Giving birth involves the most private, intimate parts of our bodies and so, requires that we be treated with the greatest level of care and protection. All of our past experience of our intimate bodies becomes alive in the present day when we give birth. Birth becomes traumatic when it includes real or perceived physical or emotional injury, danger or death to mother or baby. And the trauma can be carried by the mother, the baby or anyone who witnessed the birth. Birth experiences become traumatic when they include feelings of terror, helplessness, a sense of having no control, feeling uncared for, alone, or disrespected.
Did you have a traumatizing birth experience?
I'm sad to share that 25-35% of mothers feel traumatized by their birth experiences and suffer with longstanding physical and/or emotional symptoms. And yet some women who encounter unexpected crises in their births or who undergo emergency procedures don't feel traumatized - and don't suffer from PTSD. A piece of this puzzle has to do with the birth-related care women do and don't receive along with the medical interventions we encounter. But perhaps the most significant piece of the puzzle has to do with our emotional worlds - how well we were cared for in our past and how well we are cared for in the vulnerable phases of early motherhood. When women are well cared for, trauma is less likely.
What is Posttraumatic Stress Disorder (PTSD)?
Women with PTSD from birth trauma can have intense, disturbing thoughts and feelings that are long lasting. They may relive the birth through flashbacks or nightmares, they may feel intense sadness, fear or anger and they may feel detached or estranged from other people. PTSD often causes women to avoid situations or people that remind them of the birth and they may have strong negative reactions to things other people find benign.
Risk Factors for developing PTSD after a traumatic birth
Why do some women develop symptoms consistent with PTSD after giving birth, while others don't? We all go into pregnancy, birth and motherhood with different constellations of experience, biology and resources. Some of us are trauma survivors; we have lived through a difficult childhood where we were abused or subjected to painful relationships, or we have experienced sexual assault, or perhaps we’ve gone through IVF or medical procedures that left deep scars. When we carry these unprocessed traumas into our birth experience (as so many of us do), and we encounter emergencies or unwanted occurrences, we can be re-traumatized. The re-traumatization feeds on old wounds, creating an overwhelming sense of despair and anxiety in the present.
What are some common risk factors for developing PTSD in childbirth?
* Having experienced other trauma earlier in life
* Having anxiety or depression
* Lacking a good support system
* Having close relatives with mental health problems
* History of abuse (such as childhood abuse, sexual abuse, rape)
When present day terror and helplessness are paired with any of the above vulnerabilities, new moms struggle to recover and to harness the energy required to bond with their babies. The birth experience can replicate past feelings of powerlessness which opens a portal to old trauma, infusing the birthing or postpartum woman with deeply painful feelings and sensations. Giving birth offers women an opportunity and even a mandate to attend to past emotional injuries. Flashbacks, nightmares and hyper-vigilance focus mom's attention on historical dangers that keep her from connecting with her little one. In order to be present for baby, mom needs to feel safe in her internal and external worlds.
In our brains, trauma encodes as super-charged, isolated material that's off-limits and difficult to access and process. Those painful experiences are exiled and defensively guarded by our own protective psychology. Trauma makes it hard to connect with ourselves and with others; we are jumpy, reactive, avoidant and on-guard, careful not to trip the wires that will set off the memories. If mom is in this protective stance, it's bad news for a baby who is seeking her openness and who's health is dependent on intimate, attuned connection.
The good news: there are highly effective ways to reach those tender, isolated memories and integrate them into your wholeness so that your attention and energy can shift from protecting back to connecting. If you are the bearer of a trauma legacy - or if your birth experience was traumatic - you deserve warm, caring attention so that your trauma can be processed and you can be present for your life. Talk therapy is powerful: EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, IFS (Internal Family Systems) and CBT (Cognitive Behavioral Therapy) can be life changing. You also deserve care for your physical injuries; pelvic floor physical therapists specialize in working with scar tissue, incontinence, pain and other pregnancy and birth-specific physical issues.
What can you do to reduce the likelihood of developing PTSD?
Women are highly vulnerable in pregnancy, childbirth and the postpartum period. We develop PTSD when we feel terrified and helpless, hopeless or alone. If you are a trauma survivor or you know you have some of the risk factors for developing PTSD, it's important to prepare for childbirth in advance. Learn about yourself: What happened in your past? What are your fear triggers? And learn about your birth options: Where would you like to give birth? Who do you want present at your birth? How do you want to approach medication and interventions? Knowledge relaxes and empowers us.
Next, assemble a solid, trustworthy support team who will ensure that you are respected during your birth. Care providers can metabolize fear and create an atmosphere of confidence - or not. Care providers can use their wisdom and power to strengthen and empower us - or not. Be thoughtful about choosing your care providers. You didn't get to choose your parents, but you do get to choose your birth team! Who are the critical care providers on your team?
* BIRTH DOULA (reliable, trustworthy, warm)
* OB or MIDWIFE (trauma informed/respectful and sensitive)
* THERAPIST (educated in Maternal Mental Health)
How can care-providers reduce the likelihood of a birthing woman developing PTSD? They must demonstrate the following:
* Interest in your experience
* Respect for your wishes
* Responsiveness to your needs
* Positivity, encouragement and kindness
* Wisdom and knowledge
Women who feel seen, heard and responded to - even during unexpected crises - develop fewer trauma-related symptoms. Care providers are critical.
Know your story and your triggers.
Plan your desired birth experience.
Choose your birth team carefully.
Partners and Birth Trauma
Emergency or unexpected birth experiences can leave dads and partners traumatized too. Fearing that your baby or partner is in pain or dying and being unable to help, creates a lasting imprint that's hard to recover from. Because these birth emergencies happened to mom or to baby, and the focus is on mom and baby surviving and being cared for - oftentimes the partner's experience feels unimportant or secondary and gets lost in the shuffle.
After a traumatic birth many partners feel guilty and responsible - as though they should have been able to help or protect their loved ones from what happened. Some report that as a result of their painful feelings and memories they distance themselves emotionally to avoid being triggered. Emotional distance isn't good for new moms or babies and can create relational injuries that have repercussions for many years.
Partners who have been traumatized by birth need to be treated and allowed to process their painful feelings and memories. Trauma restricts our range of emotion and expression and keeps us from living openheartedly. Therapy can help move you out of protection mode and into connection mode.
Trauma and Personal Growth
Human beings are resilient. Many of us come out of traumatic births not only recovered, but stronger than ever. How does that happen?
We are social creatures and when we are in emotional pain, we need to connect with people and we need to express ourselves. Through the process of finding compassionate people and sharing our stories, we come to understand ourselves much more fully. We connect with others more authentically. We feel others' pain and joy more intimately and we feel FELT by others more accurately and completely. We find our voices and we become advocates for ourselves, for our children and for other women and other humans whose suffering we understand. We wake up and we show up.
Having a child taught me that I am capable of more than I ever knew. I found strength, flexibility, patience, forgiveness and undeniable, unwavering love as I made my way through a harrowing 72 hour birth experience and the difficult postpartum journey that followed. Becoming acquainted with these qualities in myself allowed a new level of trust to take root in me. I became someone trustworthy through encountering my intense suffering and watching myself persevere. And then I found the courage to share my pain and seek my own healing, all while taking good care of my little one. I am now an advocate for mothers and I want to share my confidence and vision to support you on your journey.
I see you. I feel you. And I know you can heal.
Jessica Sorci, LMFT