Birth Trauma & PTSD
This post was created to highlight birth trauma awareness week. However I really want to acknowledge that trauma is not limited to just birth, so I’m also encompassing trauma in pregnancy and post-birth. When I use the term ‘birth trauma’, in a general sense I am extending it to also include traumatic events of pregnancy and post-birth.
With that in mind, I’d like to start with a trigger warning. In fact, many of my posts, articles and stories are not all warm and fuzzy, but it’s important to note that the effects of trauma can be long-term, and you might think you’re doing fine only for something to take you straight back to the traumatic event in an instant. Hence the trigger warning – I’m going to be talking about all things post-traumatic stress disorder, distressing experiences and feelings – so it may be confronting and it may be a trigger for some. If at this point you are feeling some anxious symptoms (like panicky at what’s to come, heart is racing, on edge, fearful, reliving your own traumatic events and so on), please don’t continue. Instead, head on over to https://www.birthtrauma.org.au/ or www.panda.org.au where you’ll find some great resources and options for getting some support for these symptoms. Just know that you are not alone.
If you can't, or don't want to keep reading, here's a little snapshot of some key points that this post covers:
Ok, so what is birth trauma? Well, trauma refers to an injury. And in this case, the injury can be physical (a wound) or psychological. And if that psychological trauma is not resolved, it can progress to Post-Traumatic Stress Disorder [PTSD]. PTSD is a fairly common term most of us have heard of, but it might be surprising to learn that it can be associated with birth. Especially if you just thought (not incorrectly) that PTSD is a product of war, that many soldiers have it. How on earth are mums coming out of birth with a war condition?
Well, PTSD is an anxiety disorder characterised by flashbacks, nightmares, reliving thoughts, ongoing fear or horror following a traumatic event. Generally, the traumatic event involves a genuine fear for life. So it’s very conceivable that a mum might feel birth had been traumatic if she felt in danger during her birth, or feared for her baby’s life. The same goes for her partner or any birth support people – if they witnessed events where they feared for the mum or baby’s life, then they have experienced trauma.
It’s not as uncommon as you might think – around 33% of women will report symptoms of trauma following birth[1]. That’s 1 in 3 mums! But again, around 1 in 3 mums is having a caesarean section in Australia – so they automatically have a surgical wound, not to mention that there might be frightening circumstances behind the reason they had to have a caesarean section. Then the mums who have vaginal births, well some of them are having instrumental births, they might have experienced lots of pain, they might suffer a large tear or haemorrhage after…unfortunately, there are endless things that will affect each of us in different ways. In this study of over 2000 women who perceived their birth to be traumatic, the most common factor perceived to contribute to the traumatic birth was “a lack/loss of control”. This was stated by over half of the mums in the study. Just under half experienced a fear for the baby’s health or life, or intense pain, contributing to the traumatic birth. The women in the study commonly stated that the midwives and doctors caring for them could have communicated better, listened better, and supported them better to improve the experience. Most of the women also did not think they themselves could have done anything differently to prevent the traumatic birth from happening.
What’s the take home message here then? I think the onus is on midwives and doctors to provide an environment that is going to minimise birth trauma. Placing the focus of care on the woman, and making sure she is involved in every decision, and that informed consent is always obtained, will help to reduce that feeling of loss of control. For so many mums, they enter the birth room in the throes of labour already feeling like they are not in control of their body. We need to hand control back by empowering our mums with accurate, honest and empathic information when providing health care. And mamas, don’t ever underestimate that knowledge is power when it comes to your body, your baby and your birth. You can be as informed as possible about this by doing birth education classes, especially by independent practitioners (e.g. Calmbirth), reading books (such as those by Rhea Dempsey and Juju Sundin), perhaps watching birth videos (if that’s your think – for many it’s not, and that’s ok!), and finally, I’m a big believer in sharing stories – see my real story posts here – so ask your mum, friends and family about their experiences, and particularly what went well, and what went not so well.
When it comes to your pregnancy and birth, ask questions of your midwife and obstetrician. If they want to do a particular intervention or test, it’s totally ok to ask for a second opinion if it doesn’t feel right, or you don’t understand why. You can also follow the BRAIN rule when it comes to decision making:
B – what are the benefits of doing this? Why is it being recommended?
R – what are the risks of doing this? Will it affect me/my baby?
A – what are the alternatives to this? What other options or interventions are there? What might other midwives or doctors suggest?
I – Intuition – what does your gut say?
N – Do we have to do it now? What if we do nothing? What happens if we wait?
This is a great tool to ensure you are asking the right questions and ensuring you’re informed every step of the way. It will also help avoid the terrible “what if” questions that might occur down the track: what if we’d waited, what if we’d tried something else…too many times as a midwife have I seen someone ponder these questions after a difficult experience. Getting rid of the 'what ifs' will go a long way to providing satisfaction with the birth experience.
I also want to point out that the pregnancy/birth/postnatal experience is a subjective one – meaning it’s based on personal opinions, feelings, perceptions and emotions. No one else can tell you how to feel about your birth. If you dreamed of a drug-free natural birth, but ended up with a medicated labour and emergency caesarean, you might feel distressed by this or you might feel a bit shocked but relieved that it’s over (and have no ongoing thoughts about it). But likewise, I have worked with women who had what society would perceive to be fantastic births (natural, uncomplicated, waterbirths etc) but still experienced feelings similar to post-trauma emotions). Why? Again, see above – intensity of pain is one of the top 3 reported contributors to traumatic birth. If the woman felt out of control or in fear of her life/her baby’s life, then these are more common precursors to a traumatic experience. It’s not about what the medical world defines as complex, or complicated, or traumatic or any other negative word to describe a medical experience. It’s how you feel about it.
For those of you that are pregnant or planning a pregnancy, I urge you to look into a continuity model of care for your pregnancy and labour. Caseload midwifery (where you are cared for by a known midwife) includes mental health screening and psychosocial risk screening, and is associated with lower risks of complications (that might contribute to the loss of control/fear for life risk). A midwife who knows you is arguably much better at picking up mental health or psychosocial concerns in you. It’s also free, as it’s available in the public health system. You can read more about guaranteeing yourself the best maternity care here. Private obstetric/private midwifery care also provides continuity of care, but at an out-of-pocket cost. If none of these are an option for you, I highly recommend engaging with a great student midwife to follow you and provide continuity of care, under the supervision of midwives and obstetricians. And follow the BRAIN acronym above at all points of your health care.
Below is a quick graphic of some commonly reported feelings around PTSD, but these are just some. If you feel like something is not right, that you don’t feel yourself (or you feel this about someone you know), then keep reading for some options on quick, easy and free support.
So if you’ve got to this point and you’re recognising some of these feelings, either in yourself, or perhaps a friend, or even your partner, what can you do? I recommend heading to the Australasian Birth Trauma Association website (www.birthtrauma.org.au) to get more support. Another great option is the Perinatal Anxiety and Depression Australia website (www.panda.org.au) or phoning their hotline (1300 726 306) Mondays to Fridays 9am – 7.30pm. This is staffed by fantastic counsellors who can talk you through your feelings and support options. It might also be a great idea to head to your GP, midwife or obstetrician who can set you up with a referral to a perinatal mental health clinician for some specialist counselling. This might all seem a bit hard, but trust me – it’s worth it to feel so much better!
Finally, if you want more information or to read more, I highly recommend checking out Jess’ story (link below). Jess writes beautifully about her pregnancy and birth experiences and coming to realise her birth trauma and PTSD. You can also read about my experience with a traumatic pregnancy, or read more stats and info about mental health in pregnancy, birth and afterwards by following the links below.
I'd love to hear your thoughts on this post. Pop your comments below, or get in touch with me via email or my Instagram (@real_life_midwife)!
[1] Creedy, D.; & Gamble, J. (2018). Birth trauma and post-traumatic stress disorder. O&G Magazine 20(3): 42-43