What to do during a traumatic labour and birth to reduce the Likelihood of Later PTSD

By Penny Simkin

Between 25% and 34% of women report that their children’s births were traumatic, even though the staff and their support team may not perceive it that way. Birth trauma includes physical injury, danger, or death to mother or baby, or the perception thereof by the mother or partner. It also includes feelings of extreme fear, aloneness, disrespect, lack of control or helplessness.

The good news is that most traumatic birth experiences do not result in the syndrome of PTSD. The feelings (often called Post-Traumatic Stress Effects or Symptoms), associated with traumatic births usually fade in intensity, and become resolved with time, empathic listening, and support from key people in their lives. We may be able to increase the numbers of women who do not develop PTSD if we can identify those who have pre-existing risk factors for PTSD, and recognize when risk factors occur during labour. Appropriate actions, words, and continuous supportive attendance may reduce or reverse the symptoms and prevent PTSD. Seek opportunities for postpartum support and counselling;  Private Counsellor Jane Campbell-Kaye - 3368 1300  or Birthtalk - 3878 7915.

There appears to be pre-existing risk factors.  If the caregiver, the doula, and/or the woman/couple know about these ahead of time, they may be able to strategize preventive approaches to reduce the likelihood that the risk factors will occur. Below are the risk factors that may arise during labour that are associated with a negative or traumatic birth experience, and also specific intrapartum words or actions that are designed to reduce the trauma and prevent PTSD from developing.

What you need to know about the childbearing woman:

• Her wishes for her birth and expectations of herself, her support team, and the caregiving staff, including her preferences for pain management, routine interventions, and for the care and feeding of her newborn.
• Any issues, fears, doubts, or concerns about labour, her support team, her caregiver, nursing staff, and the environment for her birth.
• Her preferences regarding participation in her care and decision-making.

By being aware of these risk factors for traumatic birth, you may be able to put a stop to some risk factors or minimize them at the time, thus reducing the odds of future PTSD. Such actions may even transform her perceptions from negative to neutral or positive, meaning that she will not later describe her birth as traumatic.

Once the birth is over, before leaving the family, be sure to comment positively on something that she did or said that impressed you, with the intention of planting a positive interpretation of her role, especially if there were traumatic or negative aspects to the birth. Later, as she ruminates on the negatives, she may also recall your kind words, and feel better about herself.

Table 1 Lists some of the risk factors and ways to reduce their negative impact.

TABLE 1: What to do if. . .

Risk factor during labor for traumatic birth experience

Preventive or corrective action by partner, doula, nurse, or caregiver

Unexpected complications requiring a change from the care preferences.

-Explain what is happening and what is needed to correct the situation. Reassure if appropriate.-Encourage questions and discuss/consider possible alternatives.-Empathize with her feelings and questions, and acknowledge the difficulty in adjusting expectations.-Focus on what she needs to do: “What we must do now is focus on . . . (keeping a rhythm, the baby’s well-being, handling this procedure, etc.). “

Unwanted routine interventions; lack of understanding of or disagreement over reasons; feeling coerced.Powerlessness, being discounted.

-Help her learn ahead of time about policies of caregiver or hospital regarding usual routines.-Negotiate, compromise, accept the usual routines, or change caregivers.-During labor is a difficult time to discuss routines. Use techniques in box above.-If inevitable, help her adjust and rise above her disappointment, to protect her memory of the birth.

Loss of control over responses to pain (panic, loss of rhythm, crying out, writhing, dissociation).

-Take charge routine — calmly give her undivided attention, and guide her to maintain a rhythm during contractions.-Consider her stated wishes regarding use of pain medications.-If she is motivated to avoid pain medications, pre-plan a “Code word” to say if labor is too long or difficult and she changes her mind and wants pain medications. This allows her to complain without people misinterpreting her complaints as request for medication, If she doesn’t say it, her team supports natural birth. (The code word is not needed if she plans to use pain meds).

Perceived poor treatment, disrespect, lack of communication from staff.

-Encourage woman/couple to speak to staff, or the charge nurse or caregiver.-Describe the dissatisfaction; ask for another nurse or a “fresh start.”-Don’t make the problem worse.

Poor support from partner, doula, family.

-Suggest ways they may help; ask the woman if she needs some time without others in the room; explain the woman’s need for support and kindness.

Mental defeat, unable to continue, hopeless.

-Empathize and try to rally her back into participating: “We need you. Don’t stop now. You’re almost there (if it’s true).”-Explain what will happen next, and help her accept an epidural, a cesarean or instrumental delivery, if she is too exhausted to continue.-Support her decision.

Profound opposite of how she wanted her birth to be.

-Support her as well as possible through the difficult labor.-Recognize the above risk factors as signs that she may later feel her birth was traumatic, and offer opportunities for postpartum support and counseling.

Birth is not over when the baby is born. It goes on and on in the woman’s mind. If the birth was traumatic, it takes longer to come to terms with it. Sometimes PTSD develops. My suggestions are intended first to lessen the likelihood of the birth being traumatic, and, second, if the birth is traumatic, to intervene during labor with the intention of alleviating the trauma and reduce her chances of developing PTSD.

Penny Simkin is a childbirth educator, doula, birth counselor, author, and one of the founders of Doulas of North America (DONA), and PATTCh.