Birth Trauma

Birth Trauma

While there is certainly alot of success for couples (meaning that many women do end up with the births that they had hoped for), there are also the very common realities that take many women off guard:

  • The emergency C-Sections.
  • The “cascade of interventions” during childbirth that may start with induction.
  • The delivery by an Obstetrician/Midwife that was not preferred.
  • The reality of pain in childbirth and/or inadequate pain relief.
  • Lengthy labour or short and very painful labour
  • The loss of sense of control that can occur for many, many women, especially those who have a prior history of trauma or abuse.
  • The premature baby or baby with medical issues that lands a family in the NICU/SCN.
  • Birth of a damaged baby (a disability resulting from birth trauma)
  • Impersonal treatment or problems with the staff attitudes
  • Lack of information or explanation
  • Not being listened to
  • Lack of privacy and dignity
  • Fear for baby’s safety
  • Poor postnatal care
  • Breast-feeding challenges.
  • Stillbirth
  • Miscarriage

These things can happen, no matter how “prepared” or with what intentions well-meaning couples and medical providers hold on to.

Often, women present weeks, months, even years after experiencing a birth that was in someway “traumatic” for them. One of the key things we now know is that it is not the specifics of the birth events that can lead to a mum being traumatized, but her PERCEPTION of these events. In other words, what looks like a “perfect birth” on paper, in reality for that woman, she may be walking away with some significant post traumatic stress. Doctors, Midwives, Doulas, partners and family members, may assume that all is fine for a mum after she delivers a healthy newborn, but in reality, her perception is very, very different.

When looking at the probable “causes” of postpartum post-traumatic stress disorder, this is what we know may contribute to risk:

  • A perception of lack of caring: Mums feel abandoned by providers or partners during their pregnancy or childbirth experience; mums do not feel reassured or supported during childbirth.
  • Poor communication: Mums feel unheard during childbirth and feel that their perspectives around choices were not validated. Mums feel uninformed about choices being made to benefit herself and her baby during childbirth.
  • Feelings of powerlessness: Mums feel unprotected and under-supported by medical/birth staff. Mums feel that they had no control over birth process.
  • A re-triggering of old trauma histories or fears: Mums went into childbirth with intense fear and uncertainty that was not addressed.
  • Does a healthy baby justify a traumatic delivery? Mums feel that attention was on health and well-being of her baby while she went “unnoticed.”

Finally, men who witness their partner’s traumatic childbirth experience may also feel traumatised as a result.

The reality is that postpartum PTSD is not that uncommon. Statistics vary, but currently we sit at around the 9% mark of women who deliver a baby who will go on to develop symptoms of post-traumatic stress after birth.

In a recent study published in Birth: Issues in Perinatal Care (38:3 September 2011) the symptoms of Postnatal PTSD were broken down into three categories.

  1. Intrusion symptoms: Repetitive re-experiencing of the birth trauma through flashbacks, nightmares, distressing recollections of the birth experience, and psychological distress following birth.
  2. Avoidance symptoms: Attempts to avoid reminders of the birth experience such as doctors offices as hospitals, people associated with birth experience (sometimes including the baby), thoughts about the birth experience.
  3. Increased arousal symptoms: Difficulty sleeping, heightened anxiety, irritability, and concentration challenges. Feelings of being on edge “jumpy” or on guard all the time.

Consequences of Postnatal PTSD

And there can be significant consequences for mums with postpartum PTSD if support isn’t put into place.

  • Mums who suffer from PTSD are less likely to have subsequent births (and are more likely to have an epidural or a scheduled C-Section if/when they do)
  • They are less likely to receive follow-up medical care
  • They are less likely to breast feed (due to pain, feelings of violation, low milk supply, self doubt and lack of confidence, and/or painful reminders of childbirth)
  • They are more likely to have challenges bonding and attaching with their newborns (again, often due to triggering reminders of events)
  • They are more likely to experience conflict in their marriages/relationships and experience sexual dysfunction.

Mums who suffer from Postpartum PTSD are more likely to also suffer from depression.

We know that risk factors such as antenatal depression, lacking social support, previous trauma histories, breast feeding challenges, and physical challenges following childbirth can heighten a woman’s reaction to trauma. But we also know that preventive measures such as well-established stress management strategies, “health promoting behavior” such as healthy sleep, nutrition, and exercise, and opportunities to debrief birth experiences can reduce a mum’s risk for PTSD. In other words, with effort, some of these postpartum PTSD stories can be lessened.

A mum with Postpartum PTSD needs support in re-processing the experiences that led her there; in understanding why she developed the reaction that she did; in understanding the role of old and new beliefs that may have led her to her reaction to her birth or that have been created due to her experience in birth. These women benefit greatly from having an opportunity to re-frame and better understand their birth experience for what it was—to them. For many women, specific work around trauma is necessary.

It is a great privilege to be given access to a mother’s story about her birth, whether it was one that met her expectations or one that was upsetting and “traumatic.” These stories are a woman’s first experience with being a mum to a baby on the outside, and the ones that will often inform her earliest parts of motherhood. 

 

So…..What is your birth story?