There is a beast in the shadows that many of us have been blissfully ignoring, as if by doing so it will no longer exist and then we won’t have to face the unpleasant knowledge that we have been, that we ARE, failing generations of birthing people, and failing the babies that they are left to raise without adequate help while they are still beaten and broken and learning how to navigate their new state of “normal” as a birth trauma survivor.
It is estimated that around one in three birthing people will experience birth trauma (https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-016-1197-0, https://www.ncbi.nlm.nih.gov/pubmed/12581038), often as a result of how they were treated by care providers during the birthing process (and it can often be something as simple as not having something explained to them while things are being done TO them, or something that might be considered a ‘normal’ statement at any other time that is said to the birthing person unthinkingly by a care provider that leaves the birthing person feeling traumatised).
I want you to think about that for a second...
One third of the birthing population is left feeling broken, shattered into a million little pieces that haven’t been put back together properly, destroyed, like they’re nothing more than a slab of meat on a conveyer belt that isn’t worth being loved or cared for. On average one third of our worlds birthing population is leaving their births so traumatised that their mental health is devastatingly damaged by the experience.
There’s something very wrong with this picture that those words create in the mind – it shouldn’t even exist in this modern day and age where we know better and can therefore do better.
And you’d think that we would have learned to do much, much better for our birthing people after the scopolamine and morphine induced “Twilight Sleep” fiasco that lasted from its inception in 1902 until it declined from 1916 onwards as other pain relieving methods were found (https://embryo.asu.edu/pages/twilight-sleep). – you only have to Google “Scopolamine and Birth” and pages of stories, research articles and more will come up detailing everything available publicly that happened during that time, including the maternal deaths – it would not surprise me to learn if there was far more that remained private and was never released for public consumption. The real life retellings from the women who experienced it, who lived through and survived it, are haunting and often remind me of what is, still, happening to women during childbirth today.
We have our own modern day scopolamine-like fiasco forming right underneath our very noses in the forms of physical bodily trauma, outright disrespect, lack of informed consent, general mistreatment (both deliberate and unintentional), lack of communication and outright fear-mongering. It is happening in clinical rooms, at hospital bedsides, to women at their prenatal appointments and to birthing people as they are in the middle of labour. It is happening to many women right now, all around the world, many that we will never hear from and whose stories we will never get to know.
And despite a small minority of us speaking out against it and working tirelessly to stop it from happening it often feels like we are fighting a losing battle as more and more birthing people are left battered and broken by birth trauma of all types.
It likely doesn’t help that there are several different subsets to this trauma – physical trauma from the birth itself, mental trauma from the birth itself, physical trauma from the care received/not received, mental trauma from the care received/not received, mental/emotional trauma caused by a lack of consent or a lack of adequate education/sharing of needed information or even just by fear itself that was caused by words said to the birthing person by a care provider or actions made towards that birthing person by a care provider, and any combination of these listed and more that haven’t been listed – each type of trauma has a different cause, and trauma can be caused by the simplest of actions (or inactions) or phrases and often care providers don’t even realised that they have caused it.
The most commonly recognised subset of birth trauma is that caused by the physical side of birth itself and is, from a medical perspective, related solely to trauma that is done to the tissues of the body – it does not matter that this is becoming the less common form of birth trauma (mental emotional and physical combined caused by care providers actions or inactions is becoming the most common form of birth trauma these days [https://www.pregnancybirthbaby.org.au/birth-trauma-emotional]), it is the one that is known the most and therefore is the one most described and remembered by care providers when they are asked what birth trauma is or what it looks like. It is the one most commonly spoken about in the media and it is the one that is mostly remembered by the general public. And, despite all the steps and policy changes that have been made and put into place over the last 20+ years you are still more likely to experience this physical side of birth trauma with an instrumental, augmented or surgical birth than you are when compared to a straight forward spontaneous vaginal birth (https://bmjopen.bmj.com/content/8/3/e020578).
When you see, or hear, on TV, the radio, in newspapers or articles online, care providers providing damning statements about expectations for how we think that birth should go and how birth plans are just setting us up for failure because “birth just doesn’t happen the way you want it to” or “be realistic, don’t go expecting too much from your birth” (with a healthy mother and baby it can, and it usually does, go mostly as we envision it will go when care providers aren’t trying to speed things up or set limits on the bodies of birthing people just because they can or because hospital policy states that it has been too long since labour began) it is mostly the physical trauma caused by birth that they are thinking of, that they are speaking about.
And they have conveniently forgotten about the emotional and mental aspect of it, that the care and treatment received by a birthing person from the people she should be able to fully trust to respect her decisions and choices, who should have HER best interests at heart, can have the same or a far greater impact on HER perception of how HER birth went than what actually physically happened to her body can. Her perception, whether positive or negative, of how her birth went is what creates or destroys any potential mental and emotional trauma caused by her birth.
These care providers have conveniently avoided seeing and acknowledging:
- That just by having that “plan” or expectation in place she has made the effort of educating herself on what to expect for her birth, because she took the time to learn about, and then write out, what she wanted and didn’t want and what she was willing to compromise on and wasn’t willing to compromise on.
- That this “plan” or expectation helped her to, mentally and emotionally, prepare for what she would soon be facing.
- That the “plan” or expectation itself is sound and evidence based, as long as no one intervenes when intervention isn’t needed, and that any intervention that is actually needed is explained to the birthing person in a clear, concise and understandable way so that they can fully understand WHY it is needed (this really highlights the importance of informed consent! As a woman and as a mother who has been a patient many, many times throughout my life I have lost count of the number of times that informed consent has NOT been gained from me before a procedure or even a general observational check over is done, the consent was simply implied because I was already in that hospital bed and at someone else’s mercy, only very rarely am I actually asked if it is ok by me for someone to do something to me, and I am very much not alone in this, it’s so common a practice that it occurs everywhere) then make an informed decision based on that.
- That blaming the “plan” or expectation on things going wrong physically, with these things “going wrong” resulting in the mental and emotional side effects of trauma, is just making the whole thing worse and will often just exacerbate the mental and emotional pain that a traumatised person is already feeling by increasing the feelings of self-guilt over the decisions that they have made that might have led them to where they are now.
They, the care providers who are perpetuating this cycle of trauma whether they know it or not (and I am sure that most just simply do not realise what harm they are doing), seem to have forgotten the person that is inside that body that they are “trying” to keep alive and hopefully mostly physically healthy at the expense of everything else, they have forgotten that she is the one who sees and hears and feels what is happening to her, who can understand the words that the care providers are speaking around her to each other BUT NOT SPEAKING TO HER, who has feelings and emotions and has to live with what is happening to her right now in this birth for the rest of her life. They seem to have forgotten that mental and emotional health is just as important as physical health and that when the mental and emotional health of a person is not 100% the physical health can decline as well.
A care provider in a hospital setting may see upwards of 5 births a day, and many more patients in between, and they may work in the field in that hospital setting for 20 to 40 years – that means that they could, theoretically (in a minimum conservative estimate), witness from 7,300 births up to and even over 15,000 births, and hundreds of thousands of patients in total during their 20-40 year careers – that’s a lot of birthing people during that time, a lot of people who will likely, due to the natural frailties of human memory and the human mind, be forgotten the moment a care provider moves onto the next birthing person who needs (or has sought just in case it might be needed) medical care and their undivided attention.
They often don’t have time, whether due to hospital policies, training practices or even personal biases, to really get to know the people that they are caring for.
Their patients are often just dates and times on a planner, bodies to be checked and poked and prodded, heartbeats to hear and blood test results to read and decipher to see if any treatment might be needed.
In the fast paced world of hospital based medical practices, and especially in obstetrics itself, each patient, each birthing person, is simply a file on a computer saying whether they and/or their baby are healthy and if they are compliant or not and a rushed appointment to get through as quickly as possible even if the care providers would really prefer to be spending longer with each person and give them the time and attention that they need.
And why do I mention the word “Compliant”? I mention it because, more often than not, if a birthing person in a hospital-based setting repeatedly declines intervention, repeatedly says no even if a doctor has repeatedly tried to convince her otherwise, if a birthing person refuses to do what she is told, if she lashes out verbally or physically in any way, shape manner or form at the staff who may be “caring” for her during her labour, she will be labelled as “combative” and/or “non-compliant” on her records, simply because she goes against medical advice or against hospital policy or just because she goes against what a care providers personal bias would prefer that she do instead.
Sometimes when this happens social services might be asked to speak to her “just in case she might be a danger to her child”, she may have to fight just to receive the respect that she deserves, she may be physically or emotionally mistreated because she won’t go along with what others want her to do.
My own memory comes to mind of being physically held down by TWO midwives and having a nitrous oxide mask slapped onto my face hard enough for one of my teeth to cut the inside of my lip because I was screaming “no” and “stop” and writhing too much while being stitched up by a Registrar. I had not given any consent for it to be done or even been offered the chance to consent but it still made me “non-compliant” to be screaming "no" and "stop" and writhing, trying to get away, according to my records... what happened to me has happened to so many others as well, and my own personal story is very mild compared to so many of the horrific stories that I have heard in the many years since then.
Overall a birthing persons mental and emotional experience of her birth, and to a lesser extent but still just as important is her physical experience of the birth too, and of the immediate period surrounding her pregnancy and birth, will be either negatively or positively coloured by her perceptions of what happened to her and how others treated her or spoke to her.
So, to use the generic example of a birthing person going into labour, turning up at the hospital, labouring for several hours or so and then baby goes into distress and an emergency caesarean is done:
- if her perceptions of her birth are positive and she feels like she was well cared for, respected, supported, listened to and had control of and a say over what happened despite “things going wrong” during the birth, if she felt like she was well informed by those caring for her and was told everything that she wanted and needed to know when she wanted and needed to know it, if she felt safe in their care despite her birth not going as she had planned or envisaged, then she will be less likely to experience the mental/emotional aspects of birth trauma, and be less likely to be diagnosed with birth trauma as a result. She will most likely be profusely grateful to her care provider/s, she might be very glad that her birth happened the way it did, she may even feel like she made the best decision possible in the circumstances and be very happy with the outcome. Overall she will be mostly happy with how her birth turned out and will probably not have any lasting negative side effects on her mental health.
- if her perception of her birth is negative, if she feels like she wasn’t respected, wasn’t listened to, if she felt like she was physically violated by a care provider without her consent (or actually was, in what is - and correctly so - now called “birth rape”), if she felt unsupported or like she had no choices or say in what was happening, if she felt like someone had said something grossly inappropriate to her or just was simply overwhelmed and no one had actually come up to her and told her that it would be ok and explained what was happening, or had happened to her, then she will be much more likely to end up with birth trauma, she will likely experience flashbacks and be triggered by situations and/or events that bring up negative memories of what she went through, she will have negative long term side effects to her mental health, and she may even end up being one of the estimated 1.5% to 9% of birthing people who end up with PTSD as a result of their experiences (http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics/).
We need to know, and we need understand and recognise the sources, and the causes, of this trauma, because if we don’t then we can’t fix it, we can’t stop it, and we won’t be able to prevent it from happening to others in the future.
Birth trauma is the beast hounding our steps.
It is showing us where we are lacking in the support, care and treatment of our birthing people as they bring the next generation of humanity into our world.
It highlights where we can, and where we do, go wrong.
It enables us to see how different things can affect different people negatively in different ways resulting in trauma, pain, grief - creating physical, mental and/or emotional harm.
Birth Trauma is the beacon telling us that something is very wrong in the maternity care system the way that it currently is and with how our care providers are working within it, and it is telling us that drastic changes NEED to be made, very soon, or we will, one day, not very far in our future, be left with almost an entire generation of physically, mentally and emotionally damaged people.