When her twins were a few months old, Rachael was gripped by the fear that something terrible was going to happen to them. “I would lie awake at night counting how many times a minute they were breathing. I was too frightened to look in their cot,” she says. She didn’t dare leave the house in case they picked up a bug. At the same time she kept experiencing vivid flashbacks to a traumatic birth.
Rachael had suffered a placental abruption (her placenta burst) at 36 weeks of pregnancy. She was rushed to hospital and her babies were delivered by emergency caesarean section, by which time she had lost so much blood she was unconscious. She suffered acute renal failure, and one baby was born blue and silent, in a delivery room that was hushed rather than joyous. Recovering in hospital after the birth, she remembers a midwife telling her, “Don’t go thinking you’re anything special – we see bigger abruptions than you had.” Her scar burst while she was in hospital but wasn’t properly treated: months later it sealed, but with a chronic infection. She is now waiting for an abdominal reconstruction.
A new report has found that suicide is the biggest direct cause of death in the year following childbirth. Between 2009 and 2014, 111 pregnant women and new mothers took their own lives. These tragic cases are, however, only the tip of the mental health iceberg. About one in five women experiences mental health problems after childbirth – and one study found that 9 per cent of new mothers experience suicidal thoughts. While most people are aware of postnatal depression, few realise that between 10,000 and 20,000 women a year suffer, as Rachael did, with post-traumatic stress disorder (PTSD).
A lack of awareness amongst GPs means the condition is under-diagnosed – and even when diagnosed correctly, women may have to wait months for a referral to see a therapist. But while birth is by its nature unpredictable, a difficult experience can be made much worse by poor care. At the Birth Trauma Association, we hear time and again from women who have been on the receiving end of over-stretched, inadequately trained and (sometimes) dismissive health professionals.
Take Gill, who, during a painful induction process, heard a midwife say to her husband, “Is she always this much of a drama queen?” After a long labour resulting in postpartum haemorrhage, doctors failed to spot that Gill had placenta accreta – a life-threatening condition in which part of the placenta remains firmly attached to the uterus. At home for two weeks after birth, Gill was in constant pain, but was told by her midwife to buck up – until eventually she collapsed and was rushed into hospital with sepsis. Gill, who had to wait seven months for a referral to a clinical psychologist, feels she lost a year of her life to PTSD.
Or Claire, who was told by an inexperienced agency midwife that she would damage her baby if she pushed. In fact, Claire was ready to give birth, and it was only when the baby’s heartrate dropped that she was rushed to theatre and given an emergency caesarean section under general anaesthetic. More than two years later, Claire has flashbacks every day. “I'll be lying in bed, and suddenly I'm back there,” she says. She thinks about “how vulnerable and violated I felt, and how, if only I'd been more assertive, things could have been so different.” Like many women with postnatal PTSD, she felt inadequate as a mother, “For months after he was born I was convinced that I wasn't enough for him. I couldn't even give birth to him properly.”
Birth can be dangerous, and sometimes things will go wrong. But a difficult birth doesn’t have to lead to mental health problems: research shows that women who experience good care from sympathetic health professionals are much less likely to suffer PTSD. The Cumberlege report earlier this year recommended that midwives and obstetricians work together to “deliver safe and personalised care for women and their babies”. For the women whose heartbreaking stories we hear every day, it can’t come soon enough.
Kim Thomas is a spokesperson for the Birth Trauma Association