Most of us approach giving birth with a degree of trepidation but ultimately a belief that all will be fine. And for the large portion of us, childbirth IS fine. Sometimes we’re disappointed because we didn’t have the birth experience we’d hoped for. Sometimes we experience childbirth as more difficult than we’d expected, even when we HAVE expected it to be difficult. But ultimately we’re able to look back on our childbirth experience with largely positive feelings and move forward, bonding with our baby and going on the ride of our lives; ‘motherhood’.
However for some women, childbirth is traumatic. These mums are left completely distraught, usually experiencing feelings of overwhelming powerlessness, fear and horror. It’s more than the ‘baby blues’ and in fact, birth trauma creates difficulties above and beyond what is seen with postnatal depression and anxiety.
What is Birth Trauma?
Mums who have experienced a traumatic birth can experience ‘trauma symptoms’ in the days, weeks or months after giving birth. They can be plagued with nightmares or intrusive (and distressing) memories of childbirth that leave them feeling as though they are re-experiencing the traumatic parts of their childbirth experience. They can feel anxious, even panicked, and can experience constant feelings of agitation and restlessness that no amount of pragmatism, having a ‘good’ baby or reassurance from others alleviates. These mums can have significantly difficulty sleeping, feel irritable and have angry outbursts or panic attacks, avoid anything to do with the birth (at times this includes avoiding their baby) and feel detached from their loved ones.
To be diagnosed with post-traumatic stress disorder (PTSD) following childbirth, women need to experience a particular suite of symptoms, at a specific intensity and for a certain period of time. Research shows that between 2 and 5% of women meet the criteria to be diagnosed with PTSD as a result of a traumatic childbirth. However, many mothers experience trauma symptoms following a traumatic delivery that don’t quite meet the criteria required for this formal diagnosis. Regardless, the suite of psychological, emotional, behavioural and physiological trauma reactions that mothers DO experience have a significant and negative impact on their wellbeing and their experience of motherhood.
What Causes Birth Trauma?
There are a number of factors that have been shown to increase the risk of a woman experiencing birth as traumatic. Women who experience a high degree of medical intervention during delivery which occurs with significant urgency so as to prevent loss of life, often describe the delivery as traumatic. The loss of control over the birth process, the sometimes-abrupt nature of medical professionals, the recognition of risk to their own or their baby’s life, are all ingredients that can leave a woman deeply scarred by her experience. Prior traumatic deliveries, particularly those that occur within the context of stillbirth or leading to loss, are also significant triggers for PTSD.
Mia had experienced complications with the delivery of her first daughter which she described as being ‘a little scary’. However she recovered emotionally and physically quite well and was able to enjoy her experience of first time motherhood. However, the birth of her son was truly traumatic. Mia remembers the midwives and obstetrician’s demeanors changing during her delivery. They became very serious and began talking about her and what they were doing as if she wasn’t there. She remembers them giving her husband ‘a look’ as they told him to say goodbye and quickly ushered him out of the room. As Mia lost consciousness she recalls believing she was dying. Mia was unable to think about her son’s birth without crying and feeling very frightened. She found herself snapping at her husband and her daughter, was often overcome with panic and was generally extremely depressed. Mia found it difficult to bond with her son and she felt angry towards him; and then felt terrible for feeling that way.
Apart from the birth itself, miscarriage and loss of loved ones in the months leading up to birth, are also risk factors for PTSD. Previous traumatic events (separate to pregnancy and childbirth) as well as childhood abuse, are other life events that can increase a woman’s risk of experiencing birth as traumatic. Women with histories of sexual abuse can experience the poking and prodding that typically occurs during pregnancy, let alone childbirth, as once again violating. The medical procedures themselves can trigger highly distressing memories that tip them into a sequence of symptoms that mark the commencement of a formal traumatic response.
Katie was 28 when she had her first child. She’d been sexually abused as a child and had to psych herself up before every obstetric appointment so that she could cope with the routine checks her obstetrician did. Katie knew she should probably tell her obstetrician about her past but she couldn’t bring herself to do it. When her baby became stuck and she needed a vacuum extraction, Katie experienced a flashback of her sexual abuse. She felt as though she was being abused then and there, became highly distressed and then without planning to ‘checked out’ in her mind. For Katie not only was childbirth traumatic, she experienced significant grief at having missed out on being ‘present’ for her child’s birth.
Responses to Traumatic Events
Women who have experienced a traumatic birth often try to ignore the feelings that they have in response to the birth. They often use a wide-range of ‘strategies’, sometimes consciously sometimes not, to convince themselves that ‘it wasn’t that bad’. Some make frequent comments that ‘others have had it worse’. While some mothers may concede that birth was ‘awful’, their language is largely tentative and fails to adequately portray the horror that they really felt. Many are afraid to share the intensity of their reaction because doing so, makes it real. And real is scary.
Unfortunately, well-meaning family and friends can reinforce these responses. Not wanting to see the new mother struggle, some are inclined to look for the silver lining. In these instances, they may say things like ‘what’s important is that you and your baby are healthy’ and ‘put it behind you and focus on your baby’.
However, the reality is that birth trauma just doesn’t go away. Traumatic birth experiences shape women’s mothering journeys. Their distress, anger and fear from birth don’t stay at the hospital. They go home with mums and ‘sit’ between them and their baby, their partners, family and friends, leaving them feeling disconnected. When they are ready or simply when the trauma has worn them down, and much to their horror and shame, mums often admit to feeling angry towards their baby. They can start to believe they were never meant to be a mother, they aren’t a good mother, they’ve failed right from the start and that things will NEVER be different. With all the panicking, snapping, restlessness and negative thinking, mums can start to believe they will never feel like the ‘old them’ again.
What Can Be Done?
This all sounds very doom and gloom and admittedly, recovering from a traumatic birth is an emotionally painful process. However, women DO overcome their feelings of trauma and go on to enjoy their babies, partners and life once again. They DO go on to have more children, if they’d planned to do so, and the large portion go on to have a much better birth experience. However, trauma is not something that women simply wake up from one day. Getting from the point of being traumatized to genuinely feeling like your old self and moving forward is a process. There are a number of steps that women can take to help them through this part of their motherhood journey.
- Acknowledge your experience. This can be the part of the process that takes the ‘longest’ time to get to. But it’s important that you do.
- Know that you aren’t alone. Although you are distressed, angry and scared, it’s important to truly know that these feelings are a normal response to a traumatic event. You’ve come through a harrowing experience and the symptoms you are experiencing are telling you that you haven’t made sense of it yet and that you need to give yourself time to heal.
- Tell your loved ones how it really is for you. It’s important that those closest to you actually know what’s happening for you. Apart from the fact that acknowledging your trauma is an important step in your recovery, it also helps your partner understand your reactions and support you.
- Ask for, and accept, support. All mums need support, particularly in the days and months after childbirth. You need even more support if you’re recovering from a traumatic birth. Allow people to do things for you, listen to you as you talk about your experience, cry, rant or just sit with you when you need their quiet presence.
- Speak to your obstetrician, midwife, doula and ask for explanations of the medical intervention taken. Ask to be ‘walked through’ the process of what unfolded and why.
- Write about your birth experience the way you wanted it to happen. It can be very therapeutic to write about your birth experience; how you felt and what you thought. We know that having a cohesive narrative – a story with as few ‘holes’ as possible (even if unpleasant) – helps people overcome their trauma. Knowing what happened, knowing the meaning you made of parts of your story as well as the experience as a whole and acknowledging and expressing your feelings, are all important steps in healing from trauma.
- ‘Re-write’ your birth experience. There is often a point during a woman’s childbirth experience where things began going downhill. You can continue the healing process by writing down everything that happened up until that point, as it happened. But from there, re-write what you wish had happened.
- ‘Re-do’ your birth experience. Some women find it truly helpful to in some way, re-enact their birth experience as they wished it had happened. Talk through your shared experience with your baby or have the conversation with your baby that you had imagined having as you’re sitting and having a cuddle or having a bath together. Reflect on what you might find healing and give yourself the opportunity to fulfil that as best you can.
- Be patient with yourself as you get to know your baby and allow yourself time to fall in love with your baby.
- Seek counselling from a psychologist with experience working with pregnant women and new mothers AND trauma and who used evidence based treatments such as Trauma-focused cognitive behavioural therapy or Eye Movement Desensitisation Reprocessing (EMDR).
- Honour your thoughts and feelings about subsequent birth experiences. You don’t have to go to the same birth practitioner again if your trauma was in part, caused by their insensitivity and dismissiveness. Consider your options, meet other practitioners and arm yourself with as much knowledge as you can. Ask your partner to speak up about your wishes throughout pregnancy and childbirth if they see you struggling to do so.
What Can Others Do?
It’s important that partners offer as much support and patience as possible. Validating the new mum’s experience of motherhood as well as the traumatic nature of childbirth is imperative to her healing. Research shows that dismissing or downplaying the trauma, even if doing so is with good intent, can be hurtful and prolong recovery.
Talking together as a couple is vital. Each of you had a different experience of the birth and both need to be acknowledged, supported and shared. In fact, many partners also report being traumatized by a traumatic childbirth experience. Witnessing medical interventions and feeling powerless to help the birthing mother can leave many partners distressed, confused, ashamed and scared. It’s not at all unusual for partners to seek out therapy for their own trauma, particularly when they are not wanting to exacerbate the mother’s symptoms. While therapy is always a good step, and sometimes it’s helpful to delay conversations that would exacerbate each other’s trauma, it is important for partners to eventually talk with one another about their individual experiences.
While for most people childbirth is a positive experience, for some it can be traumatic. The impact of childbirth trauma can lessen over time without professional support and particularly if women follow some of the steps above. However for those who have a high number of trauma symptoms, and particularly if there are enough to warrant a formal diagnosis of post-traumatic stress disorder, seeking professional psychological assistance is imperative. Trauma can be overcome with patience and understanding and both a reflective and proactive approach.
Kirstin Bouse
Clinical Psychologist
