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As others took to sourdough baking during COVID-19 lockdowns, Tara and Andrew Clark chose to learn all they could about childbirth as their new hobby of 2020.

They were engaged a few weeks before the pandemic hit, and discovered the next day they were expecting their first baby.

Tara and Andrew Clark want other parents to experience far less trauma than they did during Maia’s birth.Credit: Paul Jeffers

Tara’s pregnancy progressed smoothly, and the Melbourne couple readied themselves with birthing classes on Zoom and books such as Birth With Confidence: Savvy Choices for Normal Birth.

But when the day came, the birth process went so horribly wrong that both parents developed post-traumatic stress disorder.

Tara’s first thought, as she was in too much pain to care for her baby, was: “Why didn’t I know this could happen?”

“Nowhere in those classes did they mention the possibility of forceps or major postpartum haemorrhage, or retained placenta,” Tara recalled.

“Nowhere did anyone mention a prolapse and avulsion [where pelvic floor muscles pull away from the bone] or was I warned about [the possibility] of the third-degree tear I also ended up with. Nowhere were we prepared for the fact we could end up with so much trauma.”

Andrew, watching on as the procedures on Tara cascaded, said he “had no idea what was going on”.

While trying to advocate for her, he felt ignored, powerless and “like I was treated as a nuisance”.

Australia’s first inquiry into birth trauma has kicked off in NSW parliament and the Clarks are among those speaking up about the lasting mental and physical impact of birth trauma. Despite their ordeal, daughter Maia, now 3, was born healthy.

Tara Clark has sought trauma-informed midwives to support her during her second birth, due this year.Credit: Paul Jeffers

The inquiry, which started last month, was triggered after 30 mothers made complaints about Wagga Wagga Base Hospital, including allegations some were forcibly held down, given inadequate pain relief or told they would be induced to free up beds.

It follows Australia’s largest study of women’s birth experiences, which found in December that one in 10 women felt violated disrespected or abused during birth.

Now the Australasian Birth Trauma Association (ABTA) and maternal health academics are calling for a national investigation to address what experienced midwifery educator-researcher Professor Hannah Dahlen describes as “a national shame”.

“I think the Commonwealth needs to take this seriously; NSW is leading the way … but we absolutely need to make this national because it’s a national shame,” said Dahlen, the head of midwifery at Western Sydney University. “This will start to lift the lid on something that’s gone on for far too long.”

Heidi Lipson experienced long-lasting chronic symptoms after the birth of her first child, Hugo.Credit: Brook Mitchell

Dahlen and Dr Hazel Keedle will soon publish further papers on birth trauma from a national study of more than 8800 women. Dahlen was part of a team that in 2022 examined mode of birth on the incidence of post-traumatic stress disorder in mothers after six months and beyond.

Dahlen’s research supports previous findings that about 30 per cent of Australian mothers say they had a traumatic birth experience. PTSD is much more common in women who have had a traumatic birth.

ABTA chief executive Amy Dawes said a survey of 1002 women, commissioned by her organisation in 2023, found one-third of respondents said they had a traumatic birth in the past five years, and 12 per cent reported it was “extremely traumatic”.

The sample included Australian parents who had either experienced physical injuries (27 per cent), mental health challenges (44 per cent) or both (28 per cent) as a result of childbirth.

“The research uncovered a staggering 79 per cent of birthing parents reported experiencing at least one symptom of postpartum post-traumatic stress disorder after giving birth,” Dawes said.

Nearly one in three reported anxiety, one in five had vivid flashbacks or nightmares, and a similar number felt “overwhelming feelings of sadness, anger, guilt or shame”.

“Despite the prevalence of symptoms and the immense impact that they can have on all facets of life, less than half (41 per cent) of birthing parents surveyed had heard of postpartum PTSD prior to the delivery of their child,” the survey found.

In June, University of Sydney research described birth-related PTSD as “strangely overlooked” and found the majority of women who displayed symptoms remained undiagnosed.

“We know that it has a profound ripple effect not just on women, but their infants and the infant’s development. And not just emotional, also cognitive, as well as on the partners of the women,” said psychologist and researcher Alysha-leigh Fameli. “We don’t have postnatal services to support these women to prevent this happening and no clear guidelines.”

Dawes also wants a national birth trauma inquiry and the introduction of trauma-informed maternity care. She called for more education to help parents make informed decisions about interventions, and better screening to ensure mothers with mental health challenges received correct diagnosis and treatment.

The NSW inquiry has so far received 50 submissions. One woman said she had been “bullied into a forceps delivery without consent … I didn’t even know what forceps were” with no anaesthetic, which resulted in a third-degree tear and caused “daily flashbacks for two years”.

Another said she had such poor pain relief and treatment that she developed PTSD and postpartum depression, and never wants to have another child.

Fiona Reid, who had been employed as a hospital clinical midwife consultant, wrote that her hospital’s complaint system “was designed to mitigate the risk of litigation and for the organisation to take no responsibility for a woman’s traumatic experience that resulted in either or both psychological harm and physical injury”.

“[Women] were not offered any ongoing support and they were not provided with a plan of care for their next pregnancy that was motivated to … improve her experience and outcome. Women felt humiliated by the process,” Reid wrote.

Tara Clark said she found trauma-informed midwives to support her and Andrew during her second pregnancy.

Melbourne midwife and researcher Robyn Matthews said her research showed 33 per cent of midwives who said they were thinking of leaving the profession cited witnessing or being involved in a traumatic event as a reason.

Heidi Lipson wants “more honest conversations” between medical staff and parents about the potential complications of birth interventions.Credit: Brook Mitchell

“Birth trauma is definitely having an impact; 12 per cent said they took sick leave in the 12 months prior to our survey because of a perinatal traumatic experience,” Matthews said.

Dawes said she did not want medical workers targeted, as birth trauma resulted from system-wide issues.

“We see birth trauma occur under all models of care and birth modalities, which is why we want more research and evidence into the causes of birth trauma, more data collected on maternal outcomes, and investment in referral pathways and support systems,” she said.

“We want to see investments in the whole maternity care system to ensure it is truly woman-centred/person-family-centred and that it prioritises choice and informed consent.”

Sydney mother of two Heidi Lipson said she experienced long-lasting chronic symptoms after the birth of her first child, describing the forceps birth as “dangerous, horrible and traumatic”.

“It made it difficult for us as a family for one or two years afterwards,” Lipson said.

The lingering pain had a big impact on what she could do as a mother and in her daily life.

More than five years on, Lipson’s pain is under control, but she has only recently returned to moderate exercise.

She made a formal complaint to the hospital and wants “more honest conversations” about birth options and potential complications.

“I am following whatever avenues I can to put my voice out there and put this [the impact of birth trauma] on people’s radar to make this experience better for other women; and for other women not to feel alone,” she said. “We can do better for women.”

Sydney University is researching PTSD among Australian mothers, to participate, visit the Australian Birth Study.

PANDA is the national perinatal mental health helpline. In a crisis, call Lifeline 13 11 14. Beyond Blue also offers pregnancy and new-parent support.

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