I look around the room, there are mums and babies everywhere. I look at their faces, smiling and happy. They are chatting, discussing if their little one is sleeping through, or sitting up yet. I stare at them, looking for a trace or a flicker that may show that deep down they are suffering too. You see Im suffering, a fear exists in me that wont let go, I watch my daughter sat near by playing with a small toy in her hand, Im trying hard not to react, to run over and check she is ok every few minutes, I know she is, I know we are both ok now, but still the ‘what if’ is there playing like a movie in my mind.
Yes, we are lucky to be here, Im lucky the doctors were able to save me as my life blood poured from me, lucky that my daughter was born in a hospital that had a neonatal unit with medical equipment to save her too. But I don’t feel lucky, because a part of me had died that night, and more of me was stolen in the weeks that followed as those I trusted to care for me treated me with unkindness, like I didn’t matter, wasn’t worth their concern, not even their pity.
So here I was, a shell of my former self, in a bubble of fear, anxiety and worry. Yet my lips felt glued together because I could not voice the way I was feeling or the thoughts that were holding my mind captive. I couldn’t put into words the visions I saw in the dark of night, or the constant worries that crept into everything I did and everywhere I went, till it became painful to do even the simplest things. No one saw behind the mask that I winced every time someone went near my daughter, or she went very far from me. But keeping the mask in place was becoming harder, when it became all too much and I could no longer stop it from slipping, I would sink into the darkness, fear gripping me and I felt alone.
Birth trauma changes lives, changes people.
Yet still many struggle to speak out, to share their story and to not feel ashamed.
Why is it that birth trauma is often not talked about? Why is it important we do so?
Fear has two faces when it comes to talking about birth trauma. Firstly, there is the fear of those that have suffered birth trauma, about the reaction of others, or how they will be viewed by friends, family, partners and also healthcare professionals if they speak out about how they are feeling traumatised. Especially can this be the case if their birth to others may have seemed ‘ok’ or if it was a birth that appeared to progress well. For others it can be that while their birth was obviously a difficult experience there is the old view that ‘well your ok and you have a healthy baby’, and that this is all that matters. Of course having a healthy baby and a women being physically ok, does matter, but also what matters is the emotional side and that this is is supported too. However after birth often there is much emphasis on the physical, medical side, that both are well that the emotional side is often ignored or left unchecked. Even if the emotional side is mentioned it is often a quick, “how are you feeling” and once again fear can hold a woman back from truly stating she may be struggling. This fear of how they will be perceived by others, or even what may happen if she reveals the emotional pain she is in can mean that women feel reluctant to fully express how they have been affected by their birth experience and instead seek to ‘move on’ or ‘get over it’ by themselves and without support. However, the effects can last a long time and it is not uncommon for women many years on, in fact even decades on, to still be suffering the impact of birth trauma.
Another face of this fear is the worry that is often voiced that somehow by speaking out about trauma, or difficult birth experiences we spread fear and this does not help other women to have a good birth experience. But is this really so? Well firstly, sharing a birth experience that was difficult or traumatic isn’t about spreading fear to others, but about acknowledging that persons feelings and what has happened to them. Granted this doesn’t mean we would do this to a room full of pregnant women, but it is important that everyone, whether their birth was positive or not has the ability to talk and discuss ‘debrief’ if you like, what happened. Sharing a birth experience that is traumatic is not spreading fear, but speaking the truth, saying ‘this is why I felt traumatised’ and ‘this is what caused my experience’.
Fear can not be a reason to prevent us talking about birth trauma, or from listening. If we do not listen to women, do not hear what they have to say about what matters to them, what care they need and why their birth was traumatic, how will we ever be able to improve birth experiences? Helping improve practice, care given, and birth experiences, means listening to all birth experiences. If we silence women and make them feel that to speak up about things that have happened, that have led them to feel traumatised is wrong, we have to ask why is it that we do not want to hear these voices? It is fear that we hold? Especially if our role is supporting women in birth should we want to hear what is it that can help us to make sure we do everything we can to reduce trauma and support women, especially in the most difficult of circumstances.
Someone is to blame
If a women is suffering from postnatal depression, we would never think for a minute that there was ‘someone’ to blame. We know that there are many reasons why ones suffer from postnatal depression, none of which are really anyones fault. However, when we think of birth trauma, often blame can very much be part of the picture.
It could be that good care was lacking or given in unkind way, or choice wasn’t supported. Maybe communication failed, or medical interventions where needed that weren’t explained or sadly done without consent. It maybe that checks failed to pick up on medical issues or concerns of the women weren’t listened to or taken seriously. With birth trauma sadly it can be the case that there was ‘someone to blame’.
This is very hard to hear and also accept. Those in the position to care for women during birth do not leave for work intending to cause trauma that day. Rather many are trying hard to make sure that they give care that shows a women respect, compassion and dignity. Yet many women and families are relating that they feel traumatised. Is the answer to stick our heads in the sand? No. Denying that birth trauma exists, or in any way minimising it only leads to increasing the chance of trauma. By openly talking about it and by listening to those that have been affected, we can instead work together to look at ways to reduce trauma. This will be difficult, to admit that sometimes things go wrong, that care isn’t always as it should be, or that we didn’t give someone the support they needed can cut to the core. But if we don’t we run the chance of many more women being affected by their birth experience that can affect them for a lifetime.
Recently I spoke at a conference on birth trauma and after a midwife came to me in tears, she clutched my hands and apologised for what I had been through. As tears streamed down her face she said she knew that she had most likely caused trauma herself that she didn’t know about on days when she had been over worked, tired and struggling to cope. She expressed that never had she meant it and she hoped that those women would forgive her. As I looked in her eyes I saw true sorrow. So I held her hands tight and reminded her that she had attended the conference and she had listened to my story and that was what mattered because by doing so, by showing a willingness to try, to know what can help, she could take that with her into her work and to would help her support families better. We hugged tightly and I again knew why it is so important that we speak up about birth trauma.
Another issue around why birth trauma isn’t talked about is often women blame themselves. They feel that they have caused the trauma in someway, maybe they didn’t try hard enough, or they didn’t follow the advice given. Maybe they feel that they ‘gave in’ to medical interventions, or didn’t cope like they hoped. Many feel that they didn’t have the birth they wanted or that their body ‘failed’ in birthing their baby. Some feel that they are weak and should be able to get over their experience and are somehow defective because they were affected. Especially can self blame accompany birth trauma if there is the loss of a baby.
How a woman feels needs to be acknowledged and she must feel free to express those feeling. Not allowing a woman to express her thoughts, or to grieve the loss of her birth experience will only serve to increase her self blame. With the right support and help in a time a woman can be helped to see that blaming herself while part of birth trauma is not a reflection of the truth. It is important that the understanding of this difficult aspect of birth trauma is explored and validated as this is needed to help recovery. If you support women in birth be careful of the words you use. In a recent discussion it was said that being prepared, doing certain things or thinking a certain way could prevent birth trauma. This again puts blame at the feet of the woman, making her feel like if only she had done this, or that, if only she had tried harder, or if only she had reacted differently. None of us know how we will reacted or be affected by a traumatic experience, it is as individual to us as every experience we go through in life. When we think of other traumatic events such as violent crime, or a natural disaster would we place the blame at the feet of the person affected, perhaps saying, ‘did you walk home alone, or why did you go there? Why then would we even hint at the possibility that in someway a women could have prevented the trauma she now feels?
We know that birth is suppose to be a wonderful experience. ‘Natural birth’ as its called is often held aloft as the prime birth experience, something to be attained as a prize or achievement. Often a positive birth experience is viewed as a birth that is without medical interventions, this can lead those that have had medical interventions or c sections to then feel they have failed and can thus lead to trauma. This can then prevent the speaking out about birth trauma, why?
Firstly if your birth was difficult or traumatic to speak up and say so can be difficult in the birthing world, as said above it can be viewed as being negative, spreading fear or even that you are against ‘natural birthing’. However why is this so? Is speaking up about birth trauma in any way related to your view of birth. Birth trauma does not make you an enemy of birth, but someone that has had a traumatic experience. It doesn’t mean that we hate birth, that we think of it only in the context of our experience but that we want others to know what we have been through. I have been fortunate to have a natural positive birth but for me it helped me realise even more how traumatised I was by my first birth. What matters is not the ‘type’ of birth but that it is positive experience for that woman and that she has the care she needs, is treated with dignity, compassion and respect, as well as given choices that are supported. A birth does not have to be any set way for it to be positive. Nor does speaking up about birth trauma mean being against the possibility of birth being a wonderful experience. It is also important to remember that there are many women who have felt traumatised from so called ‘natural births’ too and have then been afraid to speak out about how they feel. Many have reported feeling traumatised by elements of their birth but felt that they endured it due to the quest for a positive natural birth. It is important to listen to the voices of these women so we again can help women to feel supported and reduce the chance of trauma.
Secondly what about women that have set their heart on a natural birth and have then ended up with medical interventions or C-sections? When things in their birth have changed and women have had medical interventions, or C-sections can feel they have failed and thus feel traumatised. Many report that they feel their bodies have ‘failed’, that they haven’t really given birth or they are some how less than a women that has birthed a baby without the need for medical interventions. Some have reported feeling completely unprepared, believing that they were to blame or wondering why the techniques they relied on had let them down. Others have voiced that the reality of birth was glossed over, romanticised or simply not spoken about. All of this can result in birth trauma. Again often those affected feel silenced or unable to speak out about their true feelings, branded as negative, fear spreading and against natural birth. In one case I was told that a women was asked to leave a natural birth group because she her birth ended up with a C-section and those running the group didn’t want the experience of a C-section discussed because it wasn’t a ‘normal birth’.
Changing the status quo
Listening to women and what they have to tell us is important. This applies to both positive and difficult experiences. When we listen we learn value lessons that are like precious gems. These gems can enrich us and the way we support women. When we silence women or when we don’t listen to what they have to say, when we deny their feelings or their experiences we do so at the detriment of ourselves and others. Just like a gem every experience has many facets each with its own beauty. when we give that facet light is gives us something back. So too with birth trauma, each story has many facets that can help us to care better, give support better, prepare women better and we ourselves become better. To see those facets we must shed light on them, we do so by changing the status quo, by instead of turning a deaf ear, being brave and giving these experiences our attention. We can help women see that they can and should speak up, that they have much to offer, that they matter, their feelings matter and what has happened to them matters. Doing so we remove stigma, we can provide support and help that means ones can heal and recover and help them see that they are not alone.
We may never be able to fully prevent birth trauma, but what we can do is make sure that we learn form those bravely speaking out to help improve our services, so that women no matter how or where they give birth have experiences that are positive, because we treated them with kindness, compassion, dignity and respect.