Hi Julianne. Who are you and what do you do and where do you work?

 

I’m Julianne Boutaleb, a Consultant Perinatal Psychologist who has worked for over 15 years in the NHS and private practice with parents and parents-to-be and their babies (and bumps) who present with a range of perinatal psychological issues. Currently Clinical Director of the Parenthood in Mind practice which specialises in providing perinatal therapeutic services, I’ve been a Clinical Lead over the years too for Sure Start and IAPT. I’m also a member of the Birth Trauma Association and Association for Infant Mental Health and specialise in working therapeutically with birth trauma, perinatal PTSD and tokophobia (fear of giving birth) as these issues impact the mother, couple relationship and especially the parent-infant attachment. Teaching and training health professionals on these issues has also been a key part of my work since 2003. 

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How do you think staff and services may inadvertently influence a woman’s traumatic experience? 

 

I’ve been training health professionals such as midwives and health visitors on issues of perinatal mental health and birth trauma since 2003. There are 2 key messages that I try to get across: Firstly, that women and their partners often experience the hospital setting in general, and the labour room in particular as alien and frightening, and this will definitely be the case if the woman has a history of anxiety and/or birth trauma.  Secondly, that health professionals need to attend to birth processes emotionally, not just medically. One of the ways I get this message across is to get the professional to think of a time when they were being treated medically and were anxious. I then get them to think about what the caregiver did or didn’t do or say that either heightened their anxiety or lessened it. This often gets the message home about the importance of touch, of introducing yourself, of explaining to the patient what’s going to happen next and how provocative silence can be! In the busy rush of an understaffed labour ward, it can be very easy to forget these things BUT research shows that when a woman feels cared for in this way, fewer medical interventions are required to give birth, and satisfaction levels with the birth experience are higher!

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As a psychologist, what’s your experience of working with birth trauma and how do you think we can help people who have had a traumatic birth?

 

I’ve been working with women and their partners since 2003 – since the very early days when Drs Kristina Hofberg and Ian Brockington started to write about tokophobia.  Back then (and I think still now) it was essential to differentiate between postnatal depression (which was very much all that was talked about) and trauma, and how they impact parents and infants differently. Parents often come to see me for a variety of reasons – perhaps one or other of the couple is suffering from flashbacks or intrusive thoughts, perhaps the baby is not settling or feeding, or perhaps there is increased conflict or avoidance of intimacy in the couple relationship.

 

Thorough psychological assessment is key as often parents don’t themselves make the link between their trauma symptoms and the experiences they have been through. An in-depth assessment of their ‘reproductive journey’ however often helps them understand the nature of cumulative traumaand how their experiences may have impacted them and their babies.

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Once it is clear that birth trauma is at the root of what’s happening, I will usually explain how the trauma is impacting their emotions and behaviours.  Using graphs of the brain and a mix of grounding, breathing and CBT techniques, I work to give them a sense of awareness and understanding about what is happening, and also teach them ways of controlling their symptoms. For some women and their partners this may be enough, others may require more sessions to unpack how transgenerational trauma may also be causing their birth trauma.

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What do you wish women and their partners knew about birth? 

 

Having sat with countless couples over the years, I repeatedly hear them ask “But why didn’t anybody tell us it might be like this?” Although recently there has been more women speaking out about their birth experiences, couples still feel that antenatal classes do not realistically prepare them for the potential that things might go wrong in labour and how to cope. The choice of a birth partner is crucial too – ideally whoever attends should be prepared for the role of emotional support and to advocate for their partner if necessary!

 

My message to women and their birth partners is

 

1) expect the unexpected,

2) when preparing a birth plan think through options A, B, C and D and then some,

3) think about times they have managed crises previously and what worked and didn’t work.

 

In addition, in preparing for birth and the weeks after to be honest about how they usually deal with each other’s vulnerability and find new ways of supporting each other more effectively if necessary. Finally, couples should also learn breathing and grounding techniques to help them both manage their anxiety in the labour room.

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How do you think we can make birth better for everyone?

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More training for staff about how they potentially impact the birth experience for better or worse, recognition that understaffing and over medicalisation of birth leads to poorer birth outcomes for women and their babies and finally provision of antenatal classes that better prepare parents-to-be for the psychological impacts of birth and the weeks just after. 

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What do you think of current services that are available? Anything that could be improved? 

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Thankfully there has been money coming into specialist perinatal services over the last few years, but much of it has been funnelled into secondary care and MBUs. However, most parents access care via their GP or Health Visitor, and the women I see still say it is very hit-and-miss what sort of psychological care they can access. They are also clear that they want to be seen by psychological practitioners with specialist perinatal knowledge and expertise, and have access to a choice of therapeutic interventions not just CBT. It’s also vital that services need to be offered in venues and at times that suit parents, and that practitioners should be able to work therapeutically with couples and really importantly with babies too.

 

Thanks Julianne. Finally, what do you think people need who have had a traumatic birth? 

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Firstly, real understanding that trauma is in the ‘eye of the beholder’ and that women’s experiences of birth matter. Secondly, more information to share with friends and family to help them understand how crippling birth trauma can be – physically and psychologically. Thirdly, easy and timely access to specialist services to treat birth trauma which can be self-accessed both after the birth and prior to subsequent births. Fourthly, a family-focussed approach to birth trauma which supports partners and babies through the process too. Finally, a holistic approach which not only treats the traumatic symptoms, but also helps those traumatised find their identity as new parents and manage the losses and disappointments that also come with trauma.

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