What is Birth Trauma?
What happens when birth doesn’t go to plan? What do we mean by birth trauma?
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For all of us the transition to being a mum is a huge life event. For many women their birth experience happens just as they hoped and wished for, but for many women their birth experince is not at all what they expected.
Their birth is not what they planned for and this can leave women starting the journey of being a new mum feeling vulnerable and distressed.
A difficult or traumatic birth occurs when women find some aspect of their birth traumatic, distressing, and/or fearful. It doesn’t matter what you found difficult, it’s your birth and if something felt fearful, frightening, scary or out of control then that is your story. Never let anyone belittle or dismiss this.
Currently around 30% of all women find some aspect of their birth traumatic, which equates to over 150,000 women per year. That is a lot of women starting the journey to motherhood feeling really difficult and overwhelming emotions.
Yet, birth trauma is not well recognised or identified.
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I want women to be able to find support in discussing their birth because leaving birth trauma untreated in the long term can lead to enduring health issues both for mum and her family such as depression, anxiety, sexual difficulties or finding it hard to bond with your baby.
Trauma at birth encompasses more than life threatening medical emergencies such an emergency caesarean or a bleed, just as often it can be about the care and language we give to women in labour. Often women tell me it is how they were treated or spoken to that distressed them the most. This might be being ignored or dismissed by staff or feeling unheard or not listened to. We are so vulnerable during birth, we may be semi naked, tired or in pain and how we are made to feel during birth really matters.
Trauma can often stem from a lack of kindness or care, staff not introducing themselves or not respecting a woman’s wishes during birth, or women feeling coerced during labour to make rapid complex choices.
Take for example, Emily who comes into delivery knowing her midwife and having had lots of antenatal discussions about her birth preferences. Emily then has a long painful labour ending in a caesarean birth and a postpartum bleed. She perceives her birth as positive, despite it not being the birth she hoped for. Emily had someone by her side throughout explaining to her what was happening, reassuring her, allowing her to raise concerns and fears. This helped in sustaining a sense of control and choice, including for example, immediate skin to skin after birth in theatre.
In a different scenario, Anna comes onto a busy ward to meet a midwife she does not know who is courteous but not especially warm. The midwife keeps leaving the room for long periods of time and Anna is increasingly worried that her labour is progressing quickly and she might deliver on her own. Anna feels out of control and scared. She does not get a chance to ask about pain relief much and by the time she asks for an epidural, which she wanted, she is told it is too late. When the baby is born he is placed on Anna’s chest immediately uncleaned, which she did not want, and when Anna asks the midwife to take the baby and clean him the midwife makes a comment to Anna - “that’s unusual”. Anna transfers to the postnatal ward where everyone comments on how lucky she is to have had such a fast birth but she doesn’t feel very lucky or happy. She starts to ruminate about what the midwife said, doesn’t sleep all night, feels guilty about not having her son on her chest immediately after birth. Anna has a rapid four-hour vaginal birth with no complications or medical intervention. But she also has trauma from her birth experience.
How do I know if I have had a birth trauma?
With birth trauma we would expect to see a changing mood, fluctuating from sad to angry/irritable to tearful to guilty. This usually occurs alongside constantly rethinking about your birth and feeling that you cannot stop these thoughts. You may be replaying your birth in your dreams, thoughts or see visual flashbacks of moments such as a comment that was made, a doctors’ face, blood on the floor, or the baby not crying after delivery.
Women often feel unable to relax or feel on edge all the time and may be overprotective of their baby or check on their baby all the time. Women often find it hard to hear other people’s birth stories or see other pregnant women or small babies. It might be hard to return to your hospital or you may avoid seeing medical professionals.
Our response to difficult births will vary on a spectrum. Some women need no treatment, some have therapy, some women develop PTSD.
Sometimes these thoughts and feelings fade over the first few weeks after baby is born. Sometimes these feelings don’t and if they are still there most days for a good portion of the day at three, four, five months postnatal and/or are affecting your day to day life then I would encourage you to seek some support.
What might help?
The key is to try to find someone who you can be courageous enough to talk to and tell your story and to know they are really listening and hearing you. Many women dismiss their feelings or feel guilty talking about their birth experience, please don’t!
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Take a look at the 'Get Help' section for lots of ideas about how you can access support.
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It is possible to have a bad birth experience and still be a good mum and love your baby very much and we must allow women the space to process their birth. A healthy baby is not all that matters.
Often women are never asked about their birth story and so these traumatic feelings and emotions remain. I have met women in their 70s who have told me about their birth trauma for the first time.
Commonly, I encounter a woman in a second pregnancy with undiagnosed post-traumatic stress disorder for years as result of her first birth. It is not uncommon for women to never have another child because their birth experience was so traumatic.
Who you speak too depends on you, who do you feel comfortable with? This might be your partner, friend, a midwife, your health visitor or your general practitioner.
If this is too overwhelming sometimes writing it down in a blog or useing a journal can help.
Online forums can be very helpful as it allows us to speak anonymously, this might be via twitter or a peer group forum. There are some great birth trauma campaigners @nestingspace @howtohealabadbirth @birthtraumasupportfamily
Various other factors can help birth trauma such as:
Diet, try and eat on a regular basis, plant heavy meals. Ask friends to cook for you or buy you’re a meal subscription plan rather than baby clothes!
Regular exercise is a huge help. It doesn’t need money or equipment. We can all walk round the block with our baby. Or try a free 5-10 minute session from an online resource such as fitnessblender.com. If you like walking look at http://mentalhealthmates.co.uk/walks/ which is country wide.
Trying to get sleep (no mean feat with a new born I know), if you can’t sleep at least lie down and try to physically rest.
Social support, who nourishes you? Who makes you feel listened to and heard? Or makes you laugh? Seek out these people.
If you have friends and family locally great. Let them help you!
If you don’t have friends or family close it can feel so so lonely as a new mum and mother and baby groups are not for everyone. There are some great apps to link in with local mums, look at Mush and Peanut.
In London look at the amazing
https://www.takesavillage.co.uk in South London or in North London https://www.mumologist.com/the-village/
Meditation/Breathing can really help, it takes practice but you can do 2-5 minutes a day at night and over time it will help. You need to commit to it but it can quickly become a powerful daily routine for you. Free apps include Headspace and Calm.
Psychological or physical therapy. Face to face individual therapy is the NICE guideline treatment of choice for Post Traumatic Stress Disorder after birth trauma, your GP can refer you or in many areas you can self refer, try putting IAPT into Google for your area.
Personally I think after a difficult birth we could all benefit from reconnecting with our body, we often blame our bodies from failing us, dislike our body after birth or feel disconnected from our body. We may also have had perineal injuries or be left with pelvic floor issues such as incontinence. Anya Hayes blogs about this beautifully
Yoga and Pilates can really help with settling back into our postpartum body or having a massage or a lovely technique called closing the bones.
Medication. For some women prescribed medication is what they want and/or need, see your GP to discuss this. Many women take medication in the postnatal period so please don’t be ashamed about this or worried to ask for medication.
Herbal supplements I like to recommend that can also help are oral Magnesium or as Epsom Salts in the bath, all safe in breastfeeding. You can buy these from any good health food stores. You could also try Lavender capsules to help sleep and anxiety or Bach Flower Remedies such as Rescue Remedy.
Most women feel significantly better within 12-18 months with the right care. The key is to find what works for you, there is no right or wrong. So for one woman this might be a course of NHS trauma focused therapy coupled with a Magnesium supplement for another it might be using a daily meditation app at home and a weekly yoga class alongside eating really well and good support from friends and family.
It can seem never ending and terrifying to be traumatised by birth but you will get better, it can take time but you will. Please reach out and try and tell someone how you feel, that can feel so scary to do but is often such a relief to finally be able share our feelings about our birth experience with someone.
Birth Trauma Resources
Annual Birth Trauma Conference run by myself in East London each December, free, book via myself, next one 9th January 2019.
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Dr Rebecca Moore
Perinatal Psychiatrist
PTSD piece by myself below,
https://midwifethinking.com/2011/05/13/guest-post-when-birth-is-trauma/
