The 'Birth Review' - a tool for de-briefing after childbirth

The Birth Review - a tool for de-briefing after childbirth
By Julie Bell, RCompN, Doula (c) 2007

The opportunity to de-brief after your birth, with a supportive listener, is an important part of the birth process. It is really the “4th Stage of Labour”. Any birth is an intense, impactful experience. The need to process this huge event in one’s life is felt by most women. In New Zealand and most other countries, a de-briefing session like this is a mandatory part of maternity care. In New Zealand, it is called a Birth Review.

We believe that each woman’s own perceptions, opinions, responses and feelings about her birth experiences are valid, significant and extremely important for improving and optimizing maternity care in this country.

This is your Birth Review. You may use this document to inspire thoughts and ideas if you wish, or if you prefer, you can toss it in the rubbish and do it your way. Ignore any questions that don’t interest you. Add any questions you think should be in there. Please feel free to use other paper, or make your responses verbally – do whatever is helpful for you.

Part One: How Was Your Birth?

1. What was your birth like for you?


2. What happened in the events leading up to the birth?


3. What happened after the birth?


4. What was the best part of the experience for you?


5. What was the worst part, or the hardest part, for you?


6. Is there anything you would want to do differently another time?


7. Is there anything you are glad and relieved that you did /chose / consented to?


8. Is there anything you regret that you did / chose / consented to?


11. Which factors do you think had the most impact on the outcome of your birth?


12. Did you gain any valuable insights or lessons from the experience? Did you gain new awareness?

13. Did the experience change you in any way? For better or for worse?

13. What are your feelings about your birth now?

Part Two: Feedback for Maternity Services and Care Providers:

This part of your review is to help you evaluate the care you received from your careproviders and support people. Your feedback will be helpful in improving maternity services in Australia.

1. What feedback / criticisms / recommendation / suggestions would you like to give to the birth services and caregivers involved in your birth experience?







2. What did you find helpful during/surrounding the birth?







3. What did you factors did you find to be unhelpful?






4. Do you need any help on directing your feedback to the relevant personnel and authorities?






5. Is there any information, notes, or data that you would like to obtain regarding the events concerning your birth? Have you had any difficulty in obtaining this information?




Part Three: Your Post-Natal Well-being:
Having a baby is a huge adjustment. With time, rest, nourishment and support, most new parents adapt well to the many new challenges. But if after some months have gone by, you feel that you have not been able to recover from the birth and are still experiencing distress, you may wish to consider the following questions to determine if you are experiencing symptoms of Post Traumatic Stress Disorder. Do you feel that any of the following apply to you? Never? Sometimes? Often? A lot?

Partners may also wish to consider the following on their own behalf. The impact of a traumatic birth on fathers is also something that needs to be considered.

1. I experienced a traumatic event/events during/surrounding the birth:
- actual or threatened injury or threat to my physical integrity or my baby’s physical integrity.
- I felt as if I and/or my baby would not make it through alive.
- I experienced extreme physical pain and/or emotional distress for an extended length of time that exceeded my natural abilities and resources for coping with stress.
- I felt that the help I needed and requested was not provided for an unreasonably long period of time

2. The trauma keeps coming back to me in one or more of the following ways:

- I keep having thoughts, memories, flash backs or strong feelings about the birth or events surrounding the birth, often when I didn’t want to think about it

- I have disturbing dreams or day dreams about the birth or events surrounding the birth

- I sometimes act out or feel as if it was happening again, especially at times when I am half asleep or in my sub-conscious.

- I feel distressed when something reminds me of the traumatic things that happened – something little triggers a memory and then I feel upset.

- When the memories are triggered, I feel so upset I react physically – such as changes to breathing or heart rate, sweating, feeling dizzy, feeling sick or a getting a head ache.

3. I try to avoid anything that could remind me of the trauma or trigger flash backs in one or more of the following ways:

- I avoid thoughts, feelings, or conversations associated with the trauma

- I avoid activities, places or people that arouse recollections of the trauma

- I am unable to recall an important aspect of the trauma, there’s some things I just don’t remember.

- I’ve lost interest in doing things I used to enjoy and invest energy in

- I feel detached and estranged from some people

- I feel kind of numb and less able to laugh, get excited or have loving feelings.

- I can’t imagine a future for myself anymore. I can’t see ahead.

4. I feel tense and on edge, like I’m always on guard. I wasn’t like this before. I’ve experienced:

- Difficulty falling or staying asleep

- Irritability or outbursts of anger, feelings of rage

- Difficulty concentrating

- Hypervigilance

- Exaggerated startle response. Just little things can give me a fright or set me off.

5. I’ve been having these symptoms for a while now.

6. I feel it has been affecting my sleep, my relationships and my daily functioning. It’s not like me.

7. I started feeling this way straight away after the event that I found traumatic.

8. The shock was delayed a few days before I started having these feelings.

9. I have had these feelings for less than three months / more than three months.

10. I feel these symptoms are getting diminishing over time / worsening over time.

11. Are there any other symptoms you are experiencing not mentioned above?

12. Have you found anything has helped you find relief, or is helping you manage?

13. Is there anything that you think would help you, that you are having difficulty obtaining?

Part Four: Getting Help:
The following is a list of resources which may be helpful for obtaining further de-briefing support and treatment. Remember – every new mother needs and deserves support. Some people don’t reach out for help because they feel their problems are too trivial. They’re not. Some don’t reach out because the problems seem too huge or complex. They’re not. Trauma and/or depression can be very isolating. It may be tempting to withdraw, but please take heart, reach out, and keep speaking up for your needs until you find the right person for you, who will truly listen to you.

1. Trauma After Birth Support, New Zealand:
http://www.tabs.org.nz/

2. Post Traumatic Stress Disorder After Childbirth, USA:
http://www.angelfire.com/moon2/jkluchar1995/

3. Birth Crisis Network, UK:
http://www.sheilakitzinger.com/birthcrisis.htm

4. Rhea Dempsey – Birth Debriefing
PH: 03 9513 9164
E: birthingwisdom@ozemail.com.au
W: www.birthingwisdom.com.au

5. Judy Biro, Psychologist who specializes in birth-related PTSD. Located in Malvern & Chadstone (Melbourne). PH: 0425 755 486.

6. Joyous Birth forums, Birth Trauma Space: A public sub-forum to share resources and information about birth trauma of all kinds. http://www.joyousbirth.info/forums/forumdisplay.php?f=93