It’s hard to put an exact number on it, but across the United States, somewhere between 9% and 44% of women describe having a traumatic experience when they gave birth. The Utah Department of Health and Human Services also says birth trauma is largely unrecognized in maternity care.
In a new research study with the Kem C. Gardner Policy Institute, they found one thing that could help is a better approach to mental health screenings after birth. Many of the study participants, including Sadie Nielsen of Eagle Mountain, felt like the questionnaire healthcare workers gave them was not helpful.
In 2021, just after the traumatic birth of her first child and having metal sutures taken out from her cesarean section area, Nielsen received the screening.
“And I wasn't able to really answer the questions truthfully or honestly because I was just in so much pain,” she said. “I had so much fear, and I felt like where I was at — no one was really caring about what exactly had just happened to me.”
She felt the interviewer wasn’t taking the questions seriously. To Nielsen, it felt more like they were talking about the weather or shooting the breeze. She said she received the Patient Health Questionnaire-9 (PHQ-9), which includes questions about thoughts of suicide or self-harm. Utah recommends a different screening called Edinburgh Postnatal Depression Scale (EPDS) but says PHQ-9 is also valid.
Other women in the study, which looked at the state as a whole and did not judge or mention specific hospitals, also felt the provider saw the questionnaire as procedural rather than an opportunity to identify symptoms. Some also felt like their feelings were dismissed as common “baby blues” or didn’t feel like the provider would be able to address their mental health challenges. Other moms were afraid that admitting to mental health challenges could lead to having their baby taken away.
Participating in the study was a big moment for Nielsen.
“It meant so much to me to feel really heard and really like this is going to be the beginning of a beautiful new start for Utah to help mitigate birth trauma,” she said tearfully. “I felt like it was all worth it at the end. It means a lot to me to be able to hopefully help other women in the future.”
Utah women experiencing birth trauma can find help and resources at birthtrauma.utah.gov.
This interview transcript has been edited for length and clarity.
Ciara Hulet: What was traumatic about your childbirth experience?
Sadie Nielsen: I had to push for five hours, and at the top of the fifth hour, that's when my doctor said, “Hey, you're going to need a C-section.” And that moment was so terrifying for me, because I had no idea what was going on. A nurse had also come in and said, “There's a chance your baby might need to go to the NICU.” And in that moment, I felt like I couldn't breathe. I felt like my life, essentially, was spiraling out of control.
And in addition to that, I knew I just needed anti-anxiety medication. But not one time while I was in the hospital did a nurse recommend, “Hey, I can see that you're having some troubles right now. Can I help you get to a doctor who's going to help you get some anti-anxiety medication?” And it wasn't until after I left the hospital and my mom came to my house and she said, “You really need to be able to sleep.” Because I wasn't sleeping. I was sleeping maybe two hours a night. So once she was able to help me and get that anti-anxiety medication, that's when I was really able to actually start my healing.
CH: This was during the COVID-19 pandemic. Do you think that could have contributed to how things played out for you?
SN: One hundred percent. While I was in the hospital, there were constantly changing procedures and ways of how they were trying to handle COVID, which I think contributed a lot to the nurses just feeling burnt out trying to, you know, do their best with what they had been given. But I think it was really difficult for the nurses as well. And I think that's an important aspect of this to recognize, is that nurses need support too, to be able to support their patients. So when hospitals are not doing their job to support their nurses and train them to help patients with birth trauma, then the patients suffer even more.
CH: How do you think mental health problems should be screened for after birth?
SN: I did just have my second child, and the way this hospital addressed the mental health questionnaire was they had a social worker come in and give me the questions. Instead of me just filling out a physical piece of paper, she went through them with me. She was very empathetic about the things I had experienced before. And she asked me serious questions, but in a way that I knew that if I answered them in a way that I needed help this time, that she would follow up on it. I was also given resources at the end of the questionnaire that I knew I could go and reach out to someone specifically and talk to if I needed help, versus the first time, I knew I wasn't going to be able to have that option.
CH: The Utah study also found support after childbirth drops off sharply, and many participants thought there should be follow up visits about mental health. What value do you think there would be in that?
SN: Follow up means everything because typically, women only receive that six-week checkup with their doctor. And at that six-week checkup, there's not a lot of in-depth figuring out of what's going on with you. It's just another checklist. And I feel like multiple follow ups coming from multiple sources would benefit women so much, and it would help them feel so much less alone.
