ABTA was founded in 2016, when Liz Skinner, a midwife, registered nurse, child and family clinician, lecturer and researcher was in the process of interviewing affected women for her PHD thesis on ‘The Psychological Impact of Somatic Trauma’. Amy Dawes discovered Liz’s work during the journey to process her own experience after the forceps delivery she had with her first child. Amy reached out to Liz and a friendship was formed.
Shortly after meeting Amy, Liz visited the UK and met with the UK Birth Trauma Association. It was during this trip that Liz recognised the great need for women and their families to have support in Australia and New Zealand. Upon her return, she made this suggestion to Amy, and so, with initial funds donated by Professor Hans Peter Dietz, the Australasian Birth Trauma Association was founded. In 2017, a Board was formed and in that same year ABTA became a registered charity.
ABTA is reliant upon our board of advisors and also on the women, birthing people and partners who have a lived-experience of birth trauma to train and commit to voluntary service facilitating our weekday live chat support service from their homes.
We are the first charity in Australia solely dedicated to supporting women, partners and families after birth-related trauma – we listen to the voice of the consumer and respond to the unmet needs of birthing families across Australia & New Zealand. As an organisation we advocate for a multidisciplinary approach to supporting birthing families and with this, we collaborate with all health professional groups involved in maternity care to better improve our services.
– Consumer-centred. – Compassionate – Collaborative – Peer-led – Empathetic. – Inclusive – Respectful
How we practice our values:
– Consumer-centered: We focus on the needs of the individual (see also: “Our language”).
– Peer-led: Those with a lived experience of birth-related trauma shape all of our work.
– Inclusive: We support birthing individuals and their families, recognising that families
come in all shapes and sizes.
– Compassionate: We care about those who have had a lived experience.
– Empathetic: We want you to feel heard and your experience validated.
– Respectful: We accept you for who you are, and your experience.
– Collaborative: We know our purpose can only be achieved by working together with a range of people and professions, each group with important strengths and contributions.
We value information which is:
– Evidence-based – Holistic – Multi-disciplinary
How we practice our values:
– Evidence-based: Our approach is supported by the best available research.
– Holistic: Our approach takes a broad view of trauma, to include not only physical needs,
but social and emotional.
– Multi-disciplinary: Our approach involves a wide range of health professionals, each with important strengths and contributions.
Anyone can experience birth-related trauma, including:
– people giving birth;
– partners, friends and family members of people giving birth; and
– other people witnessing a birth or providing care in relation to pregnancy and birth, including health professionals.
We seek to be inclusive. All are welcome to access our services and resources, regardless of their gender, sexual orientation, profession or the circumstances in which they have suffered birth-related trauma.
“Birth-related trauma” includes any injury or trauma, whether physical or psychological, sustained at any time in connection with pregnancy, labour or childbirth. This definition is intended to be broad.
Awareness ↔ Understanding ↔ Support
IMPACT 1: AWARENESS
We raise community awareness of birth-related trauma.
IMPACT 2: UNDERSTANDING
We enhance community understanding about birth-related trauma and health care, for the benefit of individuals, families and health care professionals.
IMPACT 3: SUPPORT
We provide trusted peer-led support services for people affected by birth-related trauma.
(underpins the three other strategic goals)
We build long-term organisational sustainability.
The short answer is, no, of course not.
The long answer is more nuanced.
At the ABTA, we do not advocate for or against any mode of delivery or intervention. We believe that the best outcomes for birthing women achieved by the timely provision of information about the risks and benefits of various approaches to childbirth, tailored to the individual woman’s needs. We believe that information about risks should be thorough, but that it need not and should not be alarming, and that women should be supported to make decisions about modes of delivery that are right for them.
For some women, that might mean a planned home birth led by a private midwife; for others, it might mean a planned caesarean or induction at 39 weeks. We equally support a woman’s or birthing persons right to choose either option – indeed, any birth plan – so long as it’s an informed decision based on unbiased and individualized information, given in enough time for the person to make decisions she is comfortable with.
We are also concerned about policies that expressly seek to reduce Caesarean section rates per se. We believe that the focus of health policy should be the health of mother and baby. It is the needs of that cohort that should be the target, rather than caesarean rates as such.
Although the data is incomplete, there are early indications that a reduction in planned caesarean sections may lead to an increase in other modes of operative delivery if a vaginal birth is attempted but fails. These include ventouse and forceps deliveries. The impact of these interventions, and in particular, forceps deliveries on a broad range of women’s health measures, has not been carefully examined, and the data we have has been impacted by historic failures to gather adequate data on women’s reports of pain, and the impact of birth injuries on sexual and mental health. At the ABTA, we see many women who live with lifelong damage from forceps deliveries. We believe that women should be fully informed of the risks of an operative birth, and where they are at high risk, that the full range of options, including caesarean section, should be discussed.
There is no such thing as a “best”, one-size-fits-all way to birth. Most women hope for compilation-free vaginal births, and most plan vaginal births with or without medical intervention or pain relief. But some will not. We believe that once information has been provided at a good time and in a calm and supportive environment, a woman’s right to choose the approach to her own birth according to her own wishes and values must be respected. How many of those women choose caesarean sections or vaginal births, is we think, besides the point of good health care.
Information, support, honesty and respect for autonomy – it’s pretty simple, really.
The short answer is, because women still frequently experience birth trauma in this model of care (we know this from the women who access our support services) and to promote it as the “gold standard”, or solution to the problem, would effectively silence their voices.
Again, the long answer is more nuanced.
There is no question we support continuity of care as one way to reduce birth trauma.
It makes sense: if you see the same carer throughout your pregnancy and labour, you are more likely to establish rapport, communicate better, share pertinent information, feel relaxed and supported, and have your individual values and desires known and respected.
However, just as we don’t advocate for one mode of delivery over another, nor do we advocate for one model of maternity care over another. Continuity of care could mean continuity of midwife-led care, or continuity of obstetrician-led care; we think it’s up to the pregnant woman and her family to choose which model is right for her.
That’s not to say that midwife-led continuity models are of no benefit to many low-risk women. According to the most recent Cochrane Review (Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5. Accessed 18 March 2021) midwife-led continuity models result in less use of epidural or intra‐partum analgesia (which is important to some, but not all, birthing people) fewer instrumental deliveries and, in consequence, fewer episiotomies.
However, the same review found no difference between care models when it compared perineal trauma, induction of labour, oxytocin augmentation of labour, caesarean section, antenatal hospitalisation, post‐partum hemorrhage, length of hospital stay, initiation of breast feeding, neonatal Apgar score, or admission to neonatal nursery.
Given these latter outcomes can be traumatic – both physically and psychologically – it follows that many women, despite caregivers’ best efforts and intentions, will still experience trauma in midwife-led continuity models.
As an advocate for all women affected by birth trauma, we simply cannot ignore these findings.
The feedback we get every day suggests the model of care is less important than quality of care.
So, what does quality look like?
It’s timely, thorough, unbiased antenatal education that honestly discusses risks and benefits; it’s care that puts the individual woman – her values, goals and risk factors – at the center of decision making; it’s effective collaboration between caregivers at every stage of the journey; and it is appropriate postnatal care that extends beyond the cursory six-week check-up.
Women are traumatised giving birth at home; women are traumatised giving birth in hospital; they are traumatised in midwife-led care, and in obstetrician-led care. The one refrain we hear constantly is, I never knew this could happen to me. Why wasn’t I told? Why isn’t anyone listening to me?
This suggests that quality antenatal education is still not routinely happening across the system.
This suggests that honest discussion of risk is still not routinely happening across the system.
This suggests that shared decision making, and informed consent, is still not routinely happening across the system.
This suggests that effective collaboration between caregivers (midwives, obstetricians, GPs, mental health practitioners, maternal child health nurses, physiotherapists, social workers etc.) is still not happening across the system.
This is the stuff we need to get right before we can start calling any one model of care the “gold standard”.