Birth trauma can affect any woman who has given birth. Although it is experienced by many women, most women do not talk about it and many may not even know they have it. This silence does nothing to help women move past their trauma.
What is birth trauma?
Birth trauma is a normal reaction to events in labour and birth that you perceive as being scary, out-of-control, helpless, or painful. Birth trauma can result from pregnancy, birth or even during the postnatal period. The response may be one of intense fear, helplessness or horror. Sometimes the events trigger memories of earlier trauma that remain unresolved.
Symptoms might not emerge for many months after the birth, or even later, when you plan for the birth of your next baby.
How will I know if I have birth trauma?
The symptoms of birth trauma are many and varied. A common theme is that the trauma interferes with your enjoyment of daily life. The trauma issues may surface at different times then completely disappear. Some women experience:
- flashbacks of the event, and sudden, vivid memories. You'll usually feel distressed, anxious or panicky when you're exposed to things that remind you of the event
- avoidance of anything that reminds you of the event. Some women never talk about their births, or avoid hospitals. In contrast, other women talk about their birth trauma all the time; this is their way of expressing their extreme hurt, anger and fear.
- you may also experience emotions such as anger, irritability, and hyper-vigilance (feeling jumpy or on-guard all the time)
- nightmares of the birth
- physiological responses when you're exposed to events resembling the traumatic event, such as panic attacks, sweating and palpitations
- numbed emotions.
The personal growth that this event affords you, the insight into your values and beliefs, and the journey of healing are all very positive outcomes
What causes it?
Most of the causes of birth trauma can be avoided or lessened considerably by those looking after the woman, through simple measures such as understanding the woman's needs and expectations and providing sensitive care in response. This is where continuity of care programs offered by midwives really benefit women.
Explanations need to be provided before interventions are carried out, and in order for you to feel respected and safe, your permission needs to be sought before any treatment, procedure or examination takes place. Women also have a role to play in clearly communicating their needs and expectations to care providers. One way to do this is through a birth plan.
There's no standard cause of birth trauma. Some experiences than can result in birth trauma include:
- traumatic birth - eg, episiotomy, caesarean, forceps, a baby who was injured during birth
- emergency situations, including caesarean section
- lack of pain relief when pain relief has been requested
- impersonal treatment
- loss of control over the experience, or the perception that your wishes weren't respected
- being cared for by strangers
- invasive procedures such as vaginal examinations, episiotomy, stitches
- separation from your baby
- feelings of loss of control - eg, an induction you didn't want, a caesarean for a breech baby when you wanted a vaginal birth
- invasive procedures without explanation or your permission
- forceps delivery or suturing without adequate pain relief
- post-partum haemorrhaging.
Treatment options for birth trauma
During your path to recovery, you'll need a few helpers along the way. A trusted friend or relative can help enormously - someone who knows you well, understands what it's like to be you, and who accepts you. They need to be empathic and non-judgemental.
Some women see professionals, such as psychologists and midwives, to help them recover. Psychologists are educated to provide therapy for people who have experienced trauma, and they provide excellent services for as long as you need them. Independent midwives have usually studied counselling as part of their education, and have the added bonus of knowing about pregnancy and birth.
Family and friends can help too - for example, someone could babysit while you get some sleep or time out from your child. Some women like to talk to other women who have experienced birth trauma as this helps them see they're not alone. Sharing experiences is very healing and allows you to gain perspective and validation about what has happened.
During these times, it's easy to forget to take care of yourself. Remember to eat well and get some daily exercise. Limit caffeine, sugar and salt, and tuck into vegies, fruit and whole grains, balancing this with fish, chicken, eggs, nuts and seeds.
Natural therapies can help a lot - therapies to try include yoga, massage, reflexology, aromatherapy, homoeopathy, naturopathy and yoga.
Journaling is a great exercise; some women also draw. This gives you the added bonus of being able to use colour and "left brain" action to express yourself. When you're journaling, you might want to record your birth story. Some women write it a few times. You could write your birth story from your perspective, then from the perspective of your baby, partner, midwife or doctor, and so on. When you're writing about your experience, pay attention to any feelings that come up for you as you write. Notice how writing makes you feel in your body. As you write your story, you might begin to discover more clearly which events are particularly hard for you to deal with.
Read books or articles on birth trauma.
Some women also like to write a letter to their care providers (there's no need to post it), as this helps them express their emotions in a safe way. Other women explore the option of writing a formal complaint to the hospital or Health Care Complaints Commission.
Another option is to obtain a copy of your medical record. Simply contact the hospital medical records department or the Patient Representative (a fee may apply for this service). Once you have a copy, it's a good idea to go through your record with a professional, such as a GP, midwife or obstetrician, who can interpret all the "medical-speak" for you and help you make sense of the notes. This exercise can go a long way to answering the "why?" for you.
In the end
There's a positive end for all women who have experienced birth trauma. The personal growth that this event affords you, the insight into your values and beliefs, and the journey of healing are all very positive outcomes that can help you move forward in all ways in your life.
Advice for pregnant women
So, what can you do to avoid birth trauma? There are many things you can try:
- Be assertive about your needs. Change your care provider if you need to; ask for help; research your options from a wide variety of sources.
- Explore what sort of birth experience you'd like, then set about finding a care provider who'll support you in achieving this.
- Write a birth plan so your care providers know your preferences.
- Consider home birth as this will allow you more control over the experience.
- Get help early if you need it.
- Consider what you'll need in order to feel safe during your pregnancy, labour and birth.
Melissa Maimann is a registered midwife. She runs groups for women in Sydney who have experienced birth trauma.
You can discuss traumatic and disappointing birth experiences with other mothers in the Essential Baby forums.