News release

From: The University of New England

Birth is a life-changing event. For one-third of women, it is also traumatic. And the support mothers often receive may be adding to their psychological distress.

Concerns for the wellbeing of women “debriefing” after birth – which evidence shows can be ineffective and potentially harmful – has prompted University of New England researchers to embark on pressing new research.

Clinical psychologist Dr Lucy Frankham is collaborating with Professor Einar Thorsteinsson and the Maternity Consumer Network to evaluate Psychological First Aid for Birth Trauma as a means of reducing the risk of future post-traumatic stress, depression and anxiety. And possibly even inform global post-partum best practice.

“We believe the process of debriefing may not relieve but in fact reinforce a woman’s traumatic birth memories,” said Dr Frankham, one of few psychologists working clinically in this space. “Women are led to believe it will be therapeutic, but I see mothers struggling to deal with its negative impacts.”

Debriefing is not conducted in any other health context, is not standardised across Australian maternity care and nor is it supported by national guidelines. It is typically undertaken by midwives and medical staff in a single session, even though there is limited evidence for its benefits for birth or any other trauma. In fact, debriefing could be linked to poorer longer-term outcomes for mothers and babies.

Dr Frankham said this is because rushing to revisit trauma can disrupt the brain’s ability to process memories and create context and meaning. This may then unintentionally reshape or even overwrite the memories.

“Reviewing trauma too soon reactivates the sensory and emotional parts of memory while the brain’s alarm system (amygdala) is still activated, strengthening fear and distress. This means the event becomes more deeply imprinted as an emotional experience. An Australian study last year concluded that one-third of women found debriefing unhelpful – the same number who had reported birth trauma.”

Instead, Dr Frankham has written a training program specific to birth trauma based on the more informal and supportive approach known as Psychological First Aid. It recognises that mothers need to feel safe and connected and allow memories to consolidate before embarking on any trauma-focused recovery.

“This toolkit is not currently part of maternity services guidelines or policies. It focuses on listening and creating a sense of safety that promotes agency, connectedness and calm. If a woman wants to retell her story, she can. But we certainly wouldn’t probe. It’s more focussed on meeting immediate, practical and emotional needs, providing support and comfort, and strengthening natural recovery, all of which reduces the risk of future trauma – for the mother and child.”

Of great concern to Dr Frankham is health professionals using debriefing as a form of open disclosure, when something goes wrong during birth. “Women are sometimes invited in for a debrief, thinking they will receive emotional support, but it is a means of avoiding litigation, which is highly distressing. I have seen women who have been gaslit and told ‘no, this is what happened and we had to do this because …’.”

Founder of the Maternity Consumer Network, a not-for-profit organisation that advocates for improved maternity care across Australia, is Alecia Staines. She believes the national, randomised trial of Psychological First Aid for Birth Trauma could be “transformational”.

“Among the one-third of birthing mothers experiencing trauma, much of it is due to care provider actions or interactions,” Alecia said. “Ad hoc debriefs can then cause further trauma. We must improve the emotional and psychological outcomes of maternity care, and this program could be transformational by giving care providers the specific, evidence-based skillset they need.”

For Dr Frankham, it’s a chance to verify what promises to be a “safe, standardised post-birth response” for traumatised women. “It is only in recent years that we have even recognised birth trauma. Midwives and medical staff are doing their best but clearly need training and support with contemporary, evidence-based approaches. I hope our trial contributes to a shift in how women are supported following traumatic birth experiences; moving away from practices that are no longer recommended and towards compassionate, evidence-based, trauma-informed responses.”

Key facts:

• A traumatic birth is when a mother experiences ongoing psychological distress.
• Debriefing was first introduced into maternity care in the 1980s but the World Health Organization and the Centre of Perinatal Excellence strongly recommend against its use.
• Despite limited evidence for its safety and efficacy, debriefing is still offered as a primary response to mothers who have experienced a traumatic birth.
• A new randomised trial of Psychological First Aid for Birth Trauma by University of New England researchers will evaluate its use as a trauma intervention across Australian maternity care.