What is Birth Trauma?
Birth Trauma is a result of a physical OR emotional injury experienced during or after childbirth, or a combination of both.
Physical Trauma
A physical injury can result from tearing or an episiotomy, postpartum haemorrhage, an instrumental delivery, complications from caesarean section wounds or some kind of internal damage as a direct result from childbirth. This can result in long term issues causing pain, pelvic organ prolapse, bladder damage, bladder or bowel incontinence, pelvic fractures, nerve damage, a hysterectomy, and these can cause a great amount of emotional distress.
A women’s health physiotherapist is the first place to find help to manage or improve symptoms. Women’s health physio’s have completed specialist training on women’s pelvic health and have a range or tools and treatments to assist with these issues and are also able to provide referrals if medical intervention is necessary.
A quick tip: a Google of women’s health physio in your area should bring up a list of options close to you – but have a quick flick through to ensure that they have completed specialist training and whether you could feel comfortable with them. They will be getting up close and personal so making sure they feel safe to you is so important. Some treatments offered to you might include internal pelvic examinations so keep this in mind, but also know that this is not mandatory at all if it’s a full body no – honouring your no is a huge part of healing, too.
Emotional Trauma
Before delving into what is birth trauma, the definition of trauma is helpful here – the emotional, psychological and physiological response to a deeply distressing or disturbing event which invoked feelings of terror, horror, helplessness or hopelessness from a real or perceived threat.
This definition of birth trauma doesn't invoke how harrowing it can be, but it does encapsulate all aspects:
“A traumatic childbirth experience refers to a woman’s experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/or long-term negative impacts on a woman’s health and wellbeing.” (Leinweber et al 2022)
In this definition above, note the phrase experience of interactions – birth trauma can be interpersonal, meaning it can result from the actions of another person. It can come from a midwife, obstetrician, nurse or physiotherapist – something they said or did not say, something they did or did not do – this too can create trauma.
The impact of psychological birth trauma can present as:
Postpartum post-traumatic stress disorder (PTSD)
Postnatal depression and/or anxiety (PNDA)
Obsessive Compulsive Disorder (OCD) (For example, obsessive thoughts that can affect our behaviour, such as checking on baby constantly or recurring thoughts that impact your enjoyment of daily life).
Feeling numb and disconnected from you’re your daily life, friends or family
Difficulty bonding with baby
Difficulty sleeping
Irritability of lack of concentration, being easily startled
Ruminating on events, intrusive thoughts, nightmares or flashbacks
Avoiding reminders of your birth – driving a different route to avoid driving past the hospital for example
So who decides if your birth was traumatic or not? You do. No-one gets to tell you how you feel about your birth except for you. Three women can have exactly the same birth and feel three completely different ways about it. The difference is that their background, nervous system health, level of support, beliefs, hopes and expectations are all different and so their experiences are all interpreted differently. This is not right or wrong, it just is. So if you are having negative feelings about your birth or experiencing any of the symptoms listed above, then please know that you need no-one’s approval or permission to call your birth traumatic.
So you had a traumatic birth – you are not alone
Birth trauma can feel so lonely – everyone expects you to be over the moon in love with your new baby and people can be so dismissive about having negative feelings towards birth, because culturally this is accepted as ‘that’s just birth’ and ‘you should just be grateful to have a healthy baby’. But please know, you are not alone.
Birth trauma as it stands in Australia is reported as experienced by one in three women (and that is just what is reported – I bet it’s higher!) and within that, approximately two-thirds (~68%) report that this trauma was directly related from their interactions with a care provider. Also, from the latest stats one in ten women report having experienced obstetric violence. (Keedle et al., 2022)
According to Google, there are approximately 982 births in Australia every day. That’s 327 women who are traumatised each day, and within that, 98 women are experiencing obstetric violence. Every. Single. Day.
Also, can we note that the definition above by Leinweiber (et.al) is from 2022, and before that there wasn’t a clear definition of birth trauma. In fact, the earliest research into birth trauma only dates to the early 2000’s. Birth trauma itself is not a new phenomenon but the recognition of it, is.
It’s not your fault
Next, please know that this is not your fault. This is not the result of something that you did or didn’t do. Knowing that two-thirds of birth trauma in inter-personal, meaning it comes directly from the interactions with a care provider – this is not your fault. You can not be responsible for the actions of others, and even if you chose to hire them, you hired them in good faith believing (quite rightly) that they would have your best interests at heart.
If you are in the other one-third, know that birth will always have an element of the wild. It is unpredictable and there will always be things that occur that are outside of your control. Sometimes things just happen, and it sucks, but it is not your fault. So often we can blame ourselves for this because birth is supposed to be something that women can just do, so when it doesn’t happen we can feel like we have failed. But this is not true – either you were failed by your chosen supports, or your birth took a path down the unexpected route, and again this was not something that you could prepare for, and cannot be your fault.
You had a traumatic birth and you don’t feel ok.. now what..?
First of all – know that you can find healing. You can resolve your symptoms and start to feel better.
You might know that there are some big feelings there, but as a new mum with a brand new baby, potentially with older children around as well (and yes you are a new mum every time because every baby is different and has different parenting needs so it’s like we are starting all over again for every baby that we have) it is really common to be in survival mode for a while while you are figuring out this new dynamic. So there is no right time to address these feelings - when you are ready is the perfect time and there is no rush. But when you do feel ready, or maybe not ‘ready’ exactly but like you need to ‘go there’ and address it - here are some places to start.
Birth Debriefing
Birth debriefing can be an invaluable place to start your healing journey. Telling your story to a trained professional who will hold space for all of your feelings to be heard and who will validate your experience is so important. Make sure it’s someone who not only has experience with understanding trauma but also who understands birth. Someone who understands birth will be able to help make sense of what happened, will be able to help fill in any the blanks on what happened and why, and maybe even to help reframe aspects of your birth from both a physiological and psychological perspective. A counsellor, psychologist, mental health nurse or midwife is a great place to start. They should be able to give you tools for further processing at home as well.
Your hospital or care provider might offer birth debriefing – this can be helpful to fill in any gaps, but quite often it can come with it’s own agenda in justifying their decisions which can quite often feel dismissive and make things feel like there is something wrong with you for feeling the way that you are feeling – i.e. it can be gaslighting. Not all, but some. This is why seeing someone not related to your health care provider is really helpful. If you do want to see your health care provider to have some questions answered, consider having independent debriefing first to help take some of the emotional charge out of the event first.
Somatic Therapies
Somatic therapy refers to any type of therapy that involves going beyond talk therapy. Trauma can leave an impact on the body, brain or nervous system so sometimes a deeper type of therapy can be helpful to alleviate these symptoms.
A commonly used therapy is EMDR – Eye Movement Desensitisation and Reprocessing and many therapists will use this method to help alleviate trauma symptoms
https://www.emdr.com/what-is-emdr/#layperson
Hypnotherapy is another tool that works within the subconscious mind. Personally, in my sessions I use a process called Timeline Reset that is a very gentle method of processing any heavy, negative emotions left behind within the subconscious mind after a traumatic event which will help to eliminate the emotional charge and lead to lasting change.
Other somatic therapies that women have reported to be helpful include reiki, energy clearing, somatic experiencing, kinesiology or womb massage. There is no right or wrong here, it’s often a matter of finding what works for you and what you feel comfortable with.
Kindness
So knowing that you’ve been through something, and it’s not your fault, it’s time to show yourself some kindness and give yourself some grace. We all hold hopes, dreams and wishes for how we want our birth to unfold, and how we want to feel in our birth, this is normal. *** So when this doesn’t happen, it’s a form of loss. So there will be a grieving process around this loss. So knowing this, give yourself some time. Be gentle with yourself. Trauma is an internal injury that we cannot see. If we had an external injury, like a broken leg, we wouldn’t expect ourselves to be able to ‘just get on with it’ - we would allow ourselves time to heal. We would call in supports to help us with both the practical side of things as well as lean on our loved ones for that emotional support. So treat yourself like you would if you had a physical injury. Rest, eat well, hydrate, call in your support team for practical and emotional support. Allow yourself to feel this loss - so often as mums we are in caretaker mode 24/7 and don’t get time to be with ourselves. However, suppressing these feelings wont make them go away!! You have to feel it to heal it. Journal, cry if you need to, rage it out, move your body - whatever it is that you feel like you or your body needs, see if you can create space to do just that.
*** There will be people around you who will want to say things like ‘that’s just birth’ and ‘you have a healthy baby, you should be grateful’. This is a problem within our culture that birth is not respected or revered like it should be. You have just created life - it’s kind of a big deal, and it should be treated as such. So if anyone says this to you, know that it says way more about their beliefs that anything about you, and just keep it in mind that they’re not a safe person to share with. You are not obliged to share anything with anyone, so keep this in mind and surround yourself with safe people while it’s feeling so raw and you’re feeling vulnerable about it.