Clinical Considerations

Grieving Though Grateful:

Reconciling the Traumatic and Disappointing Birth Experience

Jaclyn Engelsher DNP, APRN

Background

Risk Factors

Implications

Community & Peer Support ResourcesEffects of Traumatic Birth

ReferencesElmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010) Women’s perceptions

and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced

Nursing, 66(10), 2142–2153.

Foley, S., Crawley, R., & Wilkie, S. (2014). The birth memories and recall questionnaire

(BirthMARQ): Development and Evaluation. BCM Pregnancy and Childbirth, 14(211).

Retrieved from http://www.biomedcentral.com/1471-2393/14/211

Harris, R. & Ayers, S. (2012). What makes labour and birth traumatic? A survey of

intrapartum ‘hotspots.’ Psychology & Health, 27(10), 1166-1177.

Please visit www.onednp.com for a list of complete references

LOSS OF CONTROL

• Unplanned C-section

• Life-threatening obstetric

complications

• Emergent obstetric interventions

including forceps and ventouse

• Precipitous birth

• Prolonged birth

• Significant pain or inadequate pain

relief

• Feelings or fear and

powerlessness

• Birth plan not realized

• Intrapartum dissociation

• Stillbirth

• Infant complications or disability

• Not provided opportunity to make

educated choices

• Unnecessary medical interventions

LACK OF SUPPORT

• Interpersonal difficulties with birth

partner

• Health providers unsupportive or

not empathetic

• Feeling mistreated by healthcare

team

• Inadequate education and

preparation for birth and

postpartum period

• Poor postnatal care or continuity

PERSONAL HISTORY

• Psychiatric history

• Previous traumatic birth

• Previous trauma

When a woman experiences a traumatic or disappointing birth, there

often exists an emotional dichotomy between gratefulness for the child

and grief toward the experience.

Between 25-34% of women world-wide experience traumatic birth

and incidence of PTSD after childbirth ranges from 1-6%, yet the DSM-5

lacks specific discussion in the sections on perinatal mood disorders,

trauma and stress-related disorders, or bereavement. Postpartum trauma

may be missed or mistaken for other postpartum mood disorders by

clinicians, and under-reported by mothers.

Platitudes such as "all that matters is a healthy baby" and

recommendations to “just move on” minimize and invalidate the mother's

grief toward the experience and contribute to feelings of guilt, anger,

helplessness, failure, or diminished self-esteem.

This presentation describes risk factors that contribute to traumatic

birth and resources for the PMH nurse to aid in prevention, diagnosis,

treatment, and collaboration.

Birth is not a merely a means to an end, but an experience independent

of the outcome. A comprehensive understanding of traumatic birth

provides the PMH nurse a foundation for enhanced assessment,

intervention, integrative strategies, and interdisciplinary collaboration to

help women at risk for or experienced traumatic birth. Knowledge of the

risk factors, characteristics, and supportive resources results in refined

diagnosis, effective treatment planning, and the opportunity to build

connections with peer obstetric clinicians.

Physical

Lactation insufficiency

Psychosomatic complaints

Gynecological and sexual problems

Disturbed sleep, appetite, and energy

Psychosocial

Ineffective maternal role attainment & bonding

Disrupted relationships

Avoidance/isolation

Fear of future birth

Lack of self-esteem and confidence as a mother

Psychological

Postpartum depression

Postpartum anxiety

PTSD

Bereavement

Compulsions

Baby Center Community: Disappointing Birth Experience

http://community.babycenter.com/groups/a1198275/disappointing_birth_e

xperience

Pinterest www.pinterest.com/onednp/traumatic-birth-resources

Facebook

• Unplanned CBAC and Birth Trauma Support Group

https://www.facebook.com/groups/111066659056348/

• Birth Trauma Association https://www.facebook.com/groups/TheBTA/

Solace for Mothers

• Website http://www.solaceformothers.org

• Forum http://mothers.solaceformothers.org

Twitter

• @BirthTraumaHelp

• @PostpartumHelp

International Cesarean Awareness Network

• http://www.ican-online.org

In addition to evidence-based assessment, diagnosis and

treatment strategies for depression, anxiety, and PTSD, there

are special considerations when considering birth trauma

Assessment

Birth Memories and Recall Questionnaire (BirthMARQ)

Differential Diagnosis

Postpartum mood and anxiety disorders, thyroid disorders,

insulin resistance

Psychotherapy

• Grief and trauma focused therapy

• Review medical records from the birth

• Encourage to write birth story

Pharmacology

Determine breastfeeding status

Collaboration Opportunities for Continuity of Care

• Primary care

• Women’s Health/OBGYN

Defining Traumatic Birth

The individual perceives or experiences the birth and/or

postpartum period as threating to the physical or

emotional integrity of the mother or the baby.

Birth

Matters