Birth Trauma: We need to talk about it

So as I mentioned, today’s episode is on birth trauma and my lovely guest Rosanna Pajak is a clinical psychologist who specializes in perinatal mental health. Rosanna has worked across clinical and community settings in both the UK and Australia, including specialist trauma services and women’s health services. As an experienced trauma informed clinician and a mother of two young boys, Rosanna is passionate about supporting parents through the experience of a traumatic birth. So stay tuned as Rosanna is really insightful and informative. In this important topic, Rosanna discusses what is birth trauma and risk factors for birth trauma, we discuss how it can impact a woman and her family. And we discuss things that can be done to help improve birth for women and ways to help heal after birth trauma. We also discuss how following pregnancies and births might be affected too and if you identify with anything that we discussed today, Rosie gives her tips for how to set out on your path of healing and recovery.

Before we dive in, I invite you if you are pregnant, or you’ve had your baby to come and join the free fitness community Facebook group, simply search ‘Pregnancy Birth and Beyond by FitNest Mama and the link is also in the show notes to come and join this rapidly growing amazing community of other pregnant and new mums who are all there to support each other and cheer each other on journeys, crazy and beautiful thing we call motherhood.

Alright, let’s get into this episode with Rosie. Hello, Rosie, thank you for joining me today on the FitNess Mama Podcast.

ROSANNA PAJAK

You’re welcome. Thank you for having me.

KATH BAQUIE

So we are chatting all about birth trauma today. And I’m so glad we’ve been able to tee up this time because it is such an important topic to talk about. And I don’t think it’s one that we talk about enough. So to start off with, could you please tell us a little bit about yourself and how you ended up working in this area of like perinatal mental health?

ROSANNA PAJAK

Sure, sure. So I’m a clinical psychologist, originally from London. So I trained over there in the UK. And one of the things I specialized in back then was trauma. So PTSD, and specifically working with like multiple for long interpersonal trauma. So I was actually working with refugees, and doing work in that space. And then when I moved to Sydney, I ended up doing research work with refugees, and then working in private practice, which is actually where I started working with new house. So it’s in my private work that I started doing perinatal mental health, which is really looking at supporting women from conception all the way through pregnancy, birth, and into that postnatal period. And because of my interest in trauma, birth trauma just started to come through more and more as something that I was interested in and enjoyed working with.

KATH BAQUIE

Yeah, right. It’s really interesting. And do you find many parallels? It might be a silly question, but if you’ve done a lot of work with refugees and women’s health?

ROSANNA PAJAK

That is an interesting question. I mean, trauma is trauma. So I think that sometimes it’s something that actually my birth trauma clients can sometimes feel like, can I really say that I’m traumatized? Isn’t this just childbirth, it’s hard, it’s difficult, it’s painful, it’s overwhelming. But really, you know, if we have a psychological experience of being afraid, feeling like we’re at risk, or someone we love is at risk and feeling like we’re horrified, helpless, very, very afraid. These are going to be experiences that are traumatic. So I think that’s sort of an important parallel to make is that, you know, this is a genuine, traumatic experience when we think about childbirth in that way.

KATH BAQUIE

Yeah. Right. And that has slid right into my next question, which is, can you define birth trauma? like what, what is birth trauma defined as?

ROSANNA PAJAK

It has pretty broad definition, I guess, like at the moment, we use that phrase birth trauma to encompass both physical birth injury, sort of trauma that might happen to the body, as well as psychological birth trauma, and, you know, the emotional experience of having a traumatic birth. And really what we’re talking about when we saying birth trauma, is it’s about how that birth was experienced. It’s not necessarily about what happened in the birth in terms of sort of more intervention or an emergency situation playing out. It’s about how a woman feels during and immediately after the birth. And what we’re really talking about is having feelings of fear, helplessness and horror, during the experience.

KATH BAQUIE

So that’s during the actual experience. And do you mean after the birth as well?

ROSANNA PAJAK

Yeah. So that critical period of during and immediately after? So if we think about, you know, the moment after somebody sort of might wake up from general anaesthetic C-section, which, you know, is something which is often very distressing and traumatic that can happen to people, or even just in those immediate moments after a normal physiological birth, how that is experienced, as well as during the birth itself.

KATH BAQUIE

They’re so broad, aren’t they? Like, one person’s interpretation of horror is very different to another person’s, but they’re all considered the same. Yeah. Interesting. Yeah.

ROSANNA PAJAK

Yeah. And it’s I said, it’s far more about how the birth is experience. So there’s this idea that trauma is in the eye of the beholder. So what someone from the outside might look at as a normal physiological birth and or your birth is really fast or you know, that’s, that’s not like a very long, long sort of painful experience, or, you know, that was a normal vaginal birth without much pain relief or intervention. Someone might think that’s a nice birth. But it’s actually if it’s about how that woman experienced it, and how she felt while she was going through, it could be a completely different experience. And that’s the stuff that will be potentially traumatic, and it can be based on a whole heap of factors.

KATH BAQUIE

I think this is so great. We’re talking because from my personal experience, after the first, my asthma, second birth, is particularly fast, and a textbook, it was great. I remember for about six months afterwards, I kept reliving it, I would wake up in the night. And I said to my husband, I feel like I’ve got post-traumatic stress. But it’s so ridiculous because I had a textbook birth. And do you know, I mean, like, you almost feel like you’re feeling shouldn’t be a feeling, because perhaps the situation?

ROSANNA PAJAK

Hmm, absolutely. Yeah, I think there can be a whole heap of confusion around, you know, can this be considered traumatic? Isn’t that just childbirth? You know, am I allowed to claim that label? There’s a lot of confusion around it. And yeah, I actually really identify that I had a very fast birth with my second son. And I still had experiences where I get, I wouldn’t say I wouldn’t say that was a traumatic birth for me. But it was certainly extremely intense, and in parts of it frightening, which have been the pieces that then intrude and stay with you sometimes and revisit you. So birth is physiologically unusual experience in terms of the mental states that we go into, due to kind of everything that’s happening in the body. And that combined with it being such an important experience in somebody’s life, and how vulnerable we feel at the time, this can all kind of come together to mean that the little moments that happen along the way, how they are actually experienced and what they feel like can really contribute to like how much they affect people afterwards.

KATH BAQUIE

Yeah. Okay. So I’d love to talk about how to deal with birth trauma, but let’s go one step back. Are there any risk factors or anything that might contribute to birth trauma?

ROSANNA PAJAK

Yes, there’s been a lot of research on this and people trying to understand, you know, what would make somebody more vulnerable? Or what are the factors that contribute, and it can be helpful to think about, so I guess we can divide these into the individual risk factors that are about person themselves. And we can then also think about the situational factors about the birth itself to kind of two groups of risk factors. In terms of personal individual risk factors, it seems that people are more likely to have a birth trauma related to first baby. So that’s a risk factor. If it’s the first pregnancy first baby. People are also more vulnerable to birth trauma if they’ve had previous mental health difficulties in the past and in pregnancy as well. So that can sometimes be respected, particularly anxiety and pregnancy. And perhaps I guess I understand that as being the fact that it can impact how a birth may be experienced if we’ve had a very anxious pregnancy that might follow through into the birthing experience and heighten the emotionality of the whole experience and make it perhaps potentially more traumatic, if difficult things unfold. The other really important factor actually is a history of previous sexual assault. So this is something that’s talked about quite a lot. But again, you know, in my mind, it makes sense. A lot of times when people are talking about a traumatic birth, they will touch on themes of control, consent, people often talk about feeling like things were happening to them being done to their body. And if we think about, you know, if a woman has had previous experiences of sexual assault, these experiences of potential coercion, lack of consent are going to load on top of that, and be experienced maybe differently. Maybe the same thing might be experienced differently by two women, if that’s a previous perspective on one of those women.

KATH BAQUIE

Yeah. Okay. So you mentioned feeling anxious during pregnancy? If a woman who’s listening today is noticing that she is feeling anxious during pregnancy, would you then recommend we try to seek help sooner rather than later? If you’re identifying anxious during pregnancy? Would it be better off seeing someone while you’re still pregnant?

ROSANNA PAJAK

Well I mean look, as a perinatal psychologist, I think I’m always going to say yes to that question. Even if we forget all about birth trauma for a second, I mean, important just to say in the light of that question. Two things, I mean, first pregnancy anxiety to be anxious in pregnancy is very normal is an anxious time. So there’s something about just recognizing that this is a time of a lot of anxiety, you’re heading into something very unknown, everything’s changing. So this stirs up a lot of anxiety for a lot of people. And also important, I guess, to recognize that just because we have anxiety and pregnancy, by no means that there’s going to be a traumatic birth, it’s just it’s perhaps service factors slightly increases the risk of a birth being experienced as traumatic, depending on what happens there. Having said that, you know, in my work, where I work with people postnatal, often it’s a fair way after the baby’s arrived, and the birth, that someone might end up actually talking to their GP and saying, I’m not okay, or seeking support themselves, and then they might, you know, end up in front of myself or someone else like me, a fair way down the track. And if I get the opportunity to work with people in pregnancy, I love that because we actually get the opportunity to do all this really important work on sense of self relationships, relationship with emotions, mental health, and wellbeing preparing for pregnancy emotionally and psychologically. So that actually is sometimes really lovely. If you can take the steps to work on that stuff in pregnancy, before then, actually having a baby alive, you can set yourself up. Well, I think if you can work on some of this stuff in that antenatal period.

KATH BAQUIE

Yeah, brilliant. That is great to know. So is there anything that can be done to help improve birth for women to improve the outcomes of birth? I guess we’ve talked about prevention, potentially. But what can be done in that interim stage?

ROSANNA PAJAK

So do you mean sort of after somebody had a difficult birth?

KATH BAQUIE

So you’ve mentioned some of the risk factors? Is there anything that can be done preventatively, but to improve the outcomes for women?

ROSANNA PAJAK

You know I mentioned that with two sets of risk factors. So the contextual factors might also be important to talk about, because those are the ones where we would hope that we can have some impact, you know. So when one of the risk factors for a birth being experienced as traumatic is there being a higher level of interventions or complications that occur, but two of the other really important ones are the amount of control a woman feels. So the level of perceived control over the experience as it unfolds, which is really, really important. And the other one is the quality of the interactions that happen in between the woman and their caregivers. So these are things that if a woman is supported, to feel in control, respected, compassionately cared for and safe, this can go a long way to kind of minimize the negative impact of some of the scary things that could happen during birth. Conversely, if a woman is treated without respect, or you know, without proper care or compassion, I find in my experience, these are these it’s these words and experiences that can stay with somebody for years and years after birth. It can have quite a significant negative impact. So I think these are really important factors that we need to look at

KATH BAQUIE

So if you’re a health professional today, are there any particular terms that come up with your client that potentially not helpful to hear?

ROSANNA PAJAK

Ah, I mean, I don’t have its particular terms I think often it’s it can be things in terms of, you know, not being involved not being talked to like stuff just happening to them. Sometimes things are done without consent. Sometimes people are talking about like overhearing staff, talking about them in a way that isn’t particularly kind. Things like an eye roll or there’s so many little ways that people can feel ashamed or like they’re failing the language, you know, that’s used as important. So, I mean, I don’t think anybody turns up in health setting and thinks I’m going to cause some drama today, like it’s never something that people are intending. But if we actually need to look at the systems of care involved and the pressure on those systems, and sometimes there are systemic level issues that are actually causing women to be not cared for, in the way that they should. You know, one thing that we know about the maternity system is like, it’s pretty focused on risk. And this is fine, you know that you we want our maternity care system to be focused on the ultimate safety of mum and baby. But in that there perhaps also isn’t enough recognition that the experience of birth can have a really profound impact on a woman’s mental health and wellbeing afterwards. Even without mental health difficulties, it can have a serious impact on women’s transition to motherhood, it’s the experience of stepping into a whole new role and a whole new phase of life. And if we have a really, really rocky start to that, that’s going to make all of that stuff a lot more difficult. And perhaps there isn’t enough recognition that that the wellbeing and the experience of the woman during birth, is actually very, very important and has wide range of impacts down the track. So the systems are not always set up to kind of value that as much as I think it should.

KATH BAQUIE

Okay, Rosie, I’m totally putting you on the spot here. But if you could make three changes to the system at the moment, to help with everything that we’ve just been talking about, what would they be to help the outcomes for women?

ROSANNA PAJAK

I would like to see more staff trained in trauma informed care. So just generally understanding how the way in which they care for people offering more choices, offering that sort of compassionate stance, I think, just some border training and some awareness across the system. I actually think I would like to see greater recognition of the impact of pelvic floor physio, and pelvic floor health, because that’s something which seems to be under discussed when people are thinking about risks and pros and cons of interventions. Yeah, and I’m thinking about my own experience here in the in that system. And I don’t remember when we talked about risks, or when I read about risks, and pros and cons, whether the woman’s body was necessarily included in that conversation of if I have this intervention, what are the risks for me and my body and my future, pelvic health wellbeing? Because that stuff also has a big impact on how women are left feeling after childbirth, obviously, and in women being supported to kind of effectively navigate through these, this challenge of birth and all the decisions that need to be made. We want women to be as well informed, educated, and empowered to make decisions as possible. So I think that would be a huge area where I’d want more information and education available.

KATH BAQUIE

Yeah. And I feel at the moment, there’s so many women seeking their own education and their own incredible courses. But it’s not something that’s standard across the healthcare system at all.

ROSANNA PAJAK

No. And that would have been my third one actually, was inequality, right? Because we can talk about how we know that, for example, there’s often a lot of talk about that midwifery group practice model and how continuity of care is, is very helpful in helping people who have good birth outcomes. But that’s available to like 8% of women in Australia. So we need to probably work on trying to reduce some of that inequality of access and provision, but also inequality of information and resources and education, because these are really important factors in helping women to navigate through birth.

KATH BAQUIE

And if you’re listening today, and you’re interested in this topic, check out one of the previous episodes, I’ll link it in the show notes. But it’s with Helen Nightingale, who’s a midwife, and she’s got an unpacking after baby service. And she said that she wishes every woman could just sit down with someone for one hour after their birth with a health professional, just to let them talk through the experience and just unpack the experience that they’ve just gone through.

ROSANNA PAJAK

Very important, because this is not something that people generally get the experience to talk about, right? Like, one of the things that we know happens after childbirth is that people are plunged immediately into caring for this new baby. So there’s feeding and there’s trying to get sleep and your body’s you know, in recovering and they’re often really isn’t the space for people to go back and pick up on like, what just happened to us and what have we just gone through. And sometimes then people feel like they just have to get on with it. And it gets kind of left there. But it is having a psychological impact the whole time.

KATH BAQUIE

Yeah. And often the way we talk to our friends and family and loved ones, it’s probably different to the way that you might talk to a health professional who’s asking questions to really probe into the birth experience and wonder maybe.

ROSANNA PAJAK

You think so.

KATH BAQUIE

Okay, your point of view, how does a woman heal after birth trauma?

ROSANNA PAJAK

Well, I think it starts primarily with recognition that birth trauma may have occurred. So this is probably the first aspect is really being able to be supported or understand for yourself, that what you went through was traumatic and give it that sort of attention that it deserves that attention. I think healing involves going back a little bit to that experience and working it through. So when we go through something that’s really intense and frightening, even if we’re not plunged into new motherhood, there can be a tendency to sort of want to hold that experience out of mind. We don’t want to go near it; we don’t want to think about it. Particularly if we’re sort of very traumatizing symptoms of PTSD, for example, people are really not going to want to think about or talk about that birth. But what we find is that actually, it’s in the going back, talking about it, being able to construct a kind of organized narrative of the experience and make sense of what happened. And why has it left me feeling the way I do. Being able to make sense of this stuff and understand them, why there might be feelings that float around as well of failure, or guilt, or shame, or a lot of grief and loss. There are so many intense feelings that can surround a birth. And I think it’s often really by going back and talking it through that we can figure out, why do I feel this way? Am I right in feeling that way? Or am I you know, do I need to change my perspective a little bit? Is there another way to view this, which is often really, really important? And do I need to make room for some feelings that are stuck here that actually I just need to process and let through and talk through. I find that when we can move through that kind of healing, when do you come out the other side, the experience isn’t gone. But it’s integrated in a way that allows people to not be avoiding it and trying to keep it out of mind. Not thinking about it all the time. But just, it’s there, and we can move forward.

KATH BAQUIE

So the experience will become part of your life and not consuming your life.

ROSANNA PAJAK

Exactly. Yes. Yes. You know, we don’t ever erase a trauma, but it’s about sort of learning. How do I live with this thing, part of my history, it doesn’t need to be part of my present or fears for the future? It’s putting it back where it belongs.

KATH BAQUIE

Okay. So if a woman wants to conceive again, and she’s been through birth trauma, how might her following pregnancies and birth be affected?

ROSANNA PAJAK

I think it’s really, really hard considering having another baby after birth trauma. In my experience, I think that women and also their partners, you know, we haven’t talked about partners today. But often partners can be very reluctant to go again, women can be very feeling unsafe or not trusting the hospital process. I think there can be a lot of concerns around a repeat experience. What if I have another bad experience on that same thing happens? And if people have experienced birth injuries, as well as with that sort of more physical birth trauma? Of course, that’s another big concern for people afterwards, like, well, what will the impact on my body be of another pregnancy or another birth? So a lot of concerns which will come up? And it’s a really individual process to work through? What does that mean for your decision making about how you want to manage a pregnancy and birth?

KATH BAQUIE

Do we have any facts or figures in terms of if you’ve had birth trauma? So again, we’re talking more the mental health side of things for one birth? Like, what’s the likelihood that you might have it for your second and third and subsequent births?

ROSANNA PAJAK

I don’t know of any specific studies that have actually looked at that, you know, most of the time when birth trauma is studied, it’s focused on one birth, which is actually probably a bit of a problem with a little bit of research. But I think often it can be really challenging to do research that goes over long periods of time, that doesn’t tend to happen as easily. It’s not as funded as much. But there is a whole body of research on women who have what we call redemptive birth. So this is a positive birth after a traumatic one. And you know, some women in those studies don’t have go on to have other children, or they have another traumatic experience. But a bulk of women in those studies will go on and have good births. And some of those have actually really tried to unpick like, well, what’s happened for those women, however, how is that they managed that and what’s happened, what have they changed from the first birth, what has been some of the factors that have contributed to them having a better birth experience, which can actually really be quite healing because people get to experience the things they missed out on the first time. And it doesn’t have to be this kind of amazing, incredible magical birth experience, whatever that means to you. It really needs to be an experience where you feel in control involved in decision making, respected and cared for properly by the people around you, where you feel like you have a voice. And all of those things can really be the pillars that can hold up and experience as it goes through the twists and turns of birth. So that’s kind of what we look for trying to create for somebody for the subsequent birth.

KATH BAQUIE

So and I guess that’s why it’s so important to unpack your story because if you can identify where in the story you felt like if you felt alone, or if you felt like you weren’t heard, then it’s easier to make changes for your next pregnancy. Whether or not that’s changing healthcare providers or changing your communication, like it’s yeah.

ROSANNA PAJAK

Yeah, exactly. So it’s very individual, you know, what’s going to be a manageable sense of control for you, we do see that for women who have had a traumatic birth, some women go on, and there’s a higher rate of elective c section. So that can be managing the uncertainty of birth, it can be finding, that’s an acceptable manageable level of control. But we can also see there’s a chunk of women who lean back from the birthing system and try to have a lot less intervention and less antenatal care and things like that. And this is why we need to go back and understand it.

KATH BAQUIE

Yeah, amazing. Okay, so what would be your advice to everyone listening who might have identified with something that we’re talking about today?

ROSANNA PAJAK

The biggest thing I would say was, don’t just think this is birth, it’s meant to be awful, I have a healthy baby, I’m kind of okay, I should just get on with things. No, if your birth has negatively impacted you, your wellbeing as a mother, your mental health, or the relationships in your family or whatever, it deserves attention. So my advice would be to seek support, find a place in which you can talk it through, this could be with a psychologist or a counsellor, there’s also a kind of peer support available, you can guide yourself through sort of a healing process yourself, it’s really important to just to seek that support to work it through.

KATH BAQUIE

It doesn’t mean that you’re going to need lots of sessions either like for some women, it might mean just one catch up session to process whereas others might need a few more sessions. Is that right?

ROSANNA PAJAK

Absolutely. Yeah. So you know, if, you know, for example, if you do go and see a counsellor or a psychologist, that’s about just having that first session to just get to know each other and have a sense of, you know, how might this person be able to work with you? And is it a good fit? And then there can be a decision that Yeah, maybe that’s one session, three sessions, or you might want to keep it going, if you’re, you know, preparing pregnancy, and then some people might, you know, decide that they’re going to come back when actually are pregnant again. So there’s a lot of flexibility there. Absolutely, I wouldn’t see it as you know, you have to kind of going into therapy for a long period of time, or I have to have a mental health diagnosis, this is something that you can seek support about.

KATH BAQUIE

Are there subsidies from Medicare, their Medicare plan for this?

ROSANNA PAJAK

So for the Medicare plan, you need to have a diagnosis. So your GP will look to see if there is some kind of you whether you meet criteria, at that time for postnatal depression, anxiety, PTSD, or you know, there’s a diagnostic criterion, quarter adjustment difficulties, which is often you know, the one that the GPS will use if a woman may not fit some of these other diagnostic criteria, but there’s difficulties in the adjustment period after a traumatic birth. So yes, you know, very worth talking to your GP to see who they can link you in with and what support is available.

KATH BAQUIE

Yeah. Okay. Great to know. So on that point, how do we find you? How do we contact you if we want to come and have a chat to you?

ROSANNA PAJAK

Yeah, absolutely. So you can find me via my website. So that’s www.rosannapayjack.com. And I offer individual therapy at the moments that can be online, Australia wide, at the moment, I’m Sydney based, but from 2022, I’ll be based in Perth offering face to face therapy there. And I’m also working on a group program, and some self-paced kind of online support programs, which I’m hoping to launch in 2022.

KATH BAQIUE

And it’s just for women like the perinatal stage?

ROSANNA PAJAK

All around birth trauma, specifically, is what I’m hoping to sort of have some groups of people can come together, understand the impact of birth trauma, work through, you know, discussing their stories with other women who’ve had difficult births, and gain that peer support as well as kind of gaining a psychological understanding of working through some of the steps to healing. So that’s something that I want to make more available to more women because you know, at the moment with perinatal mental health is a huge need. And there are really long waiting lists across Australia. And people are, you know, particularly through the pandemic, there’s been an awful lot of pressure on mental health services, and we need to find a way to bring more mental health services to more women, more people faster.

KATH BAQUIE

Yeah, but also having that ability to connect with other women who are living the same experience as you would be priceless. That’s amazing.

ROSANNA PAJAK

Yeah, yeah. So hopefully that will be something that you can find by the website next year.

KATH BAQUIE

No, not helpfully. Give us a date going to hold you to it.

ROSANNA PAJAK

I’m working on it. I’m working on it.

KATH BAQUIE

Amazing. Well, thank you so much for joining me today. It was so lovely to chat. And for anyone listening can send Rosie and myself DM and let us know if you found this episode useful. Thank you so much, Rosie. Thank you.

ROSANNA PAJAK

Thanks, Kath.

KATH BAQUIE

And before I sign off, remember my team and I will be putting together the Show Notes for this episode with all the links including how to connect with Rosie at www.fitnestmama.com/podcast. And don’t forget to send Rosie and myself a DM on Instagram. We would love to hear from you. I forgot to mention it earlier but Rosie’s Instagram is @dr_rosie_psychologist. So that’s at @dr_rosie_psychologist. I forgot that spelling right. So thank you everyone have a fabulous day and I look forward to you joining me next week for another episode of the FitNest Mama Podcast.

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