“Birth trauma is in the eye of the beholder”, wrote Cheryl Beck, internationally renowned American nurse and researcher in the field of birth and trauma, over two decades ago. Fast forward to 2025. Maternity services in Ireland face renewed scrutiny with ongoing external reviews at multiple hospitals including Portiuncula Hospital, Galway and Mayo General Hospital, as part of the Saolta Healthcare Group.

Patient Safety Advocate, Ronan Hynes, Partner at MHP Sellors offers a perspective on the growing awareness of perinatal trauma and its lasting impact on both mothers, families and healthcare providers. He also examines recent research, particularly in the United States, which has shed new light on this critical issue that demands our urgent attention.

Ronan and the healthcare team at MHP Sellors LLP are currently acting for families as part of the Critical Care Review into maternity services at University Hospital Galway, where 9 babies were delivered with subgaleal haemorrhages in 2022.

Scope

Firstly, what do we mean by perinatal trauma? Perinatal trauma encompasses physical and psychological injuries occurring during pregnancy, childbirth, and the immediate postpartum period. It is important to remember that birth processes can be both objectively and subjectively traumatic for individuals involved.

Recent Research

A groundbreaking study by Deckel et al. (2024) has highlighted several critical findings regarding perinatal trauma in the U.S. healthcare system. The research underscores that approximately 25-34% of women report their childbirth experience as traumatic, with lasting psychological impacts that can persist for years after delivery.

Deckel et. al findings include a correlation between inadequate informed consent processes and increased trauma reporting. The research also highlighted the significant role of communication breakdowns in escalating adverse events and the impact of systemic healthcare pressures on delivery outcomes.

In Ireland, a scoping review by Huschke et. al (2020) identified significant gaps in Irish perinatal mental health services. The research showed varying prevalence rates of mental health issues, with previous mental illness and lack of social support as key risk factors. The review found that current perinatal mental services are generally inadequate, with limited screening and follow-up. Recommendations were made for woman-centered research addressing diverse populations’ experiences.

Legal Implications

From a legal standpoint, healthcare providers must navigate complex responsibilities. Hospitals must maintain comprehensive documentation of patient care decisions, ensure proper informed consent procedures and implement effective communication protocols. Above all, healthcare providers must develop and maintain robust risk management strategies.

 Moving Forward

The intersection of legal practice and medical care in perinatal trauma cases requires a delicate balance. Prevention is clearly better than treatment. This applies not only to medical outcomes but also to legal risk management and professional support systems. As we advance in understanding perinatal trauma, several key areas require immediate urgent attention:

Enhanced Communication Protocols

Early acknowledgement and validation for mothers and families is critically important.  Perinatal trauma can be both objective and subjective. Healthcare providers must implement clear, compassionate communication strategies that prioritise patient dignity and autonomy throughout the perinatal period. In short, healing demands transparent acknowledgment and validation of what has transpired in the labour ward and/or theatre in the first instance.

 Prevention Strategies

Healthcare institutions must implement evidence-based protocols focusing on trauma-informed care. This includes enhanced staff training (including an emphasis on teamwork) and improved communication systems (both internal and external) between healthcare providers and patients.

 Support Systems

Establishing comprehensive support systems for affected mothers, family members and healthcare providers is crucial for long-term positive outcomes. Such systems may include but should not be limited to regular early debriefing sessions, access to mental health resources, clear pathways for addressing traumatic experiences and ongoing professional development in trauma-informed care.

Conclusion

The intersection of legal and medical perspectives in perinatal trauma cases presents unique challenges and opportunities. By understanding latest research and implementing appropriate protocols, we can work toward reducing traumatic experiences for mothers, families and improving outcomes for all parties involved. But first, as advocates, we must remember: healing begins with acknowledgment.