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Finding Myself Again: Establishing a Midwife-Led Service to Treat Birth Trauma Susie Moore
Swansea University
Wales & South West Maternity Forum
18th September 2019
Cardiff
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Aims of this presentation
To give some background to the incidence and neuroscience of birth trauma
To discuss Birth Trauma Resolution therapy and describe the implementation of a birth trauma clinic.
To present an overview of our evaluations
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Birth trauma
Birth trauma has become increasingly recognised as a distinct mental health condition associated with Post Traumatic Stress Disorder (PTSD), and the term describes women who experience the symptoms of PTSD following childbirth but who may meet some, but not all, of its diagnostic criteria.
It is estimated by the Birth Trauma Association that 10,000 women per year present with PTSD as a result of traumatic birth.
There is increasing evidence in the UK, and in other countries, that traumatic birth can have a serious impact on mothers’ and fathers’ mental health with consequences for all their relationships
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Features similar to PTSD
Distressing memories
Flashbacks
Nightmares
Anxiety
Physical symptoms
Avoidance of people of places
Loss of memory
Loss of interest in activities
Feeling disconnected from baby
Feeling disconnected from family and friends
Unable to express love or feelings
No hope or positive thoughts
Difficulty in sleeping
Outbursts of anger or irritation
Difficulty concentrating
Hypervigilance
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Features particular to
birth trauma
Revisiting images of labour and birth
Fear of and avoidance of giving birth in the future
Poor self image and feeling inadequate
Relationship difficulties
Difficulty in breastfeeding
Lack of interest and avoidance of sex & shunning physical contact
Difficulty attaching to baby and the resulting guilt
Isolation and loneliness
Postnatal depression
Avoidance of medical treatments like smear tests
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Triggers
Characteristic of PTSD is persistent re-experiencing of trauma. For birth trauma sufferers the new baby can be a reminder of the birth experience and trigger flashbacks
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Neuroscience
Several parts of the brain are important in understanding how the brain and body function during trauma.
Forebrain (the prefrontal cortex);
The limbic system, which is located in the centre of the brain;
The brain stem.
When a person experiences a traumatic event, adrenalin rushes through the body and the memory is imprinted into the amygdala, which is part of the limbic system. The amygdala holds the emotional significance of the event (the intensity and impulse of emotion).
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Rational – non rational
The rational part of our brain is the prefrontal cortex. This is the front part of our brain, where consciousness lives, processing and reasoning occur, and we make meaning of language.
When a trauma occurs, people enter into a fight, flight, or freeze state, which can result in the prefrontal cortex shutting down.
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AWEN Birth Trauma Resolution
Service
Established two years ago
Two fully trained, accredited and experienced midwives
Free, self-referral
Over 80 clients seen so far
Usually 2- 3 sessions
profound impact on woman
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Birth Trauma Resolution
Humans Givens Psychotherapy technique (course accredited by RCM)
Solution Focused – actually treat symptoms
Clients set their own goals
Assess emotional wellbeing
Use of relaxation techniques and self help encouraged
Lowering arousal
Reinforcing positive behaviours
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Themes
Interventions in pregnancy & labour
IOL
MLU – CLU in labour
Perceived near death experience
Mother and / or baby
Bereavement
Miscarriage
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Themes
IOL
Often focus on partner being sent home
Left alone
Frightened
Loss of control – not listened to
Interventions in labour
Midwifery led care Obstetric led care
Operative birth
Sense of failure
Loss of dignity
Lack of advocacy
Lack of early contact with baby
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Lack of Advocacy / Compassion
“It’s as if some midwives don’t have vaginas”
“The doctor warned me that it would be painful and that she would not stop the sweep, even if I asked her to. It was the worse
experience of my life and the midwife just stood there as I screamed for her to stop”
“I felt like a piece of meat”
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Lack of Advocacy / Compassion
“The hospital staff didn’t want me there. They were busy and I was sent away. They told me to go and sit on the smoker’s bench. I felt
exposed and silly as car drivers and passengers watched me in pain in the street.”
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Themes
Perceived near death experience
PPH
Fetal heart anomalies in labour
Bereavement
Miscarriage
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Near death experiences
“The midwife told me my baby was being taken to the morgue where it would be dark”
“There was so much blood. I can still see it now. It was like claret red”
“People still come up to me now and ask about the ‘love bite’ on my neck. It’s where the line went in. I’m reminded of it everyday
when I look in the mirror”
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Case Study
Carrie self-referred for therapy when her first born was about two years old
Blaming herself for not achieving a normal birth
Felt robbed of a positive birth experience
Frightened to conceive again
Felt alone – lost contact with friends
Goals
feel ‘normal’
Summary of labour: MLC, prepared by hypnobirthing, attended hospital in early labour, frightened. Partner sent home. Left alone. Let’s
listen to Carrie’s story.
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Case study:
Therapy – a summary
Session 1
Listening
No attempt to ‘justify’ or ‘explain’ actions
The woman’s story is accepted
She feels her experience is validated
emotional arousal reduced
Coached abdominal 7/11 breathing (deep breathing)
essential to success of treatment
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Therapy
Session 2 – 1 week later
Returned a week later – visibly relaxed
Supported into deep relaxation
7-11 breathing
GVI – bespoke to woman
Rewind therapy
moving the memory from the stuck area in the brain to the
neo-cortex
stored as a ‘normal’ memory, detached from negative
emotional arousal
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Therapy
Session 2
Completed session with ‘holistic’ releasing
Replacing negative thoughts with more positive ones – chosen by woman
confidence
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Therapy
Session 3 – 1 week later
Attended in good spirits
Feeling completely different with neutral thoughts about the birth
Declined any further treatment
Intended coming back when she gets pregnant again
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Less than one year later
Pregnant
Attended for relaxation and positive birth rehearsal
Support for VBAC
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Testimonials
I never believed the service would have helped me in the way it did. It has made my day to day life so much easier. Thank you!
I appreciated the fact it was offered to me, even though I gave birth 2 years ago it helped resolve issues in a calm manner and specifically
addressed the feelings I had.
I found the whole experience quite cathartic and in the weeks and months after the therapy I have found myself feeling as if the event is now
in the past and overall actually feeling a lot more positive about potentially having another child in the future (something which I had almost ruled out previously because of having to give birth again).
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Testimonials
It was great to have a safe space to speak openly and honestly about my birthing experience.
The therapist was completely non-judgemental and emphasised that
each woman's experience is personal to them.
Initially I was not sure if I would meet the threshold for birth trauma therapy; however, after the first session I realised that I had a lot of
negative associations with my birthing experience e.g. anxiety around hospitals.
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Testimonials
The therapist worked on my anxiety with me and it took away a huge issue in my life which I didn't realise. I was always drowning in feelings of panic and worry of not getting stuff done, which I thought was normal. I know don't have that. My anxiety pops
back every now and again but I feel I know how to deal with it now so it doesn't become a issue.
It didn’t feel like treatment. Also the effect was so rapid and yet subtle. I only saw Suzie three times in total and yet
it has genuinely improved my life.
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Moving forward
Continue to collect evaluation data through online questionnaire
Publication from this data – themes that contribute to birth trauma in relation to care given
Qualitative interviews
Future project with psychology department – sleep deprivation
Larger scale study across a geographical area to look at different approaches to birth trauma therapy for more robust and specific evidence base.
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Any
questions…….?
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Further Reading
Byrne, V., Egan, J., Mac Neela, P. (2017) What about me? The loss of self through the experience of traumatic childbirth. Midwifery, 51, 1-11.
Elmir, R. and Schmied, V. (2016). A meta-ethnographic synthesis of fathers' experiences of complicated births that are potentially traumatic Midwifery, 32, 66-74.
Griffin, J. & Tyrell, I. (2013). Human Givens: the new approach to emotional health and clear thinking. HG Publishing: Chalvington.
Mullen, J.(2107). Birth Trauma Resolution. Midirs Midwifery Digest. 27,3,345-348.
National Child Birth Trust. McKenzie-McHarg and Poote Dealing with post-traumatic stress disorder. Available from: www.nct.org.uk/McKenzie-McHarg and Poote Dealing with post-traumatic stress disorder.pdf Accessed 21.04.17
National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. Available from: www.nice.org. uk/guidance/indevelopment/gid-cgwave0598 Accessed 24.04.17
Reed, M., Fenwick, J., Hauck, Y., Gamble, J., Creedy, D. (2014). Australian midwives’ experience of delivering a counseling intervention for women reporting traumatic birth. Midwifery, 30, 269-275.
http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics
https://www.rcm.org.uk/sites/default/files/Emotional%20Wellbeing_Guide_WEB.pdf
http://birthtraumaresolution.com/birth-trauma-information/biography/