Maternal childbirth trauma: in-hospital vs. out-of-hospital birth

Last year I graduated from Laramie County Community College here in Cheyenne. Woohoo!

When I was assigned to conduct a research project during the final semester of my psychology degree, I knew immediately that I wanted to study something birth-related (surprised?)

I've heard countless stories from people who walked away from childbirth feeling traumatized. Why was this happening? Who was causing it? I decided to do more research into birth trauma. Specifically, I wanted to know if delivery location impacted levels of trauma.

My Research Question: Is reported maternal birth trauma more frequent for mothers who had in-hospital births (medical model of care) or mothers who had out-of-hospital births (midwifery model of care)?

Disclaimer!

Before I share my research and findings, let me be clear: I am not sharing this information with the goal of persuading birthing people to change their delivery location. I believe everyone should birth where they feel the safest and most comfortable. I fully realize that birth trauma can happen in any setting, and I fully realize that people can have empowering births in any setting. I am simply sharing the correlational data that I collected.

While this research was overseen by a professor and was ethically approved, it is NOT peer-reviewed. This means you shouldn't use it in your own research papers. Again, I just want to share my findings in an unofficial capacity.

Also, I apologize in advance for the dry writing in this post..... much of it is copy and pasted from my academic research paper. I hope you enjoy nonetheless!

Hypothesis

Because past research has suggested that nurturing environments lead to lower levels of trauma, I hypothesized that the percentage of mothers experiencing birth trauma will be LOWER in the out-of-hospital group (home, birth center) compared to the in-hospital group.

Methods: How I collected data

147 women voluntarily took part in my online survey regarding their childbirth experience(s). Every participant had given birth at least one time in the past 20 years, and most within the last 5 years. Most women who took the survey were from the United States and Canada, with 2 being from Denmark and Germany. The participants ranged in age from 50 years old to 20 years old, with the average age being 31 years old. Participants were found using social media platforms, mostly Facebook.

Survey participants were asked to give information regarding their type of care provider (OB-GYN or midwife) and where they gave birth (hospital, birth center, or home). They were also asked if they considered their labor and childbirth experience to be traumatic or not, and to rate their level of trauma on a scale of 1-10 (1 being no trauma and 10 being extreme trauma). Participants were also given an opportunity to explain their birth preferences, as well as an opportunity to give details surrounding their trauma or lack thereof.

**It is important to note that trauma is defined by the person experiencing it, so there were no criteria participants had to meet for their birth experience to be traumatic or not, they simply had to identify it as so.**

Results

Out of the 100 participants who delivered in a hospital, 48 (48%) reported their birth as traumatic.

Out of the 47 participants who delivered outside the hospital (home, birth center, or car), 4 (8.5%) reported their birth as traumatic.

These finding suggest there is a significant correlation between delivery location and maternal birth trauma, and that birth trauma happens less frequently outside the hospital.

Feeling safe, listened to, and supported during labor and birth were factors that played into whether a mother reported her birth as traumatic or not. 23% of the 147 total participants said they did not feel safe, supported, listened to, or confident in their care providers recommendations during their labor and birth experience. Other factors that contributed to trauma were medical problems with the baby, such as needing to go to the NICU, or medical problems with mom such as preeclampsia or hemorrhage. 

One participant reported giving birth in the car because she did not make it into the hospital in time. Interestingly, she stated that delivering in the car was not traumatic, but the way she was treated by her care providers after being admitted to the hospital postpartum was traumatic. 

Because in-hospital births are typically attended by OB-GYNs (in the US), and out-of-hospital births are attended by midwives, these results could also suggest that the midwifery model of care leads to lower instances of birth trauma than the medical model of care.

Limitations of my Study

This study was not without a handful of limitations. First, it is not peer-reviewed. It was a relatively small sample size compared to the large population of birthing people. The distribution of delivery places was not evenly split, with 100 responses being for in-hospital births and only 47 responses being for out of hospital births. If the distribution was closer to a 50-50 split, the results may have differed slightly. 

One must consider the fact that some birth trauma is caused by medical emergencies, such as hemorrhage, emergency C-section, pre-eclampsia, or other risk factors. Most of these medical emergencies take place in the hospital, because out-of-hospital births are reserved only for low-risk, healthy pregnancies. This may explain the higher rate of trauma in hospital settings as well.

Additionally, because this survey was voluntary, the results may be skewed due to participant biases. Meaning, someone might be more likely to take a survey on birth trauma rates if they indeed found their birth to be traumatic (similar to how someone is more likely to write a review if they had a bad experience). On the flip side, people who choose to birth in-home or at a birth center may be overly eager to share their positive out-of-hospital experiences. This may explain why there is such a dramatically wide gap between the two reported trauma rates. 

Lastly, because the survey was published on online social media platforms and open to anyone with access to the link, participants were anonymous and unregulated. The researcher had no control over who took the survey, and no way to know if only serious responses were being recorded. 

Future Research: Where do we go from here?

Future research on maternal childbirth trauma and place of delivery may include replicating this study with a much larger sample size. A larger sample size will provide more accurate results in line with the larger population of mothers.  Additionally, rather than looking solely at place of delivery, similar research could be conducted studying trauma rates for patients of OB-GYNs vs. patients of midwives. Perhaps the type of care provider is even more indicative of trauma levels than the place of delivery alone. 

Lastly, future research could look at the direct cause of trauma when it is due to care provider’s actions. Is it due to lack of informed consent? The pushing of unwanted drugs or medical procedures? Providers being psychically rough with laboring mothers? Poor bedside manner overall?

There is no doubt that the instance of maternal childbirth trauma is happening much too frequently, and further research is needed to get to the root cause before we can find solutions to bring trauma levels down during the labor and childbirth experience.