Almost 20% of women experience trauma giving birth

Factors associated with a traumatic birth experience included depression, induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage.

Almost 20% of women experience trauma during birth, according to research carried out at a Dublin maternity hospital.

Details of the study, which included 1,154 women who gave birth at the hospital, were revealed by midwife and researcher Ursula Nagle at the All-Ireland Maternity and Midwifery Festival 2023.

Of the women who took part in the survey, 209 said they found birth “traumatic”.

Factors associated with this included a history of depression, induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage.

Women who had raised scores on the Edinburgh postnatal depression scale also reported experiencing trauma.

Ms Nagle, an advanced midwife practitioner at the Rotunda specialist perinatal mental health service and a PhD candidate at Trinity College Dublin, said these results can help to improve services.

“The study does address a large gap in the literature by being the first Irish study to quantitatively examine the prevalence and associated factors of traumatic birth in Ireland,” she said.

“The key conclusions are that 18% of women reported that their birth was traumatic. The personal factors which were most important were current or past history of depression. The obstetric factors were postpartum haemorrhage, induction of labour, and instrumental birth.

“About 4% of women went on to develop birth-related post-traumatic stress disorder [PTSD] of the follow-up sample. 

So the onus is really on us as healthcare professionals to be aware of the risk factors.” 

The team used the City birth trauma scale in follow-up questions, developed by City University London.

“While overall our findings were low, and probably don’t fit with the clinical picture that I would see in practice, what is interesting if you look at the criteria on the [scale], over a third of women reported re-experiencing symptoms,” said Ms Nagle.

She said she often sees women who do not meet the diagnostic criteria for PTSD.  However, she added: “They are significantly functionally impaired by post-traumatic symptoms that linger around.” 

'Obstetric violence'

The day-long event at Dublin City University also heard from Australian researcher Hazel Keedle about 'obstetric violence'. 

“It is done to women by a healthcare provider. Where there can be disconcertion around the term is people think it might be obstetricians, but it is not. ‘Obstetric’ means the maternity period so it can be by any healthcare provider, including allied healthcare providers and including midwives.” 

This can range, she said, from women being uncomfortable with the number of staff in a delivery room to “being hit or slapped by a healthcare provider”.

Dr Keedle, senior lecturer in midwifery at Western Sydney University, published findings from a survey of 8,804 women in the journal Violence Against Women.

“Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments,” the study found.