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#yourstorymatters #ABTA

07 July, 2018

  

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
ABTA define birth trauma:
  • 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)
Over the years since talk of traumatic deliveries and the health consequences of these deliveries on the mother have arisen- there has been mutterings and ‘out loud’ comments about whether this is something that women should just get on with life and not worry about it. But a long time ago and I can’t remember who said this  – Amy may and if she reminds me I will attribute this- someone likened the traumatic birth to a scenario when a plane gets hijacked on the way to Paris – but 27 hours later the hijacker was successfully apprehended and the plane landed safely with no one on board dying. NO ONE would say- you got to Paris and you’re alive – get on with living, without acknowledging that the process would have been harrowing, the stuff of nightmares and for some passengers they may go on to suffer PTSD and need de-briefing and serious counselling.
For some women, this is what they go through when they have a traumatic delivery. They are handed the baby and everyone sighs with relief and that is sometimes it! So many women who have found the ABTA Facebook group (you will have to be on Facebook to go to this link) have been relieved to find a space where they can recount their story fearlessly and know that the women in this group will ‘get it’.
The question is – how much information is a woman entitled to know about the pros and cons of all the birth processes? Is it scare-mongering to inform women about the birth process by telling them what can go on in a delivery? I used to take Childbirth Education classes (a hundred years ago) and when I taught about prolapse or urinary incontinence or faecal urgency in those classes, there were those who said: “Don’t tell the ladies about that stuff- it’ll put them off having a vaginal delivery”. And I didn’t even know about levator avulsion then!! (no one did except for a doctor in the US in 1938 who described levator avulsion in a medical text-book and it was never discussed again until many years later in early 2000’s by Prof Peter Dietz in Australia and Prof John DeLancey in the US).

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).

CChildren. 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.

So congrats to ABTA for getting such fabulous exposure on the issue of traumatic birth and here’s hoping many women will be supported and assisted by discovering ABTA if they suffer a traumatic birth.
Now today is a very special day as 33 years ago I ventured into motherhood (one of the best things I’ve done in my life) and had my first-born (happy birthday darling). It definitely was very memorable (I can recount every detail still 33 years later) but thankfully, it was not a traumatic birth.
And despite me definitely having my share of pelvic floor dysfunction, neither were the next two births. Having relatively good vaginal births still changes you – I can’t imagine how having a traumatic birth would have left me. I surprisingly knew very little going into my first pregnancy and certainly didn’t contemplate the major pelvic floor dysfunction I have as an outcome. But luckily I fell into women’s health physio soon after my third baby and was able to be fanatical about pelvic floor strengthening, bracing (the knack), correct bladder and bowel emptying and all the other strategies that we teach women after childbirth and cope reasonably well on a daily basis.
But knowing what I know now, I definitely don’t believe that ‘ignorance is bliss’ is a good motto. Knowledge is empowering and a basic right for all women.
Sue with her first-born daughter 7/7/1985
(1) Some information for this blog has come directly from the ABTA website http://www.birthtrauma.org.au/about-us/
(2) Jelvsek J Eric et al (2018): Predicting risk of pelvic floor 12 and 20 years after delivery American Journal of Obstetrics and Gynaecology, Vol 218, Issue2, 222.e1 -222.e19
2 Comments
  1. shirley owen permalink

    Great article Sue. Found link first via Radio National site.I remember when Peter D first told us about levator avulsion. Very interested in the ongoing research being done. Keep the flag flying, you have been a great activist in our chosen field

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