Amy Dawes and her daughter
This week has seen the inaugural Birth Trauma Awareness Week and big congrats to Amy Dawes and the crew at www.birthtrauma.org.au for their amazing public awareness campaign which has snared interest from The Project and the ABC National News and a fantastic article from feminist and writer Clementine Ford.
Now I have worked (begged, crawled, been on bended knees) for 27 years as a representative of the Continence Foundation of Australia, the peak body for continence promotion in Australia, to try to spread the word about continence promotion (urinary and faecal) and preventative strategies for prolapse management and I have massively struggled to engage mainstream media. And yet this week has been a HUGE success for ABTA for highlighting birth trauma, its link to Post Traumatic Stress Disorder and the toll it takes on a woman’s health and family relationships.
As a result of this exposure, many women- who for years and years have just shut up and ‘grinned and beared it‘- have realised THEY too have suffered with horrific pelvic floor dysfunction, a life threatening birth event for themselves or their baby and a birth which went nothing like the birth plan and that possibly they have suffered PTSD which has significantly affected their life.
ABTA or the Australasian Birth Trauma Association was established in 2016 by Amy Dawes and Professor Peter Dietz and others (including Liz Skinner, a PHD student who has done research into the psychological impact of a traumatic birth) to assist women through their own journey after a traumatic birth by providing them with the information, resources and support required to manage their symptoms while raising a family, participating in the workforce and being active in their community.
Key activities of ABTA include:
- Raising awareness of physical and psychological birth trauma and the significant consequences for the woman and her family
- Working with obstetricians, physiotherapists, mental health experts, midwives and urogynaecologists to prevent or address these injuries more effectively
- Supporting affected women and their families
- As a physically damaging birth processes which then results in life-changing psychological and social difficulties.
- Psychological problems arising from the circumstances of the delivery (e.g. “wrong” location; pre-term; support people not present).
- Psychological problems arising from the process (e.g. labour too quick, prolonged, inadequate pain relief; feeling of loss of control; emergency caesarean section; concerns about survival of baby or self)
- An ‘uneventful’ or satisfactory delivery from the professional point of view (mother and baby well; no physical complications), but traumatising for the woman as she feels unsupported or even misunderstood by health professionals. (1)
I wrote an extensive blog on the ‘birth informed-consent controversy’a few months ago and I think the conversation is growing especially as research by a team led by Eric Jelovsek (with Prof Don Wilson amongst others) has developed UR-CHOICE, a scoring system to predict the risk of future pelvic floor dysfunction based on research looking at major risk factors. (2) This research has followed up women at 12 years and 20 years after delivery and this scoring system together with the mother’s own preference, may help with counselling women regarding pelvic floor dysfunction prevention.UR-CHOICE stands for:
U – Urinary incontinence before pregnancy.
R – Race (ethnicity).
C – Child. Bearing first child started at what age?
H – Height. Mother’s height (if < 160cm).
O – Overweight. Weight of mother, Body Mass Index.
I – Inheritance. Family history of PFD (mother and sister).
C – Children. Number of children desired.*
E – Estimated foetal weight (baby weighing greater than 4kg).
*If caesarean deliveries are indicated this is important due to an increased risk of placenta praevia and accreta with increased number of caesarean deliveries. (2)
I do believe informed consent for childbirth will be routine before I have retired.
I do believe women will understand more than ever before about what they may face with childbirth – and this is a good thing.
I do believe it is a woman’s right to be well informed about the potential pelvic floor issues that can occur with childbirth.