Debriefing after adverse outcomes of birth
The desire to talk about birth experiences is very common and for most women this will be accomplished by talking with family, friends, and other social groupings such as mothers' groups (49).
Where there have been adverse or unanticipated outcomes of birth, it is important the maternity carers become part of these conversations. For many women, the perception of their birth experience may be different to that of those providing care, and events that seem trivial to staff may have a profound negative impact on women. It is quite possible to have a severe emotional trauma following what, to the maternity carer, may seem like a perfectly acceptable birth outcome. Studies suggest that more than 20% of women report their birth experience as ‘traumatic' (50).While the individual experience of birth is subjective, it is influenced by a number of variables including perceptions of ‘medical interference', feelings about personal performance and safety of both mother and baby, cultural expectations, and how well the birth met the woman's expectations (50). An important contributor to the birth experience is the nature and quality of interactions with carers, and this is influenced by verbal and non-verbal behaviours and how the woman judges these in relation to her needs. Feelings of being ‘unsupported' or ‘abandoned' can leave women feeling that their birth experience was negative or traumatic.
Where there are concerns about a woman's experience of birth, it is ideal to begin a conversation before the woman leaves the place of maternity care. This may simply take the form of inviting women to attend for further discussions or more in-depth counselling (49). The use of open questions, careful reflective listening, acknowledgement of the woman's concerns, and willingness to answer questions are important. Apologies for what has happened are not admissions of wrongdoing and may help the woman deal with the issues. Planning for further follow-up and future pregnancies is an important part of care, and communication with staff involved in the birth is encouraged. To achieve these ends, adequate time must be set aside, and the meeting location should be quiet and appropriate for the discussion. Other family members or advocates may attend to lend support, and staff members involved may also be invited. Timely recognition and the provision of information and support can go a long way to addressing a woman's concerns about her birth outcome.