Watch Your Language!

Watch Your Language! – The contribution of health professional language to birth trauma and birth related PTSD 

Guest Post by Kath Harbisher, Bent Not Broken Trauma Counselling Project.

It’s a very difficult thing to have to consider, that how one is treated by another human being has directly contributed to one’s lived experience of being psychologically traumatised when giving birth. 

It’s even more shocking when that human being is a health professional who is meant to offer kind and compassionate care.

It is shocking when that health professional fails to meet legal, professional and ethical requirements that demand that maternity service users are treated with dignity and respect.

It is shocking when that health professional fails to uphold the legal rights of maternity service users.

It is shocking when that health professional dismisses the right of a maternity service user to have their voice heard as a legitimate determinant of their own health care needs. 
 
Birth trauma can occur in many ways, often outside the definitions so rigidly delineated by DSM 5, (American Psychiatric Association, 2013). Ayers et al (2016) give a comprehensive overview of what birth trauma is and how it occurs. In addition, it can be construed that many maternity service users feel utterly betrayed by the way they are treated by some health professionals, and it is the shock of such betrayal that may also directly contribute to psychological trauma (Freyd, 2008; Gagnon, Seulki and DePrince, 2017; Platt and Freyd, 2015). 

It all starts with language. Words have power, and this is just as relevant in maternity services (Silverton, 2017; Mobbs, Williams and Weeks 2018). 

How language is used in maternity care settings may have far greater impact then many currently acknowledge in relation to how women and birthing people subsequently define the quality of their birth experiences (Hunter, 2006). In fact, researchers like Beck, 2006; Ford and Ayers, 2011; Harris and Ayers 2012; Hollander et al, 2017; Moyzakitis, 2009; are producing data which strongly associates poor communication, which may include coercive language and bullying behaviours, as a direct causal factor for women and birthing people to subsequently define their birth experiences as traumatic. What resonates clearly from these authors is that where language is used to leave women and birthing people feeling silenced, dismissed and robbed of their right to bodily and self autonomy, this is where psychological traumatisation may emerge. 
 
Reed, Sharman and Inglis (2017) take that a step further by exploring what it is that maternity care health professionals do, that invokes trauma in women and people who are giving birth. Reed et al, (2017), identified four areas of health professional behaviour that women and birthing people found specifically traumatising – placing their own agenda above that of the woman or birthing person; dismissing the embodied knowledge of women and birthing people including infantilising them; lying, threatening and bullying to coerce the woman and birthing people into doing/agreeing with what the health professional wanted; that women and birthing people were left feeling violated. This related to not just physical assault, but also to psychological violation through the loss of bodily control and self-autonomy and resultant feelings of betrayal (Reed, Sharman and Inglis, 2017). 

It’s a very damning picture and, even worse, it doesn’t stop there. What research also indicates is that the damaging effects of these traumatising birth experiences do not just affect women and birthing people themselves, but also have the potential for long term negative consequences for their relationships with their babies, other children, partners, families and friends. It can also damage their sense of self and have profound negative effects on their confidence, their sense of self-esteem and self-value and their ability to connect with other humans in ways that are meaningful to them (Beck, 2011; Beck, 2015; Kudeva, 2015; Petersen, 1996). 

Trauma has many faces and anger is certainly one of them (Van der Kolk, 2015). Certainly anger is provoked when women and birthing people feel that their lived traumatic birth experiences and the subsequent consequences are denied, diminished and dismissed. It can result in social media pages, groups and websites like ‘They Said To Me’ where women and birthing people come together to express their pain and anger at what happened to them.  

The things said on these pages and websites can seem very damning and highly critical of maternity healthcare services. They are, and rightly so, as many of the posts reflect the maternity service user’s experience of cold, compassionless care, abusive and coercive treatment and even physical assault including interventions being performed on them without informed consent. These are breaches of UK law (Birth Rights, 2020), health professional codes of conduct (Nursing and Midwifery Council, 2020; Royal College of Obstetricians and Gynaecologists, 2019), and the ethical requirement to treat others with humanity (Limentani, 1999). 

It’s very easy to believe that the language we use to others is always kind and compassionate. That’s not always true in maternity care as sometimes that kindness and compassion is an agenda in itself. McMahon (2015) raises this issue and points out that ‘coercing with kindness’ is still coercion. 

The thing is, ‘winter is coming’ (Martin, 2011) and times are changing. Maternity care service users seem to be far less tolerant of being treated without appropriate cognisance to their legal rights. According to the NHS Litigation Authority (2012), from 2000 to 2010, compensation had been paid to 28 people where their claims of psychological damage incurred because of how they had been treated were upheld. While this is a tiny fraction of all litigation claims, but it remains significant because it evidences that there is a slow but sure move to recognising that poor treatment within maternity care services can cause psychological harm and trauma. That opens a whole new can of worms around how service users are treated within maternity care services. It stands to reason that this number has increased since 2010 and will continue to do so as maternity care service users become even less tolerant of trauma caused by inappropriate communication and behaviour from maternity care health professionals. Websites like ‘They Said To Me’ reflect the current level of disgust and contempt that maternity care service users hold for those health professionals who have bullied and coerced them into births that became profoundly traumatic experiences. It is only a matter of time before this translates into a significant increase in maternity litigation claims for the psychological harm resulting from these experiences.  

I would urge health professionals to take a long, serious look at how they use language in maternity care services. Perhaps some deep reflection around how and why you speak to maternity care service users as you do? (Schon, 1991). Ensure you are fully cognisant of service user legal rights and that you act within the requirements of your regulatory organisation’s code of conduct. Kindness and compassion needs to be the fundamental basis of all maternity care, not some add-on to avoid litigation. 

Kath Harbisher Bio 2020

Kath is a trauma therapist specialising in working with parents experiencing birth trauma and birth related PTSD, anxiety and depression. She is currently completing her Master’s degree in Psychotherapeutic practice. As a birth advocate of many years standing, Kath has a deep interest in helping parents empower themselves to get the positive birth experiences they wish to have. It also deeply saddens her that this is even necessary.

In order to help people who need trauma therapy but cannot access it readily, Kath set up the Bent Not Broken Trauma Counselling Project. It offers an online service so you can access therapy no matter where you live. If you feel that trauma therapy might help you then do contact the Project.

Please consider DONATING to support our work.

References 

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