What is Birth Trauma?
Birth despite all the best made plans and supports is unfortunately sometimes unpredictable. Sometimes It takes unexpected sudden directions. It is a very ambivalent emotive experience that can be perfectly beautiful and at the same time incredibly scary.
But what does birth trauma mean?
Birth Trauma arises as the result of a frightening or upsetting experience during a woman’s birthing experience. This can happen at any time be it a “perfect natural” vaginal delivery or “uneventful” caesarean delivery!
Because birth trauma is not about what happened to the woman, but it is about her perception of what happened to her during the difficult events.
“Birth Trauma lies in the eye of the beholder”
University of Connecticut School of Nursing 2004
So very often women experience the effects and symptoms of birth trauma even though on paper in the medical notes it looks like they had a “good birth”
Within the context of trauma informed approach, it is important to realise that trauma symptoms represent a psychological injury to brain, it is not a mental illness or disorder. This is particularly important awareness for relevant referral pathways, assessment, and support for the woman.
However, if misdiagnosed, untreated, or ignored it can manifest into, post-natal depression or anxiety
Here is how Dr Gabor Maté describes trauma
“Trauma is not what happened to you but what happens inside of you”
He describes trauma as a psychological injury locked in our nervous system, mind, and body. Which long after the trauma is gone, is easily triggered at any given time, evoking thoughts, unresolved emotions, autonomic responses, and coping behaviors all connected to the traumatic memory of that event.
In his book “When the past is always present” Dr Ronald A, Ruden states that traumatization always involves intense emotions and that traumatization in about being trapped in the uncompleted act of escape. All the ingredients of an emotionally overwhelming birth experience of which a woman in that experience would have little or no control over.
The side of the problem in Ireland
In 2022 a study was conducted in a postnatal ward in of an Irish maternity hospital which provided postnatal care for public maternity patients.
Its findings identified a prevalence of 18% of women experiencing birth as traumatic in Ireland. In 2021 there was 58,443 births registered in Ireland that would indicate percentage wise that there is as many as 10, 520 women struggling post birth, and this would be just the tip of the Iceberg as we have not even considered perinatal trauma or vicarious trauma to partners or other health care professionals.
Psychological trauma during birth impacts negatively on postnatal mental health and consequently has a ripple effect onto mother infant bonding and other family relationships.
Some causes
Traumatic or emergency deliveries either vaginal or caesarean
Lengthy about or short and very painful labour
Fear for the baby’s safety or own safety
Stillbirth
Birth of a baby with a disability resulting from a birth trauma
Need for neonatal intensive care unit or special care baby unit
Emergency medical or surgical treatment for mother or baby due to birth complications
High levels of medical intervention like c-sections, assisted deliveries, inductions, etc
Poor pain relief or being fobbed off
Feelings of loss of control
Impersonal treatment or problems with the hospital staff. Basically, not feeling cared for!
Not being listened to, heard, or validated in your needs.
Lack of information or explanation
Lack of privacy and dignity
Poor postnatal care
Trauma with a previous birth or domestic violence
Symptoms Of Birth Trauma
Intrusive Symptoms
Recurrent and unwanted thoughts or memories of the event
Bad dreams or nightmares about the event or parts of it
Flashbacks or reliving the event or parts of it
Feeling upset when reminded of the event
Feeling tense or anxious when reminded of the event
Avoidance Symptoms
Trying to avoid thinking about the event
Trying to avoid things that remind you of the event, people, places, appointments, tv programmes etc
Nervous system/ hyperarousal
Feeling irritable or aggressive
Feeling self-destructive or acting recklessly
Feeling tense and on edge, sweaty, trembling
Feeling jumpy and easily startled
Problems concentrating
Not sleeping well due to problems not relating to the baby’s sleep
Feeling emotionally numb and detached from self or others
Cognitive and Emotional Symptoms
Unable to remember details of the event
Feeling negative about yourself or feeling that something awful will happen
Blaming yourself or others for what happened
Strong negative feelings about what happened (for example fear, anger, shame, guilt)
Lost interest in things that were important to you
Feeling detachment from others or yourself
Unable to feel positive emotions (happy, excited joy)
Feeling like no one understands isolated in experience Feeling unsafe in the world
Feeling like you can’t trust anyone
Feeling like you can’t trust yourself or your instincts
How we can offer support to struggling mums in General Practice.
As GP Nurses we are well placed with multiple points of contact with mums during 6-week check-ups and at baby vaccinations to ask the relevant probing question, using and refer accordingly
We have referral Pathways within our specialist perinatal mental health network or privately to trauma informed therapists if requested.
Links
Recoursesecourseseourse
Birth Trauma Support Ireland - Private Facebook Group