Letter: Birth pangs

We have known for many years of the need for debriefing for women who have had traumatic birth experiences, since we support many of them. We also hear from many traumatised fathers. Birth Afterthoughts is providing a valuable service but while it is helping to pull bodies out of the water, it might ask who is throwing them in upstream ("The childbirth conspiracy", Review, 21 April). Obstetric units should be judged by the percentage of trauma cases they cause, not just by perinatal mortality rates.

Many of the cases we see are caused by the large obstetric factories which have replaced small units and depersonalise staff as well as mothers. Others are related to unnecessary interference with labour and birth, or inadequately supervised junior staff.

Many trusts have cut midwifery staff on post-natal wards to danger levels, so problems are not recognised. For serious cases who need therapy, there are too few specialists in birth trauma; any old psychiatrist will do.

Explanations and reassurance are fine. But as women recover, we find they want both to complain and to campaign for better care for others. Many find that therapeutic.

Beverley A Lawrence Beech

Association for Improvements in the Maternity Services

Iver, Buckinghamshire