Helping Women Face Birth After Trauma
By Rachel Gurevich
Fear of childbirth is common, but the normal anxiety many women experience is nothing in comparison to women who have been traumatized by a previous birth experience. Trauma from childbirth can lead to nightmares, extreme fear of another pregnancy or next birth, and postpartum depression and anxiety. For some, it leads to Posttraumatic Stress Disorder, or PTSD. Just the thought of having another child can feel terrifying to a woman who has experienced a traumatic birth.
"We didn't start talking at all about another child until Will was about three," explains Alyson English, a mother from Louisiana. "I said I'd like a girl, but that I wasn't sure I ever wanted to give birth again. We even talked about adoption as an alternative."
Important not to forget, fathers can also be nervous and anxious about the next birth. "I think something that can't be understated in this is the emotional toll it took on my husband," says Alyson. "When we were preparing for Will's birth, and I would ask him if he was nervous, scared, etc., he’d always say the only thing that scared him was the idea of losing one or both of us. So for him, sitting there in that operating room [the first time], seeing the doctors begin to panic, knowing I was losing blood and that his son wasn't emerging, not hearing him cry, being hustled out of the operating room when they put me under . . . He wasn't ready to go again, either. He was just as scared as I was."
Trauma during birth doesn’t always mean life threatening. A natural birth that ends with unwanted medication can be extremely traumatic for a woman who always dreamed of a drug-free experience. The hospital environment itself can cause many women to feel violated and out of control. It is the sense of a lack of control that causes many women to experience a birth as traumatic.
Mary E Tyler of Virginia experienced a long, agonizing 36 hour birth with her first child. She had hopes the second child’s birth would be better, but things didn’t go well. "I had wanted a natural childbirth with my first and had not been able to have one," explains Mary. "My second was born in a military hospital, and all they wanted was for me to shut up and leave them to do their paperwork in peace. After about 4 hours of hard labor, during which they would not let me walk and kept me monitored, and everything but chained to the bed, I gave in and asked for an epidural (they were very solicitous offering it to me every ten minutes or so).
"After I allowed them to put in the epidural, they ignored me," she continues. "They were supposed to check every half hour, and it was nearly 2 hours before they checked again. My daughter was CROWNING, and they had to rush me to the birthing room, or I would have given birth right there in the labor room. If I had not insisted on an assistant checking me (she wanted to wait another 15 minutes ‘until it was time’), I would have birthed my daughter unattended. So really, I was on my own."
Trauma is very personal. What may feel traumatic to one person may fall within the realm of "just stressful" for another. This is important to realize when caring for women. In your role as a doula or midwife, if a mother describes their last birth as traumatic or overwhelming, the worst thing you can do is try to convince her it wasn’t "so bad" or that it could have been worse. Telling her, "But you and the baby turned out fine and healthy," is not going to make her feel better. The last thing these women need is to have their feelings invalidated by a birth professional.
We experimented with some new, positive birthing imagery, and worked on exercises designed to help her "let go" emotionally and physically. I had Miriam practice holding a piece of ice to simulate a one minute "contraction." We explored different coping techniques to get through each "contraction," movement, breath awareness, non-focused awareness. We also worked on loosening up her lower body by working on some specific movements designed to relax the pelvic muscles.
"They need to be heard," explains Teresa Howard, a doula for over 200 births. "They need validation in what they feel as important and real."
Empowerment, Not Advice and False Reassurances
A natural, albeit inappropriate, response to women who have experienced a traumatic birth is to promise them that things will be different this time. The truth of the situation is no one knows what will happen with the next birth.
"You cannot reassure," advices Sheila Kitzinger, birth advocate and author of several books, including Birth Crisis (Routledge, 2006). "But you can work out how to meet challenges. They get too much advice and jollying along. Not enough respect."
The most important thing to do is discuss together what can be done to make this birth different than the last, and to create a plan of action if things go wrong again.
"Talking through the next birth with the doula and/or midwife to discuss what happens ‘if’ would be really helpful," explains Alyson. "Confronting the fears in a neutral situation instead of when they're actually up against you is much more productive."
"Listen to her and validate how she feels," explains Sheila. "It's not necessary to say much. Ask her how she means to plan so that this next birth is different, and help her sort out a strategy and a fail-safe."
A new birth center or hospital, a new doctor or midwife, a different set of supports – these are all possible ways to make next time different than last time. Often, one of the best ways to help the mother and father feel more in control is to ensure that during the birth, they remain informed on the situation and their options – something they should have experienced the first time, but unfortunately, is commonly ignored by birth professionals.
"[With my first child’s birth,] no one kept me clued in," explains Ami Weaver of Michigan. "I knew something was wrong, but no one would tell me. I knew every second counted, to prevent brain damage or death, but even as they wheeled me into the OR, I didn't know what was going on. [My son’s] heart rate had dropped because he'd gotten on his cord. I was gearing up to push when it all fell apart.
"I needed someone to keep me informed," Ami continues. "There were, thankfully, no problems with [my] other babies, but the staff was aware of what had happened before (I told them), and promised to keep me in the loop should anything arise. That was a huge comfort."
Listen, But Don’t Push
One of the more powerful ways to support a mother who is scared of that next birth is to listen. Just letting her tell her story, as many times as she needs, will help her process her past experience. But, don’t push her to talk.
"You don't open Pandora’s Box without having the tools to help her, so don't ask questions," says doula Teresa Howard. "Allow them to open up at their level as they feel they can. And then, listen. Women who have trauma have fears that need to be addressed so they can work through the fear prior to labor."
As you listen, refrain from telling her how you would have done things differently, or blaming her choices on her experience. Just as importantly, what you see as the solution may be far from what your client sees as the way to a better next birth. "The mother is in charge," reminds Sheila.
"Doulas are there to support the mother in her birth process, and that as much as we all know what is ideal, each situation is individual," explains Alyson. "I thought I wanted a VBAC (vaginal birth after cesarean). I knew it was the *right* thing to do, but when [my husband] Ben and I talked about it, we realized that more than anything, the thought of a repeat emergency c-section scared us the most. We knew the risks of c-sections, but for our family, we really believed that with the blood pressure problems, our uncertainty about the state of my original scar and the uterine wall, and our emotional concerns, we were making the right decision [we deciding on a planned cesarean].
"It's funny -- I have a friend who is a doula, and I know that as much as she didn't want me to know, she disapproved of my decision," continues Alyson. "She is a home-birth sort of gal, and I completely support my friends who can choose midwives and homebirths. I sincerely wish I could, but at least the second time, I couldn't."