WARNING: This story mentions trauma and suicide.
Explainer – Birth is supposed to be a beautiful and powerful thing, right? Well, not always.
For some, birth can be distressing, upsetting and traumatic – known to many as birth trauma.
But what is birth trauma exactly? Who does it affect? And what can be done about it?
At the beginning of Birth Trauma Awareness Week (July 14-20), here’s what you need to know.
What is birth trauma?
Birth trauma is any physical or psychological injury related to birth, with the perinatal and postnatal period often included under the umbrella term.
Perinatal is the time before, during and just after a child is born, while postnatal refers to the time after the birth.
Kate Hicks is the founder and CEO of Birth Trauma Aotearoa, a charitable trust working in New Zealand’s birth trauma space.
She said people sometimes forget that birth trauma also included baby loss, miscarriage and intensive care stays.
Experiences considered “clinically normal” may also be traumatic, Hicks said.
“Commonality doesn’t mean that it’s not necessarily traumatic.
“What we know is that psychological trauma is in the eye of the beholder, so what feels traumatic for one person can be totally fine for another person,” she said.
Who’s affected and how?
Birth trauma – despite often affecting mothers – can affect anyone: parents, children and the wider family.
How those people are affected can vary, but Hicks said breastfeeding, bonding with the baby, and the parents’ relationship were a few of the things that could be impacted.
“We often see there is struggles between parents and in their relationship because of the way the birth has unfolded.”
Individual trauma symptoms, Hicks said, may include being burnt out, intense grief or “feeling the rug has been pulled out from underneath you”.
“Many people go on to develop post-natal depression or anxiety, and even post-traumatic stress disorder (PTSD),” she said.
The long-term consequences of birth trauma moves far beyond individuals and weakens overall trust in medical professionals, Hicks added.
“A lot of trauma comes from interactions between mother and healthcare staff, so that denotes a real mistrust of the medical profession.
“What this can mean is that parents miss future routine medical appointments… which obviously impacts their own health and well-being but also put strain on the medical system.”
Trauma’s grim legacy
The leading cause of maternal deaths in New Zealand is suicide, accounting for over 40% of direct maternal deaths between 2006 to 2021.
Of the 76 direct maternal deaths, 31 were by suicide.
Direct maternal deaths refer to deaths caused directly by pregnancy or childbirth.
The 16th Annual Report of the perinatal and Maternal Review Committee noted “a significant amount of preventable mortality, and this is especially true in the groups who were most disadvantaged”.
“Māori and Pacific peoples have over twice the rate of maternal mortality compared to the group with the lowest rate (European),” the report said.
Perinatal Anxiety and Depression Aotearoa’s kaumātua and cultural advisor Joanne Rama said through a te ao Māori lens, birth trauma was intergenerational.
She said birth was a special time for mothers but could be extremely difficult when “navigating a system that is actually a little bit cruel and unkind”.
“It’s actually quite different for Māori because we are birthing in a system that is not created by us for us.”
Rama said it was important to consider that many maternal suicides happened during pregnancy, not just after birth.
“It’s [because of] what we call complex trauma,” she said.
Complex trauma is the exposure to multiple, often interrelated and interpersonal forms of traumatic experiences.
What can be done and how do people heal?
“Every practitioner has a responsibility even if the birth does not appear to be a traumatic one to do an unpack before they reach six weeks,” Rama said.
The key was acknowledging feelings and allowing an emotional response, she said.
Rama said she was recently working with a mother whose referral had ended so she did not received the help she needed.
“You know, she is not well and actually all she needs is to unpack and understand why things happen the way they did.”
Rama said she struggled with birth trauma and postnatal stress disorder herself – experiencing flashbacks and severe anxiety.
She said flashbacks, anxiety, overthinking, sleep disruption and rage were common elements of birth trauma.
Rama said she was working on a project called Hine Ora Hine Tuu, which aims to help mothers process their experiences.
“I create a space every month where they come and they heal a little bit more.
“About a month ago we had a hui and they all had to get up and share something about themselves.
“I just realised how much of a difference it has made for them in terms of what they are able to share, being able to be vulnerable and showing their emotions,” Rama said.
What role do midwives play?
New Zealand College of Midwives chief executive Alison Eddy said midwives had an important role to play in the healing and mitigation process.
New Zealand midwives operate under a partnership and continuity model, meaning they work collaboratively with women to meet individual needs.
Eddy said the structure meant there was a “real opportunity” for midwives and mothers to form a bond.
“There’s a real opportunity to sort of connect the entire process [of pregnancy, birth and the post-natal period] for the woman through that care and listen with compassion about what happened and what their experience was.”
Midwives could also be an advocate for a calm, private and safe place for the woman, Eddy said.
“The feeling of informed consent and control of the process sits with the woman and you can be an advocate for that, you know, even just making sure that no one comes into the room without being invited in.
“And if follow-up support is needed beyond the birth [ensuring] that the support is recognised, and they have access to that care.”
Eddy said getting support was not always “easy to access” or “necessarily provided universally”.
“That’s a really important part of healing and moving forward positively,” she said.
Should the government be doing more?
When asked if the government could be doing more, Eddy said “it would be great to see funded support services”.
“You know like the service here in Christchurch (Birth Afterthoughts), for example.”
Birth Afterthoughts Clinic was established in 2023 for women and their whānau to work through and understand their birth.
It is a self-referral service.
Eddy said it would be great to have more services that were “needed and freely available and offered and normalised and not seen as anything sort of stigmatised”.
By Jessie Curran for rnz.co.nz