July 19, 2023 • 36 mins
One in three mothers are likely to experience trauma during childbirth, yet it’s something that’s not talked about enough.
In this episode of Law Matters – to highlight Birth Trauma Awareness Week – Catherine Henry speaks to Co-Founder and CEO of the Australasian Birth Trauma Association, Amy Dawes, about her birth trauma experience and why she wants to see a national inquiry established.
This year the theme of Birth Trauma Awareness Week is postpartum PTSD. Catherine and Amy talk through what postpartum PTSD is and why our expectant mothers must be informed of the risks involved with birth.
Catherine and Amy delve into the stories of women who have experienced unnecessary trauma, the lasting impacts it has had on their lives, and what can be done about it.
Where to find help:
There are many organisations ready to help people who have experienced birth trauma.
For support after birth trauma for yourself or family members:
Australasian Birth Trauma Association
A volunteer-led initiative providing support to those who have experienced birth-related trauma through 1-on-1 chat sessions with a specially trained Peer Support Volunteer:
For posttraumatic mental health needs:
For support for the emotional challenges of becoming a parent:
COPE: Centre of Perinatal Excellence
Free telephone support and counselling for perinatal depression:
The Gidget Foundation Australia
For support around perinatal anxiety and depression:
Disclaimer
While this podcast is aimed to be informative, it is not intended to be a substitute for legal advice. You should see a solicitor for complete advice that relates directly to your situation.
This episode may be confronting and triggering for some people. Please know there is help available including Lifeline on 13 11 14.
For more information:Find out more about birth trauma and the law here.
Read our birth trauma client's stories here.
If you have a legal issue and live in regional NSW you can find out more at Catherine Henry Lawyers, or call the team on 1800 874 949.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Catherine Henry (00:02):
Birthing babies might sound like the most
natural thing in the world. Butin reality all birthing
experiences are dependent on amultitude of factors and none
more so than the medical adviceand care given in the lead up to
and during birth.
Hi, I'm Catherine Henry ofCatherine Henry Lawyers and in
this episode of Law Matters, Iwant to talk about maternal
(00:25):
birth choices, and what happenswhen mothers suffer trauma
during birth. For a long time,New South Wales Health had a
policy of what they termedTowards Normal Birth. But
recently, that blueprint wasrescinded in exchange for a new
set of guidelines Connecting,Listening and Responding.
Separate to that, the New SouthWales upper house of parliament
(00:48):
has recently announced aninquiry into maternal birth
trauma. We're recording thisepisode for Maternal Birth
Trauma Awareness Week. And thisyear, the theme is turning the
spotlight on postpartum PTSD.It's always a busy week for my
guest, Amy Dawes, who's the cofounder and CEO of the
(01:08):
Australasian Birth TraumaAssociation. So I'm really
grateful that Amy has made timeto chat with me today.
Amy welcome. And it's so lovelyto have the opportunity to speak
to you again,
Amy Dawes (01:21):
Thanks for the opportunity.
Catherine Henry (01:22):
I just want to say at the outset that there is
a lot to talk about. But beforewe get into our conversation,
I'm very much aware that thisepisode may well bring up
emotions for some people. So Ido want to let everybody
listening know that lifeline isalways there on 13 11 14.
(01:43):
There's also severalorganisations set up just for
new parents or parents whosuffered loss or trauma. And
I'll link to those in the shownotes. It's important to remind
people of the services that arearound and that do exist such as
yours, such as the AustralasianBirth Trauma Association,
because the feelings that comeup following a traumatic birth
(02:06):
and including postpartum PTSD,which we're going to drill down
into today, these feelings cancome up unexpectedly...
Amy Dawes (02:14):
Yeah, I think I think it's really important to
acknowledge that trauma from thebirth process is unexpected,
because society typically viewsbirth as a, as a happy event.
And so when you potentiallyemerge from the childbirth
experience, not feeling okay,that can be quite confronting,
(02:35):
if people don't know that birthtrauma is a thing.
Catherine Henry (02:39):
Yeah, well, let's just talk about birth
trauma being a thing, and whatmight seem to many to be a
simple question, but it'sprobably not a question that has
a simple answer. So would youmind just breaking it down and
telling the listeners what isbirth trauma?
Amy Dawes (02:58):
Yeah, actually, interestingly, as an
organisation, as we've evolved,we've started calling it birth
related trauma, because it's notnecessarily only the birth
experience, so it is eitherpsychological or physical wounds
or injuries that result as partof pregnancy, labour and birth
(03:21):
or the postnatal period. Andthose wounds or injuries can
have long term impacts on aparent's well being. It's really
important as well, toacknowledge that birth related
trauma not only impacts womenbut birthing people, fathers,
non birthing parents and otherswitnessing a traumatic birth as
well.
Catherine Henry (03:42):
Like the extended family, for example.
Amy Dawes (03:45):
Yeah, interestingly, I actually had a mum who watched
her daughter give birth, and sherang up and said, Do you want to
hear stories from, you know,people witnessing and I said,
Well, it's really important,actually, that you have reached
out and she was incrediblytraumatised from witnessing her
daughter have a cardiac arrestduring the birth process, and
(04:07):
she really wanted to speak soabsolutely, It's it's, it can
actually ripple out and insometimes in situations, the
person experiencing the birth,the mother or the birthing
parent, they can be okay andit's the partner that can that
can walk away with symptoms oftrauma.
Catherine Henry (04:27):
Yeah, as I said earlier, the theme of this
week's Maternal Birth TraumaAwareness Week, which we're in
at the moment is postpartumPTSD. So I wondered if you could
tell us what is postpartum PTSD?What are the signs that need to
be watched out for? And it's notalways as a result of actual the
(04:52):
birth trauma processes as you'vejust been explaining. But that
could certainly be a trigger. Isthat right?
Amy Dawes (04:57):
Yeah, absolutely. So um, I should probably preface
this that postpartum PTSD is notformally recognised as a term at
this stage. So we could say,post traumatic stress disorder
as a result of the childbirthexperience. Interestingly, the
British Medical Journalpublished some research last
(05:20):
year to say that about three to6% of women can emerge from the
birth process with PostTraumatic Stress Disorder. Often
it goes undiagnosed ormisdiagnosed. And that's really
important to acknowledge theexperiences that people go
through in their journey toparenthood can result in trauma.
(05:41):
And I was speaking to apsychologist recently, and she
actually talked to me about thecascade of trauma. And I thought
that was really interesting,because it's something that we
see a lot, you might call it thecascade of vulnerability,
because trauma is sometimesquite a big word for people. But
I'll give you an example, youmight have parents that have
gone through the IVF process,multiple processes of trying to
(06:02):
conceive, and then eventually,you know, that pregnancy comes.
And they might experiencepregnancy complications such as
hyperemesis, gestationaldiabetes, maybe they get some
unknown health conditions likepreeclampsia, so they have a
difficult birth process. Andthen they go on to have a
(06:22):
traumatic birth experience withinterventions or feeling a loss
of control during the birthfeeling like they are....we
often hear women talk aboutfeeling like they're a spectator
in their own birth. So they gothrough this traumatic birth
experience, and they come outthe other side not feeling okay.
And yet we say to them, but atleast you have a healthy baby,
(06:42):
of course, if they're luckyenough to have a healthy baby.
And we do that not just as asociety, and not just as friends
and families, but alsoclinicians quite often do that.
So you people experience thissort of cascade of
vulnerabilities. And then it'sreally difficult to access
support. And so, you know, theresearch indicates, importantly,
(07:04):
that the sooner we seektreatment for trauma, the better
the outcome may be. And I think,you know, conversations have
really evolved and we're talkinga lot more now about postnatal
depression and anxiety. But theycan often exist as trauma
symptoms, and many parents wouldbenefit from specialised trauma
treatment. And so that's kind ofwhere we're at and why we wanted
(07:27):
to talk specifically about PTSDas a result of the birth process
for this year's Birth TraumaAwareness Week, so that not only
can parents recognise the signsand symptoms, but also so
clinicians are aware that PTSDfrom the birth process does
occur. And what's reallyinteresting is birth as a
possible traumatic event wasonly recognised in 2014. So
(07:51):
although these conversationshave evolved, we know that
changes in conversations in themedical community take a long
time. And so it's reallyimportant to shine a light on
PTSD as a result of the birthprocess.
Catherine Henry (08:07):
Yeah, that's, that's fascinating. And just,
again, drawing on the focus onpostpartum, PTSD and the work
that you're doing in the PTSDarea, and the theme of this
week's Maternal Birth TraumaAwareness Week. I understand
you've just done a survey ofmore than 1000 women. What were
(08:29):
some of the major findings inthat survey?
Amy Dawes (08:32):
Yeah, it was really interesting this survey because
it wasn't.... previously in thepast, we've surveyed our huge
community, we've got a communityof over 4000 women that are
quite involved in ourorganisation, they seek support
from us, but this was anexternal survey. So it was
incredible to get that manyresponses in the space of I
think it was about a week, maybetwo weeks. I would like to say
(08:54):
that some of the findingssurprised me, but they didn't at
all. Interestingly, one in threeof the participants viewed their
birth as traumatic and one in10. Participants viewed their
birth as extremely traumatic.And so that really supports what
we already knew. Alongside that,79% of people that responded
(09:21):
indicated that they experiencedat least one symptom of PTSD.
And yet less than half of thosepeople had sought treatment for
their symptoms.
Catherine Henry (09:33):
They're really alarming statistics, and I've
read and heard and know, one inthree women do describe their
experiences as traumatic butthat was something that you
were, you're finding in the inthe surveys that you did. So can
we turn just to the messagingaround birth trauma and birth
policy, and, as you know, theNew South Wales Government the
(09:58):
focus was and what theydescribed and the way they
packaged and messaged, birthpolicy was in terms of, you
know, pushing women into whatthey termed normal birth. Yes,
you know, the the process ofbirth can be a magical moment.
And, and it's changing and andwe're what we're learning about
(10:19):
this is unfolding, when we'veseen a change in messaging by
the New South Wales governmentso that it's moving towards a
more informative and respectfulmessage. What do you think about
the messaging from the healthprofessionals and governing
bodies? What's changing? In yourview? Is there any change?
Amy Dawes (10:39):
Yeah, I mean, in terms of the messaging, what I
can talk to is obviously, thestories that we hear. And every
day, we hear stories from womenand parents, in every state in
every territory, about theirbirth experience. So I do think
the conversations have evolvedaround birth related trauma. For
a start, we're talking about it.But I mean, last year, I think
(11:03):
New South Wales released someguidelines around normal birth,
and it was actually quiteshocking to see. And they got
some real backlash around thatand subsequently changed them.
But the fact that we are stilltalking about normal birth, and
I get it, it's complicated.Because uncomplicated vaginal
birth doesn't exactly roll offthe tongue. But But what is a
(11:25):
normal birth? Because birth iscompletely individual. So So
what is great for one person canbe extremely traumatic for the
other person. And and what wesee in these stories is often
clinicians how it plays out in,in the birthing space, is that
(11:45):
still people's unique individualwants and needs are not
respected. And, and that's whatwe see.
Catherine Henry (11:57):
Yes, indeed. So just let's talk if you don't
mind about your own situation,which I suppose you would say
and propelled you into thisarea. And I know that you've
been extremely generous, sharingyour story in the past, I've
heard your story a number oftimes, but I wonder if you could
(12:19):
just talk a little bit aboutwhat happened in your case, in
your situation, with the birthof your first daughter, and how
your experiences led you to thejourney that you've had?
Amy Dawes (12:31):
Yeah, well, it did launch my career in talking
about my vagina for a living andI do joke about that, but I am
incredibly open about sharing,because that is the whole, the,
you know, that's what we do asan organisation is sharing the
lived experience stories andadvocating for improved
education. And, and it is instorytelling that that we can
(12:53):
drive change, but in my ownexperience, like lots of women,
I thought that if I did all ofthe right things, then I'd get
the birth that I wanted. So Iwas thrilled to be accepted into
a midwifery group practice. So Ihad continuity of care. I took
up pregnancy yoga, I continuedexercising, I did a private
(13:17):
birthing course, and I justthought I would breathe my baby
out. And unfortunately, shedidn't get the memo. And, you
know, to cut a very long storyshort, I ended up having a high
forceps delivery. And at the, atthe time, I was told I sustained
a third degree tear. When I wasin recovery, everybody kept
(13:41):
saying to me, Oh, you got thebirth that you wanted, because
at the time, I was very, Iwanted a vaginal birth. I was,
you know, I wanted the baby toget all those microbes and, and
I didn't know about any of therisks associated with forceps.
And that's actually the realitytoday is that we do not talk
(14:02):
about what instrumentaldeliveries mean. And yet we know
that one in four, first timemothers or birthing parents will
end up with an instrumentaldelivery. So initially, in
recovery in hospital, I was bedbound with a catheter. And on
day five, I was wheeled outsidein a wheelchair for some fresh
(14:23):
air. But I think as a new mum,you don't realise that that's
not normal. And you know, youjust are so focused on the baby.
And in fact, I was hyper focusedbecause I couldn't get to her. I
couldn't get her out of thecrib. And it was it was really
tough, but I just didn't reallyyou know, know what had happened
(14:44):
and I actually suffered faecalincontinence for about the first
six months but fortunately, Iwas in a privileged position
that I could access privatepelvic health physiotherapy and
she really helped. She helpedrehabilitate me and I just
thought things would get better.But actually at 16 months
postpartum after my first run, Iended up experiencing like this
(15:08):
heavy, sort of draggingsensation in my vagina, which I
now know to be a prolapse, whichis pelvic organ prolapse. I went
to see a physio, she palpated mypelvic floor and diagnosed me
with something called abilateral levator avulsion,
which is where I've gotsignificant pelvic floor damage
(15:29):
that has, it's no longerattached to the bone. And at
this stage, there is no surgerythat repairs that. And so, you
know, I went into thatappointment as a 35 year old
woman, and I left thatappointment feeling like I was
85, I was told that I couldn'tdo the sports that I wanted to
(15:52):
do. I was told that I shouldn'tlift up my daughter, which I
dutifully stopped doing. And Ifelt completely and utterly
broken. And of course, I feltlike I was the only one because
I'd never heard of prolapse. AndI never heard of these kinds of
injuries. And I felt like afreak. And all of those feelings
(16:13):
contributed to shame andisolation. And my mental health
unsurprisingly, quicklyplummeted. But it was my physio
that connected me with otherwomen that were further along in
their own journeys afterexperiencing forceps delivery
and subsequent injuries, andthey have similar interests, are
very active. And for me, thatwas incredibly cathartic because
(16:34):
when you go into a specialistappointment, (a) it costs a lot
of money, (b) you don't havethem that you can call up any
time to ask questions. And so tobe able to connect with somebody
else that gets it and ask them,oh, hey, have you used a
pessary? Or what does this mean?For me, it was just completely
game changing. And then when myphysio told me how common for
(16:57):
example, prolapse is, it doesimpact one in two women. I just
thought, Well, why aren't wetalking about it? And so that
kind of as a joke that launchedmy career in talking about my
vagina, but also sort of lighteda fire in me where I thought,
well, something needs to change.And that's where I stumbled,
stumbled across the work of Dr.Liz Skinner now, and she, she
(17:18):
was actually doing somegroundbreaking research in the
psychological impact of physicaltrauma. And I reached out to her
to say, what can I do? Can youinterview me and and then the
conversation evolved and, andshe suggested that there should
be a Birth Trauma Association inAustralia. And I thought, let me
make that happen and basicallyhaven't stopped since.
Catherine Henry (17:41):
I'm Catherine Henry, Principal at Catherine
Henry Lawyers and I'm talking toco founder and CEO of the
Australasian Birth TraumaAssociation, Amy Dawes about
maternal birth trauma, andpostpartum PTSD, on this episode
of Law Matters.
Quite awful injuries that yougradually learnt had happened in
(18:04):
your first birth. And certainlythose injuries you learnt were
what we regard as avoidable. Weas health lawyers, dealing with
a lot of medical negligencelitigation act for women like
yourself, who have sufferedavoidable birth trauma. I'm
fortunate to have a lawyer onour staff who has worked as a
(18:27):
midwife for two decades so sheprovides a particular insight
into this. But I was interestedto hear you say that birth
trauma from a medicalperspective has only been
recognised since 2014. And thefirst case that I did was
probably a little bit earlierthan that time. I was just
(18:47):
thinking about it yesterday, Ithink the case was 12 years ago.
So around the time that we'rebeginning to understand about
traumatic birth. And this, itwas just such a terrible story.
It's somewhat like your ownstory that you've just
described, the woman that Iacted for was from regional New
(19:07):
South Wales. Like often is thecase in maternal birth trauma
litigation, we find that thewomen that we act for, they've
had their first birth that thatit's their first birth that has
been traumatic, but they haven'thad this experience of just
breathing their babies out. Soin this particular case, the
woman's first baby, the client'sfirst baby was forcibly
(19:29):
delivered by consultantobstetrician at a public
hospital vaginally in the breechposition without any or any
adequate pain relief, and withan episiotomy, she sustained a
labral tear, and she had to haveseveral surgical procedures
afterwards. At times she neededa wheelchair, and I'm still in
(19:49):
touch with her and her husbandso I know that the problems are
ongoing. She has verysignificant physical and
psychological injuries. It was aterrifying situation for the
client and one that I know thatshe's not fully recovered from
because of that ongoingassociation. So that case
introduced me to this field, andthis area and the, you know,
(20:10):
I've felt fortunate to be ableto help this woman, you know,
process what had happened toher, it brought back to me what
I've been through, in what Ithen learnt was, uh, you know,
my own traumatic birth of mydaughter. And, and so I think
it's really important to realiseand you know, you make a good
(20:32):
point, some of these terriblesituations that arise are
avoidable, many, many are not.We're also hearing at the moment
in the press, maybe in the lastmonth of some other terrible
stories, or birth trauma thathave taken place in Wagga in
southern New South Wales. Andthe New South Wales Health Care
Complaints Commission isinvestigating complaints from 30
(20:54):
women who've had traumaticbirth. You'd like to think that
the things that you've beenthrough, that I went through,
that my, you know, that thatothers that we act for go
through, but I know that theydo. And and I wonder whether
some of these examples thatwe're talking about, sort of
provide an accurate crosssection of the types of traumas,
(21:17):
the women that you talk to havegone through.
Amy Dawes (21:19):
Yeah, and there's a few things to unpack there. And
firstly, Catherine, I'm sorry tohear that you experienced a
traumatic birth as well. And thesame with with your client. But
you did touch upon a couple ofthings, which is, firstly, the
preventable aspect of trauma. Myunderstanding, obviously,
prefacing this with that I'm nota medical professional, but
(21:42):
looking at the research in thecase of levator avulsion, which
is what I experienced as aresult of forceps that can occur
in a straightforwarduncomplicated vaginal birth. And
I remember one of the firstwomen that sort of called me up
directly after finding my numberburied online somewhere and she
(22:02):
shared her experience with me,she had actually what looked
like a textbook birth, the birththat she wanted a water birth,
and, and during that birth, shefelt something pop, and she
ended up with an avulsion andsubsequent PTSD as a result of
her of her experience. Andstatistically, my understanding
(22:24):
is that one in 10 women thathave a vaginal birth can
experience levator avulsion.That is the same statistic if
they have a vacuum delivery.What's important to note is that
forceps that risk is increasedto one in two. And that is why
it's so important to talk aboutinstrumental deliveries long
before in the delivery suite. Interms of that recognition of
(22:48):
birth related trauma, I'mspecifically talking about PTSD
as a result of the birthexperience. It's really
interesting we have I'verecently connected with Phoenix,
Australia, which is a PTSDorganisation, and they have seen
an increase in the number ofwomen reaching out to them for
support. And that kind of putbirth trauma or birth related
(23:10):
trauma on their radar. So we'rehaving some good conversations
there. The other thing that youmentioned is first birth. What
we see is, you know, itparticularly with our peer to
peer social, which is a privateFacebook support group for women
and birthing people thatidentify as having birth related
(23:30):
trauma. When we first began andstarted that support group back
in 2017, a lot of people thatwere finding us were based on me
sharing my story quite openly.So those were women,
specifically with physical andpsychological trauma. And those
women were self referred - wellfinding us themselves, and they
(23:52):
could have been anywhere intheir postpartum journey. So
they could be within six, youknow, weeks, months, but we were
seeing women have had babiesyears and even decades ago that
just hadn't had a space to sharetheir experience. And then, over
time, now, when we see peoplecoming into the group, it's
really interesting. We see womenthat have had babies, they're in
(24:13):
that first 12 months postpartum.But our second biggest cohort is
two to five years postpartum.And often people don't realise
that they've had trauma untilthey're trying to conceive or
they're pregnant the secondtime. And speaking to Phoenix,
Australia, I discovered thatpeople that have experienced
trauma have typically takesabout seven years to seek
(24:34):
support, and that's probably menor women, it's even longer. So
there's all these sort of, youknow, important things to sort
of state, I guess, and I know Ihave kind of slightly gone off
your question, but we just seesuch a diverse range of
experiences. Some of that traumais preventable when you read
(24:56):
these stories, you think, whatwhat is happening? Why are
people being treated this way?And quite often the trauma that
that that families we supporthave experienced, at some point
in their journey to parenthoodif they were treated with
compassionate care. In fact, theresearch suggests that trauma
(25:17):
can be prevented in the momentwith the application of
compassionate care and it'sreally interesting, because I
think that I didn't even thoughI feared for my life during the
birth of my daughter, I had ananethetist that was with me and
communicated with me when Ithought that I was not okay, and
they were ordering units ofblood. But that isn't occurring,
(25:38):
and that that absence ofcompassionate care alongside
invalidating and not believingan individual's experience can
be such a huge trigger fortrauma. And we hear people that
have had trauma from you know,instrumental delivery,
(25:59):
straightforward, vaginal birthsCeasarian sections. Trauma from
having a premature baby, traumafrom being separated from baby
and in a country like ours,often we have these resources at
these hospitals that are notresourced, so baby has to go to
a different hospital, that'sincredibly impactful. You know,
(26:20):
having a baby going to intensivecare, mum going into intensive
care, postpartum haemorrhage,there's so many triggers to
trauma, and we hear all of them,
Catherine Henry (26:31):
You make the very important point that women
need to know and have a full andfrank information sharing
process well before the birthprocess. And another important
point that you just made, why isit that women are treated this
way? Why is it that it's thoughtthat women don't deserve to know
what can happen? And I just liketo hear your thoughts about
(26:54):
that, because it seems to me,and and I'm always careful to
say, I don't come from a provaginal birth, or a pro C
section, perspective in this,but what I do come from is a
desire to have women know,empowered to make birth choices
with all the information. I justwondered where you see, where
have we gone on that journey.
Amy Dawes (27:16):
It's quite a complex question because I think I said
to you before we jumped onlinethat often when we're talking
about birth related trauma,often the conversation comes
down to, you know, its mode ofdelivery, everybody should have
a vaginal birth, or, you know,it becomes vaginal birth versus
Ceasarian or midwifery led careversus doctors, I think we have
(27:40):
to just take a much biggerpicture at this, a much broader
look at this. So I think, youknow, as I mentioned, as well,
is that part of the reason thatwe really want to tell stories
is because it's the stories thatwe hear that, that that paint
the picture for us. And for along time, we didn't talk about
(28:00):
this stuff. You know, birthtrauma isn't anything new. My
mum had an experience with mewhere her she had a retained
placenta, and it was just yankedout of her. And, but you just
got on with it. And I think thatwe are really sort of fed this
narrative that we should begrateful for what you know, for,
(28:20):
for walking out of the birthprocess alive and hopefully
having a live baby as well. ButI think we are actually starting
to go hang on a minute. I wantto be psychologically and
physically well, I want to bewell enough to take care of my
child and to take care ofmyself. So we're asking for
more. The other thing is, isthat I think that what we see a
(28:44):
lot is...what we hear a lot ofthe stories of, you know,
parents actually seeing thisfriction in the workplace,
between clinicians, and that is,you know, that's incredibly
confronting for someone that'sthat's going through something
that is probably going to be themost vulnerable point in their
lives. The other thing is, isthat around education, it's not
(29:08):
only education, improvededucational antenatal and
unbiased education in theantenatal period for parents
where we kind of need to givethe autonomy back to parents and
not assume we know what theywant, but actually hear what
they want and what is theirindividual circumstances, their
unique set of wants and needs.But I do think that there is a
(29:31):
gap in information for allprofessionals that work with
birthing parents and and myunderstanding at this stage is
there is not a single professionthat works with birthing
families that has anything aboutbirth related trauma on the
curriculum, and yet we know howbig the impact is, in fact, one
in three families so why are wenot learning this? Why are
(29:55):
students not learning this astheir training in there
discipline. And the problem withthat is, we're also seeing,
particularly as well in NewSouth Wales is talk around
trauma informed care. And itdoes seem to be a bit of a
buzzword. But I do think it'sreally, really important to
acknowledge that people bringbaggage into the birth suite.
(30:18):
And that can influence the birthexperience. And I don't think
we've been talking about thatenough, unless this is something
that I've really been learningrecently. And again, it's thanks
to I think of one particular mumthat shared her story last year,
for birth trauma awareness weekand her name is Hannah. And
(30:39):
Hannah was was going through thebirth experience, and she had to
have a...she ended up having anepidural. And she was completely
immobilised from you know, thechest down. And during that
experience, she ended updisassociating, and had a
flashback to when she was beingabused by her swimming coach.
(30:59):
Hannah had a pre existing traumaof sexual assault as a child.
There's some research that cameout, I think, last month, and
that research indicated that28.5% of Australian adults
between the ages of 16 and 60have experienced child sexual
abuse. That is a confrontingstatistic. But the other
confronting thing about that isthat these people may go on to
(31:23):
have children, and that traumamay be buried, or that trauma,
they may be seekingpsychological support. But that
trauma does matter when it comesinto the birth suite and those
vulnerabilities. And peoplearen't going to disclose this if
we don't have a psychologicallysafe environment. And that is
(31:43):
why it's so important to havecontinuity of carer. Absolutely.
But if if we are not askingthese questions, and also not
providing a safe environment, ofcourse, people aren't going to
disclose it. I vividly remembermyself on a much sort of smaller
context, but my lovely midwifehad asked, you know, whether I
(32:04):
had any pre existing mentalhealth conditions, I did, but at
the time, I was great, you know,I was very happy, pregnant. You
know, I thought, why are youasking me that? Why is that
relevant? I didn't know that ofcourse, if you walk in with your
baggage, with preexisting mentalhealth conditions, that does
(32:25):
increase your risk of walkingout the birth experience with
challenges. And it's the samewith pre existing trauma. One,
the World Health Organisationsays that one in three women
have experienced sexualviolence, most at the hands of
an intimate partner. This iswhat we're bringing into the
birth suite. And that is why theapplication of trauma informed
(32:49):
care is so important. But thereisn't enough education around
it. And also, if we ask peoplethese questions, where do we
send them for support? So we'vegot a real barrier for not only
do we have a professionprofessions, you know, the
maternity profession isundervalued. We've got, you
know, a workforce that is burntout because they have to do
(33:12):
incredibly long hours, peopleare leaving, midwives are
experiencing their own PTSD orsymptoms of PTSD. And so we have
an environment that reallydoesn't lend itself to good
outcomes. And I think that'sjust so important to acknowledge.
Catherine Henry (33:28):
I'd like to just ask you, following on from
that, and the importance ofeducation and the the work that
needs to be done there. What areyour hopes for the recently
announced New South Walesinquiry into birth trauma? Do
you feel... is that is that agood development? I'm sure
(33:49):
you'll say it is. But what doyou hope that we can achieve
through this inquiry?
Amy Dawes (33:56):
Catherine, I'd like to see a National Inquiry. Last
year, I mean, I think it was atthe start of this year, we had a
meeting with the Department ofHealth and we said that we would
like to start measuring birthoutcomes. We need to start
looking at birth beyond thebirth notes, beyond the six week
(34:16):
check if people go for that. Andwe actually need to be checking
in on parents at three months,at six months and a year
postpartum. Because, you know,I've already said before, that
people are not seeking supportfor trauma symptoms. The problem
with that is if they're notseeking support, what they do is
(34:37):
potentially develop unhealthycoping mechanisms that cause
further detriment to not onlytheir wellbeing but the
wellbeing of their family, theirability to bond with baby. You
know, it ripples out into thecommunity. And, you know, I
think there should be a nationalinquiry because as I said, we
(34:57):
are actually not putting thewell being of the birthing
community as a priority andthat's our next generation. So I
think there needs to be a, aninquiry that is federal
government led that that reallylooks at birthing outcomes.
Catherine Henry (35:13):
Thanks so much Amy for talking to me today on
Law Matters. You do so much, andthank you for all that you do in
this important area and I lookforward to talking to you again.
Maternal birth trauma is oftennot talked about. So if you are
suffering, please know that youdon't have to do that in
(35:35):
silence. We will put some linksin the show notes of where you
can go for help if you need it.And a heartfelt thanks to Amy
Dawes. The co founder and CEO ofthe Australasian Birth Trauma
Association for talking to metoday in this episode of Law
Matters. I'm Catherine Henry ofCatherine Henry Lawyers. And if
you need help navigatingobstetric negligence in maternal
(35:57):
health, please reach out andcontact us at Catherine Henry
Lawyers. And if you're enjoyingthis podcast, make sure you
subscribe wherever you listen toyour podcasts to stay up to date
with all the latest episodes.This podcast was produced by Pod
and Pen Productions.
Birthing babies might sound like the most
natural thing in the world. Butin reality all birthing
experiences are dependent on amultitude of factors and none
more so than the medical adviceand care given in the lead up to
and during birth.
Hi, I'm Catherine Henry ofCatherine Henry Lawyers and in
this episode of Law Matters, Iwant to talk about maternal
(00:25):
birth choices, and what happenswhen mothers suffer trauma
during birth. For a long time,New South Wales Health had a
policy of what they termedTowards Normal Birth. But
recently, that blueprint wasrescinded in exchange for a new
set of guidelines Connecting,Listening and Responding.
Separate to that, the New SouthWales upper house of parliament
(00:48):
has recently announced aninquiry into maternal birth
trauma. We're recording thisepisode for Maternal Birth
Trauma Awareness Week. And thisyear, the theme is turning the
spotlight on postpartum PTSD.It's always a busy week for my
guest, Amy Dawes, who's the cofounder and CEO of the
(01:08):
Australasian Birth TraumaAssociation. So I'm really
grateful that Amy has made timeto chat with me today.
Amy welcome. And it's so lovelyto have the opportunity to speak
to you again,
Amy Dawes (01:21):
Thanks for the opportunity.
Catherine Henry (01:22):
I just want to say at the outset that there is
a lot to talk about. But beforewe get into our conversation,
I'm very much aware that thisepisode may well bring up
emotions for some people. So Ido want to let everybody
listening know that lifeline isalways there on 13 11 14.
(01:43):
There's also severalorganisations set up just for
new parents or parents whosuffered loss or trauma. And
I'll link to those in the shownotes. It's important to remind
people of the services that arearound and that do exist such as
yours, such as the AustralasianBirth Trauma Association,
because the feelings that comeup following a traumatic birth
(02:06):
and including postpartum PTSD,which we're going to drill down
into today, these feelings cancome up unexpectedly...
Amy Dawes (02:14):
Yeah, I think I think it's really important to
acknowledge that trauma from thebirth process is unexpected,
because society typically viewsbirth as a, as a happy event.
And so when you potentiallyemerge from the childbirth
experience, not feeling okay,that can be quite confronting,
(02:35):
if people don't know that birthtrauma is a thing.
Catherine Henry (02:39):
Yeah, well, let's just talk about birth
trauma being a thing, and whatmight seem to many to be a
simple question, but it'sprobably not a question that has
a simple answer. So would youmind just breaking it down and
telling the listeners what isbirth trauma?
Amy Dawes (02:58):
Yeah, actually, interestingly, as an
organisation, as we've evolved,we've started calling it birth
related trauma, because it's notnecessarily only the birth
experience, so it is eitherpsychological or physical wounds
or injuries that result as partof pregnancy, labour and birth
(03:21):
or the postnatal period. Andthose wounds or injuries can
have long term impacts on aparent's well being. It's really
important as well, toacknowledge that birth related
trauma not only impacts womenbut birthing people, fathers,
non birthing parents and otherswitnessing a traumatic birth as
well.
Catherine Henry (03:42):
Like the extended family, for example.
Amy Dawes (03:45):
Yeah, interestingly, I actually had a mum who watched
her daughter give birth, and sherang up and said, Do you want to
hear stories from, you know,people witnessing and I said,
Well, it's really important,actually, that you have reached
out and she was incrediblytraumatised from witnessing her
daughter have a cardiac arrestduring the birth process, and
(04:07):
she really wanted to speak soabsolutely, It's it's, it can
actually ripple out and insometimes in situations, the
person experiencing the birth,the mother or the birthing
parent, they can be okay andit's the partner that can that
can walk away with symptoms oftrauma.
Catherine Henry (04:27):
Yeah, as I said earlier, the theme of this
week's Maternal Birth TraumaAwareness Week, which we're in
at the moment is postpartumPTSD. So I wondered if you could
tell us what is postpartum PTSD?What are the signs that need to
be watched out for? And it's notalways as a result of actual the
(04:52):
birth trauma processes as you'vejust been explaining. But that
could certainly be a trigger. Isthat right?
Amy Dawes (04:57):
Yeah, absolutely. So um, I should probably preface
this that postpartum PTSD is notformally recognised as a term at
this stage. So we could say,post traumatic stress disorder
as a result of the childbirthexperience. Interestingly, the
British Medical Journalpublished some research last
(05:20):
year to say that about three to6% of women can emerge from the
birth process with PostTraumatic Stress Disorder. Often
it goes undiagnosed ormisdiagnosed. And that's really
important to acknowledge theexperiences that people go
through in their journey toparenthood can result in trauma.
(05:41):
And I was speaking to apsychologist recently, and she
actually talked to me about thecascade of trauma. And I thought
that was really interesting,because it's something that we
see a lot, you might call it thecascade of vulnerability,
because trauma is sometimesquite a big word for people. But
I'll give you an example, youmight have parents that have
gone through the IVF process,multiple processes of trying to
(06:02):
conceive, and then eventually,you know, that pregnancy comes.
And they might experiencepregnancy complications such as
hyperemesis, gestationaldiabetes, maybe they get some
unknown health conditions likepreeclampsia, so they have a
difficult birth process. Andthen they go on to have a
(06:22):
traumatic birth experience withinterventions or feeling a loss
of control during the birthfeeling like they are....we
often hear women talk aboutfeeling like they're a spectator
in their own birth. So they gothrough this traumatic birth
experience, and they come outthe other side not feeling okay.
And yet we say to them, but atleast you have a healthy baby,
(06:42):
of course, if they're luckyenough to have a healthy baby.
And we do that not just as asociety, and not just as friends
and families, but alsoclinicians quite often do that.
So you people experience thissort of cascade of
vulnerabilities. And then it'sreally difficult to access
support. And so, you know, theresearch indicates, importantly,
(07:04):
that the sooner we seektreatment for trauma, the better
the outcome may be. And I think,you know, conversations have
really evolved and we're talkinga lot more now about postnatal
depression and anxiety. But theycan often exist as trauma
symptoms, and many parents wouldbenefit from specialised trauma
treatment. And so that's kind ofwhere we're at and why we wanted
(07:27):
to talk specifically about PTSDas a result of the birth process
for this year's Birth TraumaAwareness Week, so that not only
can parents recognise the signsand symptoms, but also so
clinicians are aware that PTSDfrom the birth process does
occur. And what's reallyinteresting is birth as a
possible traumatic event wasonly recognised in 2014. So
(07:51):
although these conversationshave evolved, we know that
changes in conversations in themedical community take a long
time. And so it's reallyimportant to shine a light on
PTSD as a result of the birthprocess.
Catherine Henry (08:07):
Yeah, that's, that's fascinating. And just,
again, drawing on the focus onpostpartum, PTSD and the work
that you're doing in the PTSDarea, and the theme of this
week's Maternal Birth TraumaAwareness Week. I understand
you've just done a survey ofmore than 1000 women. What were
(08:29):
some of the major findings inthat survey?
Amy Dawes (08:32):
Yeah, it was really interesting this survey because
it wasn't.... previously in thepast, we've surveyed our huge
community, we've got a communityof over 4000 women that are
quite involved in ourorganisation, they seek support
from us, but this was anexternal survey. So it was
incredible to get that manyresponses in the space of I
think it was about a week, maybetwo weeks. I would like to say
(08:54):
that some of the findingssurprised me, but they didn't at
all. Interestingly, one in threeof the participants viewed their
birth as traumatic and one in10. Participants viewed their
birth as extremely traumatic.And so that really supports what
we already knew. Alongside that,79% of people that responded
(09:21):
indicated that they experiencedat least one symptom of PTSD.
And yet less than half of thosepeople had sought treatment for
their symptoms.
Catherine Henry (09:33):
They're really alarming statistics, and I've
read and heard and know, one inthree women do describe their
experiences as traumatic butthat was something that you
were, you're finding in the inthe surveys that you did. So can
we turn just to the messagingaround birth trauma and birth
policy, and, as you know, theNew South Wales Government the
(09:58):
focus was and what theydescribed and the way they
packaged and messaged, birthpolicy was in terms of, you
know, pushing women into whatthey termed normal birth. Yes,
you know, the the process ofbirth can be a magical moment.
And, and it's changing and andwe're what we're learning about
(10:19):
this is unfolding, when we'veseen a change in messaging by
the New South Wales governmentso that it's moving towards a
more informative and respectfulmessage. What do you think about
the messaging from the healthprofessionals and governing
bodies? What's changing? In yourview? Is there any change?
Amy Dawes (10:39):
Yeah, I mean, in terms of the messaging, what I
can talk to is obviously, thestories that we hear. And every
day, we hear stories from womenand parents, in every state in
every territory, about theirbirth experience. So I do think
the conversations have evolvedaround birth related trauma. For
a start, we're talking about it.But I mean, last year, I think
(11:03):
New South Wales released someguidelines around normal birth,
and it was actually quiteshocking to see. And they got
some real backlash around thatand subsequently changed them.
But the fact that we are stilltalking about normal birth, and
I get it, it's complicated.Because uncomplicated vaginal
birth doesn't exactly roll offthe tongue. But But what is a
(11:25):
normal birth? Because birth iscompletely individual. So So
what is great for one person canbe extremely traumatic for the
other person. And and what wesee in these stories is often
clinicians how it plays out in,in the birthing space, is that
(11:45):
still people's unique individualwants and needs are not
respected. And, and that's whatwe see.
Catherine Henry (11:57):
Yes, indeed. So just let's talk if you don't
mind about your own situation,which I suppose you would say
and propelled you into thisarea. And I know that you've
been extremely generous, sharingyour story in the past, I've
heard your story a number oftimes, but I wonder if you could
(12:19):
just talk a little bit aboutwhat happened in your case, in
your situation, with the birthof your first daughter, and how
your experiences led you to thejourney that you've had?
Amy Dawes (12:31):
Yeah, well, it did launch my career in talking
about my vagina for a living andI do joke about that, but I am
incredibly open about sharing,because that is the whole, the,
you know, that's what we do asan organisation is sharing the
lived experience stories andadvocating for improved
education. And, and it is instorytelling that that we can
(12:53):
drive change, but in my ownexperience, like lots of women,
I thought that if I did all ofthe right things, then I'd get
the birth that I wanted. So Iwas thrilled to be accepted into
a midwifery group practice. So Ihad continuity of care. I took
up pregnancy yoga, I continuedexercising, I did a private
(13:17):
birthing course, and I justthought I would breathe my baby
out. And unfortunately, shedidn't get the memo. And, you
know, to cut a very long storyshort, I ended up having a high
forceps delivery. And at the, atthe time, I was told I sustained
a third degree tear. When I wasin recovery, everybody kept
(13:41):
saying to me, Oh, you got thebirth that you wanted, because
at the time, I was very, Iwanted a vaginal birth. I was,
you know, I wanted the baby toget all those microbes and, and
I didn't know about any of therisks associated with forceps.
And that's actually the realitytoday is that we do not talk
(14:02):
about what instrumentaldeliveries mean. And yet we know
that one in four, first timemothers or birthing parents will
end up with an instrumentaldelivery. So initially, in
recovery in hospital, I was bedbound with a catheter. And on
day five, I was wheeled outsidein a wheelchair for some fresh
(14:23):
air. But I think as a new mum,you don't realise that that's
not normal. And you know, youjust are so focused on the baby.
And in fact, I was hyper focusedbecause I couldn't get to her. I
couldn't get her out of thecrib. And it was it was really
tough, but I just didn't reallyyou know, know what had happened
(14:44):
and I actually suffered faecalincontinence for about the first
six months but fortunately, Iwas in a privileged position
that I could access privatepelvic health physiotherapy and
she really helped. She helpedrehabilitate me and I just
thought things would get better.But actually at 16 months
postpartum after my first run, Iended up experiencing like this
(15:08):
heavy, sort of draggingsensation in my vagina, which I
now know to be a prolapse, whichis pelvic organ prolapse. I went
to see a physio, she palpated mypelvic floor and diagnosed me
with something called abilateral levator avulsion,
which is where I've gotsignificant pelvic floor damage
(15:29):
that has, it's no longerattached to the bone. And at
this stage, there is no surgerythat repairs that. And so, you
know, I went into thatappointment as a 35 year old
woman, and I left thatappointment feeling like I was
85, I was told that I couldn'tdo the sports that I wanted to
(15:52):
do. I was told that I shouldn'tlift up my daughter, which I
dutifully stopped doing. And Ifelt completely and utterly
broken. And of course, I feltlike I was the only one because
I'd never heard of prolapse. AndI never heard of these kinds of
injuries. And I felt like afreak. And all of those feelings
(16:13):
contributed to shame andisolation. And my mental health
unsurprisingly, quicklyplummeted. But it was my physio
that connected me with otherwomen that were further along in
their own journeys afterexperiencing forceps delivery
and subsequent injuries, andthey have similar interests, are
very active. And for me, thatwas incredibly cathartic because
(16:34):
when you go into a specialistappointment, (a) it costs a lot
of money, (b) you don't havethem that you can call up any
time to ask questions. And so tobe able to connect with somebody
else that gets it and ask them,oh, hey, have you used a
pessary? Or what does this mean?For me, it was just completely
game changing. And then when myphysio told me how common for
(16:57):
example, prolapse is, it doesimpact one in two women. I just
thought, Well, why aren't wetalking about it? And so that
kind of as a joke that launchedmy career in talking about my
vagina, but also sort of lighteda fire in me where I thought,
well, something needs to change.And that's where I stumbled,
stumbled across the work of Dr.Liz Skinner now, and she, she
(17:18):
was actually doing somegroundbreaking research in the
psychological impact of physicaltrauma. And I reached out to her
to say, what can I do? Can youinterview me and and then the
conversation evolved and, andshe suggested that there should
be a Birth Trauma Association inAustralia. And I thought, let me
make that happen and basicallyhaven't stopped since.
Catherine Henry (17:41):
I'm Catherine Henry, Principal at Catherine
Henry Lawyers and I'm talking toco founder and CEO of the
Australasian Birth TraumaAssociation, Amy Dawes about
maternal birth trauma, andpostpartum PTSD, on this episode
of Law Matters.
Quite awful injuries that yougradually learnt had happened in
(18:04):
your first birth. And certainlythose injuries you learnt were
what we regard as avoidable. Weas health lawyers, dealing with
a lot of medical negligencelitigation act for women like
yourself, who have sufferedavoidable birth trauma. I'm
fortunate to have a lawyer onour staff who has worked as a
(18:27):
midwife for two decades so sheprovides a particular insight
into this. But I was interestedto hear you say that birth
trauma from a medicalperspective has only been
recognised since 2014. And thefirst case that I did was
probably a little bit earlierthan that time. I was just
(18:47):
thinking about it yesterday, Ithink the case was 12 years ago.
So around the time that we'rebeginning to understand about
traumatic birth. And this, itwas just such a terrible story.
It's somewhat like your ownstory that you've just
described, the woman that Iacted for was from regional New
(19:07):
South Wales. Like often is thecase in maternal birth trauma
litigation, we find that thewomen that we act for, they've
had their first birth that thatit's their first birth that has
been traumatic, but they haven'thad this experience of just
breathing their babies out. Soin this particular case, the
woman's first baby, the client'sfirst baby was forcibly
(19:29):
delivered by consultantobstetrician at a public
hospital vaginally in the breechposition without any or any
adequate pain relief, and withan episiotomy, she sustained a
labral tear, and she had to haveseveral surgical procedures
afterwards. At times she neededa wheelchair, and I'm still in
(19:49):
touch with her and her husbandso I know that the problems are
ongoing. She has verysignificant physical and
psychological injuries. It was aterrifying situation for the
client and one that I know thatshe's not fully recovered from
because of that ongoingassociation. So that case
introduced me to this field, andthis area and the, you know,
(20:10):
I've felt fortunate to be ableto help this woman, you know,
process what had happened toher, it brought back to me what
I've been through, in what Ithen learnt was, uh, you know,
my own traumatic birth of mydaughter. And, and so I think
it's really important to realiseand you know, you make a good
(20:32):
point, some of these terriblesituations that arise are
avoidable, many, many are not.We're also hearing at the moment
in the press, maybe in the lastmonth of some other terrible
stories, or birth trauma thathave taken place in Wagga in
southern New South Wales. Andthe New South Wales Health Care
Complaints Commission isinvestigating complaints from 30
(20:54):
women who've had traumaticbirth. You'd like to think that
the things that you've beenthrough, that I went through,
that my, you know, that thatothers that we act for go
through, but I know that theydo. And and I wonder whether
some of these examples thatwe're talking about, sort of
provide an accurate crosssection of the types of traumas,
(21:17):
the women that you talk to havegone through.
Amy Dawes (21:19):
Yeah, and there's a few things to unpack there. And
firstly, Catherine, I'm sorry tohear that you experienced a
traumatic birth as well. And thesame with with your client. But
you did touch upon a couple ofthings, which is, firstly, the
preventable aspect of trauma. Myunderstanding, obviously,
prefacing this with that I'm nota medical professional, but
(21:42):
looking at the research in thecase of levator avulsion, which
is what I experienced as aresult of forceps that can occur
in a straightforwarduncomplicated vaginal birth. And
I remember one of the firstwomen that sort of called me up
directly after finding my numberburied online somewhere and she
(22:02):
shared her experience with me,she had actually what looked
like a textbook birth, the birththat she wanted a water birth,
and, and during that birth, shefelt something pop, and she
ended up with an avulsion andsubsequent PTSD as a result of
her of her experience. Andstatistically, my understanding
(22:24):
is that one in 10 women thathave a vaginal birth can
experience levator avulsion.That is the same statistic if
they have a vacuum delivery.What's important to note is that
forceps that risk is increasedto one in two. And that is why
it's so important to talk aboutinstrumental deliveries long
before in the delivery suite. Interms of that recognition of
(22:48):
birth related trauma, I'mspecifically talking about PTSD
as a result of the birthexperience. It's really
interesting we have I'verecently connected with Phoenix,
Australia, which is a PTSDorganisation, and they have seen
an increase in the number ofwomen reaching out to them for
support. And that kind of putbirth trauma or birth related
(23:10):
trauma on their radar. So we'rehaving some good conversations
there. The other thing that youmentioned is first birth. What
we see is, you know, itparticularly with our peer to
peer social, which is a privateFacebook support group for women
and birthing people thatidentify as having birth related
(23:30):
trauma. When we first began andstarted that support group back
in 2017, a lot of people thatwere finding us were based on me
sharing my story quite openly.So those were women,
specifically with physical andpsychological trauma. And those
women were self referred - wellfinding us themselves, and they
(23:52):
could have been anywhere intheir postpartum journey. So
they could be within six, youknow, weeks, months, but we were
seeing women have had babiesyears and even decades ago that
just hadn't had a space to sharetheir experience. And then, over
time, now, when we see peoplecoming into the group, it's
really interesting. We see womenthat have had babies, they're in
(24:13):
that first 12 months postpartum.But our second biggest cohort is
two to five years postpartum.And often people don't realise
that they've had trauma untilthey're trying to conceive or
they're pregnant the secondtime. And speaking to Phoenix,
Australia, I discovered thatpeople that have experienced
trauma have typically takesabout seven years to seek
(24:34):
support, and that's probably menor women, it's even longer. So
there's all these sort of, youknow, important things to sort
of state, I guess, and I know Ihave kind of slightly gone off
your question, but we just seesuch a diverse range of
experiences. Some of that traumais preventable when you read
(24:56):
these stories, you think, whatwhat is happening? Why are
people being treated this way?And quite often the trauma that
that that families we supporthave experienced, at some point
in their journey to parenthoodif they were treated with
compassionate care. In fact, theresearch suggests that trauma
(25:17):
can be prevented in the momentwith the application of
compassionate care and it'sreally interesting, because I
think that I didn't even thoughI feared for my life during the
birth of my daughter, I had ananethetist that was with me and
communicated with me when Ithought that I was not okay, and
they were ordering units ofblood. But that isn't occurring,
(25:38):
and that that absence ofcompassionate care alongside
invalidating and not believingan individual's experience can
be such a huge trigger fortrauma. And we hear people that
have had trauma from you know,instrumental delivery,
(25:59):
straightforward, vaginal birthsCeasarian sections. Trauma from
having a premature baby, traumafrom being separated from baby
and in a country like ours,often we have these resources at
these hospitals that are notresourced, so baby has to go to
a different hospital, that'sincredibly impactful. You know,
(26:20):
having a baby going to intensivecare, mum going into intensive
care, postpartum haemorrhage,there's so many triggers to
trauma, and we hear all of them,
Catherine Henry (26:31):
You make the very important point that women
need to know and have a full andfrank information sharing
process well before the birthprocess. And another important
point that you just made, why isit that women are treated this
way? Why is it that it's thoughtthat women don't deserve to know
what can happen? And I just liketo hear your thoughts about
(26:54):
that, because it seems to me,and and I'm always careful to
say, I don't come from a provaginal birth, or a pro C
section, perspective in this,but what I do come from is a
desire to have women know,empowered to make birth choices
with all the information. I justwondered where you see, where
have we gone on that journey.
Amy Dawes (27:16):
It's quite a complex question because I think I said
to you before we jumped onlinethat often when we're talking
about birth related trauma,often the conversation comes
down to, you know, its mode ofdelivery, everybody should have
a vaginal birth, or, you know,it becomes vaginal birth versus
Ceasarian or midwifery led careversus doctors, I think we have
(27:40):
to just take a much biggerpicture at this, a much broader
look at this. So I think, youknow, as I mentioned, as well,
is that part of the reason thatwe really want to tell stories
is because it's the stories thatwe hear that, that that paint
the picture for us. And for along time, we didn't talk about
(28:00):
this stuff. You know, birthtrauma isn't anything new. My
mum had an experience with mewhere her she had a retained
placenta, and it was just yankedout of her. And, but you just
got on with it. And I think thatwe are really sort of fed this
narrative that we should begrateful for what you know, for,
(28:20):
for walking out of the birthprocess alive and hopefully
having a live baby as well. ButI think we are actually starting
to go hang on a minute. I wantto be psychologically and
physically well, I want to bewell enough to take care of my
child and to take care ofmyself. So we're asking for
more. The other thing is, isthat I think that what we see a
(28:44):
lot is...what we hear a lot ofthe stories of, you know,
parents actually seeing thisfriction in the workplace,
between clinicians, and that is,you know, that's incredibly
confronting for someone that'sthat's going through something
that is probably going to be themost vulnerable point in their
lives. The other thing is, isthat around education, it's not
(29:08):
only education, improvededucational antenatal and
unbiased education in theantenatal period for parents
where we kind of need to givethe autonomy back to parents and
not assume we know what theywant, but actually hear what
they want and what is theirindividual circumstances, their
unique set of wants and needs.But I do think that there is a
(29:31):
gap in information for allprofessionals that work with
birthing parents and and myunderstanding at this stage is
there is not a single professionthat works with birthing
families that has anything aboutbirth related trauma on the
curriculum, and yet we know howbig the impact is, in fact, one
in three families so why are wenot learning this? Why are
(29:55):
students not learning this astheir training in there
discipline. And the problem withthat is, we're also seeing,
particularly as well in NewSouth Wales is talk around
trauma informed care. And itdoes seem to be a bit of a
buzzword. But I do think it'sreally, really important to
acknowledge that people bringbaggage into the birth suite.
(30:18):
And that can influence the birthexperience. And I don't think
we've been talking about thatenough, unless this is something
that I've really been learningrecently. And again, it's thanks
to I think of one particular mumthat shared her story last year,
for birth trauma awareness weekand her name is Hannah. And
(30:39):
Hannah was was going through thebirth experience, and she had to
have a...she ended up having anepidural. And she was completely
immobilised from you know, thechest down. And during that
experience, she ended updisassociating, and had a
flashback to when she was beingabused by her swimming coach.
(30:59):
Hannah had a pre existing traumaof sexual assault as a child.
There's some research that cameout, I think, last month, and
that research indicated that28.5% of Australian adults
between the ages of 16 and 60have experienced child sexual
abuse. That is a confrontingstatistic. But the other
confronting thing about that isthat these people may go on to
(31:23):
have children, and that traumamay be buried, or that trauma,
they may be seekingpsychological support. But that
trauma does matter when it comesinto the birth suite and those
vulnerabilities. And peoplearen't going to disclose this if
we don't have a psychologicallysafe environment. And that is
(31:43):
why it's so important to havecontinuity of carer. Absolutely.
But if if we are not askingthese questions, and also not
providing a safe environment, ofcourse, people aren't going to
disclose it. I vividly remembermyself on a much sort of smaller
context, but my lovely midwifehad asked, you know, whether I
(32:04):
had any pre existing mentalhealth conditions, I did, but at
the time, I was great, you know,I was very happy, pregnant. You
know, I thought, why are youasking me that? Why is that
relevant? I didn't know that ofcourse, if you walk in with your
baggage, with preexisting mentalhealth conditions, that does
(32:25):
increase your risk of walkingout the birth experience with
challenges. And it's the samewith pre existing trauma. One,
the World Health Organisationsays that one in three women
have experienced sexualviolence, most at the hands of
an intimate partner. This iswhat we're bringing into the
birth suite. And that is why theapplication of trauma informed
(32:49):
care is so important. But thereisn't enough education around
it. And also, if we ask peoplethese questions, where do we
send them for support? So we'vegot a real barrier for not only
do we have a professionprofessions, you know, the
maternity profession isundervalued. We've got, you
know, a workforce that is burntout because they have to do
(33:12):
incredibly long hours, peopleare leaving, midwives are
experiencing their own PTSD orsymptoms of PTSD. And so we have
an environment that reallydoesn't lend itself to good
outcomes. And I think that'sjust so important to acknowledge.
Catherine Henry (33:28):
I'd like to just ask you, following on from
that, and the importance ofeducation and the the work that
needs to be done there. What areyour hopes for the recently
announced New South Walesinquiry into birth trauma? Do
you feel... is that is that agood development? I'm sure
(33:49):
you'll say it is. But what doyou hope that we can achieve
through this inquiry?
Amy Dawes (33:56):
Catherine, I'd like to see a National Inquiry. Last
year, I mean, I think it was atthe start of this year, we had a
meeting with the Department ofHealth and we said that we would
like to start measuring birthoutcomes. We need to start
looking at birth beyond thebirth notes, beyond the six week
(34:16):
check if people go for that. Andwe actually need to be checking
in on parents at three months,at six months and a year
postpartum. Because, you know,I've already said before, that
people are not seeking supportfor trauma symptoms. The problem
with that is if they're notseeking support, what they do is
(34:37):
potentially develop unhealthycoping mechanisms that cause
further detriment to not onlytheir wellbeing but the
wellbeing of their family, theirability to bond with baby. You
know, it ripples out into thecommunity. And, you know, I
think there should be a nationalinquiry because as I said, we
(34:57):
are actually not putting thewell being of the birthing
community as a priority andthat's our next generation. So I
think there needs to be a, aninquiry that is federal
government led that that reallylooks at birthing outcomes.
Catherine Henry (35:13):
Thanks so much Amy for talking to me today on
Law Matters. You do so much, andthank you for all that you do in
this important area and I lookforward to talking to you again.
Maternal birth trauma is oftennot talked about. So if you are
suffering, please know that youdon't have to do that in
(35:35):
silence. We will put some linksin the show notes of where you
can go for help if you need it.And a heartfelt thanks to Amy
Dawes. The co founder and CEO ofthe Australasian Birth Trauma
Association for talking to metoday in this episode of Law
Matters. I'm Catherine Henry ofCatherine Henry Lawyers. And if
you need help navigatingobstetric negligence in maternal
(35:57):
health, please reach out andcontact us at Catherine Henry
Lawyers. And if you're enjoyingthis podcast, make sure you
subscribe wherever you listen toyour podcasts to stay up to date
with all the latest episodes.This podcast was produced by Pod
and Pen Productions.
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