As health service providers for women and families going through the process of pregnancy, delivery and early family life, the attention is often focused on Mom. Meanwhile, one of the frequently overlooked aspects of the birth process is the emotional and psychological impacts on the birthing partner. Acting as a primary care support to the new family creates a wonderful opportunity to follow up on the wellbeing not only of Mom, but of the entire family unit. Including questions related to trauma responses experienced by the birth partner can be valuable to supporting the family’s health.
What Is Trauma?
Trauma is defined as an event that elicits feelings of fear, helplessness or horror. For many birth partners, the experience of watching a loved one undergo severe pain, and possibly significant medical intervention, creates intense fear and feelings of powerlessness. Knowing the stakes, including worry and concern for the life of the child about to be born, as well as for Mom, can be overwhelming. And many of the sights, sounds and smells – from medical equipment, to a baby that emerges blue in colour – can be difficult to process. The great anticipation, mixed with the many unknowns, and novel sensory experiences can be a perfect storm. Complications in labour and delivery resulting in high stress can have enduring effects.
Identifying Trauma Responses In Birth Partners
During postnatal follow-up visits with the family, check in with the birth partner and ask about:
- How they remember the birth. If they report recalling it as if it is happening again, including re-experiencing the feelings of fear, worry, etc. This is an indicator that the event may have been perceived as traumatic. Also, difficulty recalling the birth experience can equally be an indicator of traumatic responding. Listen for themes of confusion, fear and powerlessness/helplessness in the narrative of recalled events.
- Dreams or Nightmares. Nightmares with themes related to the birth, or persistent nightmares about unrelated topics that began after the birth, can be indicators of trauma responses.
- Intrusive memories. Ask whether thoughts of the birth come up randomly in a way that feels unwanted and intrusive. Ask about the frequency of these thoughts, as well as how intense/distressing they feel when they occur (try a rating scale to help assess intensity 1-10).
- Have they been avoiding debriefing conversations with their partner about the birth? Have they avoided situations that might cause them to be confronted with memories of the birth experience (eg. Returning to hospital for follow-up care, seeing primary care workers who were involved in the birth, talking with family and friends about the birth)? Have they avoided photos from the first hours of baby’s life? Do they become uncomfortable or evasive when asked to recount the story of the birth?
- Their feelings about their involvement. Did they feel they did the best they could to support their partner? Did they feel powerless or helpless? Did they feel fearful? Did they feel they knew what was happening, or that they were left out of the loop? Did they feel involved in decision making and advocating?
- Many people who experience traumatic events feel overwhelmed by the feelings this creates and seek to numb these feelings in many different ways. This might include sleeping, using alcohol/drugs, escapism through TV/reading/video games (used for the purpose of being not connected to themselves and the world around them, rather than for the enjoyment of the show/book/game; usually for an inappropriate length of time or at an inappropriate time of day; usually negatively impacting others including family or job).
Assessing Needs and Supporting Access to Resources
| < 6 Weeks Postpartum | ||
| Green | Yellow | Red |
| Shows few of the indicators noted above Intrusive memories may occur but infrequently and feel manageable Has access to strong support network and is emotionally capable of accessing this | Shows several of the indicators Intrusive memories occur regularly and feel intense while they are happening Feelings of being a failure in protecting partner/baby or feeling responsibility for how birth experience went Little access to support network; or seems unable to connect with supports that are available *Query prior history of mental health concerns | Shows most of the indicators Intrusive memories impair capacity to engage well in daily life, including work and tasks with family Strong negative feelings toward self for how birth experience went Little access to support network; or unable to connect with supports that are available *Query prior history of mental health concerns |
| 6 weeks - 3 months postpartum | ||
| Green | Yellow | Red |
| Frequency and intensity of intrusive memories has gradually reduced Able to talk about the birth experience with little or no discomfort No nightmares or flashbacks Has reliably accessed support network | Shows several of the indicators Intrusive memories occur regularly, intensity is disruptive Negative feelings toward self Difficulty talking about the birth experience, likely to focus on negative/fearful aspects of the experience Nightmares and flashbacks semi-frequent Occasionally seeks support, not reliably | Shows most of the indicators Intrusive memories occur regularly, impairs capacity to feel connected to others Strong negative feelings toward self Fearful preoccupation with safety, often directed toward partner and baby Significant difficulty talking about birth experience Nightmares and flashbacks regularly Difficulty connecting with supports. Tendency to avoid/withdraw or feel no one understands |
| > 3 months postpartum | ||
| Green | Yellow | Red |
| Intrusive memories have reduced or ceased Able to talk about details of birth experience with little or no discomfort and no aftereffects No nightmares or flashbacks | Shows several of the indicators Intrusive memories are disruptive Negative feelings toward self Difficulty talking about birth experience Nightmares or flashbacks Feelings may become more generalized and present as irritability, shortness of temper, easily overwhelmed in day to day life | Shows most of the indicators Intrusive memories are disruptive to building healthy connection with others Strong negative feelings toward self Fearful preoccupation with safety Fear of considering having more children Significant difficulty talking about birth experience Nightmares or flashbacks Feelings likely to become more generalized and present as irritability, shortness of temper, easily overwhelmed in day to day life. |
*If prior mental health concerns have been present, either in the past or currently, in addition to the symptoms related to the birth experience, work to connect the partner with mental health resources. Prior history can be a risk factor for developing more complex mental health concerns following a traumatic event.
Some people can initially feel acutely impacted by a traumatic event, but over the course of time process these events and experience reduced symptoms. For others, they may initially present as though they are doing well, but later find they are consumed by intrusive memories. This is why it is important that follow up care providers seek to support the family across time, asking consistent questions and listening for indicators, from all members of the family, indicative of challenges needing support.
In the green:
- Educate partners in what to look for and ways to identify if their symptoms are worsening.
- Offer partners access to contact information should they note a worsening in symptoms.
- Support partners in considering alternative narratives for the birth story that draw out the positives.
- Encourage partners to seek support from their support network.
- Encourage daily self-care, including sleep, nutrition, exercise, relaxing activities, etc.
In the yellow:
- Educate partners in what you are assessing, and the areas you identify as concerning.
- Suggest counselling support, preferably with someone specializing in trauma and understanding of the issues at hand.
- Consider referring for naturopathic support to aid in symptom management.
- Encourage partners to seek support from their support network, even when this feels hard.
- Strongly promote daily self-care, including sleep, nutrition, exercise, relaxing activities, etc. Developing a self-care plan together can be useful.
- Consider scheduling more regular follow-up visits to ensure support is accessible.
In the red:
- Educate partners in what you are assessing, and the areas you identify as concerning.
- Suggest counselling support with a counsellor specializing in trauma.
- Consider referring for medical intervention, possibly including psychotropic medication to support symptom management and capacity to function.
- Encourage partners to seek support from their support network. Promote the development of a wellness plan that identifies who the partner can connect with when struggling.
- Strongly promote daily self-care, including sleep, nutrition, exercise, relaxing activities, etc. Developing a self-care plan together can be useful.
- Schedule more regular follow-up visits to ensure support is accessible.
- Utilize consultation and collaborative care with other professionals to ensure the partner is receiving proper care.
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