Surviving a traumatic birth
Childbirth is supposed to be an empowering, amazing
experience, right?
The reality is, for some women, giving birth does not go the way
they hoped and planned, and this can be extremely traumatising.
Sarah Tennant breaks the silence on traumatic birth and how to
cope.
I have always been faintly amazed by the
matter-of-factness with which women describe their birth
experiences. "By 9pm, the contractions were three minutes apart!"
just doesn't do the throes of labour justice.
My own birth experience, factually speaking, is similarly bland. On
St Patrick's Day 2008, I was induced for fulminating pre-eclampsia.
18 hours after prostaglandin gel started labour, Rowan was born
with a nuchal hand presentation. Shortly afterwards, my cervix
clamped down on the placenta, which had to be removed with forceps.
My blood pressure stabilised, I was transferred to a birthing
centre, and underwent an unexciting recovery. Rowan was healthy and
perfect; all was well.
Except it wasn't. Months after Rowan's birth, I was hesitating at
my computer screen, wondering if it was over-dramatic of me to
google "birth trauma". My memories of the experience were of fear,
panic, and disappointment. I remembered crying into my husband's
jacket when I was told off-handedly that my planned, idyllic home
waterbirth was out of the question. I remembered my first-ever
pelvic exam, by a doctor who didn't seem to care that he was
hurting me. I remembered contracting in the dingy, dreary Waikato
delivery room. That wing was being renovated - piles of lumber lay
around, and I contracted to the soothing accompaniment of
chainsaws. I remembered hiding my panic and desperation under my
family's trademark stoicism, and feeling like I was falling apart
while my midwife commented on how well I was handling it. Worst of
all, in defiance of platitudes, I remembered the pain...
Now the thought of having another baby brought on panic. I clicked
"Search".
Reaching out
Only those familiar with the internet can appreciate how a
medium so supposedly impersonal can provide such a wealth of
support, emotion, and personal experience. Through sites such as
TABS (Trauma and Birth Stress), ICAN (International Cesarean
Awareness Network), BirthCut and Birthtruth.com, I discovered
that I was only one of thousands of women
affected by bad birth experiences. What's more, as I started to
discuss the issue among my family and friends, it turned out
everyone knew someone who'd suffered a traumatic birth. Fascinated,
I absorbed dozens of stories - from my neighbour, my mother-in-law,
my mother, through to women on the other side of the world.
Common threads
The stories ranged from medically traumatic births to textbook
deliveries, C-sections to homebirths, supportive birth teams to
abusive obstetricians. Yet throughout the varied experiences,
several common elements became apparent.
Many women described a profound sense of being cheated out of the
moment of birth - the first sight of their naked, gooey baby
emerging. Marie* was so exhausted from blood loss that she no
longer remembers the moment of her daughter's birth; Heather
described herself as "out of it" on pethidine and pain; Jill missed
the birth entirely due to an emergency C-section. Mothers who are
presented hours after the birth with a bathed, swaddled baby often
find it difficult to believe the baby is really theirs. This
distancing, coupled with feelings of resentment towards the baby
for putting them through "birth hell", can often interfere with
bonding - as can the loss of an immediate breastfeeding
relationship, which often accompanies traumatic or surgical
births.
Loss of control is another major component of birth trauma. Whether
a woman plans a hospital birth with all the bells and whistles or a
back-to-nature homebirth, unexpected complications, interventions,
or even simply pain can cause a feeling of panic and
disorientation. Many traumatic birth
stories use terms like "uninformed consent", "coercion" and
"unnecesarean" to refer to their births. A TABS (Trauma And Birth
Stress) survey conducted in 1999 said New Zealand women listed loss
of control, multi-handling (care provided by several different
people throughout labour), being laughed at, and loss of dignity as
major reasons for birth trauma.
Lasting impact
Frequently, the impact of a traumatic birth reveals itself in
postnatal depression or post-traumatic stress disorder. Postnatal
post-traumatic stress disorder (PTSD) is thought to affect a
disturbing 7% of women. A condition frequently associated with war
veterans, PTSD manifests in symptoms such as fashbacks and
nightmares of the traumatic event, partial amnesia, panic attacks
and avoidance of situations or places which trigger traumatic
memories. Women with postnatal PTSD may avoid visiting the doctor,
feel shaky when they see pregnant women or babies, or find
themselves replaying the events of the birth over and over in their
minds.
Sadly, another common trend in traumatic birth stories is a lack of
support from partners and peers. Marie reflected a common
perception when she said her husband was supportive, "but he didn't
really get it". Many women find their partners initially consoling,
but less supportive of the long-term emotional, physical, and
sexual ramifications of a traumatic birth.
Other women can be even less helpful. Jill's mother found
it difficult to comprehend that a c-section was not an ideal
birth. Other women found their trauma dismissed by one-upmanship:
"My labour was twice as long as yours and I was fine", or "It could
have been worse, look how much blood Carol lost." Such
attitudes fail to engage with the subjectivity of trauma or
acknowledge differences in birth ideology and personality which can
shape a woman's perceptions of her experience.
Healing the trauma
A few weeks after her daughter Sara's birth, Marie found herself
writing her birth story in a journal. Although she has
no plans to read it again - over three years later, the trauma is
still too fresh - the act of writing helped her begin to process
the birth. She is not alone. Confessional and often eloquent birth
stories form a large part of traumatic birth resources.
Other women turn to music or art. The post-caesarean support site
Birthcut features some provocative artwork, ranging from the
poignant to the disturbingly graphic - a c-section incision drawn
as a sad face, a woman being sliced open with a scythe.
Many of these stories and pictures illustrate an important part of
the healing process: "birthrage". This is raw, primal emotion
directed at anything from the medical system to a woman's own body.
Birthrage can easily become destructive, manifesting as obsessive
emotional investment in others' pregnancies and anger towards those
who make the "wrong" choices. However, many women channel their
anger into birth reform, antenatal education, or post-partum
support. Some provide legal information for women who are victims
of malpractice; a surprising number become doulas or even
midwives, in the hopes of providing other women with a better birth
experience.
"Debriefing" after a traumatic birth is another valuable healing
tool. Many midwives talk through the birth with the mother
afterwards, comparing impressions and discussing any interventions
that occurred. Support groups are another useful tool - the simple
fact that other women have been through similar experiences can go
a long way towards validating birth trauma. In her insightful
article "You Should Be Grateful", Gretchen Humphries points out
that the "all that matters is a healthy baby" attitude causes many
mothers needless guilt over their own trauma. Although a healthy
baby is certainly important, the mother's physical and emotional
health is not a trivial concern; nor does it mean she is ungrateful
for her baby.
Krista Scott of Ican emphasises that the birth and baby are two
separate things, and you can hate the one without ceasing to love
the other. As she puts it, a bride who slips and breaks her neck on
her wedding day doesn't love her husband any less because she's
angry about the accident.
But it's not all "touchy-feely" - professional counselling and
psychotherapy are also recommended. Another option is medication.
Many postnatal depression and PTSD sufferers have experienced
previous depression or mental illness, and can often be prescribed
breastfeeding-friendly drugs by their GP.
Next time
For some women, the trauma of birth spells the end of childbearing.
Jill opted for a tubal ligation. Faced with the desire for more
children, Marie consented to get pregnant "only on the
condition that I could have an elective Caesarean". For those who
do end up having more babies, the pregnancy may be dominated by the
desire to have a "healing birth" - usually a birth experience
diametrically opposed to the previous one. In Marie's case, a
planned Caesarean finally helped her appreciate the wonder of
birth. Many women, however, choose a less medicalised model such as
homebirth or unassisted childbirth. Indeed, changing as many
aspects of the birth as possible - location, care providers, and
support people - is often recommended, even if these elements were
not the cause of the trauma.
Birth experts are divided on the subject of birth plans, the
crafting of which often dominates a woman's third trimester. Pam
England and Bob Horowitz, authors of Birthing from Within, feel
that birth plans foster a false sense of security, and that the
very necessity of avoiding interventions may cast doubt on hospital
births altogether. Others recommend the birth plan for
crystallising a woman's own desires and priorities, but caution
against becoming too rigidly attached to every detail.
For me? There will be a next time. Mind you, I'm not fantastically
keen on the idea. But deep down, I know it will happen. And
that's a start.
Sarah Tennant lives in Hamilton with her husband Dominic and
daughter Rowan (one).
Resources and support
* International Ceserean Awareness
Network (ICAN) www.ican-online.org/
* Trauma and Birth Stress (TABS)
www.tabs.org.nz
* Birth Matters www.birthtruth.org
* England, Pam and Horowitz, Bob. Birthing from Within.
* Griebenow, Jennifer Jamison. "Healing the Trauma: Entering
Motherhood with Posttraumatic Stress Disorder." Midwifery Today 80
(2006). Online:
www.midwiferytoday.com/articles/healing_trauma.asp
* Humphries, Gretchen. "You Should Be Grateful" (2001).
Online:
www.birthtruth.org/grateful.htm
* "Could This Be PTSD?" www.tabs.org.nz/diagnostic.htm
As seen in OHbaby!
magazine Issue 5: 2009
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