An exploratory study of black mothers' traumatic birth experiences in the UK

For many mothers, childbirth is a traumatic event that carries long-term mental health implications, sometimes leading to a diagnosis of post-traumatic stress disorder. The research on traumatic birth-related mental illness and impact has directed its efforts to achieve early identification and treatment on one side, and access women's narratives on the other, producing detailed evidence for a clinical approach and a psychosocial understanding of its occurrence.

The recent UK reports on the staggering racial disparities in maternity outcomes and experiences show an overlap with well-established risk factors for birth trauma and highlight the need to consider traumatic birth through a wider ecological lens that recognizes the impact of non-medical aspects in its development, also known as social determinants of mental health.

Understanding how social determinants of health impact childbirth care delivery may support better prevention and treatment, and provide the possibility to integrate the current individual and psychosocial approaches within a holistic, ecological model of illness emergence that considers all personal, social and systemic aspects.

Social determinants have been most frequently studied by accessing large medical datasets, however, there has been a call from both scholars and public health experts to pursue a better understanding of health inequalities through a more complex system model of evidence, that includes increased attention to the lived experiences of marginalised groups.

This study responds to these calls by considering the effects of a social determinant of health, ethnicity, through the embodied experiences of traumatic birth of a group of black women. It recognizes the implications of researching black women's reproductive healthcare experiences, particularly by a white student, and attempts to counteract the intrinsic power imbalances and possible unconscious biases by means of cultural humility training and conscious methodological choices.

To this extent, it uses an art-based participatory methodology, body mapping, that is embedded in a decolonising, social justice-oriented approach, and has historical importance in providing rich insights into the illness experiences of marginalised groups. In body mapping, the researcher works as a facilitator that supports the participant in creating a life-size body map that represents their embodied narrative of events, beliefs, feelings and perceptions relevant to the research topic.

The participatory element of body mapping is also mirrored throughout data analysis and report writing, through a feedback loop that respects the participant's narrative and strengthens research quality as a member checking practice.

This study engages with the debate on traumatic birth emergence by exploring an ecological model of birth trauma, as well as contributing to the broader debate on healthcare inequalities and standards of care for marginalised groups.