Birth Trauma.
Birth Trauma
‘…an event occurring during labour and delivery process that involves actual or threatened serious injury or death to the mother or her infant….experiencing intense fear, helplessness, loss of control and horror.
…also includes an event occurring during labour and delivery where the mother perceives she is stripped of her dignity. Research by Beck et al (2013): Traumatic Childbirth.
You tube video – Traumatic Childbirth by Penny Simkin: (PS from Penny Published Oct 30th 2015.)
Introduction
I have added a new section on Birth Trauma because this is now becoming an increasing problem for women, so much so, that it is preventing them being able to feel, and parent their babies in a way that they wanted or expected to..
It is only now beginning to get the attention it deserves, and I include this section to heighten awareness of the problems associated with birth trauma, for not only the Mother and her infant, but partners, family and health professionals too.
Oxford Definition
Where trauma is defined as: ‘a deeply distressing or disturbing experience’. So a birth that leaves us feeling distressed or disturbed is a traumatic birth.
The Greek word ‘TRAUMA’ actually means ‘wound’ or ‘piercing of the skin’ or breaking of the body envelope. This can leave the person feeling helpless and depressed, but whereas physical wounds can be seen, psychological wounds cannot.
Valuable words spoken by some of today’s Expert Practitioners in Birth Trauma.
Diana Spalding
Midwife, Paediatric Nurse and Founder of Gathered Birth
I love the way she describes giving birth:
‘It is Primal, Powerful, It is everything’
‘When we give birth we do so from our core – not just the core of our bodies, but the core of ourselves.
We are open and vulnerable during and after birth, and the energy that is around us is the energy that we absorb.’
Rachel Bushing and Amanda Donnet are
Clinical Psychologists
Vulnerability
There is nothing wrong in feeling vulnerable.
Vulnerability is a real and necessary part of birth. Its primal purpose is to allow us to connect with our babies.
However the expression of threat when we are vulnerable can give rise to the expression of trauma.
Why are some women more at risk to a traumatic birth than others?
Every woman has different strengths and different levels of resilience, and will bring her own individual life experiences to her pregnancy and birth.
PLEASE REMEMBER THAT TRAUMA IS INCREDIBLY PERSONAL – WHAT’S TRAUMATIC FOR ONE WOMAN MAY NOT BE FOR ANOTHER.
And just to put things into perspective.
1 in 3 women say they had a traumatic birth, but 1 in 3 women do NOT have PTSD.
Rhea Dempsey
Author, Counsellor, Doula and Child birth Educator
Pre-existing Trauma and Stress
Rhea explains in her counselling work, that old wounds can be opened up when our vulnerability is at its highest, especially if the woman has suffered from past trauma, abuse, neglect, loss, relationship issues, or an intense fear of birth and motherhood.
Epigenetics: (the generational line)
These wounds can also be passed down from a family member, trauma can get embedded so that certain genes are being switched on or off through the generations.
She describes: ‘trauma as an internal experience, which regardless of its source will contain these 3 common elements:
• It was unexpected
• The person was unprepared and,
• There was nothing they could do to prevent it from happening.’
Necessary Medical Interventions vs Unnecessary Interventions
Necessary Medical Interventions
- Obstetric emergencies
- Neonatal complications
- Pregnancy loss and or stillbirth
These situations are likely to be recognised as being traumatic for the emergency nature around them.
Unecessary Interventions
- Routine interventions
- Cascade of interventions
These bring their own form of stress and trauma but are often unrecognised for the impact they have on the woman, by the health professionals caring for that woman.
One of the strongest predictors of a woman developing PTSD was due to interpersonal difficulties with the carers themselves.
Three main needs which have been identified as being essential to the woman FEELING SAFE:
- Her ability to be HEARD
- Her ability to have some control or AUTONOMY in her care
- And her ability to TRUST her care givers.
Unearthing the root of the trauma
What a care professional brings to the birth room is extremely important, both in their physical stance and their own emotional trauma or baggage. In other words, what we “say” and “do” are likely to make the difference between a woman feeling able, and confident to birth or not.
A list of common issues that left women feeling disempowered and traumatised:
- Lack of information, communication and understanding
- A lack of informed care
- Feeling her life was threatened and she and her baby were in danger
- Terrified of what might happen, could one or both of us die
- Helplessness (when physically could not move post epidural)
- Intimidated by the health professionals standing over me, when I was lying down, and feeling powerless
- Not being believed or listened to, or lied to
- Lack of contact with baby, delayed bonding and breastfeeding
- Nerve damage and retained products AND NO ONE TAKING ME SERIOUSLY!
It’s a powerful take home message that women expect to, and have a deep primal need be cared for, nurtured and feel safe during their birth experience and when those expectations are not realised they can regress, withdraw and often freeze.
DISSOCIATION/FREEZING
When a woman experiences this, she cannot speak, or move and appears compliant, but really her flight and fight hormones are at work here. When this happens in the birth situation the woman has no access to her logical brain, so nothing can be processed after the event. It is harder to work through but she can get there, and once it is part of a social memory the woman can find insight from her story.
This woman is therefore more at risk to developing PTSD.
We need to discover what it was about the event that was the trigger, because the memory still lives in her physical body, and her unconscious memory.
Oxytocin levels can just increase this level of isolation and trauma, unless a positive change can take place.
This can continue after the birth when baby’s deep primal need – is for “someone to meet my needs, and be present for me! “
OXYTOCIN:
We all know as the hormone of love and bonding, but it has other effects too.
During pregnancy, labour and birth, (and the postnatal period), because trauma can happen at any time), if the woman is triggered emotionally, what she is feeling can be amplified.
Oxytocin is an AMPLIFIER of whatever emotion the woman is experiencing at that time! Therefore if the woman is fearful, and she cannot be calmed that fear can intensify without support.
Continuity of Care and Birth Support
From a trained independent professional: Independent Midwife/Doula, or close female friend can make all the difference.
Continuity of Care and Carer is definitely the GOLD STANDARD model of care for women having a baby, but only 8% of the world’s population can access this type of care.
And yet, it is critical that more of this care is available to women, with the rates of trauma, distress, anxiety and depression increasing annually.
Pre- birth Prevention
Any form of this care, even if it is continuity of care within a collaborative framework in the antenatal and postnatal period, can make a huge difference.
Why? the woman has had chance to share her story, to look at risk factors for trauma and put interventions in place, such as a “birth flow chart” and or COPING PLAN, instead of just a birth plan.
During the Birth
The birth space needs to be held and protected by the continued support of a Midwife, Doula or Student Midwife.
Care Providers Stance during labour and birth
The care providers need to keep a calm presence in the birth space to help facilitate the process.
They need to be aware that any emotion can be amplified, and any feeling of threat or danger needs to be replaced with focus on soothing the woman, to reduce that “flight and flight response.
Rachel Bushing and Amanda Donnet
The Mind Body Connection
During labour and birth the mind and body responses are intrinsically linked by the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system encourages the process and makes it GO forward.
The parasympathetic keeps it on the SLOW.
Stress hormones are counteractive to the Go and Slow.
Emotional Systems and how they control how we labour and birth
Our bodies our controlled by the 3 systems below being in balance:
- Threat System – tends to hijack our brain, makes our focus very narrow, hard to concentrate, it is all about survival. Cortisol and adrenalin are involved here.
- Soothe System – is the rest and digest system, calming and help seeking. Feelings which describe the soothe system are: feeling content, safety, feeling cared for and protected.
- Drive System – is purpose driven, moving forward, making progress. Happy, excited, hunger and sexual drive are part of this system. It is also values driven.
When the threat system dominates it interferes with the natural balance between the drive and the soothe systems, consequently, these systems become totally out of balance and trauma can ensue.
How to recognise the signs of Birth Trauma in yourself and others:
The image below is shared from a wonderful website and resource put together by UNFOLD YOUR WINGS. CO.UK
It shows in a pictorial format the symptoms you may be experiencing, and some of the reasons that may have caused you to feel this way.
There will be an event in your pregnancy, during your labour and birth, or just afterwards, which will relate or resonate with one of the above.
Post Traumatic Stress/ Birth Trauma
It is important to remember that all births will have some stress attached.
After the birth at any time, whether that is 3 months or even a year, if the woman, or her partner start to suffer from any of the below, then Post traumatic Stress/ Birth Trauma could be the likely diagnosis.
Psychological symptoms may include:
- Feelings of intense fear, helplessness or horror in reaction to reminders of the experience, for example words, smells, rooms, clinicians
- Fear and anxiety about going outside
- Poor self image
- Memories (flashbacks) of the traumatic vaginal delivery during sexual relations
- Trying to push feelings away and get on with looking after your baby
- Difficulty sleeping due to bad memories or reminders of the birth
- Feelings of isolation
- Irritability, anger and guilt
- Anxiety and panic attacks
- Avoiding reminders of the traumatic birth such as location where it occurred (avoidance reactions)
- Feeling emotionally numb or detached from others, activities, or your surroundings
- Sweating, shaking, headaches, dizziness, or gastrointestinal upsets and chest pains not connected with a medical condition
- Alcohol or drug use
- Struggling to bond with your baby. Australasian Birth Trauma Association (ABTA)
Physical symptoms may include:
- Pain around the site of the episiotomy or tear in the perineum (between the vagina and anus) after birth
- Urinary or faecal incontinence
- Difficulty opening or emptying bowels
- Pain or difficulty having sex
- Constant low back pain
- Awareness of a bulge or lump at the vaginal opening
- A dragging feeling in the pelvis or a sense that something is ‘falling out’, this may be increased by standing, lifting, tiredness or with a period
- Vaginal or pelvic muscle laxity. Australasian Birth Trauma Association (ABTA).