Avoiding Birth Trauma: A Laudable Goal

Those that regularly read this blog, know that I do not think much about using rates of cesarean as a measure of quality for maternity care. Yet many health administrators and policy analysts seem to think that lowering the rate of cesareans is a laudable goal. In the more than two years since my daughter was born, I have come to know just how misguided this goal really is - and believe that it is time that quality in maternity care was measured differently.

Birth trauma is a negative outcome of the birth process - one that could and should be avoided in many cases.

Having read the accounts of women who have been traumatized by birth, in addition to my own experience, it is clear that birth trauma is not caused by the mode of delivery. There are women who have vaginal deliveries and are traumatized. There are women who have cesareans and are traumatized. There are women who have vaginal deliveries and are not traumatized. There are women who have cesareans and are not traumatized.

Birth trauma is also not caused by the location of delivery. There are women who are traumatized by home birth. There are women who are traumatized by hospital birth. There are women who are not traumatized by home birth. There are women who are not traumatized by hospital birth.

Further, birth trauma is not caused by the choice of care provider. There are women who have midwives and experience birth trauma. There are women who have doctors or obstetricians and experience birth trauma. Further there are women who have midwives or doctors or obstetricians who do not experience birth trauma.

Also having read the accounts of women traumatized by birth, in addition to my own experience - the impacts are lasting and wide ranging. There are women who would like more children, who choose to forego additional pregnancies. There are women who having had a negative experience in one pregnancy, make risky choices in subsequent pregnancies in the hopes of avoiding a repeat experience. There are women who experience excessive anxiety in their subsequent pregnancies. There are women who suffer from post-partum depression and post-natal post traumatic stress disorder - many of whom suffer in silence. Some women who experience traumatic births are left with lasting physical repercussions for either themselves or their children.

Despite the significance of traumatic birth experiences, for women, their children and their families - it largely goes unmeasured. As a result it remains poorly understood and stigmatized.

Would it not be better to measure things that actually gauge quality care than to monitor a measure because it is easy and pretending that it has anything to do with quality?