Thousands of women will go through a frightening or traumatic birth, the effects of which will continue to impact on them, and their partner, long after they return to work. Ensuring they aren’t left struggling to cope alone is crucial to facilitating their recovery, explains Birgit Lundgren.
It is estimated that between 10% and 20% of women who give birth develop some form of mental illness, ranging from anxiety and depression to more complex conditions such as post-traumatic stress disorder (PTSD) and psychosis.
With about 665,000 births a year in England, this means 66,500-133,000 women a year develop problems. Yet the first in-depth audit of the extent to which women are being supported to recover shows that in 2016 just 2% of all those who gave birth were supported, meaning many thousands went untreated.
About the author
Birgit Lundgren is head of clinical services at employee wellbeing and mental health solution provider Validium
A report commissioned by Health Education England found that, even though one in five mothers have problems such as postnatal depression and post-traumatic stress disorder linked to childbirth, just 1.3% of obstetrician’s time, 1.4% of midwives’ time and 0.79% of health visitors’ time is taken up with treating maternal mental ill-health. Meaning thousands are going untreated.
The result is that although most employers might think they’re getting back the same employee who went on maternity leave, thousands of women are still suffering the consequences. With a significant number of men, who witnessed the life of their partner, or baby, being put at risk, left similarly traumatised.
Make birth trauma less ‘taboo’
Many of those left struggling to cope with perinatal mental illness will feel guilty about seeking help if they managed to leave hospital with a healthy baby. Terrible as their ordeal was, and painful as any ongoing physical injuries are, they will try to reconcile themselves to their experience by reasoning that it could have been so much worse and at least no one died.
This is a great shame because, as with all mental health issues, the longer someone is left unsupported, the more chance there is of an acute issues, such as anxiety or depression about what happened during the birth, spiralling into a more serious issue such as post-natal depression or PTSD.
Critical to ensuring more people get timely support is educating women to understand that it is okay for them to ask for help, even if they have a healthy baby.
Employers can help by using events such as Birth Trauma Awareness Week to raise awareness of the extent of the problem and bearing in mind that giving birth isn’t a positive experience for everyone.
When you check in with the mother or father following the birth, instead of just asking if the baby is a boy or girl and how much it weighed, ask how the birth went and how everyone’s feeling.
If they’re clearly distressed about their experience and suffering from the symptoms of trauma, which include shock or denial about what happened, anxiety and fear, guilt, shame, self-blame, feeling sad, hopeless or disconnected and numb, the sooner you can encourage them to seek appropriate emotional support the better. Knowing at this stage, whether or not they had a traumatic birth, will also help you to plan better for their return.
Advocate psychological first aid
As with any other trauma, how the employee is helped to recover and make sense of their experience within the first few days and weeks is critical to helping to prevent more serious psychological problems from developing further down the line.
Although they will no doubt have numerous healthcare professionals surrounding them in the days after the birth, especially if still hospitalised, many of these doctors and midwives will be more concerned with the physical recovery of the mother and child, than with her or her partner’s emotional recovery.
If the birth was particularly traumatic, those involved will gain from being offered psychological first aid (PFA) to help them feel safe and calm again, in much the same way that someone experiencing an attack or witnessing a serious car crash might.
This involves attending to basic needs with compassion, by giving the employee the space they need to relive and make sense of their experience, while also encouraging them to do small practical things that make themselves feel safe again.
Rather than rely on stretched healthcare professionals to provide this, if you suspect that your employee has experienced a traumatic birth, remind them of any specialist trauma support services they might have access to through work, even while still on maternity or paternity leave, such as the OH department or a specialist employee assistance programme (EAP).
If your organisation doesn’t provide access to qualified trauma specialists, be ready to provide them with a list of specialist charities they can call for support instead.
Listen with compassion
The desire of someone affected by a traumatic event to talk about it will persist for far longer than the desire of those surrounding him or her to hear about it.
Let’s take male employees. They will often return to work very soon after becoming a father, and those who witnessed a particularly traumatic birth will most likely still be struggling to make sense of it. They might want to keep reliving what happened, as there is a healing element in doing so that is incredibly important for them. So rather than trying to change the topic or dismiss their concerns by pointing out that it all worked out okay (assuming everyone at least came out alive) colleagues should be encouraged to give them the space they need to make sense of their ordeal.
You can even ask them how they had imagined the birth would go, or how they expected it to go, to help them express their distress at how differently things transpired. In many cases, a birth can be traumatic simply by the lack of control those involved felt.
The most common feeling after an emergency c-section or “assisted delivery” is helplessness. The mother may feel that she was deprived of the experience of giving birth or had invasive things done to her that were out of her control. While the father might feel that he was reduced the role of bystander and unable to support his partner in the way he had prepared to do.
Whatever went “wrong” (and in these situations, perception might be as horrific as reality), part of their recovery will involve acknowledging that their birth experience wasn’t what they had hoped for.
Remember, what enables one person to heal will be very different to what enables another to heal, so while pointing out positive outcomes, such as the addition of a healthy baby to the family, might help one person to come to terms with a traumatic birth, it could make someone else feel resentful towards their baby or partner about the price their body had to pay to achieve this.
Managers should therefore be encouraged to listen with compassion, so they can help the employee to make sense of their situation and direct them towards any support services in place, such as a trauma specialist associated with the EAP or OH department, but deterred from attempting to counsel or advise the employee, as this could make things worse.
Adjust working conditions
It takes time to recover from a traumatic event, to feel that you or your loved ones are safe again and for that event not to define your future or affect your relationships with others.
Most people who have been through a traumatic experience will remain scarred by it, but there comes a point at which the initial wounds heal and the scars, while always there, cease to hurt, allowing the person to start functioning as normal again.
To help the employee get to this point, have an open and honest conversation about how the workplace can realistically help them to recover. If really strong overhead lights are a trigger reminding them of the environment they were in at hospital, is there another part of the building they can work in for a while?
If they’re still hyper-vigilant, jumpy and anxious this might be making them feel forgetful, making it difficult for them to organise their day in they way that they could have previously. If so, how can their manager help them to plan their workload and minimise unnecessary interruptions so that they can focus on one task at a time.
In many cases, maternity mental ill health is undiagnosed and the employee might not even realise they have a problem. The sleep deprivation with any new baby is expected to take a certain toll, but if the individual is particularly out of sorts, make a point of gently opening up conversation about how they’re feeling and what work can do to help.
Be clear about what work can do, in terms of adjusting physical working arrangements or working hours, but also be clear about what the employee needs to take responsibility for, in terms of seeking proper mental health support – be this through work or privately.
Agree a plan of action and check in with the employee, on a weekly basis, to support them in making this happen. Monitor any symptoms being exhibited to decide how extreme this is. If they have extreme PTSD and are bursting into tears on a daily basis or screaming at colleagues, they might need to take some time off or be moved into another role while they recover.
Provide professional rehabilitation
In many cases, a traumatised employee will feel like they have been let down by healthcare professionals. For their employer to dismiss them or fail to help them to recover will make them feel let down again, exacerbating their symptoms.
Rather than lose a once highly valued employee, an increasing number of employees are asking us to provide individual mental health assessments to diagnose the underlying issues limiting their ability to attend or perform at work, the cost of providing treatment and the likely prognosis for recovery.
This allows the employer to determine whether or not the cost of treating the employee to overcome their symptoms represents a reasonable adjustment or not.
In this sense, employers can not only help employees to recover, but actually bring about their recovery to bridge the gap left by the NHS. Typically for much less than the cost of supporting ongoing absence or performance issues due to mental health issues incurred following exposure to a traumatic birth.
‘Thousands of mothers left to cope alone with mental illness’, The Guardian, July 2018 https://www.theguardian.com/society/2018/jul/30/women-mothers-mental-health-problems-care-nhs-report
Universal Perinatal Mental Health Services: National Findings Overview, NHS Benchmarking Network, February 2017 https://www.hee.nhs.uk/sites/default/files/documents/NHS%20Benchmarking_Universal%20Survey.pdf