Theme 4
I Had No Idea
This theme describes the culture of secrecy and pressure to ‘suffer in silence’ throughout pregnancy, birth and the postnatal period. Women seemed to feel that they were unprepared for birth, that many things during birth came as a total shock. During and after birth, they described messages (both actual and imagined) that led them to feel that they could or should not speak about their feelings. This contributed to a general sense that the impact of their birth should be dealt with alone. When help was considered, women described not knowing where they could go for help. For those who did manage to seek help from services, or personal relationships, there was a clear message that talking about their experience was a healing and positive experience.
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4.1. I Had No Idea
Throughout the stories there was an underlying sense that the reality of birth was a complete shock. Before birth, women felt that their expectations had been unrealistic ‘the only stories I was told were of mums who had easy natural labours with no pain relief…if you had anything less you must have done something wrong’, ‘I had no idea what we were facing’, ‘for many people expectations of birth are vastly different to the reality they experience’, ‘hard to deal with a body that seems to be hard for babies to get out of’.
During birth, again there was a sense that information had been kept from them that they should have known prior to delivery ‘I had no idea that a quick labour was possible’, ‘I wasn’t told to ‘inform myself’, ‘I had no idea what was normal’, ‘I wasn’t expecting it to hurt’, ‘I didn’t know enough’. This was exacerbated by professionals not communicating with women during labour: ‘nobody explained I was haemorrhaging’, ‘nobody really spoke to us about it’, ‘I didn’t feel anything was explained to me’.
Most surprising to many women was the difficult experience they faced once the baby had been born, being left alone without their partners in hospital with little support: ‘It was the aftercare when things went wrong’, ‘after birth was more traumatising’, ‘not allowing my husband to stay’.
4.2. Stop Making a Fuss
‘We were told there was nothing unusual about this and that my labour was normal…this added to the trauma really - being made to feel like somehow I just hadn’t coped with something that was so “normal”’
The stories contained a number of messages which women received during and after birth, which led to them questioning their feelings about their experience: ‘Dr telling me there was no need to cry’, ‘she told me to stop wasting time’, ‘stop making a fuss’, ‘pull myself together’. This was added to by cultural messages downplaying the maternal experience ‘you should be grateful your baby is here’, ‘so you had a bad birth? Baby ok? Well then, never mind’, ‘A healthy baby is all that matters’.
This led to women blaming themselves for their feelings: ‘Get over it’, ‘If only I’d been stronger’, and trying to manage their difficult feelings alone ‘I gritted my teeth and coped’, ‘I felt weak to admit I was struggling’.
4.3. The Secret Shame
Throughout the stories women described their isolation, dealing with such difficult feelings alone. Partly, this was due to not wanting to admit their experience was so different to the ideal they had expected ‘there is a stigma around how we should be feeling and how amazing, magical and beautiful the whole experience is supposed to be…even the slightest deviation from that and we clam up, not wanting to be judged or criticised, we just say ‘it’s fine’ and struggle on’
Women were also reluctant to describe their experience, due to their self-blame and shame ‘the secret shame among mothers’, ‘I blamed no-one but myself’, ‘I was too embarrassed’. But also as a coping strategy, to avoid the difficult feelings that might be brought up ‘I tried to repress the experience’, ‘coping mechanism to push it to one side’. Of course, having a newborn to focus on also meant that reflecting on the experience was easy to avoid ‘I focused on the baby’, ‘pressure just to keep going’.
It was felt that others would be scared or burdened by hearing about the birth experience ‘feel bad about sharing the details’, ‘do not want to scare others’ - but when women attempted to talk ‘no-one wants to hear the gory details’, ‘whenever I tried to voice my fear generally I was shut down’.
It should be noted that women also feared sharing their feelings ‘I felt that I would have the baby taken off me, so I soldiered on, unaided’.
4.4. Nowhere to Turn
Even when women did wish to talk about their experience, time and time again they felt that help was hard to come by ‘I was never asked if I needed help’, ‘was not offered help’, ‘nobody asked how I felt or explained what happened’, ‘no-one to talk to’.
This of course made women even more reluctant to seek help for their traumatic experience ’the lack of support I received from the NHS was borderline shocking’, ‘I knew something wasn’t right but my experience of seeking help pushed me away too’.
4.5. Talking Really Does Help
For those women who received support following their birth, almost universally this was a positive experience. This took on various forms, simply sharing their story was helpful ‘Birth debrief helped’, ‘talked me through my hospital notes…it was amazing’, ‘need to understand what happened’. Sharing the story particularly with other women was noted as helpful ‘I got to debrief my first birth with many different amazing women and I also got to see it in different ways from different perspectives’, ‘need to speak to other women’, ‘encourage talking…just being ears and listening’.
Some worked to process the birth experience through therapy or other forms of support ‘in just four magical sessions, my symptoms came way down’, ‘I put the work in, I went there’.
It was suggested that talking helped through shifting the sense of blame away from the mother and more to external factors ‘this isn’t my fault’, ‘I did nothing wrong’, ‘I’d been blaming myself…everything that happened was inevitable’.
Occasionally, women did not gain any benefit from the support they were offered ‘I’ve had CBT, tablets, mental health team…there is nowhere to turn for birth trauma’.
Reflections - We tell women to be informed, but they depend on people telling them where to get information from. Not everyone has access to gaining that information themselves. Do we need to talk about this more in Antenatal appointments and classes? Or even talking to people at school and university? Talking to our kids?
Certainly there a need for better aftercare, that first night in hospital was a particularly dark time for many women when it could and should be a time of excitement, with women feeling nurtured as they start their mothering experience.
There is a clear thread running throughout of how unhelpful messages from society and professionals lead to women internalising their experience, blaming themselves and trying to cope without appearing to be struggling. The combination of the depth of feeling about their experience and their inability to talk about it means that some fall out is inevitable, and this comes out in the psychological impact and impact on relationships. A vicious cycle is then created when women finally attempt to seek help, and find that it is not forthcoming, exacerbating their feelings.
When the right support is found, this is a positive experience, as women are able to move away from the shame and self-blame following their birth, and instead consider the factors which led to their traumatic experience. Most women had not attended ‘formal’ therapy but instead had been supported by other women, and occasionally midwives during birth debriefs.
When talking wasn’t helpful, it seems that this may have been as the support was not focused on the trauma of the birth. Women seemed to suggest that just acknowledging the difficulty of the experience went a long way to helping them feel better.
