Policy & Charter
The BTA’s Executive Committee has
agreed the following policy statement regarding the purpose
of our work:
The purpose of the BTA is to
work for the prevention of birth trauma and to support
women suffering from it. We are mothers helping other
mothers and working to establish respect for basic
human dignity as a cornerstone of maternity practice.
This is most effectively achieved by providing woman-centred
care which includes good communication, the provision
of quality information and involving the woman in
decision-making. The BTA believes that on receipt
of the best information available, it is then the
woman’s right to choose how she wishes to give
birth and that her decisions should be respected
wherever clinically possible and should not be subject
Our Charter sets out the ways in which we believe
this policy can be best achieved.
The BTA calls for more funding for research to develop
our understanding of the experience of childbirth. Fundamental
to this understanding, is the paramount need to respect
a woman’s basic human rights throughout the birth
We believe that a traumatised mother is not a 'healthy'
one and that maternity service providers should understand
that childbirth has a psychological outcome as well as
a physical one. Hence, the common sentiments expressed
by women traumatised by their birth experiences should
be acknowledged, although these experiences should not
be generalised. These sentiments include the need for more
complete information prior to birth, the need to maintain
control over their birth process, the need to be free to
view their pain as a personal issue and the desire for
explanations after birth.
The BTA calls for the Government to address the following
- Antenatal classes have an important role to play. Managing
expectations properly does not prevent trauma but it
may help prevent a culture of
self-blame and guilt. Frank discussions about emergency procedures and medical
interventions may enable women to be better prepared. Further, a more ‘women-centred’ approach
should be adopted by antenatal educators with the recognition that the individuality
and emotional well-being of women are important. This is an important message
for women to receive from health care providers and it includes the supply
of realistic information about pain and pain relief options, including the
availability of different types of pain relief at local hospitals. Women
frequently report that inadequate pain relief is an issue which contributed
to, or created, their traumatic experience, so it is essential that women
are free to make their own decisions about the way they view pain. Ultimately,
antenatal education should empower women to pursue their own birth choices.
However, the BTA is aware that maternity practices need to be changed to
ensure that women's wishes are, in practice, respected.
- Hospital education can help too. Specific tours could
be set up, on an antenatal basis, to help those women
having highly “medicalised” births.
- There should be contact with doctors and midwives if
a highly “medicalised” birth is anticipated
with sufficient time to ask questions. This should entail
appropriate education of doctors and midwives in strategies
to prevent the development of PTSD. It is important that
medical staff understand that mental and physical health
are of equal importance. When discussing the risks of
different procedures, it is vital that both physical
and psychological risks are addressed.
- Information about the possibility of PTSD should be
available to women on an antenatal basis in the same
way that most ante natal groups talk of Post Natal Depression.
This would decrease the risk of isolation felt by some
women who cannot put a ‘label’ to the way
they feel after their births.
Labour and birth
- Information is the key. When women face obstetric
complications, they need to be fully informed of the
options, procedures and associated physical and psychological
risks. The woman must be central to the decision making
process. Good quality leaflets and sympathetic information
produced by hospitals can help enormously.
- Women need to be presented with their choices in plain
English so they are allowed to make their own decisions.
This is particularly important because a high level of
intervention is often marked by a sense of fear, loss,
and pain at a physical and emotional level.
- Women need to be given as much time as possible to
talk through their decision with appropriately qualified
staff. If emergency procedures are necessary, the woman
and her partner should be given as much information as
possible and should be treated sensitively. Their decisions
should be supported appropriately and care should be
individualised, this includes pain relief provision and
complete information about the well-being of their baby
because fear and lack of trust are commonly associated
with later traumatic experiences.
- All maternity staff need to be trained fully in this
area, so that those practices which contribute to or
cause traumatic experiences can be eradicated.
- The BTA believes that properly trained midwives providing
constant, sensitive and responsive care to women in labour,
whether at home or in hospital, are vital in preventing
trauma. Adequate resources must be made available for
Postnatal hospital care
- There is no consistent relationship between mode of
delivery and PN PTSD and women who have not undergone
classic ‘emergency’ birth experiences can
still suffer trauma. Thus, maternity services should
carefully explore the best ways of sensitively raising
this issue on the post natal ward, perhaps by giving
women information about possible symptoms.
- Unfortunately, many women have negative experiences
of post natal care in hospital which frequently compounds
their trauma and although women who have caesarean sections
may receive some support other mothers who have had difficult
births do not. The BTA campaigns for decent, sensitive
and supportive post natal care in hospitals for all women.
- In particular, if research proves this to be helpful,
the opportunity to
‘de-brief’ should be provided to women but only if staff are trained
appropriately to listen and refer where necessary. An open culture would undoubtedly
assist many women if debriefing takes place in a compassionate and frank environment.
However, there are obvious issues of avoidance of the event by the woman and
damage limitation by the hospital which must be considered. Therefore, the BTA
calls for urgent research into and consideration of the efficacy and most appropriate
timing of de-briefing.
- As part of their professional development, it is important
that medical staff constantly review their practices
to ensure that cases of Postnatal PTSD are minimised.
It is therefore essential that there is liaison between
the Primary Care services, Health visitors, midwives
and obstetricians. The BTA believes that the incidence
of Postnatal PTSD should be a performance indicator for
the obstetric services.
- We believe that midwives or health visitors should
screen women for PTSD symptoms a few weeks after birth
and identify those who might need help.
- Local support networks could tackle isolation. Many
women feel unsupported and detached from those who have
had ‘easier’ births and may as a result feel
somehow inferior. Ultimately, this means that emotions
which are genuinely held, and which should be freely
expressed, are repressed. The BTA calls for health care
professionals to review the availability of support to
women in their areas. There is an urgent need for communication
between health care professionals about the nature and
scale of available provision.
- Health visitors and GPs need to recognise the difference
between PTSD and PND. The consequences of misdiagnosis
and wrongly prescribed
anti-depressants can be grave. The BTA demands specific training for all
health care professionals dealing with women who have given birth.
- Psychotherapy helps validate a woman’s experience
and reduces the risk of long term trauma. Psychotherapy
services available to tackle these issues should be brought
to women’s attention on discharge and by their
Health Visitors. The BTA calls for the provision of appropriately
trained psychologists and therapists to be increased
and adequate funding to be made available.
- The BTA calls for an effective follow up provision
after discharge from the midwife as well as screening
(as for PND) at the 6 week and 6 month
- The BTA campaigns for the reality of secondary tokophobia
(fear of childbirth usually after a traumatic earlier
birth) to be considered and understood and appropriate
provision made for psychotherapy to prevent debilitating
anxiety and depression. Women also need to be provided
with sensitive support and advice about all of their
options if they wish to go ahead with another pregnancy.