Positive Health Online

Co-Researchers: Dr Jenny Hallam, Dr Chris Howard, Professor Abigail Locke and Ms Melissa Owens

Recently it was announced that the NHS aims to recruit 3,000 extra midwives to enable pregnant women to be supported by the same midwives throughout pregnancy and birth. This continuity of care is important because figures released by the birth trauma association in 2018 state that 20,000 British women suffered from Post-Traumatic Stress Disorder (PTSD) after giving birth and an estimated 200,000 suffered from birth-related trauma. This indicates that pregnant women need better support.

A good birth experience is important for women because positive birth experiences have been linked to feelings of empowerment (Lundgen, 2005). However, negative birth experiences have been associated with feelings of guilt, violation and depression (Bailham & Joseph, 2003). Furthermore, negative feelings and post-traumatic stress have a long-term impact upon the mother/baby bond and family dynamics (Ayers, Eagle & Waring, 2006).

Birth preparation is particularly important in tackling birth-related trauma. Green, Coupland and Kitzinger (1990) reported that women who had positive expectations about their birth went on to experience feelings of control over the birth experience, which led to feelings of satisfaction. Negative expectations about birth led to less fulfilling birth experiences and negatively impacted on women’s wellbeing. As part of a recent research project, I investigated the Positive Birth Movement and the kinds of support it can offer pregnant women preparing for birth (Hallam, Howard, Locke & Thomas, 2018).

The Positive Birth Movement

The Positive Birth Movement is a community group established by Milli Hill in 2012 with the aim of informing women of their birth choices, sharing birth stories and offering support for women during and after their pregnancy. Positive Birth Movement groups invite all pregnant women and mothers to attend regular meetings held in their local area. These meetings centre on a specific discussion topic and are led by facilitators who come from a wide range of backgrounds; some are doulas (people who offer support during pregnancy and before and after birth) and midwives, whereas others are women who are passionate about birth and want to offer support.

During the research project, women who regularly attended Positive Birth Movement meetings shared their experiences of pregnancy and birth with me. Women spoke about the lack of support they received from their midwife and discussed the ways in which the NHS left them to fend for themselves. In an effort to find out more about birth, women spoke to friends or paid for private antenatal classes. However, they reported that the advice they received focused very much on the negative aspects of birth and presented it as something to be frightened of.

The Positive Birth Movement was spoken about as being a transformative space that was a welcome antidote to feeling alone and fearful of birth. For the women involved in the research project, the Positive Birth Movement meetings were empowering. They allowed them to hear authentic birth stories, gain access to relevant information and connect to a community who would support them through their pregnancy. This indicates that the Positive Birth Movement has the potential to help support midwives to tackle birth trauma by setting expectations for a positive birth and also providing women with the information needed to provide a sense of control.

Choice and Promoting a ‘Good’ Birth

Research suggests that women vividly remember their first birth experience and their memory of this life-changing event has far-reaching consequences for how they see themselves as both a woman and a mother (Simkin, 1992). Positive birth experiences are associated with long-term benefits for women relating to their relationship with their babies and their confidence in the mothering role. The importance of promoting a positive birth experience and the need to adequately support women during labour is reflected in recently developed health policy that emphasises respectful, women-centred care in childbirth (NICE, 2010).

However, many women still do not receive the support they need and birth trauma has recently been featured in the news. An increasing number of women are sharing their traumatic birth experiences and encouraging other women to speak out about the issue.

Within the research literature, the significance of the levels of ‘control’ women feel over their birth experience is highlighted. Green and Baston (2003) reported that this control takes two forms:

1. The internal control the woman has over her own body, in relation to the noises she makes for example;
2. The external control the woman has over the medical staff and the decisions that they make in relation to her birth experience.

The Importance of Midwives

Midwives play a pivotal role in emotionally supporting women through labour and also shaping the amount of external control they have in relation to their birth. As such, midwives are expected to have highly developed interpersonal skills which enable them to quickly build a bond of trust with the birthing mother, as well as the excellent communication skills needed to clearly relay information to her about how the labour is progressing and any interventions that are needed. Finally, midwives are expected to work with the birthing mother to help ensure that her birth choices are respected.

In order to further understand the role of control and the ways in which midwives can help women achieve positive birth experiences, I recently worked on a research project in which women shared their birth experiences. Within the project, six women gave detailed accounts of their births – some positive, some negative and some resulting in birth trauma. Within the accounts, the importance of being an active mother, a woman who took control over the decisions relating to her labour, was stressed. An open and informative communication style that built a trusting relationship was presented as central to facilitating the active mother (Hallam, Howard, Locke & Thomas, 2016).

In addition to this, emotional support and a personal connection between the birthing mother and midwife was emphasized. This individualized level of care broke down the barriers between the medical staff and the woman, leading to a respectful birthing environment in which the woman was treated as a person and not a patient. Negative experiences were characterized by the midwife not listening to the woman or acting as her advocate. Failure to support the woman’s choices and a lack of genuine care led to an ‘us and ‘them’ dynamic, in which the midwife was seen as siding with the medical staff and not the woman. Given the importance of compassionate care, the current financial pressures and lack of midwives within the NHS is a concern.

References

Ayers, S., Eagle, A. and Waring, H.  The effects of childbirth-related post-traumatic stress disorder on women and their relationships: A qualitative study. Psychology, Health & Medicine 11(4)  389-398 DOI: 10.1080/1354850060070840. 2006.

Bailham, D.  and Joseph, S.  Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice. Psychology, Health and Medicine 8, 159–168. 2003.

Green, J.M. and Baston, HA.  Feeling in control during labor: concepts, correlates, and consequences. Birth 30, pp. 235–247.Hall S.M., Holloway I.M., (1998). Staying in control: women's experiences of labour in water. Midwifery  14  30-36. 2003.

Green, JM., Coupland, V.A. and Kitzinger, J.V. Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth 17, pp. 15–24. 1990.

Hallam, J., Howard, C., Locke A. and Thomas, M. Empowering women through the positive birth movement. Journal of Gender Studies. DOI: 10.1080/09589236.2018.1469972. 2018.

Hallam, J., Howard, C., Locke, A. and Thomas, M.   Communicating choice: an exploration of mothers’ experiences of birth. Journal of Reproductive and Infant Psychology. 175-184. DOI: 10.1080/02646838.2015.1119260 2016.

Lundgren, I. Swedish women’s experience of childbirth 2 years after birth. Midwifery 21, 346–354. 2005.

NICE. Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors. NICE guidelines [CG110]. Retrieved from https://www.nice.org.uk/guidance/cg110/chapter/Woman-centred-care 2010.

Simkin, P.  Just another day in a woman’s life? Part II: Nature and consistency of women’s long-term memories of their first birth experiences. Birth, 19, 64–81. 1992.