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Can children be traumatised by watching their mother give birth?

Jamie Oliver hit the headlines a few months ago: Not because his wife, Jools, had given birth to their fifth child, nor because it was his second boy. It wasn’t even because he’d created some new exciting recipe. No, Jamie Oliver hit the headlines because his two eldest daughters were present at the birth.

As may have been expected, anyone who was anyone had something to say on the matter. Yet public controversy aside, what does the field of PTSD (post-traumatic stress disorder) have to say about it?

Childbirth-related PTSD is not actually a recognised diagnosis in the DSM V (Diagnostic and Statistical Manual of Mental Disorders), yet it is a well-documented and not-infrequent consequence of a traumatic birth. When we talk of birth trauma usually, we are obviously referring to the mother who has just been in labour – the culmination of a long nine months. Although usually associated with things like military combat, natural disasters and violent attacks, a traumatic experience can be anything involving the threat of death or serious injury. Thus, taking into account factors such as loss of control, dignity and the absence of informed consent, it may be no wonder that birth itself is now considered a very possible cause of PTSD.

PTSD can and should be treated or it can have far reaching consequences. Most NHS Trusts and many private organisations have specially trained clinicians who can offer treatment. EMDR is a treatment of choice for PTSD, recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organisation (WHO).

“In the eye of the beholder”

“Birth trauma is in the eye of the beholder”, wrote Cheryl Beck for Nursing Research over a decade ago, (Nursing Research January/February 2004 Vol 53, No.1). According to The Birth Trauma Association, men who are present at the birth – now a reported 90%, according to the National Childbirth Trust – may also feel traumatised as a result. It would seem that allowing your children to share the experience is not something that should be taken lightly.

Yet according to the BBC, midwives are reporting an increasing number of parents who want their older children to be part of the experience. Arguments include helping the family to bond, preventing jealousy and passing on positive messages about giving birth. “With the right support and preparation, why shouldn’t children be involved”, the Royal College of Midwives (RCM) director for England, Jacque Gerrard, is quoted as saying in the Guardian.

But of course, this will all depend on what kind of delivery it is, family psychologist Dr Mair Edwards tells the BBC. “If the birth is going well and everything is going to plan then it can be a fantastic experience,” she says.

“The problem is if it isn’t a smooth birth there can be panic and that can be really traumatic. As a mother you’ve also got to be comfortable with people watching you. It’s a very personal choice.”

Whilst there doesn’t seem to have been a whole lot of out-and-out criticism of the practice from experts, nor any conclusive evidence to suggest it can result in trauma, it is not something which should be done without any thought. After all, as RCM spokesperson, Gail Johnson, has previously said: “It can be distressing for some children, particularly if they are younger, to see their mother in pain.

“She may use language in labour that she normally wouldn’t dream of using in front of her children, and the blood and faeces that are a perfectly normal part of birth can be shocking to a child.”

“A child of any age will need some preparation for the experience”, NCT Senior Policy Adviser, Elizabeth Duff, is quoted as saying. “No matter how wonderful it can be to watch their sibling being born, it can also be a confronting experience for a child to see their mother in pain or losing blood.”

Yet despite agreeing, in theory, that there is nothing potentially dangerous overriding the practice, the experts do seem somewhat divided on due process. “There is no magical age,” New York midwife, Ann Linden, is quoted as saying. “In fact, certain children may be comfortable with the idea at age 7, for example, and aghast at the thought at age 12, and interested again at age 15.”

Advice for parents

Here is some useful advice for mothers who are considering allowing their children to be present during childbirth, from the parenting website, Babycentre:

  1. Discuss labour properly: Read books, watch videos and encourage questions. Explain exactly what the child will see and make sure they still want to be there after knowing what the process actually entails. There’s no point shying away from the details in theory, only to go full guns blazing at the actual event! Preparation is key.
  2. Assign someone to care exclusively for your child during the birth. You are, pretty much, going to be out of commission, so ensure that someone with whom your child has a close and positive relationship with is present at the birth. That way if the child wants to leave at any point or needs comforting, they will have someone.
  3. Encourage your child to use the ‘family room’. No child needs, nor should they, be present at the whole birth, so encourage them to take breaks by doing something light-hearted, such as watching TV or reading a book. Make it clear that it is perfectly acceptable for them to only come in the delivery room after the baby is born if this is what they would prefer.
  4. You can change your mind. Like with everything else to do with the birth, nothing is set in stone, and you can decide during the event itself that it would be better for all involved if your child was not present.
  5. Discuss the birth afterwards. If your child was present at the birth, make sure you give them ample opportunity to discuss the experience – however, preoccupied you may be with your newborn.