Can you tell us how you think the birth landscape has changed during the time you have been working with pregnant and new families?
There have been many positive changes. There is a much greater awareness, I think, of the need to fully involve women, birthing people and their families in their decisions around pregnancy and birth, and offer genuine choice in place of birth, and choices within birth. When I first started working with pregnant women, stand alone birth centres were a new thing and I remember thinking they were just incredible. Now they are an accepted option in many parts of the UK. I think women, birthing people and families are much more aware of their rights during birth, and hypnobirthing has gone from something a bit woo-woo to pretty standard. Having a doula is also something which many more families seem to be opting for and is seen as being a choice for all. The impact of birth is spoken about much more widely, and is now part of NHS England planning.
However, I do feel that I have seen far too many negative changes too. The impact of austerity on the NHS has been heartbreaking, with so many of the services which were women and family centred being removed, and many birth centres have closed down. Those who work in birth - midwives, doctors, anaesthetists, health visitors, doulas, and so on - are suffering from burnout after years of having their services underfunded and approaches being more about targets than people. Despite having seen and been involved in campaigning for a different narrative around birth, so many still come out of their birth experiences feeling so bereft, feeling that unnecessary interventions or coercive practices had a negative impact on their birth experience and their mental health. And somehow there is ever more pressure, and more judgement and attributions of success or failure around birth, than before.
Can you tell us about the Make Birth Better campaign. How did it start and what were your intentions at the beginning?
Originally, Make Birth Better grew out of an Instagram post I did back in 2017!! It explained the difference between PTSD after birth and post natal depression. I got a lot of messages from women telling me that it had really resonated with them, and it got me thinking about the common themes in the stories they were telling me. Birth trauma is still something we don't talk about nearly enough, and so many people are left feeling a sense of personal failure. So I invited people to send me their birth stories, and I analysed them to draw out the key themes. I set up a website to share them, and also asked other professionals working with birth trauma to add themselves to a shared map so that people could find support more easily.
That initial campaign put me back in touch with Dr Rebecca Moore, perinatal psychiatrist, who I had worked with in Tower Hamlets previously. Becca, who has a longstanding interest in birth trauma and set up the Birth Trauma Conference, was planning to bring together people who were interested in trying to make a change. We discussed how difficult conversations around birth could be - how dichotomous these discussions often become - and agreed there was a need for a platform for all voices - parents and professionals, and representative of everyone giving birth not just white, middle class. heterosexual, able-bodied women! Becca arranged a meeting in January 2018 and we agreed then to begin the Make Birth Better campaign. That initial collaboration, initially with just 8 others, was the beginning of the network of brilliant individuals and organisations who have been the backbone of Make Birth Better and supported us, guided our thinking and kept us motivated!
We officially launched in July 2018, and since then we have grown to a core team of 6. I took a big step back from the day to day running of it last December, and Nikki Wilson came on board as our CEO. Nikki has worked her socks off since then turning a very passionate but somewhat disorganised organisation into a fully functioning CIC with much clearer objectives.
What is the future of Make Birth Better?
We have a clear vision - to create a world where people no longer suffer from birth trauma. We believe so much of birth trauma is preventable, and even when someone has had a difficult experience, with the right support this does not have to become inevitably traumatic. Our aim is to do this by targeting prevention as well as diagnosis and treatment so that people can quickly access help. We see birth trauma very much as a systemic problem with system-wide solutions that involve each and every one of us. Through our campaigning, education and research we hope to achieve five key goals: change the prevailing narrative around birth through providing a platform to hear a wide range of birth stories and experiences, we aim to reveal the systemic nature of birth trauma through creating and being involved in research, to upskill all professionals around the prevention, assessment and treatment of birth trauma, advocate for wellness in professionals, and provide information and signposting to parents and professionals.
Over the next few months, we will be launching our sparkly new website (much easier to navigate and find resources!), offer another training as well as develop an annual Summit and online training course, establish our Champions role and continue working alongside other brilliant organisations supporting their work where possible. At the moment, our main focus is on sharing the results of the survey we sent out over lockdown, with some truly heartbreaking statistics.
Where do you think the biggest ‘black hole’ is in maternity care? Is it as high up as policy makers, somewhere around middle management or nearer the front line?
Society? I think so many problems in maternity care stem from the way in which we treat women and birthing people when they are pregnant. Women who have been raised being told they can 'have it all' are suddenly spoken to as if they don't know how to make the right choices for their baby and their body, and are pushed through an overburdened, under funded system that just doesn't have the resource to treat each person as a whole human being with valid and valued needs and desires. To me, the whole maternity system needs a shift. But, often, it comes down to money. Shortcuts have to be made because there just isn't the money to provide the staff needed to make a meaningful difference.
What are the defining characteristics of 'Birth Trauma’? Sometimes it is hard for new families to differentiate between feelings of overwhelm and exhaustion following a difficult experience, and ongoing need for medical help or specialist support.
Birth trauma is a really broad term and confusing in many ways. It describes symptoms of trauma which may be related to the birth experience itself or the journey to and following birth - including the fertility journey, breastfeeding journey, postnatal experience. Some women (around 4%) have PTSD after birth, but many more have some symptoms of trauma but without meeting diagnostic criteria - we think up to a third of women find some aspect of their birth traumatic.
It is not unusual to feel overwhelmed and exhausted even after a birth that wasn't difficult. Where you might be looking for trauma would be if someone is very preoccupied with their birth and birth story, or may be avoiding talking about it completely. Often you would hear about feelings of failure and self-criticism around the birth, I often hear people talking about how they let down their baby or even the staff. People may experience flashbacks, or nightmares - these may not be images, or verbal recollections, sometimes it's just a feeling. You would expect to see some hypervigilance, such as being a bit more jumpy than you might expect, and often people are preoccupied with the safety of their baby. There is a brilliant Scale - the City Birth Trauma Scale, which you can use to establish whether birth trauma is present in a client. Important to note too that it may be the partner who has been traumatised by what they witnessed.
Do you think there is anything during antenatal education that can prepare women for a more positive experience of birth? Can we avoid Birth Trauma before it happens?
I do think we can prevent birth trauma from happening for many people, and there are many different strands for this. Most important to me is about the individual and their experience. Often people have already experienced trauma in their lives which emerges when they are feeling so vulnerable in late pregnancy and during birth, and it's really difficult to ascertain this beforehand unless you really take the time to get to know someone - which is why a relationship with a doula can be such a powerful thing. It gives that foundation, then, to think with someone about what they need to feel safe, and that is different for everyone. Many people go into birth with a lot of fear, and reassurance often isn't enough, it can help to really unpick where that fear is coming from and build alternative narratives. For example, so few people have seen what a peaceful birth looks like, thankfully we have YouTube available to help to create the picture that birth doesn't have to be scary.
I also think that the narratives that exist for women at the moment, the pressures we face, are really unhelpful when it comes to birth. Being a 'good girl' and doing what we're told, having to cope alone without asking for help, that birth is something we can 'succeed' or 'fail' at. This can create false expectations. It's important that we talk about the realities of birth, that it can be beautiful but it is also hard work, and messy, and surprising.
You must hear some heart-breaking stories from families in your care. How do you stay ‘protected’ and what self-care measures do you access for yourself?
I do, and it doesn't get any easier. I have a brilliant supervisor who I speak to at least once a month, more if I need to, and I also turn to peers to debrief. I think because when I am listening to birth stories I am listening out for meaning and linking themes together, you do keep a more objective stance in the room with someone although obviously I'm often very moved by what I hear. And shocked, on many occasions. But my role is to contain their feelings about their experience, so it's really important to me that I don't impose my own feelings on to their experience. Their time with me has to be about them, and them only - especially when they are telling me about an experience that should have been about them and wasn't.
In terms of self-care, I have to make sure I have time to decompress after a session and process what I've heard, often that would just look like me sitting in a chair staring out of the window! But I'm careful to not hold on to trauma in my own body and I do notice that I need to take time to bring my own adrenaline down again sometimes. I've spoken to others who work with trauma and we've talked about how occasionally you do need a break from that work, otherwise you can start to see the world through dark-tinted glasses, so I try and also look for the joy in life too! And if I notice I'm getting a bit angry and indignant about the state of the world, and maternity care, I have a couple of days away from it. We're so lucky in the team at MBB that we all give each other the space to do that and someone is always happy to pick up a piece of work when another team member needs space to breathe.
I think what makes it easier too is that I do truly believe that we can make a difference. To individuals that I work with, it is always incredible seeing a traumatic experience lift away from someone and lose it's power. And within MBB, I do believe we can change things for the better. I have to!
When a doula supports a family who have recently been through birth trauma or are expecting a child after a previous traumatic experience, what is the one thing we should try and do? What is the one thing we should try NOT to do?!
One thing to try and do - Just LISTEN. Validate. Empathise. And only then, plan for how they will feel safe in the here and now.
One thing not to do - Reassure. So often reassurance is heard as invalidation.
Okay, now we can mention Covid! Have you seen an increase in birth trauma due to the stresses of the pandemic?
Not yet, but I think it's coming. We are releasing the results of the survey we did over lockdown, asking pregnant women and professionals about their experiences of maternity care over lockdown. 458 parents-to-be shared their experience. They described feeling 'Devastated’. ‘Frightened’. ‘Powerless’. ‘Helpless’. ‘Shocked’. Over 90% of mothers told us that their maternity choices had changed, and that information was often unclear which raised stress and anxiety. Most worryingly to me, half of the women who responded who had been receiving mental health support said that this had stopped. I feel like we are in the waiting room at the moment, because those women who had difficult experiences, who laboured without birth partners present, who spent their postnatal period alone, with little support - they might at present be too shell-shocked to know how it has affected them, or they might find it too difficult to find out how to access the support they need. I think we will see the impact of this for many months to come.
I’ve been lucky enough to hear you speak on several occasions and now understand so much more about the ripple effect of trauma on midwives and those caring for birthing people. It can be the same for doulas. Do you think this has gotten worse during the pandemic?
I think that professionals working with those who give birth were already working in extremely difficult circumstances before the pandemic, and they have often had to fill the gap of birth partners during this time. So reaching deep to give more when their resources were already low. Again, I think it will be some time, when people feel more settled and are more able to process what we have all been through globally, before we see the impact of this on people's mental health. I would say, if you are reading this, please make the time to allow yourself some space to do this.
There have been some anecdotal reports that things have been better for new families - less visitors, more women-centred care, is this your experience?
I have heard this too, that there has been more opportunity for bonding with babies and this has had a positive impact on breastfeeding rates. Many people have had partners at home for longer too, which has been beneficial. But many of the new parents i have spoken to are feeling really isolated at the moment. They are missing the opportunity to introduce their new baby to the world, often they may live far from family and I've heard many parents really grieving about the loss of seeing that relationship with their family and baby develop. It's harder for people to create the networks which can be such a lifeline. So, yes, there have been positives for many people but it doesn't take away.- I don't think - from how difficult this experience has been.
Emma was interviewed for The Doula by Editor Trudi Dawson.
Chartered clinical psychologist Dr Emma Svanberg (DClinPsy) is known as The Mumologist and works with parents and parents to be supporting them through their parenting journey. Working as part of a Collective, Emma and her colleagues together offer whole-family support in person and through her online community The Village. Together with perinatal psychiatrist Dr Rebecca Moore, Emma co-founded Make Birth Better, a Community Interest Company devoted to reducing the impact of birth trauma, in 2018. Emma is a published author and her work has been featured in The Guardian, Marie Claire, BBC News and Mother & Baby. She brings over 10 years of academic and clinical experience to help parents and professionals on their journey through parenthood.
Emma is the author of Pinter and Martins Why Birth Trauma Matters. Insta @mumologist www.mumologist.com and www.makebirthbetter.org
