The impact of a traumatic birth on future pregnancy’s among young women aged 18 to 35 years in the United Kingdom

The impact of a traumatic birth on future pregnancy’s among young women aged 18 to 35 years in the United Kingdom

Introduction

Background

According to Beck (2015), a significant number of women experience childbirth as traumatic. This particular experience can give rise to potentially harmful lifelong impact on both the physical and mental health of the mother. Besides, it has other implication on the relationship between the woman and her baby, her family, and partners. Most importantly, traumatic childbirth has a significant impact on the future decisions of the woman in future decision concerning pregnancy and birth. The United Kingdom in 2016 had a total of 696271 births out of which the Birth Trauma Association estimated that a total of 200,000 women exhibited traumatic birth where a significant number develop the posttraumatic stress disorder. Similarly, Boorman et al., (2014), establishes that about 25% of women who have undergone the child delivery process reports traumatic childbirth experience. Most of them believe that their health or the health of the baby was in danger, or there was a serious threat to the emotional or physical integrity during delivery.

According to Kim and Lee, (2014), childbirth can give rise to the debilitating traumatic stress emerging from the threat to the physical integrity and injury to either the mother or the baby. The delivery process is likely to trigger traumatic stress responses, as well. In turn, mothers start exhibiting anger, anxiety, apathy, and dissociation as well as the disconnection within the few first weeks after birth as a response to the overwhelming event. Expectant women enter into the delivery systems with the hope and assumption that their expectations will be met, their children will be safely delivered, their bodies respected, and have a stress-free delivery. According to Todd (2015), this phenomenon of birth trauma exhibits an array of traits that are similar to those portrayed by PTSD.

The rationale for the choice of the topic area

Compared to other forms of trauma, childbirth trauma is unique because it is tied to the event that generally results in a positive outcome, which is the birth of an infant. Also, it bears tremendous societal pressure for the mothers who have undergone it to portray happiness about their childbirth as well as embrace the perception that having a healthy kid masks the negative impacts of the birth. Despite being viewed as a joyous event, the process of childbirth is often accompanied by episodes of both psychological and medical trauma. To date, much study has gravitated towards understanding the prevalence of childbirth posttraumatic stress disorder and the factors that are linked to the development of the symptoms of this condition. There is, therefore, a need to establish, synthesize, and appraise evidence of the Negative Impact of the childbirth trauma on the future of the reproductive decisions made by women, especially in the subsequent births. In particular, this research assesses the impact of childbirth trauma as a factor that impacts the birth rate that is crucial in identifying the areas for prevention as well as helping obstetricians and midwives to improve woman-centred care.

Research aim and objectives

This research aims to investigate whether the women’s experiences of traumatic childbirth affect their future decisions concerning subsequent childbirth.

The study objectives include:

• To review the concept of childbirth trauma
• To investigate the fear of birth
• To examine the experiences of women during birth in more details that are considered to be traumatic.
• To establish the relationship between negative childbirth experiences, fear of birth, and subsequent childbirth decisions

Research question

This study seeks to answer the following questions:

RQ1: What are the lived experiences of mothers who define their childbirth as traumatic?

RQ2: What factors impact future birth decisions?

Significance of the study

This review informs the fear of subsequent childbirth as a result of the childbirth trauma to enable the understanding and, ultimately, prevention and treatment of the problems of postnatal PTSD (Simpson and Catling, 2016). The findings to the healthcare professional, particularly in the provision of emotional and social support to the mothers to create a positive childbirth experience, which in turn would enhance positive outcomes of the subsequent pregnancies. Through exploration of the cases of traumatic birth, the healthcare service providers may better comprehend the consequences of the perceived trauma both during birth and postnatally. Midwives and nurses are always at the frontline in both processes of labour and delivery and thus contributes significantly to influence the mother’s experience of childbirth. It is therefore crucial for these professionals to better understand the perceptions of traumatic childbirth that is essential in improving interventions as well as creating g trusting relationship with women to establish a positive birth experience. Finally, the findings from this study will aid the service providers in assessing, treating, and follow-up standards to care for childbearing women and to prevent childbirth trauma.

Literature search strategy

Databases used

A computerized literature search was conducted on seven bibliographic databases, including PsycINFO, CINAHL, Embase, PubMed, Cochrane Central Register for Clinical Trials and Psychology and Behavioral Sciences Collection, and Medline. ProQuest database specifically to search for dissertations.

Search terms

The following keywords were used: negative childbirth experience, painful childbirth experience, reproductive decisions, reproductive choices, future reproductive decisions, delayed subsequent births, delayed pregnancy, and fear of birth.  Other search terms used include unwanted childbirth experience, traumatic childbirth experience, painful childbirth experience

Inclusion criteria

Studies whose research focused on lower-risk childbearing women aged between 18 to 35 years without any history of complications were selected. Regarding the intervention, the papers that were chosen are those whose intervention in pregnancy was purposed towards the improvement of the experience of childbirth. The control was the normal routine care offered by healthcare personnel based on the maternity care clinical guidelines. Lastly, the outcomes were childbirth experiences and subsequent childbearing.

Exclusion criteria

The articles published in any other country other than the UK were excluded. Those articles which failed to describe studies that investigated planned homebirths included comparison groups and neonatal outcomes, and childbirth experiences were excluded because they presented minimal evidence into the childbirth experiences.

Review of Literature

Introduction

The previous chapter presents an overview of the reality of women’s experiences in both labour and delivery process and how they result in the development of childbirth trauma as well as post-traumatic stress disorders following the childbirth. The literature review sections present an in-depth synthesis of the existing research about the experience of mothers during childbirth, trauma, and its impacts on future reproduction decisions. It offers a critical review of the present literature which pertains to the subject of childbirth trauma, how it results in childbirth fear and finally how it impacts future women’s reproduction decisions.

Overview of the childbirth trauma

In any woman’s life, the element of childbirth is a unique and pivotal experience (Keedle, Schmied, Burns, and Dahlen, 2015). According to Greenfield, Jomeen, and Glover, (2016), the current society has perpetuated the myth of having an uninterrupted and joyful transition into motherhood by every woman. However, the experiences of childbirth have dramatically changed over the past decades which involved the shift of care from the home setting into the acute care setting that offers medical interventions and technologically intensive care to women during childbirth (Kendall-Tackett, 2014). Consequently, Shorey and Ang, (2016), the notion of a joyful and uneventful delivery should be banished and the postpartum period taken into consideration to prevent depression and stress that might result from childbirth experience.

The transition into motherhood, according to Gottvall and Waldenström, (2002), gives rise to postpartum anxiety and mood disorders, including PTSD and PPD. Similarly, the study by Kendall-Tackett (2014), establishes that healthcare professionals who previously focused only on the issue of PPD are broadening this scope to include the incidence of and the traits associated with the trauma linked to the childbirth. In addition to these, Ayers, (2014) in the PTSD research, finds outs that both posttraumatic stress symptoms and depressive symptoms among women are often exhibited during labour and delivery process and hence a need to establish an environment that guarantees women positive experience during the child delivery proposes. As a result of these concerns, the importance of women’s experience in the delivery room and the influence of these experiences after birth has turned be a major focus by various recent reports from institutions such as the Institute of the Health Visitors and chanties, the Royal College of Midwives, and the NSPCC as well as the cross-party parliamentary manifesto. In this particular context, therefore, the recognition of problems that women experience during childbirth becomes more significant because they contribute to the psychological disorders including puerperal psychosis and postnatal depression as well as future childbirth decisions.

Concept of childbirth trauma

According to Todd, (2015), accurate discussion of traumatic childbirth experiences and other forms of trauma associated with childbirth begins with a thorough definition of the childbirth trauma that is often used differently in literature. In relation to this, Hollander et al. (2017), argues that two forms of trauma may accompany childbirth. The primary trauma refers to the moments when the mother experiences traumatic childbirth. Ababneh, Al-Ja’freh, and Abushaikha, (2017), assets that personal nature of childbirth accompanied by threats to the safety of both the child and the mother as well as the intense emotion during delivery renders the woman more vulnerable to the trauma. On the other hand, Greenfield, Jomeen, and Glover, (2019) define secondary trauma as re-traumatization exhibited by mothers that have previously experienced trauma as a result of sexual as well as other forms of traumas. Similar, Leeds, L. and Hargreaves, (2008), acknowledges the existence of the two forms of trauma and argues that researchers have failed to show consistency in differentiating between these forms of birth-related trauma experiences. Additionally, the past history of trauma is perceived by Vesel and Nickasch, (2015) as the important predictor of the postpartum post-traumatic stress disorder. Therefore, there is a need to differentiate other forms of traumas with childbirth trauma in order to determine its actual impact on the mother in future reproduction decisions.

The concept of childbirth trauma has been at the centre of most debates among the clinicians (Fenech and Thomson, 2015). According to Anderson and Gill (2014), the acceptance of this concept has been spurred by the modifications of the diagnostic cities on the DSM-IV for the post-traumatic stress to include childbirth among the traumatic events. Similarly, Fenech and Thomson, (2015) associated this psychiatric traumatic birth model of the childbirth trauma as the childbirth that to the PTSD and hence defined via the DSM-5. Contrary to this, Vesel and Nickasch, (2015) claim that the definition is more biased towards the appraisal of an event as well as the reactions of individuals to the event and not only the event itself. Also, the medical definition of this term as it is widely utilized in research relates to the event of the childbirth, and the mode of delivery despite the literature revealed that of every woman that undergoes operative birth exhibits the trauma (Boorman et al., 2014). These variations according to Simpson and Catling, (2016) originates from the controversies stemming from the fact no single statement is utilized in the literature to define childbirth trauma, but various terms are used to provide meanings that slightly differ.

Various scholars have attempted to define the concept of childhood trauma. According to Leeds and Hargreaves, (2008), terms such as difficult birth, traumatic experience of childbirth, birth trauma, PTSD, PTSS, and negative birth experience are often used interchangeably to define childbirth trauma. Similarly, Beck (2015) asserts that PTSD and PTSS are clearly defined using the diagnostic criteria available in the DSM-5. However, despite these two conditions being the potential outcome of the traumatic birth, not every traumatic birth predisposes the woman to exhibit either of the traumas (Gottvall and Waldenström, 2002). Therefore, the childbirth trauma concept is ill-defined, and less understood prompting a need to conceptualize this term to differentiate it from other diagnosable medical conditions that are likely to originate from the mode of delivery or the experience (Rodríguez-Almagro et al.,2019).

Thomson, and Downe, (2010), defines traumatic birth as any birth where the woman considers as distressing to the extent of perceiving it as the trauma. It comprises the trepidation associated with future births. Leeds and Hargreaves, (2008) on the other hand, defines childbirth trauma as the event that is exhibited during any stage of the childbearing process including serious threatening injuries and in some occasions to the death of the mother or the child. Simialrly,  Størksen, Garthus‐Niegel, Vangen, and Eberhard‐Gran, (2013), defines childbirth trauma as any labour or delivery process that comprises the strong fear of fetal or maternal injury or death or any terrifying outcome during the delivery process. From the above literature, childbirth trauma can be defined as an outcome the mother’s self-assessment of the long-term memories of events during childbirth. This particular explanation entails most of the vital factors of childbirth experience including fulfilment of expectations, feelings of control, participation in decision making and confidence (Keedle, Schmied, Burns, and Dahlen, 2015). Also, this definition correlates with Patterson et al., (2018), the assertion that most studies measure the childbirth experience via the validated childbirth questionnaire or through the direct question regarding the general perception of the mother’s experience during childbirth.

According to Hollander et al., (2017), about 30% of the childbearing mothers report a traumatic childbirth experience. Similar findings are recorded by Reed, Sharman, and Inglis (2017), which establishes that a significant number of women report negative experiences during the labour and delivery process. The research entails a mixed-methods study involving 748 women that filled an online survey and responded to the statement ‘describe the birth trauma experience and what you found traumatizing’. Compared to the research by (Beck 2015), four themes can be unleashed from the data which include ‘violation’, ‘disregarding embodied knowledge’, ‘lies and threats’, and ‘prioritizing the agenda of care provider’ The definition of childbirth trauma can, therefore, be associated to the influence of the actions of the care provider as well as their interactions with the mother during delivery.

Childbirth trauma in the UK

The birth trauma association reports that in the United Kingdom alone, a total of 1000 women experience PTSD annually that results from the traumatic birth. In addition, 200,000 women are likely to become traumatized and exhibit some related symptoms. Shorey and Ang (2016) study the negative childbirth experience of a woman and how this experience impacts her future reproductive decisions. This research demonstrates that every mother perceives experiences during birth differently. However, a vastly different childbirth experience may cause the mothers to develop the feelings of losing control over their bodies and thus perceives themselves as being incompetent (Greenfield, Jomeen, and Glover, 2019). Through the investigation of emotions and the support needs that follow distressing birth among women in North-west England, Thomson, and Downe, (2016) surveyed a total of 400 women in maternity hospital. The findings reveal that 43% of the respondents had a history of trauma associated with a previous birth and 74% re-experienced or continued to experience adverse response during their current pregnancy.

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