Many thanks, Rebecca, for talking to me today. Firstly, who are you, and what do you do?

 

I am Rebecca Moore, I am a perinatal psychiatrist working in London in the NHS and privately. I have been working in this field for 20 years and I am really passionate about all women being able to access high quality, bespoke care to maintain their emotional and physical health during and after pregnancy. I personally believe care should be much more holistic and include diet, exercise, sleep, hormone assessment as well as therapies and possibly medication. I am training currently as an Integrative Practitioner and I find that way of working really chimes with women, and they feel fully supported. 

 

Many women in the campaign spoke about feeling that, it wasn’t the birth itself which caused trauma, but the way they were treated by healthcare professionals. Why do you think staff and services may (inadvertently) negatively influence a woman’s experience? 

 

That’s a big question! Firstly, let me say that I see HUGE numbers of women with birth trauma, around 30% find some aspect of their birth traumatic and 4% meet criteria for PTSD. If women have a history of abuse or depression/anxiety 19% of that group will have PTSD after birth. That’s huge! 

 

In number terms, that’s around 190,000 women per year feeling traumatised by birth.

 

Then this group of women go home and no-one asks them meaningfully about their birth experience, so all that trauma sits there festering and can cause massive long term problems for the mum, her relationship with her partner, friends, family and baby. 

 

I have met women who have only had one child because their first birth experience was so bad and no-one has ever asked them about it. 

 

 I think the impact of staff and services is huge and a real part of the problem. Most birth trauma is not about medical emergencies actually, but about the sense of being cared for by staff. Our words cost nothing but they can harm and cause wounds that last for years. 

 

I’d like to say that attributing poor outcomes to staff is not about me demonising staff. Midwives often get singled out for this and click-bait headlines in the national press don’t help this issue at all. Midwives are part of the issue but so are obstetricians, GPs, Health Visitors and services as a whole.

 

I work in, respect and love the NHS as both a doctor and a patient. 

 

However, in maternity units we have a real problem and, from my clinical work, it’s getting worse not better. More and more women tell me their negative birth stories and I hear these stories week in, week out. 

 

I think the issue needs to be thought about and flow from the top – and we are talking about a huge change in the way we care for our NHS staff. 

 

For me, the key issues are training – often staff simply do not realise or want to think about how they personally can cause birth trauma. And the second strand is how we are caring for staff.

 

We know that the rates of burn out and turnover are very high in midwives and labour ward teams, and for me this means women in labour get cared for by traumatised, burnt out staff. Not always of course, but far too often. 

 

Staff are working under too much pressure day in and day out, they need better pastoral care, they need regular reflective team feedback, they need to be complimented and praised more  - rather than only seeing seniors when something goes wrong. They need to be rotated through jobs so they don’t get burned out. 

 

When we have a midwife coming to work with nothing left emotionally to give we can see how then the first time nervous mum gets treated in a way that is just about good enough, but with no meaningful kindness, no compassion, so she walks away feeling traumatised. 

 

We need to train student midwives, midwives, managers, nursing assistants and obstetricians about birth trauma. 

 

We also need to highlight that we can do so much to change outcomes, and most of it needs no extra training or costs. For example, we can emphasise the need to communicate well, to choose our language well, to be kind, to involve dads, to show compassion and empathy. 

 

Thanks Rebecca. Another theme from the campaign was feeling underprepared for birth. Women felt they ‘had no idea’ about what birth entailed and the outcomes that could happen. What do you wish women and their partners knew about birth? 

 

Just that they had a lot more real conversations before birth. It’s a hard line to draw but we can have conversations that are not too scary nor too rose tinted. We need to teach more women about the actual realities of birth. It will hurt, it might be unpredictable, it might not go the way you would choose. And think about how they would handle that. 

 

Ideally women should be having these conversations with a named midwife and having these conversations with enough time to explore their hopes, fears and thoughts. 

 

I am all for women having birth preferences, but this must be grounded in the fact that birth cannot always be controlled. 

 

The more we involve partners, the better. Then they can also advocate for their partner if they temporarily lose their voice in labour. 

 

I also want women to know that they have the right to say no in labour. They have power and control and autonomy. Trust your instincts, if something feels wrong or coercive ask for it to stop and ask for a second opinion. 

 

What is available in your area for women to debrief after a difficult birth? 

 

Birth debrief generally is very variable. Sometimes it’s done by a midwife, in some areas it is a peer support group. The quality varies widely. Some women will not want to return to the same hospital where the trauma took place. 

 

And lastly, how do you think we can make birth better?

 

• Education of healthcare providers, women, partners about birth and especially staff about birth trauma and the impact of language and communication

• Continuity of care, a named midwife who looks after you for all your pregnancy, delivers you and sees you after birth for a month. Not going to happen in reality but it would dramatically improve the experience for most women!

• Listening to women and giving them time, as much time as they need, really listening and empowering women to feel in control and confident. 

• Women centred care

• Kindness and compassion

• Trauma focused care

• Allow women to stay in hospital if they choose to. We often shove women home after 24 hours with this little creature, after long difficult labours and no sleep!   

 

Many thanks for speaking with me Rebecca. 

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