“I’ve debriefed her”: the problem with debriefing

I heard an obstetrician say that she is struggling to “debrief” all the women on postnatal ward whose care she was involved in, but she is trying her hardest. Not all wards have an obstetrician who will give over her time to sit with each and every woman on that ward to talk through her birth with her. This obstetrician mentioned that although she tries to get to every woman on the same day that the baby was born, she is struggling to do so.

As she spoke, I balked. Why? Now, I really don’t want to criticize this compassionate and hardworking member of staff. She is, I am told, one of the best. But I simply felt a tiny bit of horror that the word “debrief” was being used in this way. It’s a bit like many years ago, when I was told that people were using the word “counselling” in a very different way to what I considered counselling to be. I thought counselling was when you actively listen to some-one for an hour, and in doing so, they find their own way through their distress. But others were saying that they were “counselled” at work as a form of redress or a kind of telling off, dressed up as an act of generosity or kindness. 

The process of “debriefing” has become quite confused, misused and overused. While you are reading, I’d like you to take a moment to reflect on this: Why do we offer debriefing services? 

• Because women want it
• Because it helps women understand what happened at their birth
• Because it helps reduce PTSD
• Because birth professionals want to explain why they did what they did
• Because it helps women come to terms with what happened
• Because there is a good evidence base for it
• Because it saves money in the long run
• Because it helps professionals feel better
• Because others do it so we feel we should
• Because women value it
• Because it reduces the chances of litigation

There are many reasons. Do they ALL apply? Or just some of them? Or some of them in some services, and some of them in other services? I rest my case. Debriefing has become a little confused.

Now, onto another question. This one is a little more basic. What actually is debriefing? Once again, just try to answer this one for yourself, before you carry on reading. What actually happens during a debrief? Here are some options for you: 

• A one to one conversation about what happened during the birth led by a midwife with the notes
• A quick bedside chat with a birth professional about the birth and what happened and why they did what they did

Actually, that’s the only 2 options I’ve got, because that seems to be what debriefing services offer at the moment. But did you know, that that is never what debriefing was supposed to be about? It has morphed from its original evidence-based definition. 

And this begs a whole heap more questions.

• Why is this called “debriefing” and where did that term come from?
• Is it evidence based?
• Why are we offering it?
• Are we questioning how we offer it?
• Do women come away feeling better?

And here is the clincher: Is there a chance that debriefing services could exacerbate a woman’s distress, rather than relieve it? 

The answer to the last one is yes. There is research evidence that debriefing services can make trauma worse.
And here’s another thing. There is no evidence base for the benefit of providing debriefing services in the format that maternity care offers. But we just do it anyway!

It is really exciting that within the next 50 years or so, we will start to ask for an evidence base for the emotional care that we provide, as well as for the physical care. Thankfully, that process is already starting. In our Birth Debrief workshop, we (Mark Harris and Mia Scotland) explore all the questions in this blog, and we go further, to explore why debriefing can retraumatise, and how to debrief more effectively and safely. It’s the only workshop that we always do together – which makes it even more fun for us to run. So you get one clinical psychologist, one NLP master, one midwife, one birth doula, two authors, and two experienced professionals together for a day for one price. Oh, and you get information about how to provide a fabulous birth debrief service too. Come and join us!

Yours,

Mia Scotland