How does birth trauma affect women?

Listening to Women After Childbirth, by Alison Brodrick & Emma Williamson (Routledge; £32.99), reviewed by Dr Kate Redman.

Listening to Women After Childbirth helps us think about the links between women’s birth experiences and mental distress. This well-researched book strikes a balance between research and clinical case studies which help to connect the reader to the emotion of the issues involved, bringing the book to life. Attention is paid to the experiences of partners attending the birth and of staff who work in this area, who may also suffer from traumatic responses.The main focus of the book is on supporting those who have been traumatised by the process of giving birth, but it isn’t so much a ‘therapy’ book. Rather, it provides a range of information on how best to support women who have been negatively affected by a birth experience, with guidance on how to develop appropriate services to support them and their partners.

I found it interesting to read about the Birth Afterthoughts model – a stepped care approach in which midwives typically offer an opportunity for women to discuss their birth experience in the first few days and weeks (with the aim of ‘defusing’ distress). Then if women or partners want a more detailed discussion of the events around the birth, they self-refer to a Birth Afterthoughts service. This service tends to be midwife led, using a counselling model to help clients to process their experience, whilst providing screening guidance for PTSD and other post-birth mental health problems. Clients who need more specialised help can then be referred to appropriate services.

Fear of childbirth is also addressed, particularly for women who have had a previous traumatic birth experience and who are fearful about giving birth in the future. The authors work with clients using a predominantly cognitive behavioural approach and illustrate how this can be used by clinicians to help their clients.

The book provides a useful chapter on therapeutic interventions that may form part of a Birth Trauma service. At present, the current research is focused on EMDR, trauma-focused CBT and compassion-focused therapy. As this area is developing, it will be interesting to see if other therapeutic approaches such as CAT (Cognitive Analytic Therapy) or schema therapy could also be a helpful way of supporting clients who present with complex cases.

The penultimate chapter centres on how to support midwifery staff who may have experienced workplace trauma. The authors explore framing staff support using a self-compassion model and advocate for regular restorative clinical supervision. The aim of this is to offer a safe space for staff to reflect on what they experienced and to help them to emotionally process the demands that their role can place on them. This approach has been shown to reduce stress and burn out for staff who work in maternity services. The final chapter looks at using the narratives and understanding gained from Birth Afterthoughts sessions to facilitate reflection, offering ideas for staff training.

I enjoyed reading this book. It provides helpful information on how to integrate psychological services into maternal and post-natal care, which I feel is immensely important for women and their families.

- Reviewed by Dr Kate Redman, Chartered Clinical Psychologist, NHS

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