Birth Trauma Awareness Week 2024
This week I had another chat with Jeremy Lee from ABC South West Vic on Radio discussing Birth Trauma Awareness Week. Click the links to download the 12min recording, listen online with the transcript or read below!
Birth trauma awareness week
Jeremy: It's hosted each year by the Birth Trauma Association who pick a theme, and this year the focus is informed consent. The recent New South Wales Royal Commission into Birth Trauma apparently received over 4,000 submissions. And in May they handed down some findings in their reports.
One of their findings was that a number of individuals who've suffered preventable birth trauma in New South Wales and the experiences of the people who gave evidence to this inquiry are distressing and unacceptable. And another finding was that urgent efforts must be made to address avoidable and preventable factors that contribute to birth trauma. Which is pretty alarming for New South Wales but what about Victoria? Chloe Burger is the director and physiotherapist at The Lady Physio here in Warrnambool and has some experience with this, Chloe. Welcome to you.
Chloe: Thank you.
Jeremy: Um, why don't we jump straight into it in fact, to the report so you've had a look at the New South Wales report I understand?
Chloe: Yeah, there's been a lot of interest in this report in New South Wales and obviously there's a big impact around the country and it's also made an impact in other countries. You know, it's sparked an inquiry in the UK as well. So it's an amazing achievement for New South Wales to have this inquiry and for it to hopefully have flow on effects to the rest of the country and other places around the world as well.
Jeremy: So tell us a bit more about some of the key things really that came out of it for you perhaps and were they surprises or are these things that you see everyday I suppose?
Chloe: Yeah, I think working in pelvic health and seeing a lot of women postnatally, it's really evident that people are experiencing traumatic births. And it's really evident that there's a lot that we can do to try and prevent that. So I think the biggest findings were that, you know, a lot of it is preventable and a lot of it needs to focus on education for women and families before they give birth so they're aware of what birth involves and they have realistic expectations around birth. And then also about that, you know, care afterwards and, informed consent training for maternity professionals and all of those kinds of things.
Jeremy: So when we talk about it being preventable that, what indicates that, there are I'm presuming people on both sides here, maybe health professionals uh, you know, people who are giving birth as well, who are not fully informed or not, I don't know. I mean, what, what, what do you think is going wrong here?
Chloe: Yeah, I think one of the things is that, women aren't fully informed and they also don't have informed consent practices. And I guess the level of medical interventions that happen during birth in Australia, can't be explained just by medical necessity. And of course, interventions do save lives and they do help prevent serious injury. But I think a lot of the time women aren't prepared for these medical emergencies and they're also not prepared for interventions and consenting to them, so they don't understand the risks and the benefits and that's not explained to them before these interventions. And because of that, they feel a loss of control and they feel helpless and they feel like they have experienced trauma due to that. It's not actually usually the event that causes the trauma. A lot of people can go through these medical emergencies and if they're prepared and well-supported they might not experience it as traumatic.
Jeremy: Yeah. Because, I mean, just anecdotally, you often need people when they're pregnant, sort of say, look, just give me the drugs, you know, but I guess that's, that's probably the worst way to approach this that attitude? Yeah,
Chloe: Yeah, I think there's lots of attitudes that do contribute to it. And I think that people just aren't aware of the things that they can do to prepare themselves to prevent it, but also care providers aren't aware of the things that they're doing that might be contributing to it as well so that's where we need more training. And also, a continuity of care model is one of the biggest things that's come out of this report as well. So having a midwife that you know, throughout your pregnancy, that's there during your labour can then help you feel a lot more supported. So that's something that we need to do a lot more of.
Jeremy: It's kind of alarming when you say care providers, isn't it? Cause, I mean, these are people who, you know, this is their job when you think, well, these are people who surely should have the patient, first and foremost, perhaps and making the experiences as good as it possibly can be.
Chloe: Yeah, definitely, and I think sometimes it's the system that's puts them under pressure as well. It may not be them themselves at fault. And their system is so under pressure that they are having to do things that maybe they're short on time and they don't actually have the time to explain these things to pregnant women and their families before birth. And they might not also understand the risks that need to be, you know, given to patients. They don't have that time to explain that.
Jeremy: Another thing I sort of sometimes I hear anecdotally is this idea about convenience as well, and, you know, things sort of being scheduled, but obviously when it comes to birth, I mean, you can't really schedule birth.
Chloe Yeah, definitely. Yeah, for sure and I think there is a little bit of that and, you know, we'll do an induction at 39 weeks, you're at risk of this, this and this, and you need an induction when really they're perfectly healthy and they don't actually have any evidence that they need an induction, but it suits their schedule or the amount of people that are in the hospital. And I guess that medicalisation of birth is part of the reason that we have so many interventions and you know, women themselves need to learn to push back on that and say, what's the evidence that I need an induction, what are the actual risks so that then they can make an informed choice about whether they want that induction or not.
Jeremy: Yeah. And why is that not happening do you think? You think people are perhaps just a bit scared or is there still this thing about, you know, it's a medicine I'm not going to understand that, someone's going to always going to know better than me and whatever they say is going to be right.
Chloe: Yeah, I think that paternalistic model of health care is still very evident and strong, and people do listen to and trust their doctors, which they should. But also there is definitely an element of where people should be questioning those things. If they don't feel like it's right, then they need to do their own research and question that. It shouldn't be that that's the case and it should be that women's rights and preferences are really respected, but a lot of the time that isn't the case, unfortunately and that's what we've seen with the report. That's what people have put in and as you said, there was 4,000 submissions. That's an unprecedented amount of submissions to any Royal commission or report, which is really amazing. And I think a consumer advocacy group in New South Wales, Better Birth's Irrewarra, they were really important in getting a lot of advocacy and getting a lot of people to put these submissions in because it is such a traumatic event. It's hard for people to, you know, put in something through that inquiry. So it's such an amazing effort.
Jeremy: Chloe Burger is with us here on breakfast Director and Physiotherapist at The Lady Physio. We're having a chat about this recent New South Wales Royal commission into Birth Trauma, and it is Birth Trauma Awareness Week as well. I mean, in your experience, Chloe when people are fully informed, and are prepared to take more control, does it work in their favour? Are health professionals willing to accept that and work with people?
Chloe: Yeah, I think more and more people are and aware that women do have the, a lot of the time, the education to understand these complex medical issues and they do want to understand. And I think when they do, you know, put their preferences forward, most of the time, I think they will be respected. And I guess there's those situations where they aren't, and they're the situations that we're hearing about in the report, which needs to change. But I think more and more people will be, respected and that's part of the continuity of care and the benefit of that because your midwife who knows you, then they can be your advocate as well and they can advocate for you with the rest of the medical team that you might be having when you're giving birth. So I think that's a really good thing. So if you're pregnant really important to, try and get onto a Continuity of Care Program, we have a great one in Warrnambool here, but there is limited spaces. So hopefully more and more, it will continue to get more funding so that we can have more people having that continuous care that helps prevent birth trauma.
Jeremy: Yep. Maybe to localise this a bit then, but what do you sort of see and experience locally around this? I mean are their issues perhaps with not enough people are available to talk people through this or, give people the help that they need or the knowledge that they need?
Chloe: Yeah, definitely. I think our continuity of care model is great, but as I said, there's limited spaces and you have to get in really early to get on to that model where you can have one midwife with you, who'll be present with you at birth. So that's really tricky for women. If you haven't got a spot on that, then that can lead to obviously some disappointment and also just not having that support that you need. And then I think there's not enough awareness about education and about speaking through those informed consent and the risks. So I see a lot of women in the clinic who have had say a forceps delivery or a vacuum delivery and they were never explained that there's a risk of pelvic floor injury, and then they have a significant pelvic floor injury and that can affect them for the rest of their life. So again, what's come out of the report is that postnatal physiotherapy for women who've had birth injuries is really important as well.
Jeremy: I mean, you mentioned before you had a lot of what happens here is not during the event, but the effects afterwards. So that is an example, I guess, of some of the things that do happen after somewhere down the track perhaps, for people who've had birth trauma?.
Chloe: Yeah, definitely. So there's physical effects obviously in terms of injuries, but there's also obviously the emotional and psychological effects and, you know, trauma on partners that have had to witness the pregnant woman go through these things. So a lot of people do need psychological support and that's what's been recommended as well, more help afterwards to help people cope with traumatic events that can happen during birth.
Jeremy: So for you then probably not a lot of surprises by the sounds of things in this report. Have you heard anything about how it's been received by health professionals and so on or other people in the industry?
Chloe: Yeah, I think there's a lot of support for the report, but there's obviously a lot of criticism as well, for things that weren't included, a lot of women did experience, their birth or describe it as violent, so Obstetric Violence is a term that we've heard a lot, but it's also a term that wasn't included in the report because of the connotations of, you know, it only including obstetricians, whereas Obstetric Violence does happen from all professionals. And I guess that was something that was a criticism of the report, but also this is only the start, they're wanting to look at the government giving some response to these findings. So the government has until the 29th of August to give a response. They're not legally binding findings. So it's one of those things where now the government gets to pick what they implement based on that. So I think it's only just the start of this fight and it's only just the start of getting more and more awareness and help for women in these situations.
Jeremy: Yeah and a great thing to be talking about given that it is Birth Trauma Awareness Week. I mean, lastly, what's your real takeaway or message for people, if someone's pregnant now, listening to this thinking. Oh, Maybe there's a lot I need to think about here that I haven't thought about. What do you say to people?
Chloe: Yeah, I think if you're pregnant, it is not about inciting fear and we don't want people to be fearful and worried about birth. One third of women described their birth as traumatic, but that means two thirds of women aren't so that's a really good statistic. So it's something that you should focus on and also as I said, try and get onto that continuity program, if you can, if you're pregnant and then just try and get all of the advice that you can and all of the education that you can while you're pregnant and question those decisions from a health care professional if you're not sure whether it's something that you need, then ask them questions or ask for a follow-up appointment and get some professional advice from a physio or from a midwife. Or even having your own private midwife might be an option for some women, if you can afford it. It's all of those things, just thinking about what you can do to try and reduce any issues coming through during your birth. And birth is unpredictable and there is going to be things that will happen, but it's about preparing for those emergency situations so that you're not traumatised by them.
Jeremy: Thanks very much for that great to have a chat to you this morning. Chloe Burger there, who is the Director and Physiotherapist at The Lady Physio in Warrnambool and some thoughts there around that recent New South Wales Royal Commission into Birth Trauma.
