Everyone wants a straight-forward birth with mum and baby 100% ok at the end of it – of course we do, that is not too much to ask. But pregnancy and birth can be unpredictable and it can be impacted by different factors.
I have been working with expectant parents for almost 18 years so I know birth and its preparation well, as well the varied expectations of parents and what can impact labour and cause it to be more complicated.
I am passion about equipping parents as well as I can for the unpredictability, of working with their midwife/doctor to continue to gather information, to know their options, to be able to stay as calm as possible and to put themselves at the centre of their care. But I never make promises of an easy, straight-forward birth and my sessions include lots of discussion about the reality of birth. This is combined with positivity about mindset, robust coping strategies, assertiveness and just breathing to stay calm because you have to put yourself in the hands of a medical team. I am aware it can sound bleak but labour and birth isn’t always straight-forward so thorough preparation and discussion can lead to more realistic expectations and preparation. Having a caesarean is not a failure, having an epidural is not a failure – they can both be necessary, normal and positive.
Labour and birth is also very subjective so what can be difficult and challenging for one woman, could be ok for another. A change to a birth plan doesn’t have to mean an emergency and it doesn’t have to be scary or traumatic but we experience these situations differently. I am simply of the opinion that if a woman is upset or traumatised by something around the birth of her baby, then it was upsetting or traumatising.
So, what can make labour traumatic?
- Until labour starts, you don’t know what it feels like and what your pattern of contractions will be like – the intensity of contractions or the length of labour can be challenging and hard to deal with. A long labour can be exhausting and sometimes frightening, especially if you feel unsupported or don’t know that this can happen. And a fast labour can cause shock due to the speed and intensity of the contractions and this can sometimes mean that babies are born unassisted by medical support at home or in the car.
- If there is an issue with your baby’s heart rate, which can led to an intervention such as assisted delivery with an episiotomy, forceps or ventouse or an unplanned caesarean, which could also be an emergency
- If you didn’t feel safe and looked after in labour – we need to feel safe and cared for, especially if labour is more complicated, when you might feel more vulnerable and in need of support.
- If you didn’t feel communicated with – women can feel very vulnerable at times during labour and birth so good, effective communication with partners and medical staff is crucial.
- If you thought that either you or your baby could die – if you or your baby are unwell, this can leave you feeling upset or traumatised.
- if you or your baby are injured during the birth
- if a baby is poorly or stillborn
Thankfully, true emergencies where lives need to be saved are pretty rare in labour and birth – they are not the norm but they do happen and it can be frightening when they do.
Your baby’s heartbeat will be monitored in labour and interventions can become necessary – this can be an emergency which happens quickly or it can be an indication that a baby is not coping well with the contractions and steps need to be taken to prevent an emergency. Good communication is vital.
One of the main issues I come across when I talk to mums who are upset after the birth of their baby is lack of communication and support – being left alone and feeling ignored and unsupported with contractions, length of labour, lack of options and information can leave some women feeling upset and traumatised.
The Birth Trauma Association states that about 30,000 women (4%) a year experience birth trauma but they also estimate that 30% of women will experience some symptoms of PTSD.
The BTA describes the four symptoms of PTSD as:
re-experiencing the trauma (e.g. flashbacks and nightmares)
avoidance (the woman avoids any reminder of the trauma)
negative cognitions and mood (such as feelings of guilt)
and arousal (such as hypervigilance). In effect, the brain is still in flight-or-fight mode, constantly alert to the threat of danger.
Can some birth trauma be avoided?
Many cases of birth trauma probably can be avoided, which is a hard thing to accept. Because trauma can be caused by what happens around birth rather than the actual labour and birth itself, good communication and respect can make a crucial difference: two women could have identical labours but if one experiences a lack of communication and empathy or if there is lack of dignity or respect this can have a traumatic impact, whereas the other woman may have felt safe, informed and looked after.
We can’t control what others say or what care they provide but we can speak up, partners can advocate, we can refer to a different member of staff, we can say no if something doesn’t feel right and we can ask questions to gather knowledge and to stay informed, especially if labour has become complicated. However, not everyone feels confident, comfortable and able to do this, which can make being listened to harder.
I can’t stress enough the importance of being able to speak up if you need to, put yourself at the centre of your care so you feel listened to.
But emergencies can leave little time for information and explanations, which can be scary because you just have to go with it.
As a practitioner who specialises in pregnancy, birth and postnatal issues, as well as a mum of three, I know how different labour and birth can be – I listen to hundreds of birth stories and experiences each year and there is a diverse range of reactions to labour and birth which include: enjoyable/wonderful/amazing; it was a means to an end; bloody hideous, never doing it again; I did it; we got through it; upsetting/scary/traumatic.
It’s such a personal experience and each women owns their own feelings about it.
As part of my work I talk to women about birth during postnatal group sessions, as well as during 1:1 birth debrief sessions. Women often say they feel that they have failed, that they must have done something wrong or that they are clearly shit at birth – which breaks my heart. These feelings and memories need working through but it is also worth holding on to the simple fact that: YOU HAVE NOT FAILED, YOU ARE NOT BAD AT BIRTH, YOU HAVE NOT DONE ANYTHING WRONG.
Birth isn’t going to be the same for everyone, we are all different and we are not robots. We can also be let down by the system which currently doesn’t have enough midwives and, at times, can appear to be rigid and difficult to navigate. So please do speak up if you need to, do some good, thorough and effective birth prep and know how to stay as calm as possible if an emergency should take place.
This might be a hard read and I wish all births were easy, straight-forward and well supported. If you have been left feeling upset and traumatised after the birth of your baby, please do talk it through with someone who is qualified and experienced. I am able to talk through births with parents but this also involves talking through potential next steps if there is birth trauma, as it be necessary to see a therapist for treatment.
If you are experiencing any birth trauma, this does need addressing rather than ignoring and hoping it will go away as it can impact life with flashbacks, panic attacks and increased anxiety.
We live in a society that says we should be grateful for a healthy baby (we are) but dismisses the health of the mother. The experience of how we birth can have a huge impact on mental health, as well as on our confidence and on our ability to parent. It is a complicated issue but opening up and talking about it is the first step.
My aim of writing this is not to terrify but it is to acknowledge that birth can be hard and to acknowledge the women (as well as partners but that is another blog post) who are left struggling and recovering afterwards.
Sources of support:
Janine Smith | Birth, Baby & Family
A specialist in pregnancy, birth and early parenting
I am a mother of three and I was diagnosed with PTSD after the birth of my third baby.