No matter how a woman delivers her child, she will come out of the experience with lots of feelings about the process. Many women struggle with birth trauma and its repercussions. Philadelphia-based doula and childbirth educator Brittany McCollum of Blossoming Bellies Wholistic Birth Services discusses birth trauma and ways to prepare for a satisfying birth, as well as resources and guidance for those who struggle with negative feelings about their birth experience.
In an ideal world, all women would come out of their births feeling amazed at what they have done, feeling love and devotion towards the little person whom they have brought into the world, and feeling awe at the power that is inside their body and mind. Instead, we have many women come out of their births feeling like something was done to them and that is a problem. We have women coming out of their births feeling that they have not been listened to and that is a problem. We have women coming out of their births feeling like the choices they made were not their own and that is a problem. And that is happening far too often in our national maternity system, with up to 6% of women exhibiting post traumatic stress disorder (PTSD) and up to 24% having at least one of the three components of PTSD after childbirth (Jukelevics).
Traumatic birth can be defined a million different ways; an unwanted cesarean, a natural labor turned into a medicated birth, a scheduled cesarean where labor starts before the birth date and preparation is lacking, a labor with all intentions of getting pain medication yet moving too fast to have it administered are just a few of the scenarios that can lead to feelings of stress, fear, and loss of control. How can women remain as in control of their births as possible? How can women come out of their birth experiences feeling empowered and positive, regardless of the manner with which they brought their children into the world? How can we, as a country and a community, implement ways for these positive changes to take place?
Independent childbirth education classes (those not associated with the place of birth) can help women build confidence in approaching their births and explore the best way of birthing for them. Many out-of-birth-place classes aim to empower women and their partners to take control over the decision-making process and to be active participants in their birth. Classes that cover the legal rights that women have in their birthing space, that guide couples in how to have conversations with their care providers and not be afraid to ask questions – what does this entail? what are the risks and benefits? alternatives? what happens if we do nothing? and how likely is that to happen? – are crucial to developing the skills needed to be active decision makers. Only when armed with the knowledge of how to be advocates for one’s priorities in labor can one truly feel like they are able to retain control over the decisions that are made during labor.
Choosing a place of birth with providers that are philosophically aligned with the beliefs one holds about birth is first and foremost. Many birth workers have heard the saying before, “Don’t order sushi at an Italian restaurant” because it can be so easily applied to birthing practices. When possible, choose the best provider and birthing space for the outcome for which you are looking. Surround yourself with providers that will help you stay centered and supported in the birth choices you make and guide you in feeling safe and empowered throughout the process.
Whether birthing in a hospital, birth center, or at home, it is crucial that the conversation with the care provider be an open and honest one. The best way to break down social barriers is to discuss. Remember that the care provider is a person, not simply a doctor or midwife, and when they are treated with respect and interest in the knowledge that they possess and bring to the table, it’s amazing how open the dialogue becomes. In a hospital or birth center, often the practices are large and clients are only truly getting to know their provider in the moment of birth. Sometimes doctors, midwives, and nurses are working with three or more laboring women at once and their time is stretched thin. Opening up, conversing about priorities and wishes for labor, helps a provider to become invested in the birth experience that the client wants and helps make that client their top priority. In a homebirth setting, working with a midwife with whom one feels philosophically in line and having mutual respect throughout the pregnancy helps develop the comfort and relaxation needed in labor to help the process unfold and build the necessary trust in birthing. Understanding the midwife’s limitations and boundaries as well as taking the steps necessary to make labor as smooth as possible can help both parties stay aware and in control.
The very nature of labor encourages a loss of cerebral control and a return to instinct and intuition. Understanding this prenatally, making choices in choosing a provider and place of birth that are in line with one’s beliefs and expectations in labor, and surrounding oneself with fearless support can allow a woman to feel safe and able to move into this space of instinct and intuition without needing to maintain a watchful eye. When safe, supported, and able to be vulnerable, women can maintain control by trusting in their body’s instincts and abilities. One on one labor support in the form of a doula has been shown to decrease the need for interventions ranging from induction and augmentation to medical pain relief to a lesser chance of cesarean birth (Hodnett). And doula support has been shown to increase the likelihood of mom feeling positive about her birth and her baby (Klaus).
When expectations for labor are set and the steps are taken to help ensure that the process goes as “planned” but the plans unravel, it can be very challenging to process in the postpartum. Women working through birth trauma need to be supported by friends and family. Perhaps one of the most common things that new moms are told when they voice negativity about their births is “At least you have a healthy baby.” As true as that statement is, it completely negates the mother’s feelings, contributes to feelings of isolation, and can create guilt and in a new mom. Women need a space to share their birth stories openly and without judgment. Women need to feel listened to and feel like their experience matters in order to begin the healing process. Postpartum depression, postpartum anxiety and OCD, post-traumatic stress disorder, and postpartum bi-polar disorder can all stem from a birth experience where the woman has felt like her rights, her sense of self, and her control over the decision making was taken away. According to the Mayo Clinic, symptoms of depression include loss of appetite, insomnia, intense irritability and anger, overwhelming fatigue, loss of interest in sex, feelings of shame, guilt, or inadequacy, severe mood swings, difficulty bonding with the baby, social withdrawal, and thoughts of harming oneself or one’s baby. Symptoms of PTSD include flashbacks, avoidance, and hyperarousal (“Post-Traumatic”). Partners and postpartum support people should all be familiar with these signs so they can step in as needed and connect mom to local resources. It is not about other’s judgment on how a birth unfolded but how well a mother (and her partner) are integrating the experience into their new identity and lifestyle as a family.
Healing from a traumatic birth experience takes time, patience, and perseverance. The healing process is like a spiral; just when one feels like they have moved past, the hurt is triggered again and the feelings again need to be dealt with. However, every time the trauma is revisited and worked through, there is the potential for healing.
For general information and links to local resources and experts, please visit Postpartum Support International online or by calling 1-800-944-4PPD. There are also many local support groups and resources that can help provide support while working through the healing process. International Cesarean Awareness Network also holds local monthly meetings in Philadelphia and Media, providing workshops and a meeting space for working through birth trauma and learning about options for future pregnancies.
Breastfeeding support groups and new parent groups are also great places to talk with other moms who may have experienced or are experiencing similar situations and feelings. You can check out A Child Grows’ round up of local breastfeeding support groups here.
Getting out with your baby, surrounding yourself with other new parents, and talking through your thoughts and feelings about the birth and the new, often rocky, path of motherhood is so important and builds a sense of community and forges a path of healing.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. “Continuous support for women during childbirth.” Cochrane Database Systematic Review 17 Oct 2012;10:CD003766. doi: 10.1002/14651858.CD003766.pub4. NCBI. Web. 27 Jan. 2015.
Jukelevics, Nicette. Understanding the Dangers of Cesarean Birth: Making Informed Decisions. Praeger, 2008. Print.
Klaus, Marshall H. M.D., John H. Kennell, M.D., and Phyllis H. Klaus, C.S.W., M.F.T. The Doula Book. Cambridge: Perseus, 2002. Print.
“Diseases and Conditions: Postpartum Depression.” Mayo Clinic. n.p. 11 Sept 2012. Web. 4 Feb 2015.
“Post-Traumatic Stress Disorder (PTSD).” National Institute of Mental Health. n.p. n.d. Web. 4 Feb 2015.
Brittany Sharpe McCollum, CCE(BWI), CD(DONA) is the owner of Blossoming Bellies Wholistic Birth Services, providing childbirth education, doula services, workshops for expectant parents, breastfeeding classes and support, infant and toddler nutrition classes, doula training and mentorship opportunities, and pelvic bodywork workshops for birth professionals from doulas to childbirth educators to midwives, nurses, and OBs in the greater Philadelphia area. Her classes can be found in South Philadelphia, Fairmount, Fishtown, West Philly, Mt. Airy, and Collingswood, NJ. Brittany began Blossoming Bellies in 2006, after the birth of her first son left her feeling that there was a great need for women and their partners to be empowered and confident in their births while finding the resources and education in the community to support that. She encourages women and their partners to explore their birthing options, to be aware of their rights, and to be empowered to make informed, evidence-based decisions throughout the childbearing year. Brittany lives in South Philadelphia with her husband, two sons, and daughter. Check out her services at http://www.blossomingbelliesbirth.com/ and follow Blossoming Bellies on Facebook and Instagram.