Birth can be a traumatic experience – filled with sights and sounds, which if associated with fear, can become locked into our minds. It’s of course not birth itself, which is traumatic, but the circumstances in which the baby comes into the world. Birth can be a calm, empowering experience. But many factors which can emerge during labour, including a loss of control and dignity, can leave women with the opposite impression of their births.
The Birth Trauma Association estimates that in the UK, 20,000 women develop Post Traumatic Stress Disorder (PTSD) as a result of birth trauma each year. A further, 200,000 women may feel traumatised by childbirth and develop some of the symptoms of PTSD. These numbers are particularly high, and yet there remains little understanding of or support for birth traumas.
The word trauma means a deeply distressing or disturbing experience. Psychological trauma is often defined as an event whereby the person subjectively experiences a threat to themselves, in some way. Within labour, some women experience a myriad of medicalised sights and sounds, equipment, difficult requests, procedures and messages. And many develop symptoms of PTSD, which might include distressing recollections of the event, flashbacks, nightmares, emotional numbness, and avoidance of places, people and activities that remind them of the trauma.
I often see women in therapy with post-natal depression or anxiety, who come to see me unsure of why they feel the way they do. I find that when they begin to talk, I’m aware that they have never spoken about their labour or how it’s affected them. And 9 out of 10 times, the birth was traumatic; something the mum is generally not aware of until we start to process it. They are often experiencing flashbacks from the labour, difficulty sleeping, avoidance of memories and pictures of the birth etc., but put this down to lack of sleep, adapting to the new baby and mood issues.
Trauma undoubtedly affects mood, however this is poorly understood. Anxiety is often a tell tale sign of trauma, with physical symptoms such as difficulty sleeping, or nightmares. Shock, confusion, anger, anxiety, guilt, shame, feelings of disconnectedness and urges to withdraw are just a few of the emotional symptoms. However only when starting to talk about how they feel, do women share their distressing experiences and voice that they had not understood the link between their individual birth and their mood.
So how can we process our experiences of birth trauma?
The story of our birth is often caught in glossy photos, through rose tinted social media updates and birth announcements. In fact it often feels like people only want to hear good news. But when a third of births experienced are traumatic we need to start being realistic, and to share our imperfectly perfect experiences. To speak openly about our experiences (when we can) and to talk about the good, the bad and the ugly can be important. The more we listen to others less than perfect experiences, the more we fight our inner shame about our experiences.
NHS Birth Reflection services are particularly helpful for women to deconstruct and begin to learn about their birth experience. Often sections are hazy and not clearly remembered, and midwives can help women understand their reactions as well as why decisions were made when they were made. Women reflect on using these services in a positive light, better understanding an important aspect of their life.
Therapy is also helpful in managing symptoms, and processing the birth experience. Sometimes It seems like the safest way is to avoid, but avoidance potentiates the symptoms. Gently visiting the memories in a safe place, alongside our midwives, therapists and other professional support services, is key.
Prolonged exposure (PE), is a form of CBT where we re-experience the traumatic event through remembering it and engaging with rather than avoiding it. It can teach us to approach our trauma-related memories, feelings, and situations, decreasing PTSD symptoms and improving mood. Eye Movement Desensitization and Reprocessing (EMDR) is also very helpful in alleviating the distress associated with traumatic memories. It alters the way these traumatic memories are stored within the brain and making them easier to manage.
The power of support groups, and finding a tribe of women can make all the difference. Talking to other women and realising you are not alone, can be very powerful.
We need to treat ourselves with the kindness we deserve, giving ourselves time and space. And to process the huge adaptation our bodies and minds have had to make, as well as processing the distressing memories.