Does debriefing about a difficult birth stop it turning into trauma?

For some women, giving birth is a joyous occasion; however, others find it a distressing and traumatic event. Approximately one in three women describe their birth as traumatic, often due to medical emergencies such as caesarean sections, heavy bleeding, or the need for intensive care for the newborn. The trauma is not always caused by the emergency itself but can also stem from feeling unheard, lacking information, or undergoing procedures without full consent.

Around one in five women who experience a traumatic birth develop post-traumatic stress disorder (PTSD), which can include symptoms like unwanted memories, nightmares, avoidance of reminders, and feeling constantly on edge.

The question arises: can debriefing about a difficult birth prevent it from turning into trauma? The answer is not straightforward, as not all women find debriefing helpful. Hospitals offer postnatal debriefing sessions, but the approach varies widely, from general conversations with maternity health professionals to more structured sessions specifically aimed at discussing a birth event.

Some women find debriefing beneficial, feeling heard and gaining closure, while others do not see any clear benefit, especially when it comes to preventing PTSD.

Timing is crucial when it comes to debriefing. If conducted too early, women may relive the traumatic event before they are ready, potentially causing more harm. The World Health Organization and the UK's National Institute for Health and Care Excellence recommend against routine single-session psychological debriefing. However, opt-in debriefing for women who specifically request it or are referred can help reduce PTSD symptoms.

Continuity of care, such as having the same midwife throughout pregnancy, birth, and post-natal periods, can also build a trusting relationship where women feel listened to and supported.

Rather than a one-size-fits-all approach, the evidence suggests that the key factor is that women who want a debrief should have access to one at a time that feels right for them, focusing on the questions they truly want answered. Nevertheless, any debriefing should be part of a referral to a health professional trained in perinatal psychological trauma, such as a psychologist or counsellor with experience in birth trauma. These professionals can help process the traumatic event and provide the necessary support.

Even with proper support, some women may still develop PTSD symptoms, which can be challenging to identify due to the postpartum adjustment period and sleep deprivation. Symptoms may include vivid memories and flashbacks, withdrawal from family, and difficulty bonding with the baby. These can significantly impact the family dynamic. However, many women with such symptoms remain undiagnosed as routine screening by maternity services often focuses on depression rather than birth trauma.

The City Birth Trauma Scale, developed by researchers, is a tool to help healthcare professionals identify PTSD symptoms specifically related to childbirth, enabling them to provide the right support. If you are considering a debrief with a healthcare professional after a distressing birth experience, it's essential to think about what you hope to gain from the conversation, such as understanding the medical aspects or having your experiences acknowledged.

Before a planned debrief session, requesting a copy of the hospital, medical, or birthing notes can provide a concrete basis for discussion.

When preparing for a debrief, useful questions might include what decisions were made, when they were made, and details on any medical terms or procedures, ensuring they were explained at the time. It's also important to request the presence of a support person and specify the health professional conducting the debrief, such as a known midwife or obstetrician.

Ultimately, the decision to debrief should be individual, and if not ready to discuss the childbirth experience, it's reasonable to decline. Given the psychological impact on women and their birth partners, timely discussions, individualized care, and access to appropriate ongoing perinatal mental health support are crucial in supporting families.

For those showing signs of perinatal mental illness or PTSD related to pregnancy or birth, support is available through Helpline (1300 24 23 22), Birth Trauma Australia (1300 726 306), PANDA (1300 726 306), and COPE or Lifeline (131114).