With the recent archaic decision by the Supreme Court of the United States to overturn Roe v Wade, conversations about autonomy, health and medical care for women are more important than ever.
At Brave Legal, we have received enquiries from families who have been affected by birth-related trauma, many of whose stories involve a lack of control during birth, feeling powerless, unsatisfactory medical care and ongoing health issues. Birth-related trauma has been an ongoing issue faced by those who have the capacity to give birth and, until recently, little support from the medical profession has been provided to those who are affected.
The focus of this article is birth-related psychological trauma. Birth-related psychological trauma is beginning to be recognised in the medical community as avoidable trauma, or at least trauma that can be lessened to some extent. A 2020 Birth Trauma Association UK Survey found that ‘poor communication contributed to 9 in 10 cases of birth trauma.’ The way to mitigate against the risk of psychological trauma is to empower not only the medical professionals, but also the person giving birth and their support team, with knowledge.
Informed consent and knowledge
Informed consent, especially in the context of vaginal births, is one of the most controversial issues surrounding birth-related trauma. Informed consent involves full disclosure of the benefits, risks and alternative pathways for treatment to the person who ultimately will be required to make a decision about their body and their birthing experience – sometimes in the pressured environment of the delivery suite when the intended birth experience is not occurring as hoped or planned for.
For many people, a birthing plan is developed during their antenatal period in conjunction with their family and medical team so that everybody involved understands what their ideal birthing experience is. However, as with any other medical procedure, there are inherent risks that are associated with giving birth and unfortunately, it does not always go to plan. If medical professionals do not inform the person who will give birth about potential birthing scenarios involving the use of forceps, other instruments or surgical intervention, including episiotomies, it is arguable that the person cannot truly plan or be prepared for their birth and the sometimes unavoidable adverse outcomes.
There is a view that not providing information about the complications that may arise during delivery will prevent the person who is pregnant from being frightened by the potential risks, worried or made to feel anxious – and that they may seek to avoid a vaginal birth in fear of what ‘could happen’; however, ultimately, to have the power to make decisions when required, one needs to know the potential consequences.
There are significant benefits of detailed and careful antenatal education to both the person giving birth and medical professionals involved with the birth. The dynamic nature of childbirth makes the process unpredictable and, in some situations, fast paced. This can create a stressful environment which is not conducive to providing education or explaining complex medical concepts.
If a person giving birth is armed with this knowledge, and complications do arise leading to the need to make a decision about assisted delivery, they will have an understanding of the potential consequences and be able to make an informed decision in stressful circumstances. Although physical injuries as a result of the assisted birth may be unavoidable, the psychological impact of an unexpected instrumental delivery may be reduced given the preparedness and the ability to make a decision based on an understanding of the procedure, injuries and ongoing postnatal care.
Further, antenatal education is beneficial to health professionals, especially those involved in the birth. This is because, although the risks still need to be explained, providing information early will significantly reduce the burden on the health professionals who need to advise and explain the proposed procedure, as they can rely on the prior education provided by their colleagues and have confidence that the person giving birth understands the potential outcomes and consequences.
We recently provided advice to a woman who gave birth to her first child two years ago. She had an uneventful pregnancy which was considered low risk and her birthing plan was to have a vaginal birth.
She was admitted to hospital on the expected due date and was placed in the birthing suite. She recalled that during the first stage of labor and at the start of the second stage, the environment was supportive and calm. However, as she was pushing, she was told that the medical team needed to use forceps to safely deliver her baby.
She had not been provided with antenatal education about instrumental deliveries and she recalls feeling immense pressure to make a decision about her body and child without knowing the consequences. She ultimately provided consent, while she was giving birth, to instrumental delivery and an episiotomy.
Her child was healthy but, as a result of the birthing experience, the woman was diagnosed with post-traumatic stress disorder. When we spoke with her, it was apparent that she was not necessarily critical of the way the medical professionals handled her birthing experience – she viewed them as doing what they needed to do to ensure that she and her child were safe; she was critical of the lack of education and resources available to her during pregnancy to prepare her for the complications of birth and potential consequences.
She said that had she understood what a forceps delivery and episiotomy were prior to the birth, she would have understood the risks and would have been able to make an informed choice. She said that she still would have consented to the procedure, however, she would have been psychologically prepared for the physical consequences and may have avoided the psychological injuries that she continues to suffer from.
The Australasian Birth Trauma Association (ABTA) is a national charity that is committed to reducing the instances and impact of birth-related trauma, while supporting affected people, families and health professionals. In examples like the case study above, where there may not be an avenue for legal recourse, ABTA provides the opportunity to connect with a community who have similar experiences and engage in support groups to a wider network of people who have been impacted by a traumatic birth injury.
Brave Legal Associate Jyoti Haikerwal was named as the 2023 winner of the Personal Injury Category for the 30 Under 30 Lawyers Weekly awards. She is also a volunteer with the Australasian Birth Trauma Association and is currently volunteering as Risk Officer and providing support to Board members with the aim of providing resources, mentoring and advocacy.