14th July 2025
To mark Birth Trauma Awareness Week 2025, we are delighted to share this blog from Nikki Morgan, Perinatal and Infant Mental Health Lead Health Visitor, Kent Community Health NHS Foundation Trust.
Birth trauma is a significant and often overlooked issue affecting many of the clients Health Visitors support. Research indicates that up to 30% of parents report their childbirth experience as traumatic, often due to unexpected complications, inadequate support, or feelings of loss of control during labour (Ayers, 2004; Beck, 2018).
Birth trauma causes profound and lasting physical and psychological harm. It may involve physical injuries such as perineal tears, uterine rupture, or injury to internal organs, alongside long-standing psychological effects. Women often report symptoms of post-traumatic stress disorder (PTSD), anxiety, or depression resulting from a traumatic birthing experience. (Ertan et al, 2021)
Understanding birth trauma is essential, not just for parents, but for the health professionals who support them. Untreated birth trauma can have an enduring negative impact on someone’s mental health (Brown, 2025). Research shows that traumatic or negative birthing experiences can affect parent-infant bonding, potentially undermining long-term family wellbeing (Miller, Rowe & Nandwani, 2023). By understanding and identifying birth trauma, we take vital steps to enhance perinatal mental health at a population level, ultimately improving outcomes for families.
Our role: Perinatal and Infant Mental Health Lead Health Visitors
Supporting families with birth trauma forms a significant part of the role of the Perinatal and Infant Mental Health (PIMH) Lead Health Visitor. In Kent then are four PIMH Lead Health Visitors:
- Fadzayi Maraike – Tonbridge and Malling, Maidstone, Tunbridge Wells
- Sonya Nichols – Thanet, Canterbury, Swale
- Sarah Reed – Dartford, Gravesend, Sevenoaks
- Nikki Morgan – Dover, Deal, Ashford, Folkestone
We provide training, support and guidance to the health visiting service; with an emphasis on prevention and identification of perinatal mental health difficulties, early intervention and the promotion of secure relationships between parents and infants. A key part of this work is providing trauma-informed care training to our workforce, equipping staff to understand and recognise trauma’s impact on parents and infants. Trauma-Informed Care is an approach in healthcare that understands the complex impact of trauma on individuals and seeks to create a safe client/clinician relationship that avoids re-traumatisation. By utilising our professional skills, trauma informed care seeks to build trust and promote empowerment in the care process (NHS Health Education England, 2019), thereby fostering a culture of empathy and improving the overall quality of mental health care in the community.
Building on these foundations, we are working collaboratively with Make Birth Better and Susan Ayers, the co-author of the City Birth Trauma Scale. Make Birth Better is a campaign in the UK formed of a collective of experts who bring together lived experience and extensive professional knowledge. The initiative was founded with the goal of developing collaboration among various healthcare professionals, parents, and policymakers to address challenges within maternity care and advocating for a wider understanding of traumatic birth experience. The City Birth Trauma Scale is a validated self-report tool that assesses trauma symptoms specifically related to childbirth, supporting clinicians in the identification of birth-related trauma in clients.
As PIMH leads we have collaborated to produce and implement a shortened version of the scale for the health visiting team to use in their practice. Additionally, as part of our initiative, we are introducing the question, “Did you find any element of your birth traumatic?” at every mandated contact with the health visiting Team. This ensures that every parent has an opportunity to reflect on their experiences and opens the door for necessary support. For those who report a difficult birth experience in response to this question, we are asking health visitors to trial the shortened City Birth Trauma Scale form, to gather more structured insights into their experiences The shortened City Birth Trauma scale provides a structured approach to identify and assess birth trauma effectively. We hope the streamlined version tailored for Health Visiting colleagues will facilitate discussions around traumatic experiences more easily, reducing the stigma and encouraging openness.
For clients who are identified as potentially having experienced birth trauma, our service will offer a multi-stepped care approach. Active and empathic listening, whilst validating birth experiences, may be sufficient to support many parents. Additionally, we advocate signposting for a birth debrief, if appropriate, and to helpful resources such as:
- birthtraumaassociation.org/ – Founded and run by women who have experienced birth trauma, dedicated to supporting women and families who have experienced traumatic birth.
- makebirthbetter.org/ – A collective of experts who bring together lived experience and extensive professional knowledge of birth trauma and vicarious trauma.
- https://masic.org.uk/ – MASIC exists to support women who have suffered severe injuries during childbirth known as OASI (Obstetric Anal Sphincter Injuries) they challenge stigma and drive change.
Where further support is required, we promote referral to our local talking therapies service which fast tracks all perinatal referrals, offering a range of group and one-to-one counselling options. Talking therapies in Kent & Medway | A direct route to NHS Talking Therapies
Image credit: Kent Community Health NHS Foundation Trust
However, for families needing more specialised support, we collaborate with Thrive KMPT | Thrive – Psychological Support for Birth Trauma and Loss, a local service that provides psychological assistance for birth trauma and loss. This service addresses the psychological impacts that can arise from traumatic birth experiences, with a team of specially trained trauma therapists. We have built networks with Thrive by implementing a local information system where Thrive informs the Health Visiting team of clients they are working with. This is beneficial for ensuring awareness of any emotional safety care plans and additional support required for subsequent births. By working together, we aim to provide a holistic support system for parents throughout pregnancy, birth, and parenthood.
Finally, we are working closely with a quality improvement team made up of Make Birth Better, Thrive and Specialist Perinatal Midwifes. We meet every two to three months to maintain momentum. We are working together to evaluate the effectiveness of the birth trauma training, direct client questions and the tailored city birth scale we are implementing. We are collecting new data and feedback to compare and measure the impact of the training and assessment tools. Collecting client data and analysing clinician feedback will allow us to refine our approach, ensuring that we are meeting the unique needs of families in our catchment area.
We’re proud to share that in May 2025, the Kent Health Visiting Team received an award from Make Birth Better in recognition of our dedicated efforts to improve awareness and screening of birth trauma. The award celebrates our ongoing work to enhance detection, assessment and support for those affected by birth trauma.
Addressing birth trauma is a clinical necessity in providing holistic and compassionate care within the health visiting service and we will continue to work collaboratively with organisations like Make Birth Better and integrate trauma-informed practices into our work. We emphasise the importance of listening, validating and supporting client’s experiences in their journeys. Together, we can foster healing and resilience, paving the way for stronger parent-child relationships and healthier families.
References:
Ayres, S. (2020). The City Birth Trauma Scale: A Tool for Identifying Birth Trauma. Journal of Perinatal Psychology, 12(3), 250-265.
Beck, C.T. (2018). Birth trauma in women: A review of the literature. Journal of Women’s Health, 27(1), 1-12. DOI: 10.1089/jwh.2017.6352
Brown, C. (2025) Reframing trauma through Social Justice: Resisting the politics of mainstream trauma discourse. Abingdon, Oxon: Routledge.
Ertan, D., Demet, M., Ozyurek, E., Akyuz, A., & Karaman, S. (2021) ‘Psychological impact of traumatic childbirth on mothers: PTSD, anxiety and depression’, European Journal of Obstetrics & Gynecology and Reproductive Biology, 261, pp. 82–87. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962315/ (Accessed: 21 May 2025).
Miller, K., Rowe, H., & Nandwani, K. (2023). The impact of birth trauma on birthing parents: A review of physical and psychological outcomes. International Journal of Women’s Health, 15, 45-58. doi:10.2147/IJWH.S123456
NHS Health Education England. (2019). Trauma-informed care: A practical guide for health care professionals. Retrieved from: https://www.hee.nhs.uk/sites/default/files/documents/Trauma-informed%20care%20-%20A%20practical%20guide%20for%20health%20care%20professionals.pdf
