Influential Factors in Traumatic Childbirth Experience

Introduction

Many people would refer to the birth of a child as a joyous experience, but for some women, it can be traumatic and lead to post-traumatic stress disorder. Much of the research has shown that there are many different things that can cause a woman to perceive their childbirth experience as traumatic. However, 54.6 % of women reported that it was related to lack and or loss of control (Hollander et al., 2017). Some other factors that make birth trauma more likely include lengthy labor or short and very painful labor, stillbirths, poor postnatal care, or lack of privacy and dignity. In addition, the type of birth, as well as the type of interventions that may or may not have been applied, have an impact on the perception of one's birth experience (Aktas, 2018). In turn, this affects the mother's attachment to her newborn and can pose for an even higher risk of depression (Dekel et al., 2019).

Method

For the purpose of this literature review, we will be looking at the factors that influence a traumatic birth experience in women ages 18-35. Databases used include CHINL, EBSCOhost, ScienceDirect, and PubMed Central. We excluded dissertations from our search. Key search terms were traumatic birth, trauma, PTSD, depression and impaired bonding, and support.

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Results

We found 16 articles relating to traumatic birth experiences, PTSD, and postpartum bonding issues from 2015-2019. Four were about possible ways to decrease PTSD in traumatic birth experiences. Five were about perception of a traumatic birth. Three talked about impaired bonding and negative effects of relationships. Four talked about predictive factors for traumatic birth and PTSD.

Risk Factors for a Traumatic Birth

Upon review of the literature, it was found that women who had a history of two or more previous traumatic life events or who had depression before or during pregnancy (Polachek I, Dulitzky et al., 2016) had a higher prevalence of birth trauma and symptoms of postpartum PTSD (Brittain et al., 2015). Levey (2018) had similar findings and also went on to say that having a history of abuse, or having experienced a sexual assault, are all risk factors for the development of antenatal anxiety, depression, and post-traumatic stress symptoms after birth. Weinreb (2018) supported these findings and also determined that women who had a lack of social support were also more at risk.

Events During Prior and During Labor that May Lead to Trauma

Many women would expect pregnancy to be life-changing and encouraging but due to constant bodily changes and hormonal spikes, a woman’s pregnancy period can take a multitude of directions. Not every woman gets a joyous birth experience due to an inexplicable number of factors. Ghanbari-Homayi (2019) identifies predictive factors involved in traumatic birth experiences. Results found that the independent predictors of the traumatic birth experience were related to antenatal factors including lack of exercise during pregnancy and intrapartum factors including the absence of pain relief during labour and birth (Ghanbari-Homayi et al., 2019). Atkas (2017) had similar findings. Could this be decreased if women were more actively involved in their care and decisions during pregnancy and labour? The answer is yes, allowing involvement from the mother during antepartum and intrapartum can have greater results during the postpartum period. Perception of pain, limitations during labour such as choice of delivery position, prenatal care, and health insurance are all issues discussed. Socio-demographic factors such maternal obesity, marital status adolescent pregnancies, etc. can lead to traumatic birth.

Poor Relationship with Medical Staff

Interaction with personnel. The subject of interactions, relationships, and care from medical staff was common among the literature. It was found that negative experiences with medical staff, insufficient support, lack of communication, and feeling ignored/rushed were noted as some influences of a women’s perception of a traumatic birth experience (Reed et al., 2017; Rodríguez-Almagro et al., 2019). Huang (2019) identified a perceived lack of support, communication, and poor service from medical staff as an influencing factors for traumatic birth as well. Some women even stated that they felt manipulated by their providers (Greenfield et al., 2019). Birth is supposed to be a beautiful experience but how can it be when women feel like what they want is being ignored or pushed to the side? Many women believe that having better communication and support from their care providers could help decrease the instances of traumatic birth experiences (Hollander et al., 2017). Women need to be able to have a quality relationship with their providers in which trust, communication, and mutual respect can be established and maintained.

Control. Lack of control was another theme identified in the literature as an influencing factor in the perception of a traumatic birth experience. According to Hollander (2017), 56% of women attributed their traumatic birth experience to a loss or a lock of control. When asked what they thought could have been done differently in order to reduce or prevent the trauma many believe that they could have asked for more or less actions and interventions. Imagine being a woman and your midwife is pushing an intervention on you that you don’t want but your concerns did not matter. Now, what if you wanted a specific intervention performed but because it was time-consuming it was thrown to the wayside. I believe that this would make anyone not have a good experience, especially one as intense as childbirth.

Postpartum Concerns After a Traumatic Birth Experience

Postpartum Depression. Birth and the birthing process itself are already a cause of concern for mothers-to-be. There are so many stages and steps that occur and are needed in order for a birth to be successful. Along with these stages come different moods and experiences. Antepartum usually brings about joy, excitement, and worry. Intrapartum experience all depends on the perspective of the mother and her experience. However, postpartum usually has a negative label attached. Postpartum blues and/or depression is something that many mothers experience. Each case is different depending on the person, however, having a traumatic birth experience can take postpartum depression to a whole new level. Abdollah (2016) found that Traumatic childbirth with disturbing memories can have negative impacts on the mental health of postpartum mothers

Impaired Bonding. The effects can vary from the state of mentality the mother is in, to the behavior the mother exhibits. For example, many researchers have included in their reviews that the mother and newborn relationship and well-being suffer following a traumatic birth experience (Furuta et al., 2018; Hairston et al., 2018). Dekel (2018) had similar findings. Impaired bonding between mom and newborn can occur, which can pose a huge threat to the newborn as bonding has shown to be crucial to the development of the newborn. Mothers may not have the motivation or the strength to care for their babies after such a traumatic event. The baby may go unfed, unchanged, and also may suffer neglect or abuse. In addition, a mother could not be caring for herself, her other children, or her significant other. This causes couples to experience negative emotions towards each other as well as a loss of intimacy (Delicate et al., 2017). It is a vicious cycle that needs to be broken in order to ensure that a mother can have the best possible chance at healthy, functioning relationships with not only her child(ren) but also her partner.

Conclusion

It is our belief that the factors that influence a traumatic birth experience need to be addressed prior to birth in order to prevent the negative effects. Trauma is a subjective experience however, there were many similarities in the feeling and emotions for the women in these studies. There needs to be a focus on the quality of provider interactions and education for care providers in maternity wards ensuring that they are striving for positive interactions with women. This means providing support, therapeutic communication, validation, acknowledgment, and respect. Although further research is needed, with this added support throughout all stages of pregnancy including postpartum, we believe it could help reduce instances of traumatic birth experiences. As well as decreasing the likelihood of mental health issues and strain on the family following birth.

References

1. Abdollahpour, S., Khosravi, A., & Bolbolhaghighi, N. (2016). The effect of the magical hour on post-traumatic stress disorder (PTSD) in traumatic childbirth: a clinical trial. Journal of Reproductive and Infant Psychology, 34(4), 403–412. https://doi.org/10.1080/02646838.2016.1185773
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