Birth Trauma: Factors and Impact

Many families with children express to me they were surprised by their birth experience, for a number of reasons. We cannot predict exactly what will happen when it's time to bring a baby into the world. The unexpected changes (even if we have briefly discussed them) are what can set the stage for a traumatic birth experience, especially if a family feels disempowered or not fully informed. Some examples include unexpected beginnings, such as induction of labor or the need for baby to be in the NICU; emergencies, like distress of baby during labor or high blood pressure; or the feeling of being out of control or unable to make informed choices, resulting from poorly controlled pain that leads to suffering, neglect or condescending attitude from care providers, or the inability to make educated decisions due to time limitations and emergency situations. This does not mean any birth with unexpected changes leads to trauma; it simply means there are many variables, and with variables come opportunities for positive and negative outcomes.
 
Here is what we know: 1/4 to 1/3 of women report feeling traumatized by their birth experience. These numbers are likely low. This figure does not include the number of partners, doulas, family members, and medical staff who may have witnessed unexpected labor circumstances or neglect or mistreatment by care providers. And possibly the most important aspect of birth trauma: if the family experienced the birth as traumatic or felt as if they were in danger or their baby may not survive, it was traumatic. The perspective of the family is the only one that matters when it comes to whether or not they have experienced trauma.

The impact of birth trauma can be minimal to devastating. For some parents, it becomes a matter of having failed the very first parenting test they were faced with. They had a plan for their birth and they didn’t accomplish it; they brought their baby into the world in a way that felt harsh and wrong; they feel that if they could have tolerated the pain, suffering, or pressure from the medical staff just a little while longer, the outcome would have been different. Sometimes they are terrified of even thinking about having another child, lest they have to face the idea of another horrible birth experience.

Families often report a cluster of symptoms after enduring a traumatic birth experience. These include flashbacks of the birth, sometimes moments they hadn’t thought about since they were in labor; wanting to avoid discussing the birth at all, even with trusted family and friends; numbness; anxiety or panic; and feeling like something bad is about to happen, all the time (also called hypervigilance). These symptoms are the body’s reaction to a traumatic event. Your brain is throwing up red flags to tell your body the situation is not safe (because it didn’t feel safe at the time), and sometimes it gets stuck in this place. It’s often exhausting and frustrating, not to mention how scary it is to feel like you are back in that terrifying moment.

Traumatic or unexpected birth experiences radiate into other parts of our lives. They impact not only our own self-esteem and trust of the world around us, but can impact our relationship with our baby, our partner, our family, and our community. When I work with families after a difficult birth, I ask about postpartum depression and anxiety as birth trauma can significantly increase risk. Conflict in the family is also a real concern, as each family member’s experience of the birth may have been different and they are having challenges expressing what they saw and how they felt. This is a place where families can feel a lot of isolation. A partner may have witnessed the person who is most important to them suffering in labor, or in the midst of a serious medical emergency, and can’t stop seeing those images. Navigating these situations is difficult, and support can really help.

Knowing this information, it’s so important that families who have difficult birth experiences receive support. In Asheville, we have a wonderful program called Survivor Services at Mission Hospital. This program allows families to create a more in-depth birth plan to avoid triggers for past negative experiences—the family does not have to disclose the trauma, and the services are free. Wonderful organizations like PaTTCh (Prevention and Treatment of Traumatic Childbirth) are developing guidelines to reduce traumatic birth experiences, educating families about their choices, and informing medical providers of best practices for empowered childbearing experiences. When I work with clients who have a history of traumatic childbirth, I recommend they hire a doula (actually, I recommend all families hire a doula, but that’s a different blog post). Doulas help families feel safer, more informed, and more supported, as well as increase positive birth outcomes. If your family experienced trauma in the birth of your baby(ies), you do not have to suffer alone.