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How to know if you experienced a traumatic birth and how to cope with the negative impacts
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As I prepare for the birth of my fourth child, I am reflecting a lot on my last birth experience. It was June 2020— an uncertain and stressful time to say the least. Going into the birth, there was so much fear and anxiety related to COVID-19. I was imagining worst case scenarios like being separated from my baby if one of us tested positive or my husband not being allowed to attend the birth. The COVID-19 precautionary procedures were changing so rapidly that even my OB couldn’t give me a clear answer to what my labor would look like. The only thing that seemed clear was that I would be delivering this baby into a scary and uncertain world.
Given all of this stress, it was not surprising at my 40-week appointment that my blood pressure was so high that my OB sent me immediately to the hospital to start the induction process. I had never been induced before so I added that to the list of stressors and uncertainty going into this birth. I tried unsuccessfully to get labor going on my own (walking nearly 7 miles in the hospital hallways). When that didn’t work, the OB broke my water and labor started quickly and intensely. This labor was by far the most painful labor I had ever experienced and felt helpless and unsupported without the presence of my doula (at the time, only one support person was permitted).
I was immensely relieved when it was finally time to push. My previous second stages of labor (translation: the “pushing” stage) had been brief and relatively easy. Yet, with this one, I could tell that I was not making progress. The doctor and nurses kept telling me that I was doing “great” but I could tell by the look on their faces that something was wrong. What I didn’t know is that my baby’s shoulders were stuck (a complication referred to as “shoulder dystocia”). The OB acted quickly and dislodged my baby before a C-section or other more extreme measures were necessary.
However, it quickly became clear that my baby wasn’t breathing as he emerged. Because this was my third baby, I was immediately concerned when he wasn’t crying and even more concerned when they whisked him away from me without a word. Every nurse and doctor in the hospital seemed to descend upon the room, while my husband and I desperately asked over and over again “Is he okay?!?!?” No one answered us which only increased our panic. After what felt like an eternity but was probably at most minutes, I heard that sweet cry and they placed the baby on my chest as if nothing had happened. I felt so relieved and grateful but those minutes of pure panic and terror were hard to forget.
I told my birth story over and over again in the coming days as I tried to understand exactly what happened. However, the only response I got from most medical providers, family, or friends was how grateful I should be that everything was okay and reminders that it could have been much worse. And I was extremely grateful but I felt like I also needed acknowledgement of how scary the entire experience was. It seemed like there was an attitude of “these things just happen during childbirth.”
Childbirth can be a scary and traumatic experience for birthing people as well as their partners. There should be room to express both gratitude about the birth as well as process the trauma, anger, and feeling of loss that may have occurred at the same time. We should be allowed to acknowledge the difficult or scary parts of the birth experience and/or mourn the birth experience that was lost. An emerging line of research on birth trauma can help us to understand just how common this experience is and how to cope with this experience.
What is a Birth Trauma?
Research finds that up to 45% of mothers report experiencing “birth trauma.” Yet, despite almost half of mothers experiencing birth trauma, it is rarely included as a part of labor and delivery preparation, screened for in the postpartum period, or even discussed. It seems to be something that birthing individuals are just expected to “get over,” particularly when everyone is physically healthy after the birth.
Birth trauma is poorly defined in the research and the terms “birth trauma” and “traumatic birth” are often used interchangeably. A concept analysis based on previous research proposed the following definition of birth trauma (read the concept analysis here):
‘The emergence of a baby from the body of its mother, in a way which may or may not have caused physical injury. The mother finds either the events, injury or the care she received deeply distressing or disturbing. The distress is of an enduring nature.’
Birth trauma can also occur in birthing partners or any observers of the birth. Birth trauma can even occur in observers if it was not experienced as traumatic by the birthing individual.
How Do You Know if You Experienced Birth Trauma?
Whether or not your birth is “traumatic” is determined only by your own individual experience. A doctor or nurse present at your birth may perceive the birth as entirely uncomplicated and typical but based on your own experience of feeling unsupported or afraid, it may be a traumatic birth.
The DSM-5 defines trauma as the experience of “actual or threatened death, serious injury, or sexual violence.” It can involve experiencing the event yourself, witnessing others experience it, or even learning that it happened to a family member or close friend (or this in case, an infant). It is important to note that birthing individuals are in such a vulnerable position that you may perceive the threat of an injury or death even when a medical professional may not. However, many clinicians and researchers think the definition of trauma should be broader-- an individual can perceive an event as traumatic even if it does not involve threatened injury or death. Trauma may instead be defined as an event that disrupts foundational beliefs about yourself, others, or the world, and/or changes the direction of your life (for example, you think in terms of before and after the trauma).
On the other hand, a difficult birth or birth involving injury to you or the baby doesn’t necessarily lead to birth trauma. Regardless of what happens during the birthing experience, it is entirely up to the birthing individual to determine whether it was a traumatic experience or not.
Symptoms of Birth Trauma
Symptoms of birth trauma can include:
Psychological distress related to your birthing experience
Repetitive and intrusive thoughts, flashbacks, or nightmares about your birthing experience or anything related to it
Avoiding people, places, and memories related to the birth
Being overly aware of potential threats to you or your baby
Feeling guilty or blaming yourself
Having difficulty remembering important parts of the birth
The birthing experience significantly and negatively changing your thoughts about yourself, others or the world, or causing a significant and negative change in mood
Examples of Birth Trauma
Birth trauma can include late miscarriages or stillbirths, medical complications for the birthing individual or baby, emergency C-sections, resuscitation at of the infant, hemorrhaging during or after delivery, any type of birth injury, the infant being taken to the NICU, the baby being born with disability or illness, or feeling in extreme pain or out of control during labor. Birth trauma may also include obstetric violence, which is any medical procedures performed without consent, a lack of respect or information from medical professionals, or anything that dehumanizes or takes away the rights of the birthing individual. However, it is important to mention again that birth trauma can be any experience that the individual perceives to be traumatic. What medical professionals see as a successful and smooth delivery with no medical complications may be a traumatic birth.
What Are the Impacts of Birth Trauma?
Birth trauma has a “ripple effect,” meaning it has long-term and wide-reaching impacts on many areas of a mother’s life. Birth trauma may negatively impact breastfeeding experiences, increase anxiety related to later pregnancies or birth experiences, and negatively impact your relationship with your partner for up to 2 years.
Birth trauma may also disrupt bonding with your infant. When you experience a traumatic event, you often experience distress related to anything that reminds you of the trauma. In the case of birth trauma, your own infant can remind of the traumatic event. In one qualitative study, women reported an initial feeling of rejection toward their infant which faded over time.
Those who experience a traumatic birth may also experience an immense sense of loss about their birth experience, transition to motherhood, or sense of self. They may experience a fear of childbirth in the future, and/or make a decision to not have additional children or have an elective C-section in order to eliminate uncertainty about future births.
However, many people who experience traumatic birth are made to feel shameful or ungrateful if they discuss it as such. Many people are told that as long as they have a healthy baby that the birth doesn’t matter or are told that their birth complications could have been worse.
Birth Trauma and Mental Health
Birth trauma dramatically increases the risk for postpartum depression with some studies showing up a 4 to 5 times increase in the risk for postpartum depression in mothers reporting a high level of birth trauma. Birth trauma is also associated with an increased risk for postpartum depression in partners. Birth trauma also increases the risk for postpartum anxiety and elevated stress during the postpartum period. Birth trauma may even increase the risk for postpartum psychosis.
Research also indicates that 4% of all mothers and 18.5% of high-risk mothers go on to develop PTSD as a result of a traumatic birth. How do you know if your response to birth trauma might be PTSD?
Intrusive memories, dreams, or flashbacks and/or psychological distress related to anything that reminds you of the trauma
Avoiding anything that reminds you of the trauma or avoiding thoughts, feelings, or memories of the trauma
Changes in thoughts or mood related to the event (such as, not remembering an important aspect of the traumatic event, the event changing your beliefs about the world, yourself, or other people, blaming yourself, or persistent negative feelings)
Differences in arousal or reactivity (such as, difficulty concentrating, sleep problems, irritable behavior, hypervigilance, etc)
These symptoms are still present 1 month after the traumatic event and they cause significant distress or impairment in day-to-day functioning
If you think you might meet criteria for postpartum depression, anxiety, or psychosis or PTSD, consult with a mental health professional as soon as possible.
How Can You Cope with Birth Trauma?
Seek out a mental health professional who specializes in perinatal mental health, particularly if you have symptoms of postpartum depression, anxiety, or psychosis, or PTSD. Research suggests that therapy after a traumatic birth decreased symptoms of trauma, self-blame, depression, and stress. Postpartum Support International can help to connect you with local providers.
Don’t let anyone (or yourself) invalidate your trauma by telling you that it could have been worse or that you should be grateful for any positive aspect of it. Birth trauma is defined by your emotional experience after the event, not by the outcome. It is also possible to be both grateful for any positive aspect and recognize that the birth was traumatic and that you are mourning the loss of the birth experience you wanted.
Seek out social support from other mothers, friends, or family during pregnancy and postpartum. Research finds that mothers with social support are less likely to experience PTSD after childbirth. Social support can include both practical help (babysitting, help with housework, etc.) as well as emotional support. Postpartum Support International has free online support groups, including a Birth Trauma support group.
Write down your birth story. Research finds that telling a coherent story after experiencing trauma may help with recovery and coping. One study found that postpartum women who were asked to write down their birth story (including the emotions they experienced) showed lower levels of depression and PTSD symptoms. In this study, women were asked to write twice per day for 15 to 20 minutes. Writing your story down prevents avoidance of traumatic memories which tends to have a negative impact and may help you to integrate the complex emotions you are experiencing. However, if you worry that this exercise could be very distressing to you and/or that you could not cope with the emotions it brings up, make sure you consult with a mental health professional and only engage in these types of exercises under their guidance.
Challenge any thoughts related to self-blame. Self-blame is a common experience among birth trauma survivors. When you notice yourself experiencing these thoughts, challenge them with thoughts and evidence that take the blame away from yourself. For example, after I had my daughter at 36 weeks, I obsessed over everything I did that day that may have caused premature labor (going for a long walk, eating spicy food, not hydrating, etc). When I had these thoughts, I would remind myself that starting labor was not my intention and there are women who do all of those things and more when they are 40 weeks pregnant and do not start labor (I would later realize this first-hand when I was 40 weeks pregnant with subsequent pregnancies and nothing worked to start labor).
If you would like to experience birth again and are able to, find medical providers and a doula that are supportive of your choices. Support during labor and birth may reduce your chances of experiencing a traumatic birth again. A doula, in particular, may be helpful since their only role is to provide you with support. In addition, having control over your birth experience may reduce your chance of PTSD. Many people who experience a traumatic birth schedule an induction or an elective C-section for subsequent births in order to be more in control. Protecting your mental health may be reason enough to make these decisions. Find providers that understand the importance of protecting your mental health during the birthing process.
Ask for skin-to-skin care immediately after birth if possible. A randomized controlled trial found that skin-to-skin in the hour after a traumatic birth resulted in improved mental health immediately after the birth and two and three months after the birth. However, it is very important to mention that many birth complications make it impossible to experience skin-to-skin contact in the hour after birth. The benefits of skin-to-skin contact for mental health continue up to 12 weeks after birth and it is likely never “too late” to start skin-to-skin care.
Advocate for more sensitive and responsive care for birthing individuals and increased mental health resources in the postpartum period. Research finds that lower quality interactions between birthing individuals and providers are associated with a greater chance of developing PTSD after childbirth. All birthing individuals deserve to be heard and supported throughout this process.
Post-Traumatic Growth: When Something Beautiful Comes from Trauma
With time, survivors of a traumatic birth may experience something called “post-traumatic growth” (see here for a scientific explanation). Post-traumatic growth is a positive psychological change that occurs as a result of a traumatic incident. It does not mean the distress of the trauma is not still there or that you see the trauma as something positive but that the trauma shakes you to your core in such a way that it causes you to re-examine your life and make positive changes. Researchers use a metaphor of an earthquake to explain post-traumatic growth (see image below). An earthquake causes destruction which requires you to rebuild in new ways. You would never have wished that the earthquake occurred but you can still recognize the beauty in the rebuilding.
Research suggests that almost 50% of mothers may experience posttraumatic growth after a traumatic birth. In particular, most mothers reported that they have an increased appreciation for life, enhanced sense of personal strength, and improved ability to relate to others after a traumatic birth. Mothers report that they feel stronger, more empathetic to others in pain, more assertive in fighting for their own needs, and more deeply connected to partners, friends, and children. One mother explained it in this way: “At first, the very fabric of your being is shattered, destroyed. Nothing makes sense. The pieces do not go back together again. Rather, it is a gradual, new, very different kind of becoming.”
What makes you more likely to experience post-traumatic growth?
Seeking guidance and support from others. Seek out social support from therapists, friends, and family after a traumatic birth. Research finds that seeking guidance and support from others is related to enhanced post-traumatic growth.
Using approach-oriented coping. Approach-oriented coping means actively focusing on the trauma in order to seek help from others, understand how it happened, using problem-solving, and/or accepting the results of the trauma. Research finds that approach-oriented coping is associated with greater post-traumatic growth after childbirth.
Being patient. Research finds that the longer it’s been since the traumatic birth, the greater symptoms of post-traumatic growth. Post-traumatic growth won’t happen in weeks or even months— allow yourself time to process and grieve a trauma before expecting any type of growth.
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All Parenting Translator newsletters are reviewed by experts in the topic to make sure that they are as helpful and as accurate for parents as possible. Today’s newsletter was reviewed by Kayleigh Summers, LCSW. Kayleigh is a licensed clinical social worker and private practice owner in Downingtown, PA. She specializes in perinatal trauma and has specific training in both perinatal mental health and EMDR. Kayleigh uses her training as a licensed therapist and her lived experience as an Amniotic Fluid Embolism survivor to treat and support families experiencing perinatal trauma. Kayleigh has also created thriving birth trauma support communities through Instagram and Tik Tok, as well as her podcast, where she provides connection, story sharing, and resources to support those experiencing birth and perinatal trauma.
Instagram & Tik Tok: @thebirthtrauma_mama
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Welcome to the Parenting Translator newsletter! I am Dr. Cara Goodwin, a licensed psychologist with a PhD in child psychology and mother to three children (currently an almost 3-year-old, 5-year-old, and 7-year-old). I specialize in taking all of the research that is out there related to parenting and child development and turning it into information that is accurate, relevant, and useful for parents! I recently turned these efforts into a non-profit organization since I believe that all parents deserve access to unbiased and free information. This means that I am only here to help YOU as a parent so please send along any feedback, topic suggestions, or questions that you have! You can also find me on Instagram @parentingtranslator, on TikTok @parentingtranslator, and my website (www.parentingtranslator.com).
DISCLAIMER: The information and advice in this newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical, mental health, legal, or other professions. Call your medical, mental health professional, or 911 for all emergencies. Dr. Cara Goodwin is not liable for any advice or information provided in this newsletter.