Birth Trauma

For most women pregnancy comes with excitement and anticipation to meet your little one. For some pregnancy and birth also bring anxiety, fear and vulnerability that one is dependent on health care professionals to manage their health as well as their baby’s. Pregnancy, birth and parenting bring up emotions so similar to past trauma that it is often the catalyst for difficulty coping.

During pregnancy and birth women may experience self-doubt, not wanting to offend others by stating their needs or that they are uncomfortable, feel they are suppose to trust and not question doctors, embarrassment that they don’t have control over their body functions, their fears are minimized, they may ask for help and get a negative response, may feel objectified and not seen as a person, feel a loss of control, vulnerable and dependent on others for needs to be met. It is rare that we hear about the fear, embarrassment, vulnerability and feeling unheard that unfortunately accompany many births. These are such intimate experiences that many women share them rarely if at all. They may feel shame for not fully embracing the experience. They may feel that no one will understand or worry they will be perceived selfish because they are thinking of themselves and not devoting every minute to their baby. These incidents happen far too often. We need to do a better job of supporting each mother’s unique experience of bringing life into the world and being born into their new role as a primary caregiver.

Several factors increase the risk of a traumatic birth:

• Prolapsed cord
• Preterm labor
• Medical trauma during pregnancy
• Unplanned C-section
• Use of vacuum extractor or forceps to deliver baby
• Baby going to the NICU
• Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery
• Women who have experienced previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD
• Women who have experience a severe physical complication or injury related to pregnancy or childbirth, such as severe postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia, perineal trauma or cardiac disease
• Gestational diabetes
• Past miscarriage, pregnancy loss or infant death
• Complications with feeding

Symptoms seen during a traumatic incident

• Shutting down, looking spacey, appearing fearful or blank stare
• Overly agreeable, confusion, indecisive
• Tense, shaky, fidgety
• Not following directions
• Irritable/angry
• Wanting to flee or fight back
• Overly talkative
• Overly apologetic
• Asking a lot of questions or the same questions repeatedly

Symptoms often seen after a trauma include

• intrusive thoughts, images or sensations associated with the birth or past trauma
• flashbacks or nightmares
• avoidance of stimuli associated with the event including thoughts, feelings, people, places and details of the event
• persistent increased arousal (irritability, difficulty sleeping when baby is asleep, constant worry that something bad will happen, exaggerated startle response, feeling that no one can care for baby besides mom)
• anxiety and panic attacks
• feeling a sense of being detached or that the world feels surreal

What we can do to help

• Advocate for doctors to stop, listen, give choices, educate women about what they are doing and why, slow down and avoid phrases like “I thought you wanted this, It will only take a moment, this isn’t so bad and there are worse experiences”. I shutter just hearing many of these, they all minimize a woman’s experience and make her feel she is doing something wrong by saying she’s uncomfortable or wanting to be more informed during her care. Ask if it is helpful to explain a procedure before, during, after, or not at all
• Thank women for sharing how they really feel, trusting us with their thoughts and feelings
• Redirect them to additional emotional supports if needed
• Talk to women and partners before a birth to inquire about what their preferences are
• Ask what makes them uncomfortable and what would make them more comfortable
• Avoid a rigid birth plan, have an ideal but be flexible with end goal that momma and baby are healthy
• Create a safe, nonjudgmental space for women to be what they need to be during birth and postpartum so they can find their strength and feel empowered as a new momma. Let them tell their story, only ask clarifying questions and normalize their emotions.
• Support momma to find a feeding technique that they are most comfortable with (nursing, pumping/bottle feeding, formula)

Resources in our community Please talk to your friends, family, neighbors and normalize  that birth trauma, postpartum anxiety and depression are real and with help they will be okay.

Therapists who have been trained by PSI are listed on the Perinatal Emotional Health Network of Western NC FB page https://www.facebook.com/pehnwnc/notes/. Other community resources are also listed on this page.

 Recommended therapy for perinatal mood disorders and trauma include

• Cognitive Behavioral Therapy (CBT) -challenge negative thoughts, distortions, increase compassionate self-talk, support awareness of how emotions and thoughts contribute to responses.
• Dialectical Behavioral Therapy (DBT) -teaches distress tolerance, emotional regulation, mindfulness (be present in the current moment) and relationship/communication skills
• Eye Moment Desensitization Reprocessing (EMDR) targets past trauma and supports reflecting on past experience while maintaining calm and gives one the ability to notice things about the experience that help give new meaning and acceptance to experience.

Encourage play dates and groups and connect with other moms who “get it”.

Support groups available:

• Mindful Mothers- coping and making sense of the challenges of parenthood.  Tuesdays weekly 9:30-10:20a Skipping Stones Counseling 3601 Sweeten Creek Road Arden, 28704
• Everybody Yoga Fridays 11-12p weekly, children welcome
• Infertility- send a message at AshevilleInfertilitycounseling.com to inquire about openings, 2^nd Monday monthly 6-7:15p
• Online support groups through postpartum.net

Postpartum Support International (postpartum.net) is the most well known organization that supports the emotional needs of mothers, partners and other caregivers. It has a wealth of evidence that shows that postpartum depression, anxiety and rarely psychosis are real. With help you will be well.

I have been amazed to see how our mountain community is rallying around mothers and families in the last several months. With crisis comes the opportunity for great change. I am honored to support families who recognize that they need help and who are courageous to ask for that help. So brave are we when we are aware of what we don’t know, what we want to know and to bravely seek those answers that will make us better parents, partners and friends.