October 28, 2010

Birth Trauma

I have had the fortune to support women through labor and delivery in the role of a labor support doula for the past seven years, and as prenatal yoga teacher for the past nine. During this time, I have listened to many birthing stories, and unfortunately, not all of those stories have been positive. Many mothers go through difficult birthing experiences, and are often not given the space to digest and process how they feel. I understand that this is not the most joyful topics, but I feel that it must be addressed.

Birth trauma is often defined as physical injury to an infant during the birth process. However, I am taking the definition from the mother’s perspective. Maternal birth trauma covers a wide variety of unfavorable experiences. For example, the mother may feel that during her labor she was unheard or unsupported, or she may feel that she was humiliated or made to feel weak and exposed, as birthing requires a level of physical exposure that can be difficult for many women. There are rarely other times in one’s lives that we are expected to be so open about one’s physical nakedness. The laboring mother is dressed in a thin robe exposing her bottom (quick tip- put a second robe on to cover your bum) and then also expected to spread her legs and expose her vagina to everyone present in the room. In some cases, the birth trauma is so severe that it includes the flashbacks with which PTSD is commonly associated. Linda [name changed for privacy] experienced this after her child’s birth in every part of her life, including lovemaking: “I couldn’t have sex at first because I saw the [hospital staff’s] faces whenever I had my legs apart.”

Additionally, some women have a hard time recovering from an undesired outcome of birth. That could be anything from disappointment in how labor unfolded to having an unwanted intervention, like an episiotomy or cesarean. I have had several mothers express their desire to have a natural birth, and were angry at themselves for either taking an epidural or for having to have a c-section.

About a year ago, I was at a labor that had a very abrupt turn of events. The baby was going into distress and the doctors reacted skillfully and quickly. The doctors – in my opinion- did a great job reacting to the baby’s distress, but this resulted in a very chaotic environment in the delivery room. Things were happening very quickly; the mother was given an episiotomy without warning (or local anesthesia) or consent, and there was a lot of back and forth talk of cesarean being necessary among the doctors. The baby was delivered (safely) with the aid of a vacuum extraction, and both the mother and baby were physically in good shape after the birth. However, I never talked to the mother in depth about how she felt afterward. As an observer, I found the trauma and emotion from the birth overwhelming. I can’t image how she felt.

There is also the trauma of feeling pressured into making a choice or decision that you did not want. Many mothers express pressure to submit to an induction they did not want, and then feel regretful if it turned out to be a difficult labor and delivery. Most hospitals have a time limit with how long a woman can labor or push.

Mothers are justifiably reluctant to discuss the psychological damage of childbirth because they don’t want to be labeled abnormal or crazy. Many mothers have disclosed to me that they find it very difficult when people say to them , “Look at your beautiful, healthy baby. Doesn’t that make it all worth it?” I also hear mothers say, “I had a horrible birth, but at least I have a wonderful baby.” Please do not think the outcome of the baby is not of great importance. It most certainly is; however, it is important not to discredit what the mother is feeling, and how the experience she endured affected her.

Here is what one brave mother, Joy, recently told me. “Whether or not you want an epidural, no epidural, scheduled c-section or to give birth hanging from the ceiling, you should prepare yourself for the possibility that any of the above could happen (or even something you don’t think of). And it is normal and natural to mourn what DIDN’T happen during labor and delivery. People will say “all that matters is a healthy baby.” While true, this statement glosses over the fact that you have spent a significant period of time thinking about, imagining, and preparing for birth and it can be hard to process an experience that may have felt traumatic. It is OK to feel bad and grieve a little, even though you are so happy with your little baby. Also, don’t forget that if it was traumatic for you, it was probably also traumatic for your partner.”

Birth stays with us for life whether it be a delightful story or a traumatic one. I was brought up with my mother talking about my birth to anyone that would listen. As she likes to say “I was almost born on Storrow Drive (For those not from Boston- it is the equivalent to the West Side Highway). I have a very positive view of a quick, easy labor. Last Thanksgiving I was talking to my husband’s grandmother about her births. It is amazing that she could recall, with so much clarity the events of her birth- 65 years ago! She ended up after many, many hours in labor having a c-section. Still to this day, she carries a cloud over her head about the difficulty she endured. The births we experience then colors our outlook on the birthing process.

While I am in no way positioning myself as a trained therapist, I do feel confident in offering the advice of honoring what you are feeling and seeking support if desired, to digest the experience. There is no reason to feel embarrassed for feeling sad or disappointed from a birth that progressed differently than you had envisioned. By allowing yourself the time to process and work through the experience, the difficult impression of a arduous labor may shift and be lifted. And the lasting impression may be of the joy of your happy, healthy baby.



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