From Pain to Power: Transforming Birth Trauma into Strength

If you do not have a positive birth, you are not alone, many ForWhen callers have phoned to talk about their birth stories and are seeking support services related to their complicated or traumatic birth experience.

When things don’t go as planned, whether medical intervention is required, there’s a medical emergency, or you’ve had a complicated and difficult labour, new mothers or support persons can leave these scenarios with a negative childbirth experience and birth related trauma. 1 in 3 women or 34-45% of mothers report their childbirth experience as being traumatic, which can often leave women feeling alone and distressed by their emotions and reactions.

Having a traumatic birth can have a lasting impact on a woman’s health and wellbeing. It’s also important to note that birth trauma does not only affect the mother but can also have an impact on your birthing supports, whether it is the father, a partner or non-birthing parents.

The thought of giving birth can create anxious and excited feelings about the birth, these are all normal. To help you be prepared for your birth, you can contact your local hospital to see what antenatal classes are available. It is also a good idea to have a birth plan in place and to speak with your health care professionals about your birthing wishes. In the birthing plan, it is always advised to discuss your wishes with your birthing team in the event there is an emergency and decisions need to be made outside of your plan to ensure the safety of you and your baby.

Now that you are finally in the birthing suite, you may find that your care providers are often focused on the medical side of the birth, rather than the emotional support of the birthing experience, which can make you feel many emotions including feeling neglected, disappointed, or overwhelmed. It is also felt that the expectations of those involved after giving birth, is to forget any traumatic events of the childbirth, move on and just accept what happened!

But many ForWhen callers who experienced a traumatic childbirth describe feelings of disappointment, grief, anger, shame, failure and a lack of confidence when looking back on their birth and during the postnatal period.

What is birth trauma?

Birth trauma is defined as physical and emotional or psychological suffering during the birth that is a result from either medical complications, physical injury or negative reactions during the birthing experience. Some examples include, sudden changes to the birth plan, emergency caesarean, and postpartum depression after-birth complications and inadequate care received from health professionals.

Many women experiencing the results of a traumatic birth may feel they can’t speak up when society conveys the message “a healthy baby is all that matters” and that they should be greateful. Birth trauma is subjective to your own experience. If you feel you have experienced birth trauma, you don’t need to justify it or go through an assessment to prove it. You have lived through your experience so if it’s a traumatic birth experience for you, then it’s a traumatic birth experience!

For women who go through these experiences, there can often be a long-lasting impact on their lives. It can trigger anxiety and fear about going through another pregnancy, sometimes leading to the decision whether or not to have another baby. It can also lead to bonding and relationship difficulties with their baby as well as fear of hospitals leading to reluctance in seeking treatment.

Even though 1 in 3 women experience a traumatic birth, birth related trauma and its side effects are poorly recognised and many women who suffer as a result of their traumatic birth, do not receive any treatment through support services.

Understanding traumatic birth experience

Having a traumatic birth can often be difficult to process and make sense of. We know that every woman’s birthing journey is unique for them and how you perceive your birth is what matters. We must keep in the forefront of our minds that it is not about how health professionals perceive your birth went but it’s about what that experience was like for you. Everyone is different and every women’s health experience is unique to them and needs to be acknowledged as such.

Birth Trauma has been defined as a perception of ‘actual or threatened injury or death to the mother or her baby’. However, it has been argued that the perception of trauma is in the ‘eye of the beholder’ and should be defined by the woman experiencing it. You may experience psychological birth trauma when things do not go the way you had planned. Sometimes your birth experience can also be affected by a traumatic event from your past including: sexual abuse, assault, childhood sexual abuse, and domestic violence.

There are two types of birth trauma; physical birth trauma & psychological trauma, it can also be a combination of both. Physical birth trauma often involves complications with your birth that has resulted in an unexpected injury and/or adverse outcome. These can include:

• Perineal tears or injury
• Pelvic floor damage
• Pelvic organ prolapse
• Pudendal neuralgia (nerve pain/damage)
• Infected stitches
• Emergency caesarean

Psychological birth trauma may involve a perceived lack of control with feelings of disempowerment or pressures to comply with medical procedures due to not being involved in decision making or being offered an opportunity to provide informed consent before or during the birth process. This can leave women feeling out of control and fearful for their wellbeing and that of their unborn baby. Some women describe having an out of body experience, having delusional thoughts or panic attacks as a result.

To help in these types of situations, it’s a good idea to be informed before your birth, especially if it’s your first one, on what to expect from a good, reliable source. Let’s face it, sometimes Dr Google or other women discussing their birthing experiences can cause more fear with a large range of worst-case scenario stories to fill our thoughts. Antenatal classes are available in many areas that include information on birth, options during delivery and information to help you make any decisions needed along the way so you’re as prepared as you can be.

It is not unusual for it to take time to recover from physical and psychological birth trauma and you may experience symptoms of distress for a few months. It is important to seek support for birth trauma if you feel it is impacting on your enjoyment of parenting, attachment relationship with your baby, other relationships and general capacity to function.

Emotional and behavioural changes

When you experience psychological & physical birth trauma it can impact on all aspects of your life. It is important to explore what some of those emotional and behavioural changes are:

• Feeling dazed, agitated, overactive and/or withdrawn, disorientated, and emotionally numb
• Anxiety symptoms that can sometimes lead to panic attacks. You may experience increased heart rate, palpitations, sweating, wobbly legs, dry mouth and a sensation of butterflies in your stomach
• Depression and/or anxiety – which can look like a low mood, lack of enjoyment, sadness, crying, lack of appetite, not being able to sleep when baby sleeps, or unable to switch off thoughts and constant worry about your baby
• Blocked memories, or flashbacks from the birth. Some women with significant birth trauma struggle to listen to or watch birthing stories on television as it triggers a trauma response
• Perceptions of worthlessness, shame, guilt through to feelings of failure. This could include feelings that your body failed you if you were unable to have a vaginal delivery
• Grief, loss and sadness for the birth they had hoped for
• Struggling to bond with baby and even avoidance of baby
• Feeling on-edge, feeling extremely alert or watchful
• Fear of sexual intimacy
• Social withdrawal and avoiding being around others
• Relationship issues
• Feeling powerless, confused, hurt, abandoned, frightened, disrespected and disregarded

Intrusive thoughts or flashbacks

When you experience a significant trauma sometimes those memories can be retriggered by a smell, a sound, visual cue or hearing someone else’s birth story. Traumatic birth experiences can be similar to recurring nightmares that live on. This can have an impact on future hospital admissions and future births, triggering a reminder of the traumatic event.

Impact on your relationships

Birth trauma can place stress on your relationships and even cause relationship breakdown along with parenting, posttraumatic stress disorder and lack of self-identity. Sometimes we may push our partners away due to fear of intimacy or resentment that it happened to our body. However, it is important to recognise that partners can also be experiencing trauma from witnessing the events that threatened the life of their partner and child. When both parents are struggling to cope with post traumatic stress, it is difficult to work on keeping the relationship healthy as our own struggles can drive a wedge in the relationship.

Birth trauma can also affect professional development and our relationships with other family members and friends. When we experience trauma and a threat to our own life and that of our baby, we tend to withdraw from others. We can delay dealing with the birth trauma with the immediate needs of caring for a new baby taking over.

Due to the trauma you may need support to work on the bond with your baby. Responding to your baby’s needs with love and warmth can be difficult following a traumatic birth for a variety of reasons. Some people find themselves blaming their baby for their trauma.

If you are still experiencing the above symptoms 2 weeks after the birth of you baby, then it is time to seek support.

Long term impact

A traumatic birth can cause deep distress or psychological disturbance that continues long after the birth. Tokophobia (fear of childbirth) can occur which may be a deciding factor in having another baby. Woman often fear or delay having another pregnancy due to previous negative birthing experience and possible loss they have experienced. Interestingly partner’s may be ready for another child well before the woman is psychologically ready.

Some women may reach a decision not to have more children due to risk factors and the fear of having another traumatic experience. In some cases, a diagnosis of complex post-traumatic stress disorder (CPTSD) may be made for post traumatic stress disorder (PTSD) and this will require treatment by professionals to manage effectively.

Risk factors

There are some risk factors that may make you more vulnerable to birth trauma. These are:

• Previous traumatic birth experience
• Post Traumatic Stress Disorder (PTSD)
• Previous birth where there was a lot of pain experienced after birth
• History or current mental health conditions, including antenatal depression or anxiety
• Past trauma history; domestic violence, sexual assault
• Pregnancy with complications, where additional monitoring may have been needed
• Having a fear of birth
• Poor care or support prior to or during the birth

Getting help early before your birth can help address these issues to reduce the impact on any future birth experience. ForWhen can help find the right supports and services for you.

Complicated births, where unexpected medical intervention is necessary for the mother or baby, can be a risk factor for a traumatic birth experience, but with good communication from assisting medical and support people, does not necessarily lead to a traumatic birth experience. Being kept informed about your options and what’s going on is really important. This is something you can talk about with those who plan to be with you during birth. They can then speak up on your behalf to help you get the information you need to make decisions.

Coping Strategies for Transforming Trauma into Strength

You may find you want to block out your birth experience or find yourself going through a mix of emotions, feeling sad, angry, frightened, anxious or depressed thinking about your birth experience. It’s important to identify these signs early and seek help. Phoning ForWhen is a good place to start, where you will find an understanding clinician who is able to provide a listening ear and help find the right support or service for you and your baby.

You can regain power, control, strength and positivity by processing your birth experience in a way that works for you. You may find that speaking to a health professional, such as a perinatal psychologist at a time that is right for you to be helpful. Some women find that writing their birth story is a way forward towards healing.

Peer support, from someone who may have been through a similar lived experience, can offer a place of validation and understanding. Debriefing with the medical team from your birthing hospital can provide a space for you to get answers and find out why certain decisions were made, helping to move forward and provide options for any future births.

Therapy and counselling options

There are many forms of therapy for birth trauma. The main form of treatment for birth trauma is talking therapy delivered by a trained therapist such as a perinatal psychologist, counsellor or mental health social worker who specialise in birth trauma. Cognitive Behavioural Therapy (CBT) provides the tools to identify and challenge unhelpful thought patterns, which in turn changes mood & behaviour. You may feel guilty and blame yourself for things you couldn’t change and CBT helps to understand what happened is not your fault.

Trauma Focused CBT (TF-CBT) is also used to focus on the impacts of the birth trauma and Post Traumatic Stress Disorder (PTSD in particular). Eye movement desensitisation and reprocessing (EMDR) is a treatment found to be highly effective with PTSD, where the therapist guides you to make rhythmic eye movements while recalling and processing the previous traumatic birth event.

Building a support network

Social network plays an important role in a woman’s experience of birth trauma. You may find group therapy helpful. Talking about your feelings in a group setting can help you to form a sense of community by connecting with others who have gone through similar challenges. Couples therapy can help you and your partner open the lines of communication and strengthen your relationship by understanding one another’s experience.

Friends and family can also provide a supportive network during the healing process, while online communities found on social media platforms such as Facebook and the Australasian Birth Trauma Association may be helpful. Finding and accepting emotional support by talking to a health professional or others who have been through a similar experience can be therapeutic.

Medication

Sometimes you may need antidepressant medication alongside therapy. The most widely used antidepressant medication know as selective serotonin re-uptake inhibitors (SSRIs) is the main medication prescribed to treat symptoms associated with birth trauma and PTSD. In some situations, anti-psychotic medication is required for disabling symptoms or behaviours.

Developing healthy coping mechanisms

This is a time for you to be gentle on yourself and acknowledge that your body has done an amazing job by giving birth and that you have been through such a lot. Don’t feel ashamed to set boundaries and ask for help or accept the help that is offered or to turn away visitors and take time out as you need.

Although it’s a busy time with your new baby, self-care is so important in your recovery. Remember to take time to try to get out in the sunshine and go for a gentle walk. This is both good for you and your baby. Sunlight will help to increase your feel-good endorphins and help to regulate your sleep.

Not getting enough sunline during the day can cause sleep problems at night. It’s important to nourish your body with nutritious food while avoiding alcohol and caffeine as much as you can. Try to enlist help from your support team such as your partner, family and friends. This is a time to lean into your village. Accepting support will free you to bond with your baby and to catch up on sleep where you can.

Some complementary and alternative medicine treatments such as acupuncture, where a thin needle is inserted into certain meridian points, which helps to stimulate the flow of life energy has been found effective in lessening PTSD symptoms. Mindfulness involves paying attention to the present and focusing on everyday experiences and accepting thoughts and feelings without trying to cling to them or push them away helps to reduce symptoms of anxiety and depression and rumination of thoughts. Meditation is often used for relaxation.

Some apps such as the Smiling Mind, Calm or Headspace offer a variety of free mediations and guided sessions. Deep breathing or breathing exercises can help quieten down the stress response. Expressive writing, which involves writing about the stressful event has been found effective in reducing symptoms of the anxiety disorder and depression PTSD. Art therapy is another creative outlet which has a similar effect in helping deal with these symptoms. Talk to your health professional to see what may best suit you.

Bonding with your baby

The bond between you and your baby plays a part in your baby’s development. Spend time talking, singing, cuddling, smiling and gazing into your baby’s eyes. These will help your baby feel secure with you and help their brain and emotional development as you respond to their needs and cues.

Seeking support services & health professionals

The Australasian Birth Trauma Association has lots of useful information on their website plus contacts to support groups.

The level of postnatal support maternity care that is offered to women can have an impact on whether they will go on to develop distressing reactions to their childbirth experience. If postnatal support is not offered, it is important to reach out for support. With your consent, someone else may do this on your behalf.

You may also want to arrange a debrief with your birthing hospital so they can talk you through the reasons why medical staff made the decisions that impacted your birth experience and it also allows for you to ask questions and seek clarity. Many women feel abandoned by their healthcare workers and powerless during the birth. Write down your questions. Debriefing can be an empowering step forward in recovery subsequent to traumatic childbirth.

If you’re not sure where to go, contact ForWhen to speak to an understanding clinician for support and navigation to a service that is right for you.

Healing, growth & empowerment through recovery

It is important for you to seek support. By acknowledging and addressing the birth trauma healing, growth and empowerment support women can take place through recovery.

Birth trauma is distressing and complex.  A traumatic birth can leave you with emotional, psychological and physical scars which can also be triggered by what has happened in the past. The factors that contribute to birth trauma are many and often out of your control. Birth trauma is real and can have a lasting impact on your wellbeing, affecting relationships with those around you, including your bond with your baby.  Once you have acknowledged that you have experienced birth trauma you can move forward towards healing.

Calling ForWhen is a good place to start. There are many strategies that can be applied to work through the trauma such as therapy delivered by a perinatal psychologist. It’s important to work out what’s best for you. Accepting emotional and practical support from family and friends and applying self help measures is a good step forward in your move towards recovery.