We know that for many women pregnancy and childbirth is a wonderful life event.
However, for many women this is sadly not the case. Around I in 3 women in the UK each year find some part of their maternity
journey traumatic, and a smaller proportion develop PTSD.
There are lots of reasons that someone might have felt traumatised, this might
have included feeling dismissed or alone, feeling at risk of harm or feeling there
was a lack of consent in your care. This can lead to a range of new feelings and
emotions that might include nightmares, replaying the birth all the time, feeling on
edge and angry or not being able to talk or think about your birth at all without
getting upset.
One of the commonest ways families are initially offered support after a
challenging or difficult maternity experience is with a birth reflections meeting.
These services have been in place in the UK for many years but are all offered in
slightly different ways in each NHS trust. So wherever you live each service will be
unique.
Reflections services are now offered by virtually all the maternity trusts across the
UK and can have slightly differing names such as birth reflections, debrief or
afterthoughts. Most places increasingly use the term reflections service as this is
what it is , it’s a space to come and think about your experience, what went badly
and why and maybe things that went well too.
So it is really important that women know what reflections services are and how
they may be of use so they can decide whether to attend for one or not. Its entirely
your choice to have one of these reviews.
The actual meeting is usually with a medical professional, almost always a midwife,
and is usually held in a hospital setting but some trusts now offer these meetings
online or at people’s homes. Typically it will last about an hour. Ask if you need an
interpreter present.
Some services allow you to self-refer or your GP, midwife or Health Visitor can
refer you and then a date will be sent for you.
Sometimes trust have a timeline of having the meeting within a year of any care
but others do not. The services are free and open to anyone who feels it may be of use.
The aim of these meetings is to offer women and their partner or a family member
a space to go through their notes if they wish but also to talk through any of the
events of your pregnancy, labour, and birth. It can often be the first chance you
might have had to really talk through your experience in any detail with anyone.
A good birth reflections service should feel safe, kind and validating for you, the
aim is to allow you to voice your experience in your own way and in your own
pace. You should feel heard and that any feelings (anger, sadness, or confusion) are
respected.
Sometimes they can also help explain why certain procedures, such as emergency
caesarean birth, for example, were needed or go through the timeline of your care.
The meeting can also be a space to look at additional support and signpost people
for more specialised care, so there might be a discussion about local therapy
services or support groups you can access.
Practical Tips for the Meeting
It can be helpful to have requested your notes and read them before the meeting
but it’s not essential.
Beforehand try to really think about what you are hoping for, I would suggest to
go in with a list of questions as it can feel an emotional meeting and we can forget
things we wanted to say or ask. This might include the timeline of events, answers to specific questions or perhaps
help in thinking about and planning for a future pregnancy.
So for example you might want to ask:
What does this word mean in my notes?
Why did my baby go to NICU?
Take someone with you, this might be your partner, mum or a friend so they
advocate for you and also support you. You may feel emotional and that is OK.
Don’t forget it is your meeting for you so it’s also fine to ask for a pause or a break
if it feels too much. Also remember a birth reflection is not a formal complaint procedure. If you also
want an official investigation into your care, you can contact the hospital’s PALS
service.
Brith Reflections meetings do not feel helpful for everyone, we have to be honest
that the research into the effectiveness of these meetings is mixed. For some
women, it is too hard to go back to the hospital where their trauma occurred or
they can feel that in these meetings they are still not heard or answers cannot be
fully given.
There is a growing body of people who also now offer private birth reflections
spaces, often midwives, which can feel more impartial to than an NHS review and
thus more of use and there is also an excellent book on birth debriefing written by
Ilyin Morrison that can be of help. You can find these services easily online.
