Providing psychological therapies for perinatal trauma and loss in maternity services: A personal reflective blog by Dr Camilla Rosan

Recently, we published an incredibly important update to our position statement on 'Providing psychological therapies for perinatal trauma and loss in maternity services'. We make four recommendations in the report which include:

1. All maternity staff having a crucial role to play in preventing and reducing psychological trauma in maternity services by providing compassionate and person-centred care in a trauma-informed way
2. Women and birthing people having access to NICE-recommended, evidence-based psychological assessment and therapy for Post-Traumatic Stress Disorder (PTSD) following perinatal trauma and loss, which includes trauma-focused Cognitive Behaviour Therapy (TF-CBT) and Eye Movement Desensitisation Reprocessing (EMDR)
3. Not providing non-evidence based and non-NICE recommended therapies or techniques (including but not limited to: Rewind Technique; Birth Trauma Resolution; Conscious Perinatal Resilience Method)
4. Trauma-focused psychological therapies only being provided by psychological practitioners who have the core professional background and appropriate training to provide them.

We do not make these recommendations without being mindful of the context. We know that there is no getting away from the fact that maternity services in the UK at the moment are in a crisis. In the last few years, we have had special inquiry after inquiry that all conclude the same thing – far too many women and birthing people are being traumatised in maternity services. The reasons for this are complex and systemic and beyond the scope of what I want to write about here. What I can say is that every week, I hear stories of maternity and VCSE practitioners who are worried about these traumatised women and birthing people, and desperate to help them. 

So it makes complete sense to me, that when these practitioners hear about an affordable, one or two day training that promises to give them the skills to deliver a brief psychological intervention (namely the Rewind Technique, Birth Trauma Resolution or Conscious Perinatal Resilience Method) that will completely remove the trauma symptoms, that they would of course be jumping at the chance to attend and get started. Not least because we know how incredibly tricky it can be to get referred and treated in the over-subscribed and understaffed NHS Maternal Mental Health Services or Talking Therapies Services. But there is no quick fix for trauma and quick fix therapies are not safe and all these well-meaning practitioners are being sold a lie. This updated position statement explains why. Treating birth trauma and perinatal post-traumatic stress disorder is tricky and very complex.

Like many things in the psychology world – this is personal to me. I will share a little bit of my story with you here to try to explain why. 

I had a difficult childhood that was chaotic and unstable and during that time I experienced repeated, relational traumas whilst I was developing a sense of myself and where I fit in the world. In my late teens, when it was no longer possible for me to continue living at home, I went to live independently in a hostel in London while I tried to study for my A-Levels at a local sixth form college. 

During this time, I started to develop PTSD symptoms and was referred to a Human Givens Counsellor by my GP. She was a lovely, warm and patient women who I remember feeling a connection to. On our fourth session together, she guided me through the Rewind Technique in relation to a specific traumatic memory that I was struggling to share with her. This was with very little preparation (she did not tell me she was going to do it before she started) and certainly no time spent on grounding techniques to help me avoid dissociating during treatment. 

What happened next was very scary. I had a seizure and was taken to hospital where I was intubated in intensive care as I was in a coma for two weeks. And what followed was three months of seizures, further intubation in intensive care, temporary paralysis (I couldn't walk without a wheelchair when I was lucid) and significant memory loss and cognitive impairment. Everyone was confused about what was going on and I was referred to the Queen's Square Hospital for Neurology and Neurosurgery in London where it slowly emerged that my symptoms were "psychosomatic" or what we would now call dissociative. My experience was an extreme form of bodily shut down in response to my trauma. This was all triggered by a well-meaning, but untrained, practitioner delivering a non-evidence based approach - the Rewind Technique – to an unsuitable client. 

Clearly this is an extreme and unusual response and a case study of one, but it illustrates that treating trauma is complex and difficult and that if even one other person went through what I did, then we should be cautious! 

We do not let people attend a one-day CPD and then let them perform surgery on someone – the idea is entirely preposterous. So why do we hold the treatment of psychological distress to a different standard? It is not safe to treat trauma unless you are qualified and trained to assess PTSD and complex PTSD alongside other presentations (i.e neurodiversity and mood disorders) and risk factors, and then use these to formulate a treatment plan based on what the research evidence tells us works. PTSD is one of the only mental health difficulties where the research has found that some treatments can make things worse (for example through structured debriefing immediately after a traumatic event).

Also, we have fantastic evidence-based treatments for PTSD (trauma-focused CBT and Eye Movement Desensitisation Reprocessing) - so why cut corners? 

Having said all this, I think it is very possible that approaches like the Rewind Technique might work really well for some people. I have spoken to lots of practitioners and indeed psychologists who have anecdotal evidence of its positive impact for birthing people following childbirth and other perinatal trauma. But we simply do not have the evidence yet about who it works well for and how it should be delivered to achieve that benefit. And until we do – it is not safe to keep offering it to women and birthing people.