When a woman experiences a traumatic or disappointing birth, there often exists an emotional dichotomy between gratefulness for the child and grief toward the experience. This presentation describes characteristics that contribute to traumatic birth and resources for the PMH nurse to aid in prevention, diagnosis, treatment, and collaboration.

1. Grieving Though Grateful:
Reconciling the Traumatic and Disappointing Birth Experience
Jaclyn Engelsher DNP, APRN
Effects of Traumatic Birth Community & Peer Support Resources
Clinical Considerations
Background
When a woman experiences a traumatic or disappointing birth, there
often exists an emotional dichotomy between gratefulness for the child
and grief toward the experience.
Between 25-34% of women world-wide experience traumatic birth
and incidence of PTSD after childbirth ranges from 1-6%, yet the DSM-5
lacks specific discussion in the sections on perinatal mood disorders,
trauma and stress-related disorders, or bereavement. Postpartum trauma
may be missed or mistaken for other postpartum mood disorders by
clinicians, and under-reported by mothers.
Platitudes such as "all that matters is a healthy baby" and
recommendations to “just move on” minimize and invalidate the mother's
grief toward the experience and contribute to feelings of guilt, anger,
helplessness, failure, or diminished self-esteem.
This presentation describes risk factors that contribute to traumatic
birth and resources for the PMH nurse to aid in prevention, diagnosis,
treatment, and collaboration.
Risk Factors
Implications
References
Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010) Women’s perceptions
and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced
Nursing, 66(10), 2142–2153.
Foley, S., Crawley, R., & Wilkie, S. (2014). The birth memories and recall questionnaire
(BirthMARQ): Development and Evaluation. BCM Pregnancy and Childbirth, 14(211).
Retrieved from http://www.biomedcentral.com/1471-2393/14/211
Harris, R. & Ayers, S. (2012). What makes labour and birth traumatic? A survey of
intrapartum ‘hotspots.’ Psychology & Health, 27(10), 1166-1177.
Please visit www.onednp.com for a list of complete references
LOSS OF CONTROL
• Unplanned C-section
• Life-threatening obstetric
complications
• Emergent obstetric interventions
including forceps and ventouse
• Precipitous birth
• Prolonged birth
• Significant pain or inadequate pain
relief
• Feelings or fear and
powerlessness
• Birth plan not realized
• Intrapartum dissociation
• Stillbirth
• Infant complications or disability
• Not provided opportunity to make
educated choices
• Unnecessary medical interventions
LACK OF SUPPORT
• Interpersonal difficulties with birth
partner
• Health providers unsupportive or
not empathetic
• Feeling mistreated by healthcare
team
• Inadequate education and
preparation for birth and
postpartum period
• Poor postnatal care or continuity
PERSONAL HISTORY
• Psychiatric history
• Previous traumatic birth
• Previous trauma
Birth is not a merely a means to an end, but an experience independent
of the outcome. A comprehensive understanding of traumatic birth
provides the PMH nurse a foundation for enhanced assessment,
intervention, integrative strategies, and interdisciplinary collaboration to
help women at risk for or experienced traumatic birth. Knowledge of the
risk factors, characteristics, and supportive resources results in refined
diagnosis, effective treatment planning, and the opportunity to build
connections with peer obstetric clinicians.
Physical
Lactation insufficiency
Psychosomatic complaints
Gynecological and sexual
problems
Disturbed sleep, appetite, and
energy
Psychosocial
Ineffective maternal role
attainment & bonding
Disrupted relationships
Avoidance/isolation
Fear of future birth
Lack of self-esteem and
confidence as a mother
Psychological
Postpartum depression
Postpartum anxiety
PTSD
Bereavement
Compulsions
Baby Center Community: Disappointing Birth Experience
http://community.babycenter.com/groups/a1198275/disappointing_birth_e
xperience
Pinterest www.pinterest.com/onednp/traumatic-birth-resources
Facebook
• Unplanned CBAC and Birth Trauma Support Group
https://www.facebook.com/groups/111066659056348/
• Birth Trauma Association https://www.facebook.com/groups/TheBTA/
Solace for Mothers
• Website http://www.solaceformothers.org
• Forum http://mothers.solaceformothers.org
Twitter
• @BirthTraumaHelp
• @PostpartumHelp
International Cesarean Awareness Network
• http://www.ican-online.org
In addition to evidence-based assessment, diagnosis and
treatment strategies for depression, anxiety, and PTSD, there
are special considerations when considering birth trauma
Assessment
Birth Memories and Recall Questionnaire (BirthMARQ)
Differential Diagnosis
Postpartum mood and anxiety disorders, thyroid disorders,
insulin resistance
Psychotherapy
• Grief and trauma focused therapy
• Review medical records from the birth
• Encourage to write birth story
Pharmacology
Determine breastfeeding status
Collaboration Opportunities for Continuity of Care
• Primary care
• Women’s Health/OBGYN
Defining Traumatic Birth
The individual perceives or experiences the birth and/or
postpartum period as threating to the physical or
emotional integrity of the mother or the baby.
Birth
Matters