When is a birth a traumatic birth?

Defining a reflection in accordance with Raynor et al (2005) it is a process by which a person recalls their experience, thinks about it, mulls it over, and evaluates it in order to lead to a new understanding and appreciation. Reflection must also lead to a changed perspective and not only involve an analysis of events. (Atkins and Murphy 1993). In this reflection I am trying not to get bogged down in self pity, self recrimination and self justification which is why writing within this group I can hopefully find an objective view point on what has occurred.

How is Post Traumatic Stress Disorder defined?

It is the term given to a psychological and physiological set of reactions anyone may experience when something traumatic, scary or bad happens (TABS 2001). In 1980 the American Psychiatric Association said that a trauma had to be outside the usual range of human experience, in 1994 the definition was altered to include events in which a woman feared for her life or bodily integrity and meant as a consequence women who suffered as a consequence of giving birth could be defined as such.

Reflection on the case
A couple of weeks ago I visited the local unit to find a past woman of mine in having an antenatal assessment with another midwife during her second pregnancy. I had been her LMC for the first pregnancy. I was told by the new midwife that I was considered to be responsible for the 'trauma' she suffered during her first birth. I was immediately horrified and couldn't recall anything specifically traumatic about the event. I have spent the last week looking through the notes and for the life of me I cannot find how the said event works in relation to me.
The pregnancy was relatively uneventful there were the usual frequent trips to be checked over at the hospital for 'spotting' and there was some evidence of the primigravida's anxiety but nothing which seemed out of the ordinary.
She was seen by me on labour ward at 2am at term in ?spontaneous labour. The complaint was backacke, with one documented tightening felt in 25mins. On vaginal examination unsurprisingly she was 0.5cm dilated head was -3station and the cx was still 2cm long. I started a CTG for reassurance to her and all was normal. But she didn't want to go home and her mum didn't want to take her home. I telephoned the obstetrician and it was agreed that she could have some pethidine and go on to the ward for reassessment in the morning. At 02.50 Pethidine was given and she was shown to a bed on the ward where the ward midwife took over and at 03.20 I went home. The records documented by the ward midwife show a check over at 03.20, 04.30, 05.00, 05.15,05.35,06.30, 07.00,07.30. I was contacted again at 07.15 to attend. I live out of town a 30min drive in to the unit after getting out of bed organising childcare I made it to the unit at 08.12.
Good labour progress was observed and a decision made with consent to perform another VE. This time she was 7cm, membranes intact head -2. Everything progressed well spontaneously, at 08.45 contractions became expulsive in nature with an urge to push at 09.10. Spontaneous pushing began at 09.30 and membranes became visible at 09.50. At 09.55 there was SROM, clear liquor draining and normal birth at 10.00 in squatting position. Actually I was lay full length on the floor! EBL was 250mls with 2nd degree tear sutured. There was a physiological 3rd stage with ecbolic given 30mins later when lochia appeared to be a little heavy and 2 large clots were expelled from the uterus. She felt faint at 11.30 but following some fluids and something to eat all was well. The baby weighed 3930gms and was a boy. I am convinced had she not been in an upright position and laboured in an upright position then she may have had difficulties with the birth.
She also states I never visited her postnatally. I have again reviewed the notes there are 12 contacts recorded on the notes 9 visits 3 phone calls which I made to her not her to me. I made a referral to the GP on day 5 because I was concerned about her emotional state, the breastfeeding consultant visited and the Plunket nurse saw her in her first week home. She also had support from the Karitane nurse.

I am searching now for a model on how to reflect upon this experience so that I can learn from it and take it forward.