The NHS is responding to a surge in cases of birth trauma by setting up specialist support services to reduce the rising demand for a caesarean delivery from those who, after a bad experience, are scared to undergo labour again.
Midwives say increasing numbers of women are so badly affected by their first experience of birth that they are postponing for years, or abandoning, plans to have any more children.
... At Liverpool Women's hospital, for example, the number of mothers who have asked for an elective caesarean with their forthcoming child, because they suffered trauma the last time, has risen 40%.
"Tocophobia [fear of childbirth] is a distressing psychological disorder that is growing at an alarming rate," said Simon Mehigan, a consultant midwife at the hospital. Most of the women with birth trauma he works with "are so fearful about giving birth for the second or third time that they are making themselves unwell". Typically, this fear is a result of experiences during the first pregnancy or delivery and can often be traced back to a lack of information or explanation about what was happening, he added.
... In January Stepping Hill will launch a specialist birth trauma support clinic run by a consultant midwife, Debbie Garrod. "Last year I saw 21 women who were troubled by something that happened during their birth, usually a first birth. Before 2009 it was a handful. This year so far I've seen 48 women," said Garrod.
Many other hospitals across the country are also introducing similar counselling services run by specially trained midwives to help women work through their fears and discuss the pros and cons of natural and surgical births. The apparent growth of tocophobia has prompted fresh debate over the variable quality of NHS maternity care as well as prompting some to claim that it is due to women being less prepared than previous generations to endure pain during childbirth.
Ah, I see, it's the woman's fault again?
Dr Tracey Johnstone, a consultant in foetal maternal medicine at Birmingham Women's hospital, said a more confessional culture, soap operas' portrayal of birth as painful and dramatic, and women's reluctance to withstand labour pain lie behind the increase.
"Women are more frightened of labour and delivery now. Among women there almost seems to be a competition about who has suffered the most during childbirth, talking about 18-hour labours and the like, and that scares other women before they have their babies," ...
"A lot of women are less tolerant of pain now. They should realise that childbirth is painful," she said. The greater medicalisation of birth – with more women having pain relief, or a caesarean or being induced – is also making women unsatisfied ...
But Cathy Warwick, general secretary of the Royal College of Midwives, said: "There is a worry that, with the increasing birthrate, there are just not enough midwives. If women don't have support throughout their labours, then they are more likely to feel they have been let down and left alone, and had too little information and explanation, so are more likely to end up feeling traumatised."
Cathy has hit the nail on the head: the availability of a supportive midwife, preferably a midwife known and liked by the woman.
She added that the NHS would need another 3,000 midwives in order to help women properly during labour.
More and more women are contacting the Birth Trauma Association by email or Facebook or through its helpline. ... "Some women have a quite horrific experience of childbirth and often feel they weren't listened to because they had a baby who was well. Given the lack of care it's no wonder 30% find it traumatic."
... "We're looking into why some births become complicated and traumatic. That could be because the foetus became distressed due to lack of oxygen, or because the baby couldn't be delivered because the uterus seemed to run out of energy, or women not always having the support they need during long labours," said Wray.
"It's vital for the NHS to understand why so many new mothers are left traumatised because this affects so many women, their future fertility and their psychological wellbeing."
Angela Almond suffered birth trauma after having ... her first child ...
It was only by getting extra support from a specialist NHS midwife that she felt able, six weeks ago, to have her second child, Scarlett, naturally.
The 32-year-old music teacher and husband Stuart, 31, a marketing manager, live in Liverpool.
"It was a difficult birth with Amelie. I was having a checkup four weeks before she was due when they unexpectedly told me that I was in the early stages of labour and that they were going to admit me there and then and induce me.
And here we read of an intervention that, on the face of it, was completely unnecessary. Whatever was wrong with waiting for labour to take its course? The story of trauma follows:
"The main trauma for me was all the intervention: being induced, having my waters broken for me and being examined all the time. And I found being in such an unfamiliar clinical atmosphere frightening and intimidating.
"I was in for three days and three nights altogether, which didn't help. That was partly because my labour didn't progress well because I didn't dilate enough. In the end they had to use both forceps and a ventouse suction cup to get Amelie out, which was frightening and stressing.
"There was a high turnover of midwives, who were always rushing around looking after patients. Things were going on but staff were too busy to explain what they were doing and why.
"I didn't know what was happening or going to happen, and I didn't like that lack of control.
"I was also left alone a lot of the time and didn't feel supported or reassured.
"I found that first birth experience so frightening and so bad that it was putting me off having a second child. I wanted more children but was put off by the thought of going through another labour like that.
"When I got pregnant again I knew I needed some support. I was frightened at the prospect of nine months of worrying about the labour, and didn't want that to stop me enjoying the pregnancy.
"Labour is a frightening prospect to the bravest of people. After becoming pregnant I thought I might ask for a caesarean section, to help avoid what happened first time round. But luckily soon after that I was referred to Simon Mehigan, a midwife at Liverpool Women's Hospital who helps women who have had a traumatic labour. He was absolutely brilliant. He supported me throughout my pregnancy and labour. He guided me and reassured me. Eventually I felt confident enough to have a home birth – Simon's idea – which he attended.
"The fact that it was at home empowered me and I felt safer and more supported than if I'd had Scarlett in hospital."