I am all for women feeling in charge, in control, empowered and able to make their own choices about where and how to give birth to their baby. But what happens when the mother has no choice?
Yesterday, the National Institute for Health and Care Excellence (NICE) issued draft guidance stating that “women experiencing a straightforward pregnancy should be encouraged to give birth in a midwife-led unit rather than a traditional labour ward”, and “a home birth may be just as safe for low-risk pregnancies.” (source: BBC Online).
Pregnancy and birth should be recognised as natural and beautiful. However, what this draft guidance fails to acknowledge is that even a low-risk birth can go wrong, and the lack of support for mothers after experiencing a traumatic birth. It perpetuates the taboo.
I am not a midwife, nor am I an obstetrician. I am still aware that even the most finely-crafted birth plan can go awry because the baby has other ideas. I am aware that women can consider themselves to be a ‘failure’ because they had to have an unplanned episiotomy, or an epidural when they had imagined they could cope with gas-and-air pain relief, or be rushed in for a Caesarean section when all the pushing in the world hasn’t brought a result.
I am all too aware of what it feels like to feel a failure, and the world’s worst mother. I had no choice but to have an emergency Caesarean section under general anaesthetic at just 24 weeks and four days along because I had severe pre-eclampsia and HELLP syndrome. I had no choice because I had to be taken by emergency ambulance to a specialist hospital two hours’ drive away from my home. I had no choice because my son would have been stillborn, and I would have suffered lasting organ damage, or died too.
Sadly my beautiful son Hugo died aged 35 days. He fought an incredibly hard battle and everything possible was done to save him. I am heartbroken.
Luckily, thanks to the swift intervention of the medical teams, I am now mostly physically ok. The psychological effects will take a lot longer to heal though. I have written about that in more detail here.
My situation is perhaps unusual because I have the double whammy of a traumatic birth experience and dealing with the devastation of losing my much-wanted, much-loved baby.
Unfortunately, I know I am far from unusual in finding it difficult to get support for perinatal mental health issues. Perinatal mental health can encompass a wide spectrum, from the emotional such as ‘baby blues’; psychological, such as trying to overcome a traumatic birth; and severe episodes such as postnatal depression and puerperal psychosis.
Women who have suffered a traumatic birth need dedicated and targeted emotional and psychological support to help them overcome the distressing event. As with any illness, early intervention is likely to lead to a positive outcome, and more quickly.
I have been fortunate to have family, friends and health professionals to lend a sympathetic ear, and mothers who have been through a similar experience to empathise with.
What I need to help me get better is professional help. I feel no embarrassment or shame in admitting that. I have lost my precious son, and there is nothing else in the world that can happen to me that can cause me any further hurt. I also know I am unwell, and want to get better. I need to be able to come to terms with my ‘new normal’.
I am also fortunate that my GP has referred me to an Improving Access to Psychological Therapy (IAPT) service. This is all about cognitive behaviour therapy (CBT), which is a kind of talking therapy that can help manage problems by seeking to change the way you think and behave. I really hope it can help me.
The referral came because I specifically asked for it – I am not sure if I would have got it otherwise. It will be two to three weeks before I will get an initial phone call from them to find out what help I need, so even longer before my first appointment.
An added frustration was finding out I could have referred myself. But then, I wasn’t sure if I would have known how to access the service. It is a bit of a chicken-and-egg situation.
Access to perinatal mental health seems to be, to use that awful Daily Mail phrase, a ‘postcode lottery’. It really shouldn’t be. Women who have experienced a traumatic birth need to be aware of what support is out there, and how to access it.
There are likely to be concerns about ‘flooding’ services with patients, but it’s possible not all mothers will feel the need to make contact with an IAPT service. What is important is knowing what support is available, if needed. Support is available through a range of methods: in addition to talking therapies, there are things like phone helplines, and online forums.
It is unacceptable for women who have had a traumatic birth to leave hospital without knowing what support is available, and have to proactively seek it out themselves, as I did.
Some women may feel so helpless and disempowered as a result of their experience that they may never get the help they need.
Pregnancy and birth is a beautiful, natural experience. But please don’t promote that at the expense of acknowledging that things don’t always go to plan, and ensuring mothers get the support they desperately need to overcome their ordeal.
I am asking NICEly. Please help break the taboo of traumatic birth.