How important is resilience training in ante and post-natal teaching and support?

Building Resilience in birth - A response to 'Mumsnet is driving women to request Caesarean Sections..'

This blog was prompted by the wonderful post on Instagram by @birthtraumasupportfamily who pointed out an article in The Telegraph titled 'Mumsnet is driving women to request caesarean sections, a leading midwife has warned'.

The sub header for which is: ‘Catriona Jones, a lecturer in midwifery at the University of Hull, said up to 14% of expectant mothers now suffer from Tocophobia, which is defined as an unreasonable dread of childbirth.’

This Tocophobia she lays the blame for at the feet of TV dramas and social media.

Now, let me be absolutely honest. I get irritated by ridiculous interpretations of birth in film and TV. Most antenatal teachers and birth workers do. Too often we will see the women in shrieking pain...everything falling apart…an emergency! Then in steps a handsome young doctor (hopefully George Clooney) and he will save the day. The horror of birth...rescued by the might of modern medicine...if rescued at all.

I am heartily sick of it.

However, Catriona Jones is quoted then saying: 'Sometimes we can be more drawn to reading about that than about the women who give birth in a beautiful calm situation where everything turns out to be very straight-forward and lovely.'

It is a common theme in ante-natal teaching. Listen to the good stories, not the bad ones.

Why?

Well this is a complex issue. We human beings do need to pay attention to threat. It is the reason we rubber-neck on motorways. The reason why people get stuck into watching hours and hours of News 24 if a major incident occurs, the 9/11 attacks, or the tube bombings for example. We do this because we are mammals and we need to be able to assess threat. To understand it. To see if it is coming for us. To ensure that we are safe.

It is an entirely normal, mammalian response.

It is absolutely different to unsolicited birth advice. Auntie Maude telling you that you are crazy for going over 43 weeks without 'getting that baby out safely'.. or 'just take that epidural immediately, it'll be the best thing for you, you'll be begging for it!'.

From these poor birth stories we create our sub-conscious blue-prints for birth. Obviously as teachers we aim to alter the sub-conscious belief systems about birth and replace them with positive stories and beliefs. So we do ask women to avoid terrible birth stories or interpretations. This helps to reduce fear, a major issue in the fear, pain cycle.

Now, when I teach or coach I ensure that we note the difference between women talking of birth trauma and unsolicited advice. Women and their birth partners need to understand why other women feel the need to tell them the shocking and upsetting details of their own birth trauma, and it is this. We are not offering women who have had a tricky or traumatic birth the assistance and counselling that they need. They are not doing it to be mean.

Quite often, after a catalogue of interventions, worries, forceps or c-section, they are patted on the shoulder and told that their baby is fine.

And that they are fine.

And that is it.

Now, when we as humans suffer trauma, it can overstimulate the amygdala, the oldest part of the brain. Then that trauma is not moved on to the cortex, the thinking brain. It has not been rationalised and put to history. It remains current.

When anyone suffers trauma, birth or otherwise, they can experience flash-backs, panic attacks, feelings of anxiety or worthlessness. This can lead to Post-traumatic Stress Disorder and potentially eventual anxiety & depression. It seeps out of them, it never leaves them.

I like to explain it as your home smoke alarm. Now, my smoke alarms main job, its very reason for being is to let me know, loudly, if my house is on fire.

However, my smoke alarm cannot actually tell the difference between the house burning down, or the morning toast being left in the toaster too long. Or sausages....or next door’s barbeque.

It's basically a bit crap.

However, it valiantly attempts to do its job, shrieking its warnings when anyone attempts to cook anything.

So, this is how it feels for someone who has suffered trauma, such as birth trauma, but hasn't had the opportunity to process that and move on.

They have to talk. They really have to.

So what are we offering women who have suffered birth trauma? Well, very little, if anything at all.

And now this article.

"please be quiet dear, you're giving the other ladies Tocophobia"...it's not good enough really is it?

So, the system is a bit broken. Anyone who has birthed will know that. Underfunding, technocratic birth models, lack of effective knowledge are all leading to this. It would take someone only 5 minutes of reading messages on the very wonderful Ten Month Mamas group on Facebook to see the bullying that takes place and the lack of support they feel. The dearth of evidence based information in local NHS trusts and the conveyer belt of care, which regularly forces women into post-term inductions or treatments that they do not fully understand or perhaps truly require.

Perhaps it is this that is causing the Tokophobia? not a mum talking about her labour on Mumsnet.

My interest, however, is what we as antenatal teachers can do about it? And by antenatal I cover everyone who interacts with pregnant ladies and their birth partners, be that Hypnobirthing, NCT, Calm birth, Mindful birth, Yoga birth and more..

For me? Over and above everything else I teach, I think it is resilience. Teaching women resilience.

Why?

Well, I can talk to two women who have for the most part had fairly identical births. Both of those births have changed direction, decisions had to be made, interventions were required.

One will see it as a positive birth experience. They were a part of the decision making process, they were confident that the path was correct even though it was not what they had hoped and planned for. They rolled with the changes and birthed their baby. It wasn’t ideal but they are fine.

The other will have suffered trauma. They may have been scared, shocked by how quickly what they had planned was withdrawn from them. They felt out of control, manhandled and something taken from them that they cannot now easily verbalise.

We all know people in life who have had horrible things happen to them, but have survived and thrived. We know others who have not. The difference is resilience. Mental flexibilty, growth Mindset or toughness if you prefer.

The website for Mind (mind.org.uk) sums this up very well:

'Resilience is not just your ability to bounce back, but also your capacity to adapt in the face of challenging circumstances, whilst maintaining a stable mental wellbeing.

Resilience isn't a personality trait - it's something that we can all take steps to achieve'.

Why are Mind interested in resilience? Well, emotionally driven people use a black and white thinking style and thus find it more difficult to come to terms with major changes or experiences. If a person has a tendency to black and white thinking they may have thoughts that are all encompassing, they may be self-focussing, jump to conclusions too easily, blame others or themselves, have exaggerated feelings, they catastrophise, have to be perfect or put themselves down. This means that if things go wrong they will struggle to cope.

Beyond giving birth, having a baby can be a hand-grenade thrown into a relationship or a life. Post-natal depression rates are considered to be at between 10-20% (gov.co.uk Aug '17) but many bodies believe this to be far higher.

Now PND is sometimes viewed as a biologically based condition attributable to a high level of hormonal imbalance after childbirth but there is no evidence that the majority of PND is due to hormonal imbalance. Depression can develop weeks or months after a birth and can affect both men and women. Simply put there are circumstances that may trigger depression and childbirth, traumatic or not is no different to any other circumstance (bar thyroid gland issues which I hope to cover in the future).

So, if we enable women when pregnant to become more resilient, to move away from emotionally driven black and white thinking to realise if they are struggling as early as possible, alongside our usual course materials we could not only improve rates of traumatic birth but rates of post-birth depression.

If women are fully engaged with their material, read and employ methods of understanding such as Sara Wickham's wonderful Intention, Indication, Individualisation (What's Right for Me, 2018), trust their instincts, stand by their choices but enable them to be absolutely flexible during their births, we will be setting them up for birth and parenthood far more effectively.

Maternity care needs to change. Women's voices need to be heard. We need to understand trauma, not silence it...TV dramas and social media are not really the enemy.