Traumatic Birth: The Silent Struggle
Published on: January 12, 2021
Midwife Emma McNerlin examines the sensitive topic of perinatal trauma and its impacts on new parents; as well as the support and services available to help them heal and move forward.
By: Emma McNerlin
Research suggests that around 4% of women who give birth develop postnatal PTSD (Post Traumatic Stress Disorder) and a further 30% experience some symptoms of PTSD but not the full-blown condition. The COVID-19 pandemic has not only restricted global travel but also affected local birthing protocols; it increased anxiety and worry for expecting and new parents, placing them in a state of heightened alert at a time which is supposed to be filled with anticipation and joy.
Birth can be unpredictable. The psychological impact of a traumatic birth is an uncomfortable truth of our birthing practice, and it is often minimized and ignored. Postnatal PTSD can also be misdiagnosed by doctors as postpartum depression, but treatment pathways for these two conditions are different, so it is really important when talking to women to explore the symptoms in detail and listen carefully to what is being said (Strauss, 2015).
When a person goes through trauma, the mind goes into an unusually hyper-aroused, fight-or-flight state. The brain’s amygdala, which normally helps store memories, becomes hyper-responsive, leading to an exaggerated sense of fear. Parts of the brain that normally inhibit the amygdala stop working. When something reminds a sufferer of their traumatic experience, their unusually terrifying memories feel like more than memories; they feel like they’re still happening. (Dekel; 2017).
PTSD is a severe and long-lasting reaction to trauma, its diagnosis is based on displaying at least nine of the symptoms from the following table of categories for at least one month (DSM IX)
Symptoms of Post Traumatic Stress Disorder
Many women experience trauma but may not meet the threshold for a PTSD diagnosis. Nevertheless, their symptoms can be debilitating and the guilt and anxiety they feel can lead to a negative spiral of isolation and private suffering, putting strain on their relationships and sometimes their bonding. They can experience guilt for feeling so negatively about their birth, especially if the outcome has been what one might describe as happy with a healthy baby.
Birth can be traumatic for many reasons; it can be as a result of an emergency for the mother or baby at birth, which may have led to a period of separation. In this case it could be trauma caused by a perceived threat to the life of the mother or child. An unplanned C-section can be traumatic as the birth veers away from the original plan, and into unknown territory. Even a lack of communication, an unsympathetic physician, or examination or procedures without consent can cause trauma. It is important to remember that partners can experience trauma as well while witnessing an emergency in the birth room. There is no-one’s right to place a value judgement on another’s experience of trauma, it is their truth and if they are to be helped, they need to be heard.
Despite well-meaning encouragements to leave it in the past, to move on and to focus on the positive, those who experience trauma cannot wish themselves better. Time is not always a great healer. No amount of positive thinking or affirmation will fix it, it is entirely involuntary, our primitive brain cannot distinguish that the threat or trauma has passed. Whilst it is not possible to change what happened that caused the trauma, with treatment symptoms can greatly improve. Talking therapy such as trauma-focused Cognitive Behavioral Therapy (CBT), and Eye Movement Desensitization and Reprocessing (EMDR) have been shown to have good results for those suffering from birth trauma (NICE, 2014).
For birth trauma, it is not recommended to conduct trauma-focused debriefing (or re-telling of the traumatic event). It is thought that this deepens the neural connection of the memory to the trauma centre of the brain, the amygdala, therefore, worsening the symptoms. Hence unlike those suffering from postnatal depression who benefit greatly from group support, those experiencing postnatal trauma should avoid group-based interventions reliant on re-telling and sharing their traumatic experience.
Newer non-psychotherapy interventions are also becoming more popular for those who have experienced birth trauma symptoms. Tapping (or Emotional Freedom Therapy) involves physically tapping meridian points on the body while recalling a traumatic event and verbalizing the physical sensation, then reframing it to release the trauma (Griffin, 2005).
3-Step Rewind has also produced significant anecdotal success in treating trauma. This method is rooted in Neuro-Linguistic Programming (NLP); it involves deep relaxation, recalling the event in a specific way while feeling safe and secure and finally imagining coping in the future and responding differently. Because rewind is conducted in a state of deep relaxation it allows the person to safely access the memory in the subconscious brain to shift it from the amygdala to the long-term memory centre (the hippocampus). This technique should only be conducted by a highly skilled and certified practitioner (Birthing Awareness, 2020).
Evidence suggests that one in three birthing women experience some degree of psychological trauma related to their birth, there are no statistics available for the extent of trauma and PTSD among partners. Many are suffering in silence or are not able to access support or treatment. This can have a lasting and detrimental effect on families. Identifying the problem and accessing treatment early would greatly improve outcomes. Tools are available to help identify trauma and birth-related anxiety. The BAMBI Bumps Team can help to signpost you to these tools and to professionals who can help treat birth related trauma.
References and useful websites
Strauss, I. (2015) The Mothers Who Can’t Escape the Trauma of Childbirth https://www.theatlantic.com/health/archive/2015/10/the-mothers-who-cant-escape-the-trauma-of-childbirth/408589/
Dekel (2017) Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00560/full
Griffin, J. (2005) PTSD, why some techniques for treating it work so fast. https://www.hgi.org.uk/resources/delve-our-extensive-library/anxiety-ptsd-and-trauma/ptsd-why-some-techniques-treating-it
DSM (IX) Excerpt on PTSD Definition: https://www.ncbi.nlm.nih.gov/books/NBK83241/
NICE Guideline on Perinatal Mental Health: https://www.nice.org.uk/guidance/cg192/chapter/1-recommendations
Generalised Anxiety Disorder Scale: https://med.dartmouth-hitchcock.org/documents/GAD-7-anxiety-screen.pdf
Edinburgh Postnatal Depression Scale: https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/edinburgh-postnatal-depression-scale.pdf
Birth Trauma Association: www.birthtraumaassociation.org.uk
Birth Trauma: Definition and Statistics: http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics/
Birthing Awareness Publishing: www.birthingawareness.com
About the Author
Emma McNerlin is a UK trained and registered Midwife, First Aid Instructor and owner of Bumpsy Daisy Café and Community; a cafe and parenting community centre for new and expecting parents offering birthing classes, hypnobirthing, First Aid workshops and baby classes. Emma has been the BAMBI Bumps and Babies Coordinator since 2015. Prior to coming to Bangkok in 2014, Emma worked as a clinical midwife in a busy London hospital with 6,000 births per year. Emma lives with her husband and teenage son and when she is not working she enjoys baking, aqua-aerobics and singing badly at karaoke.
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