Understanding birth trauma
“Although the popularly desired outcome is ‘healthy mother, healthy baby,’ I think there is room in that equation for ‘happy, non-traumatized, empowered and elated mother and baby.’” – Midwifery Today
For many women the experience of childbirth can be traumatising; leading to long lasting effects both physically and psychologically. Regardless of the type of delivery or the eventual outcome, many women report that their birth experience was distressing or traumatic. Birth can be perceived as traumatic if the woman felt intense emotional reactions like fear, horror or helplessness during the labour. This, along with a trauma history can increase the risk that a woman could carry the emotional scars of childbirth long after the baby is born, and the physical wounds have healed.
“I felt like everyone was focused on the baby’s health and sort of forgot I was even in the room- when it became an emergency situation, they didn’t even really tell me or my husband what was happening”
“Still to this day I cannot even drive past the hospital where Amelia was born. She’s 7 and at school now but the thoughts of going past that place sends shivers down my spine…. I’m not sure I will ever be able to go there again. It’s why she doesn’t have a little brother or sister”
“I had my heart set on a certain type of birth, and nothing went like I imagined. When I had this beautiful happy baby, I felt like I wasn’t entitled to complain or grieve for that lost birth experience”
“My birth was beautiful but afterwards I had a horrible recovery with multiple injuries as a result of the labour. I had several operations and didn’t really get the quality time in the initial days with my baby. I feel like I was not able to bond with her and that still makes me sad today”
“My obstetrician couldn’t be at my birth and I was so anxious about the birth process anyway. Not having a person in the room that I knew was very upsetting for me. I found the other medical staff cold and mechanical. It might be every day for them, but this was likely going to be my only birthing experience”
These are just some of the stories that we hear from women who talk about a traumatic birth experience. While each women’s story is unique, there are some common themes that seem to emerge when we look at birthing stories. The themes include:
Feeling uncared for- during labour some mothers feel that they were either abandoned, unsupported or in some cases even ignored by health professionals or their family.
Feeling uninformed- in many cases women feel that things happened to them and they were not communicated with effectively to make informed choices.
Feeling powerless- especially when there has been a lot of medical intervention, many mothers feel that they had no control over what happened during the birth.
Feeling discarded- some women report that while the focus was on the baby, the mother’s own needs were not met during the labour
There can be serious consequences for mothers who have a traumatic birth experience with many going on to develop postnatal mental health issues. Outcomes could include:
Inability to bond or attach with baby
Reduced likelihood of subsequent births and pregnancy
Possible interferences in breastfeeding
Conflict in interpersonal relationships after the birth
Difficulties in sexual relationships
Postnatal depression or anxiety
In some cases, post-traumatic stress disorder (PTSD)
When birth trauma results in PTSD a woman might experience several symptoms including:
Intrusive reminders of the birth via nightmares, flashbacks, and intrusive thoughts that lead to psychological distress;
Avoidance of anything that reminds the mother of the labour or birth including doctors, hospitals, sometimes the baby and possibly others involved in the delivery;
Increased bodily arousal which can impact on sleep, make it hard to concentrate and increases feelings of anxiety or irritability. This is like being on edge all the time as though the body is still under threat.
The symptoms of PTSD can remain for a long period if not addressed appropriately. Some women might never seek help for these symptoms whilst others might seek treatment but be misdiagnosed with depression or anxiety. It is important to make the distinction between these conditions as the evidence-based treatment differs for depression, anxiety and PTSD.
Complicating a trauma birth experience is glib and often well-meaning comments like “oh well, at least you have a happy, healthy baby”. For many women they feel that they are not entitled to have a strong emotional reaction to their labour if they have been ‘blessed’ with a healthy baby. This can really invalidate the woman’s experience and create a sense that they can not or should not react in this way. Often women will think about other stories they’ve heard about infertility, pregnancy loss or sick babies and downplay their own experience as though theirs is not worthy of the intense feelings she might be having. This can complicate the recovery process after a birth trauma; adding guilt to an already incredibly stressful situation. This might also limit the mother’s willingness to seek help or talk to trusted people in her life about the experience, further compounding any emotional impacts.
While birth trauma can be incredibly impactful for a woman and her family there are several strategies to help women to overcome this experience. Possibly most important is being able to acknowledge that the birth was a difficult experience regardless of the outcome. It can also then be important to assess what impact the experience might have had on important relationships with either family, partner or even baby and how to rebuild or repair. Other important steps for women after a traumatic birth experience is being gentle with yourself, trying to reduce feelings of guilt or self-blame that can complicate recovery and talk to a trusted person who has the capacity to give the emotional support needed.
We also know that even in the case of PTSD there are several treatment options that can help women to process her labour and make meaning of this significant event. This can help the mother to reduce the impact on her life and her parenting right now whether the birth was 5 weeks or 5 years ago.