News release

From: Murdoch University

We can intervene in pregnancy to reduce birth trauma and birth-related PTSD

Antenatal care is the routine health and wellbeing support provided to women during pregnancy to help them prepare for a safe and healthy birth.

The NSW Parliamentary Inquiry into Birth Trauma (2023–2024) found that birth trauma affects one in three Australian women, and one in ten women develop post‑traumatic stress disorder (PTSD) related to childbirth.

“Treatment for childbirth trauma is a serious public health issue and one that we can act on,” said Dr Kelli MacMillan, Clinical Psychologist and Senior Lecturer in the School of Psychology.

“While more research has focused on postnatal support and intervention, there remains a glaring gap in research on cost‑effective antenatal intervention capable of facilitating a preventative model of healthcare as well as optimal maternal and child outcomes,” she said.

Led by Dr MacMillan, a team of researchers conducted a systematic review of previous research to identify existing antenatal treatments for childbirth related PTSD and evaluate their effectiveness.

A total of 2034 relevant research papers were identified with only 12 studies included in the final sample.

“This small final sample of evidence reflects the lack of focus that childbirth trauma research has had until only recently, despite childbirth having existed since the beginning of human beings,” Dr MacMillan said.

Key Findings

• Childbirth plans were the most commonly applied intervention, helping women feel more in control, with an increased sense of mastery and overall positive birth experience, with one study also showing fewer PTSD symptoms.
• Midwife‑led education and counselling sessions eased women’s fear of childbirth and boosted their confidence heading into labour — giving many a stronger sense of preparedness.
• Therapies like haptotherapy and hypnosis showed early promise, helping women better manage distress and depressive symptoms, as well as fear of childbirth.
• Trauma‑informed care, such as flagging psychological needs in a woman’s medical file improved communication and women’s feelings of safety and support.
• Eye Movement Desensitization and Reprocessing (EMDR) therapy was found to be safe during pregnancy, though it didn’t outperform usual care in reducing fear of childbirth.
• Most effective interventions were low‑cost and did not require specialist mental health clinicians, making them accessible for hospitals and community maternity services to adopt.

Across the 12 studies reviewed, low‑cost interventions like childbirth plans, midwifery‑led psychoeducation, counselling, haptotherapy, and hypnosis all showed potential to reduce fear of childbirth and improve women’s experiences.

“We know that when women are given clear information during pregnancy with involvement and empowerment in the decision‑making, their birth experience is more likely to be positive,” Dr MacMillan said.

“The World Health Organisation defines a positive birth experience as a fundamental right for all women.”

Dr MacMillan said integrating antenatal education into midwifery practice was essential.

“Except for EMDR, most of the identified antenatal approaches don’t require specialised training,” she said.

“They can be delivered by midwives or hospital staff with the possibility of integration into routine maternity care.

“We need to identify women at increased risk of childbirth trauma who have a fear of childbirth or who are carrying risk factors such as previous trauma, low social support, or a difficult past birth, and may benefit from antenatal intervention.”

This project received grant funding from the Women and Infants Research Foundation to support a critical next step — identifying valid and reliable screening for childbirth trauma that may be integrated into routine maternity care.

“Our team are conducting this research in collaboration with researchers in the United Kingdom who have designed a childbirth trauma screening measure in response to the same urgent need to address childbirth outcomes for women.”

Dr MacMillan emphasised the need for more research in the area, immediate focus, and action.

“Our review shows just how powerful primary antenatal intervention can be, but we still need more research to understand which approaches work best for different women. The early evidence is encouraging, now is the time to build on it.”

The study, Childbirth Related Post- Traumatic Stress Disorder and Childbirth Trauma: A Systematic Review of Available Primary Antenatal Intervention, can be found in the journal Birth: Issues in Perinatal Care.