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Empowered or powerless? Contributing factors to women's appraisal of traumatic childbirth

02 December 2021
15 min read
Volume 29 · Issue 12

Abstract

Background

Approximately one-third of women reflect on childbirth as a traumatic experience and the way women appraise their birth experience is significant to their postnatal wellbeing. This study aimed to identify and compare experiences of childbirth for mothers who reflect on birth as a traumatic or non-traumatic event.

Methods

Semi-structured interviews were conducted with 14 mothers in the postpartum period who appraised their birth as either traumatic or non-traumatic. The data were analysed using thematic analysis to elicit themes and subthemes.

Results

Thematic analysis revealed two contrasting themes relating to whether women felt empowered or powerless during birth. Empowerment was associated with women's trust in their maternity care, the sense of control they felt over their body and birth and the extent to which they felt informed of their options. Being powerless was associated with distrust towards healthcare services, feeling as though they lacked control over the process and feeling ‘in the dark’ about what was happening.

Conclusions

Women's sense of empowerment during birth is an important contributor to the appraisal of childbirth as a traumatic or non-traumatic experience. Empowerment is largely determined by the dynamic between a mother and the support around her.

Approximately one-third of women appraise their birth as a traumatic experience (Ayers et al, 2016) and the prevalence of experiencing a traumatic birth are suggested to have increased for women giving birth during the COVID-19 pandemic (Mayopoulos et al, 2021). There are many factors that contribute to a traumatic childbirth experience, but a woman's subjective perception of birth is consistently a stronger predictor of trauma than her obstetric experience (Czarnocka and Slade, 2000; Söderquist et al, 2006; Dekel et al, 2017). In this sense, birth trauma is regarded as being ‘in the eye of the beholder’, as a mother's traumatic birth experience may be viewed as routine practice by healthcare practitioners (Beck, 2004). Because of this, women who experience a traumatic birth often report that they have not voiced their distress through fears that their concerns would be dismissed (Moyzakitis, 2004). A woman's perception of their childbirth experience is significant to their postnatal mental health. A woman's appraisal of her birth is one of the most influential factors for developing symptoms of postnatal post-traumatic stress disorder (Beck, 2004). From the wider literature on post-traumatic stress disorder, it is known that a negative appraisal of a trauma event can evoke a current sense of threat and motivate avoidance behaviours that can perpetuate post-traumatic stress disorder symptoms (Ehlers and Clark, 2000). Therefore, in order for maternity care to provide early and effective support, it is imperative that research focuses on women's unique appraisals of their birth experiences to identify characteristics of birth that may cause women to reflect on childbirth as a traumatic or non-traumatic event.

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