The BTA’s Executive Committee has agreed the following policy statement regarding the purpose of our work:

Our Charter sets out the ways in which we believe this policy can be best achieved.

The BTA demands 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 process.

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 demands that the Government address the following issues urgently:

Antenatal education

• 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 this purpose.

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 demands 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 demands 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.

Postnatal support

• 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 demands that health care professionals 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 demands that the provision of appropriately trained psychologists and therapists be increased and adequate funding be made available.

• The BTA demands that there should be effective follow up provision after discharge from the midwife as well as screening (as for PND) at the 6 week and 6 month check-ups.

• The BTA demands that the reality of secondary tokophobia (fear of childbirth usually after a traumatic earlier birth) should be 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.