Birth Trauma: Unveiling the Impact (part 1)
So, you’ve come home from hospital with your baby. The first few weeks have been a whirlwind but things are now settling into a slightly lesser version of chaos. Or not? Maybe it’s been days, weeks or months and you are feeling constantly on high alert. You can’t help but feel like there will be an imminent catastrophe; there is no option not to. Your body and mind feel in complete disarray, you feel alone and the “old you” is a distant memory. What’s more, you start to feel guilt and shame linked to the idea of not being able to “hold it together” or cope like “everyone else”. Is this a sign you aren’t made to be a mother? Is the baby better off somewhere else? Is there something wrong with you?
IN BRIEF:
Birth trauma can relate to anything that happens before, during or after birth.
While linked to an event(s), the impact of trauma stems from how you felt during an event.
Birth trauma triggers our threat system and disrupts feelings of safety in the body and mind.
Birth trauma symptoms are automatic, varied and can be more or less intense.
Birth trauma is highly treatable and with the right support, most make a full recovery.
How Common is Birth Trauma?
Trauma is a bit of a buzzword these days with influencers, musicians and athletes alike openly talking about it. Curiously, the notion that trauma is something that only effects war veterans somehow continues. We know that around 4-6% of women experience Post-Ttaumatic Stress Disorder (PTSD) within the perinatal period. Many more will experience trauma symptoms to a lesser degree. In the UK, up to 700,000 women give birth every year which means 42,000 women could be impacted by birth trauma every year. So, in short, trauma within the perinatal period is common. In this blog, I hope to outline what trauma is, its impact and some steps toward healing. This blog is the first in a two part series with the second focussing on healing from trauma and strategies to help yourself or someone you care about.
What is Birth Trauma?
To understand this, lets first consider trauma more generally. Psychological trauma refers to the emotional aftershock of a deeply shocking or distressing event(s). Often these are situations where we are left feeling unsafe, helpless, powerless and our nervous system becomes completely overwhelmed. The term birth trauma is a bit misleading as it can refer to a traumatic event which occurs any time before, during or after birth. However, we know that the risk for PTSD is increased between one and six months after birth. Maybe you have experienced a traumatic event related to an antenatal appointment, severe sickness, fertility treatment, being in hospital, birth itself, delivery complications, going home or feeding. Maybe childbirth was not what you expected or you might feel angry that medical staff ignored or disrespected you. Trauma can relate to a single event (like traumatic birth), or it can be connected to multiple ongoing events (such as fertility treatment). PTSD during the perinatal period may also be entirely unrelated to pregnancy as old trauma from the past can surface or resurface.
While trauma is linked to an event, it may come as a surprise that trauma has less to do with what actually happened and has more to do with how it felt for you, how it was experienced and what happened afterwards. This makes sense because we know what might feel traumatic to one person may not to another. Birth trauma also has a lot to do with the medical system and societal expectations. Unfortunately, the narrative too often solely focuses on the mother. It has been suggested that the term “obstetric trauma” is a more fitting term. Of course it is important to note that birth and the medical system is not inherently unsafe.
When I am working with clients who have experienced birth trauma, I am interested in how the experience was for them and how it was perceived. Tell me about how it was for you? Did you feel fearful, unheard, unsafe? Did you feel out of control, helpless or powerless? Did you believe that either you, or your baby, would die? I’m also really interested in what your support was like, before, during and afterward. Did you feel cared for, listened to and supported? Who was there? Were you left alone? This is important as good support can act as a buffer against developing PTSD after a traumatic experience. So, if you went through something horrendous but you had quality care, this can significantly reduce your risk of developing PTSD. Importantly, not everyone who experiences a traumatic event will go on to develop trauma symptoms and not everyone who has trauma symptoms will develop PTSD. Indeed, the majority of people do not.
The transition to motherhood naturally involves a realigning of identity and adjustment on many levels which can of course, in of itself, evoke stress and anxiety. Therefore, parents navigating birth trauma suffer two-fold with trauma and the natural anxieties that occur with such a life-changing adjustment. Unfortunately, trauma symptoms too often get misdiagnosed or missed entirely.
Is Trauma just in the Mind?
Absolutely not. Our body and physiology is central to understanding the impact of trauma, both during and after an event. Humans have a threat system which has evolved to keep us safe. The threat system is a full body response and when triggered you will notice all sorts of physical changes. During trauma, your body is flooded with stress hormones and the old fear centres deep in the brain, shut down unnecessary bodily processes, including the digestive system (because who needs to be digesting last night’s curry when being chased by a tiger!). This is a smart evolutionary response designed to free up resources so that our body and mind can better respond to threat, and be more likely to survive. For example, with more blood pumping to our muscles we are more likely to be able to flee any predator. With dilated pupils we increase vision and are more likely to see a threat. We rapidly move from a state of connection and safety into heightened state of threat. This can show up as anxiety and/or it may mean completing shutting down and feeling numb.
We have a system within the brain which is akin to a librarian and is responsible for information processing,. This system filters and processes incoming sensory data before moving it into our long term memory with a time-stamp. This system also shuts down during trauma. Because of this, the memory of the traumatic event does not get processed and can hang around in our awareness. This explains why we can be so easily triggered by sounds, smells, sights, tastes and feelings which transport our body and mind back to the time of the trauma. When it comes to trauma, the past is not the past. It is the present.
What Happens in the Body after the Traumatic Event?
The impact of trauma lingers long after a traumatic event. Slight tangent alert! Let’s consider a zebra who is eating grass when a hungry lion appears from nowhere and starts a chase. The zebra’s threat system automatically kicks in and it manages to escape, the lion is nowhere to be seen. So, what does the zebra do? It goes back to eating the grass and its body and mind swiftly return to a feeling of safety. So, what has this got to do with birth trauma? Well, the human brain operates slightly differently and while amazing, there are some glitches. Firstly, human brains have evolved in a way that leads us to be naturally sensitive to threat and anxiety. Our brains operate as if we are hunter gatherers, so, it’s really all about survival and being better safe than sorry. The human mind’s ability to time travel i.e. think about the past, future and create imagined scenarios is double edged. That is, when a traumatic event is over, we don’t return to feelings of safety like the zebra, we continue to be on high alert long afterwards. Constantly looking over our shoulder for the lion. Just in case. It’s like our internal fire alarm keeps alerting us to a fire long after it has been extinguished.
What are the Signs of Birth Trauma?
A heightened threat response shapes our thoughts, feelings, physiology and behaviours. It threatens our belief in safety and at worst, our ability to trust ourselves and others. It can also block our capacity to receive care and compassion.The signs might include :
Having unwanted distressing thoughts or memories
Flashbacks (images, memories, sensations or feelings that you felt at the time)
Nightmares
Physical or emotional distress when around reminders
Patchy memory of the event
Avoidance of situations that remind you of the trauma e.g. walking past the hospital or meeting new mothers
Avoidance of thinking about the event
Irritability and anger
Trouble getting to sleep or staying asleep
Poor concentration and focus
Hyper-vigilance
Worry that something awful might happen to you or your baby
Feeling on edge and jumpy
Feeling guilty or as if you are somehow to blame for what happened
Negative thoughts about yourself or the world
Despair, depression
Mothers who suffer from trauma symptoms often end up structuring their lives around it, doing everything they can to avoid triggers that remind them of their trauma. Many people report symptoms worsen in the evenings which also makes sense given that our ancient ancestors would be much more vulnerable in darkness due to being unable to see predators.
A diagnosis of PTSD is related to the severity of your symptoms, how long they have lasted and the impact they have your life. It is important to remember that all trauma symptoms are a fully natural response to circumstances. Our threat response is involuntary and you are not consciously choosing it. It is not your fault your body is responding in this way. Your body is trying to protect you and keep you safe from further threat. Indeed, a highly sensitive threat system is helpful when staring into the eye of a tiger, but when you are trying to juggle looking after a new-born, do the washing and make a sandwich, well, not quite so much! Your trauma symptoms are a completely normal response to abnormal events, and are not a sign of some inherent flaw.
Risk Factors for Birth Trauma…
While the psychology behind developing PTSD is complex, there are some known risk factors which make some individuals particularly vulnerable to experiencing trauma symptoms. Again, this does not mean you will definitely experience trauma if you have these risk factors, and most who experience a traumatic event will not go on to develop PTSD.
Childbirth not going to plan, or matching expectations
Needing intervention and assistance during labour
Delivery complications
You or your baby sustaining an injury
Still birth or neonatal death
Not receiving adequate and consistent care
Feeling a loss of control or lack of choice
Poor communication/not being respected
Previous trauma (including previous birth trauma)
A tendency toward anxiety
Worrying that you or your baby will die
You/your baby needing medical help after birth
Individuals affected by birth trauma unfortunately often find that there is nowhere to turn for support. They find that other mothers who have not had traumatising births find it hard to understand or relate to the impact of a traumatic birth. This leads to isolation and shame where woman may feel somehow weaker than other women. Too often, the focus is on having a healthy baby and the belief that this should make up for any trauma that has occurred. Individuals can feel incredibly guilty, it wasn’t that bad, I shouldn’t feel this way.
The Ripple Effect of Birth Trauma…
Birth trauma can have a ripple effect. Relationships with friends and family may worsen and considering another baby can feel impossible. Many women end up feeling conflicted by their desire for another child and their determination to avoid another pregnancy. Consequently, couples delay having another baby or avoid it altogether. Woman may also lose interest in sex or intimacy which adds to the existing strain on relationships. For many, it’s not until the next pregnancy that trauma symptoms surface and they become aware of the impact from the first. Some women also avoid any medical appointments that reminds them of their birth experience, including smear tests. Many also worry about the impact of birth trauma on bonding but the good news is that the majority of mothers are able to bond with their baby, despite trauma symptoms. Partners and medical staff are also at risk of PTSD but this is a lot less talked about.
Healing from Birth Trauma…
The body has a natural healing system and for many symptoms often settle down within a month or so naturally. For some, trauma symptoms persist, worsen and can develop into PTSD. This is not something that can be alleviated by “pulling yourself together” or “focusing on the positives”, despite what other people may say. Fortunately, PTSD is highly treatable and there a number of evidence-based approaches that can help you fully recover. The current recommendations for trauma treatment include Trauma-Focussed Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation Reprocessing (EMDR) therapy. Other approaches including Compassion Focussed Therapy (CFT) and Acceptance and Commitment Therapy (ACT) can also be helpful. Research shows that most people who go on to become pregnant will have a better experience next time.
If you have been impacted by birth trauma or would like to explore it further you can:
Talk to your GP or midwife about how you feel
Request professional mental health support (from a suitably qualified professional)
Ask for practical and emotional support from friends and family
Access support from organisations such as https://www.makebirthbetter.org/ and https://www.birthtraumaassociation.org.uk/
Stay Tuned for Part 2….
