News
Birth trauma inquiry: No more suffering in silence
A landmark parliamentary inquiry has found rates of birth trauma are unacceptable and recommended an overhaul of the health system.
One in three Australian women experience birth trauma. One in 10 are victims of obstetric violence, and one in 25 develop PTSD.
‘Every birth [must be] met with dignity, respect and compassion.’
This summation by NSW Upper House MP Emma Hurst, Chair of the Select Committee on Birth Trauma, should go without saying.
Yet the recent NSW Parliamentary Inquiry into birth trauma has demonstrated that the health system sadly falls short of this standard.
The landmark inquiry included 4000 submissions from health professionals and patients. It found many people have suffered distressing and unacceptable experiences from preventable birth trauma, which in some cases represented forms of obstetric violence, and that urgent efforts must be made to address avoidable risk factors.
According to the World Health Organization, three in 10 women in the world do not receive adequate postnatal care, which can lead to recurring pain and trauma. In Australia, birth trauma affects one in three women.
‘This is the first time a parliamentary committee has examined and reported on birth trauma – and it was long overdue,’ Ms Hurst said.
‘The personal stories shared were heartbreaking and revealed systemic issues that must be urgently addressed.
‘Birth trauma and obstetric violence are global health issues … the unprecedented scale of evidence the inquiry received reflects the number of birthing parents [who are] unnecessarily traumatised giving birth.’
The recently released report makes 43 recommendations, including:
- increased access to continuity of care models with a known provider
- more comprehensive antenatal education
- a review of laws regarding informed consent and formal training for maternity workers in this area
- greater investment in mental health support, post-partum services and trauma-informed care.
The report also recommends increased funding for psychological support for mothers experiencing pregnancy loss and for these women to have spaces in public hospitals separate from mothers and babies.
However, Ms Hurst remains critical of the recommendation regarding obstetric violence, considering it ‘watered down’ by other committee members.
‘[The recommendation] fails to recognise the power imbalance between birthing parents and health practitioners, and the systemic issues that were clearly presented to the committee regarding the presence of obstetric violence in maternity care systems globally,’ she said.
‘Failure to even consider legislative changes to protect birthing parents from obstetric violence is unacceptable.’
Obstetric violence includes any act by a healthcare worker that causes harm to someone who is pregnant, is giving birth or has recently given birth, such as performing examinations or treatments without consent, failing to respect dignity and confidentiality, threatening, blaming and discrimination.
Research from Western Sydney University suggests this occurs in up to one in 10 Australian women.
Psychologist and University of Sydney researcher, Alysha-Leigh Fameli, gave evidence at the inquiry, which she considers a monumental step forward.
‘There were some really great recommendations for preventing birth trauma, including more continuity of care models and investing money into more training for midwives, GPs and obstetricians,’ she told
newsGP.
Mrs Fameli was, however, dismayed that other recommendations were vague, despite clear supporting evidence.
‘Some recommendations were left too open to interpretation and so will be difficult to translate into clear guidelines and real changes in policy,’ she said.
‘They really failed to give weight to obstetric violence – to even use this internationally recognised term. If we don’t adequately call it out for what it is, we invalidate the up to 10% of women who experience it.
‘It is a broken system where women are harmed.’
Wagga Wagga-based rural generalist obstetrician, Dr Trudi Beck, also provided evidence to the inquiry. (Image: Facebook)
Mrs Fameli is currently studying the ‘rippling neuropsychosocial effects’ of birth trauma on both mothers and their babies. Sadly, approximately
one in 25 of these women will develop post-traumatic stress disorder (PTSD).
A key finding in her research is that PTSD following birth trauma often goes unrecognised. She recommends adopting the UK’s
City Birth Trauma Scale, which has been
successfully validated as a screening tool for PTSD in Australian women with birth trauma.
‘While Australian women are routinely screened for post-partum depression and more recently anxiety, the symptoms of PTSD are often completely overlooked,’ Mrs Fameli said.
‘Although there is some overlap, there are unique symptoms of PTSD really getting missed or dismissed as being normal “new mum” behaviour.’
She explains that while both depression and PTSD can cause low mood and loss of enjoyment in activities, the following symptoms are all uniquely suggestive of PTSD:
- A dramatic change in how a mother views themselves or the world
- Pervasive self-blame (including blaming oneself for not being able to overcome symptoms)
- Distressing memories and flashbacks
- Avoidance of things that remind of the birth, including the baby themselves
- Hyper-arousal and lack of sleep, even when the baby is sleeping
‘Lots of women with PTSD push through their symptoms or mask their suffering for the sake of their families,’ Mrs Fameli said
.
‘Because they are still somewhat functional, they don’t quite meet criteria and so recognition is difficult. It is often only when mothers come in with infants who are tricky to settle or have feeding difficulties that PTSD from birth trauma is uncovered.
‘It is very important that these women are identified and receive appropriate care and support for PTSD. While symptoms might subside eventually, they will often recur when triggered by the next pregnancy and birth.’
Mrs Fameli considers Australian GPs to have the most important role in recognising and managing patients with birth-related PTSD.
‘Our postnatal care system is extremely fragmented and ill-equipped,’ she said
.
‘We don’t have clear referral pathways or support systems so often the GP is the first person that women will go to for help or as part of the six-week postnatal checkup.
‘GPs are the face of the healthcare system for postnatal women. Once a GP recognises the seriousness of a mother’s birth trauma and identifies symptoms of PTSD, they can then work really closely with the patient and coordinate care with allied health to completely change the trajectory for the mother and baby.’
Wagga Wagga-based rural generalist obstetrician, Dr Trudi Beck, also provided evidence to the inquiry from a uniquely rural perspective, advocating for adequate funding of multidisciplinary care including, but not limited to, the crucial six weeks after birth.
She considered the process well thought out and conducted in an empathetic manner which successfully engaged the relevant stakeholders.
‘It was very positive to see recommendations regarding better support for women dealing with pregnancy loss and for GPs coordinating multidisciplinary perinatal care,’ Dr Beck told
newsGP.
‘It was also great to see acknowledgment of the importance of rural GP and GP obstetricians in providing continuity of care in poorly resourced regions.
‘From this report, the Royal Australian and New Zealand College of Obstetricians is conducting analysis of obstetric services in regional NSW to better distribute resources for all country towns, not just major rural centres.
‘A number of my patients travel 150 km to seek care due to a lack of regional perinatal services.’
She was wary, however, of the use of the term, ‘obstetric violence’, instead preferring to promote ‘shared decision-making’.
‘I fully agree that there’s plenty of vulnerable women who experience birth trauma that is at least, in part, due to system errors preventing them from receiving a proper standard of care,’ Dr Beck said.
‘However, as soon as you start using terminology associated with criminal acts or violations of human rights, I think that divides people rather than encouraging them to seek a common ground.’
Resources and support
Aside from asking a doctor or midwife for advice, patients can get help and information from:
Log in below to join the conversation.
birth trauma mental health obstetric violence obstetrics perinatal health PTSD
newsGP weekly poll
Health practitioners found guilty of sexual misconduct will soon have the finding permanently recorded on their public register record. Do you support this change?