerlessness in relation to birth trauma, which may contribute to some experiencing serious mental illness themselves. Their shaken belief in the birth process subsequently led to more defensive practice, particularly due to the fear of litigation/legal consequences from something going wrong. The study found that this heightened fear on the midwives part may hinder the normal physiologic birth process as midwives increase their use of medical interventions, that can have short- and long-term health effects for mother and baby., Additionally, the report discussed how the midwife–mother relationship is also threatened as the focus is on midwives’ self-protection rather than clinical care, and ultimately, care is compromised as it is no longer evidence-based. This trauma also led to midwives struggling to build empathetic relationships, which further increases the chance of the mothers they care for having trauma themselves.

In summary, research has found that fear of childbirth, unnecessary interventions, unexpected mode of birth, and labour and birth complications have been associated with a traumatic childbirth, but interestingly, more women report trauma in relation to poor interaction with maternity healthcare professionals. For example, a perceived lack of control and involvement in decision-making, and feelings of disrespectful care, disconnection, helplessness, and loss of dignity, which demonstrates how compassion and respect are some of the most vital qualities that a maternity healthcare provider must embody.

How can birth outcomes be improved globally?

In general, recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women’s rights and autonomy before, during, and after childbirth; and preventing maltreatment and obstetric violence. There is also a big push for principles of trauma-informed care to be integrated across maternity settings, and for national and international guidelines to increase awareness of traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment.

In the UK, Theo Clark has laid out recommendations for tackling this endemic of birth trauma in her UK report. She proposes that it is completely counterintuitive that the NHS medical negligence budget has been increased, with more money spent on compensation payouts for inadequate maternity care, than on the front-line services in maternity units themselves. Her inquiry stresses the need for more midwives, obstetricians and anaesthetists on the frontline looking after mothers directly. Understaffing is a serious problem within the NHS and in many other countries’ maternity systems too, leading to poor outcomes for many women and babies.

In the US, this systematic review of childbirth-related trauma looked at how to address the trauma after it occurs, and highlighted the impact of trauma-focussed therapy within 96 hours of birth, particularly midwife-led therapy, but also preventative concepts like mindfulness and pre-birth education.

While we completely agree that investing in well-trained maternity staff and well-funded maternity systems, complete with effective technology to deal with valid pregnancy complications, and introducing better after-care support, is important, we are of the belief that a complete overhaul of how birth is viewed and approached culturally will have the best outcomes for families everywhere.

The highly medicalised approach to birth (which most national government guidelines currently promote), that has been on the incline since the 1950’s, is at the root of why so many women experience trauma. Birthing people are often subjected to interventions that aren’t needed, especially with obstetric-led care which typically views birth as risky business - understandably, as obstetric training involves risk assessment and dealing with emergencies. However the flip side to this is that obstetricians are often uncomfortable stepping back and allowing expectant management (a "wait and see" approach) where a healthcare professional closely monitors a patient's condition without immediate intervention, allowing for natural progression or resolution of the issue.

In fact, many obstetricians have never seen a natural, physiological birth unfold, and can feel uncomfortable being present without wading in with their suggestion of interventions. And unfortunately, private obstetricians will often want to schedule a birth around their other commitments (whether personal or professional) which is evident from the alarmingly high and unnecessary C-section rates reported in many developed countries.

Even in the public healthcare settings, hospitals are working to time constraints. Which can mean that if your birth isn’t progressing at the speed they want it to, they will encourage interventions to get the baby out, so they can move on to the next mum on the labour ward ‘conveyor belt’.

Often, what’s best for mum and baby can sadly be secondary to hospital business. Unnecessary medical meddling into women’s bodies often comes at a devastating cost not only to mothers that may need counselling for PTSD but for the adverse outcomes these interventions can have on babies too. For example, babies that are starved of oxygen and born with cerebral palsy, due to undergoing a traumatic birth where the use of Pitocin (synthetic oxytocin) has been poorly managed via the IV drip, causing overly strong contractions that can deprive a baby of oxygen, known as birth asphyxia. Some further information about the risks associated with induction of labour via Pitocin can be read here.

Priorising compassionate midwife-led care and continuity of care for natural birthing over obstetrics in hospital hierarchy would make a huge difference. But the fear culture of birth needs to be removed first and foremost, allowing midwives more autonomy to do their highly skilled and nuanced job of supporting and encouraging women throughout their births. Similarly, if more midwives were trained in hypnobirthing and used these incredibly-effective tools to assist women during their labours, the prevalence of drugs and vaginally assisted births (e.g. surgical tools such as forceps/ventouse) would be greatly reduced, preventing a great deal of trauma.

In fact, this research compared the outcome of pre-planned home births compared to pre-planned hospital births for women of low obstetrical risk, and found statistically better birth outcomes of women who choose to have a home birth, in a supported, safe and comfortable environment, away from a hospital setting, with the report noting ‘less interventions and fewer ‘untoward outcomes’, when at home.

Otherwise, research consistently shows that the quality of the relationship a woman has with her healthcare providers during childbirth is a strong predictor of her overall satisfaction with the birth experience. This includes factors like feeling respected, supported, informed, and involved in decision-making. Healthcare professionals must start listening to women.

Women carry their babies and can feel and intuitively know when something isn’t right, so the seriousness of tuning into a mother’s concerns - irrespective of her age, race or ethnicity - cannot be emphasised enough. Sure, there are many first time mum’s especially, that are overly anxious and can worry unnecessarily, which healthcare teams contend with a lot and can distract them from dealing with real emergencies. However a woman should always be given the benefit of the doubt, as in the most severe of cases, this can mean life and death. It’s critical that women keep speaking up, as gut and intuition are your superpowers and won’t let you down. Similarly, if they feel that the baby is doing just fine, and medical teams have their own agenda to rush birth, then mothers will benefit from knowing that they can take all the time they need.

Otherwise, certain practices can minimise the chance of physical trauma, for example regularly massaging the perineum ahead of birth to prevent tears, or mentally-preparing to advocate for your wishes during a hospital birth, including discussing this with your birth partner, midwife or doula. At Conscious Birth Hub we have designed our Signature Hypnobirthing Course to go over all these aspects and more, to best prepare you (and your birth partner) both physically and mentally for whatever may occur. We also offer Wisdom Sheets on key topics, and various support services that provide a deeper knowledge of what choices might be best for you, or how to find your voice when it matters, along with supporting you to have a better connection to your intuitive guidance, that will always bring about the best possible outcome.

For those who have experienced birth trauma, please know that you are not alone, and there are ways to overcome the feelings you carry. Nothing that happened was ever your fault, know that you did your best under the circumstances, and there is always a positive lesson to take-away from any negative experience.

If you have given birth, whether it was a positive or challenging experience, we would also invite you to use your experiences to positively impact other women in the future, by filling in our 10-min survey that is designed to collate the birthing experiences of as many women across the world as possible. Over time, we intend to determine what has worked best for positive birth outcomes through lived experience, and not just clinical data. Please share the survey with your mothers, sisters, friends, colleagues or anyone else that might be interested to get involved, as there is no time limit or age limit on sharing best-practices for birthing.

For anyone that has experienced birth trauma and would like further support,, there are some great resources below.

https://www.birthtraumaassociation.org/

https://www.makebirthbetter.org/

https://pandasfoundation.org.uk/

Sending love and light x