Preparing to give birth again after a previously traumatic birth experience is often a huge mental and emotional challenge. And it can feel even harder if you are having to navigate through your pregnancy seeing a different person at each appointment!
Most women want continuity of care when giving birth – in fact, it is one of the biggest requests women are making of our maternity care system right now (1). I think most women intrinsically know that the opportunity to work with the same person throughout pregnancy, birth and postpartum recovery would be the best way to get all our needs met. But there is also lots of good evidence that supports the importance of continuity of care, with continuous midwife care shown to have the most beneficial outcomes for both mother and baby (2).
Why is continuity of care important if I’ve experienced birth trauma?
After a previously difficult birth experience, continuity of care can make a huge difference to your experience of pregnancy, as well as your birth.
Continuity of care gives you the opportunity to explain that you have been through birth trauma and have this understanding held throughout your pregnancy and birth. Importantly, you only have to tell that story once, not multiple times to different providers. This can help you rebuild trust in professionals and lay the foundation for genuine collaboration.
As you get to know each other during your pregnancy, you can arrive at your birth with a sense that your fears are understood. You can also work together to on a birth plan that will meet your emotional needs. We get so much our sense of safety in birth from knowing we are understood, supported and empowered to make informed decisions. This will be more important than ever after a previous birth trauma.
Getting to know your main care-provider during pregnancy can make it much easier to navigate complications or situations that arise during your birth. As humans, we feel safe based on how we are being treated by others around us. We are always picking up on signals as to whether we are safe or not with the people caring for us. Negative interactions with care-providers are a major factor in causing birth trauma, with many mums describing feeling threatened, afraid and upset due to their way they were talked to, treated or touched during birth. If this happened to you, finding some continuity might be particularly important, enabling you to feel safe enough to give birth again.
Why is continuity of care still so hard to get?
Despite the increasing evidence for the benefits of continuity of care for all women, currently only about 40% of us receive it. This needs to change – particularly in response to the high rates of birth trauma reported by mothers in Australia.
So what’s going on?
There’s huge variability across Australia when it comes to continuity of care, with the provision of the various models of care depending on the resources (and the ideology) of your local health system. This means that not everyone can access continuity of care, even though there is evidence that has the best outcomes for mum and bub.
Another part of the issue is that many of the mums I work with, who have experienced complications or interventions in their last birth, end up finding it harder to access continuity of care for their next birth.
I would argue that women who have experienced previous trauma are at the greatest need for continuity psychologically, but current policies within the maternity system focus on medical risk factors – and you might they prevent you from being able to access certain models of care.
With all this in mind, here are my tips to get more continuity of care as you prepare to give birth again:
- Speak to your nearest midwifery-led care team asap.
As soon as you see those two pink lines on the test, grab your phone and call your local MGP! In the public system, if you can get your name on the MGP (midwife group practice) list asap, you might be able to work with the same midwife throughout your pregnancy, birth and postnatal recovery. They will be able to tell you if you are eligible based on risk factors and your previous birth experiences – it’s good to know this early so you can explore other options if they can’t accept you.
- Consider a private midwife
If you already know you want to reduce unnecessary intervention in your next birth, a private midwife might be the way to go. They can be a wonderful way to access true continuity of midwifery-led care. Some private midwives will support you to birth at home, whilst others have admitting rights to hospital and can support you there.
- Seek out a trauma-informed private obstetrician
Birthing with an obstetrician may well increase the likelihood of medical intervention in your birth. But if already know you will feel safer with certain medical risks well-managed, or are choosing intervention for your birth, then this might be right for you. Working with a private obstetrician you know and trust could help you feel more secure during pregnancy.
- Hire a doula
After a previously difficult birth, many parents find working with a doula hugely beneficial in their next birth. Doulas are non-medical birth companions who can support you both practically and emotionally before, during and after birth. If you are going to hire one, be clear about what you want them to provide for you – do you want advocacy support, hands on labour support, or both?
- Request a student midwife
Whilst you might be willing to invest in having a better experience of birth this time around, money is a concern for most of us and it isn’t always possible to hire additional support like a doula. If you are birthing in the public system and finding it hard to access continuity of care, you can request a student midwife for free support! They’ll follow you throughout your pregnancy, so you can build a relationship with them. Whilst they may not always feel able to speak up and advocate for you in the hospital system, they can help you learn about various policies and be a valuable sounding board.
Finding a care provider you feel safe with is probably the most important decision you will make when giving birth again after birth trauma.
You deserve to build a birth team which understands what you went through last time and are able to support you both practically and emotionally.
If you are preparing to give birth again after birth trauma, I’ve created a free guide for you covering some other important steps you can take to feel more emotionally prepared. Download your free copy of ‘Five Ways to Prepare for a Better Birth Next Time‘ today.
- Faktor L, Small K, Bradfield Z, Baird K, Fenwick J, Gray JE, Robinson M, Warton C, Cusack S, Homer CS. What do women in Australia want from their maternity care: A scoping review. Women Birth. 2024 Mar;37(2):278-287.
- J. Sandall, H. Soltani, S. Gates, A. Shennan, D. Devane, Midwife-led continuity models versus other models of care for childbearing women, Cochrane Database Syst. Rev. 4 (4) (2016). Cd004667.
