Women talk: narratives of six women's understanding of traumatic birth and post traumatic stress disorder following childbirth

Abstract

Pregnancy represents a normal crisis for all women. Though it has been recognised for a long time that childbirth can be associated with short and long-term psychological morbidity it is only recently that it has become accepted that women can develop Post Traumatic Stress Disorder (PTSD) following childbirth. Underpinning this study is a philosophy that values that pregnancy and birth are normal physiological processes. These philosophical underpinnings are informed by narrative inquiry where stories are treated as data and there is attention to the potential of stories to give meaning to people's lives. One to one in-depth interviews/conversations were used to allow six participants to provide narrative accounts of their recent traumatic birth experience and PTSD. The process described by Emden (1998b) was used for creation of core stories in order to 'give voice' to women's experiences and the stages proposed by Van Manen (1990) were followed to search for themes that gave meaning to the narratives. Three distinct themes emerged regarding women's understanding of traumatic birth and PTSD. The first, "Traumatic birth" contains the five sub themes of "Being prepared", "Continuous, safe and supportive care", "Relationships", "Communication" and "Choice and control". The second distinct theme "Post-traumatic stress" includes two sub themes of "More than postnatal depression" and "Signs and symptoms of PTSD". The sub theme "Signs and symptoms of PTSD" also contains four further sub themes; "Avoidance", "Nightmares or re-experiencing events", "Numb, detached, isolated and shattered" and "Anxiety, anger and depression." The third distinct theme "Helpful strategies" contains five additional sub themes of "Talking and writing", "Support groups/works", "Medications, counselling and EDMR", "Clinical records" and "Knowledge". Recommendations for midwifery practice include the need for midwives to reflect on their personal philosophy of care; honour women's perspective of birth; take women's experiences into account when providing intrapartum care and pay attention to their birth experiences during postpartum follow up. Midwives need to be aware that postnatal distress is more broadly based than previously thought. This study will be useful for students, practitioners and educators involved in the provision of maternity care. Suggestions for further research have been identified.