Through the birth trauma support work that I do and the multitudes of conversations I have had with women on the topic of birth, I have come to believe that most birthing women have very low expectations regarding what constitutes a ‘good’ birth. For many, the bar is set as low as mum and babe simply surviving the birth process. The terror a woman feels when she is rushed into theatre for an emergency caesarean due to her baby showing signs of distress, is deemed what then? A typical response to a ‘difficult’ birth? That’s trauma, people. When we fear for our child’s wellbeing it is traumatising. Why then, do so many women deny their ‘difficult’ births as being traumatic?
Our cultural norms discourage women from viewing birth as a potentially empowering and positive transition into motherhood. We need only consider the portrayal of birth in mainstream media to see how, instead, a culture of fear is maintained around birth (One Born Every Minute, being a prime example). Under this guise, the standard for a birth to be labelled ‘normal’ or ‘good’ is significantly lowered. It is hardly surprising therefore that when the word trauma is used in relation to birth, many automatically assume that something extreme must have occurred that caused, or nearly caused, death or disability. And even then, if the mother and baby survived they are deemed “lucky and ought to be grateful,” rather than “traumatised and in need of support.”
Katie (not her real name) attended a Voice for Parents ‘Birth Trauma Support Workshop’. In her evaluation of it, she suggested that we consider changing the name of our workshops. This was her reasoning: I tried to invite a friend to this workshop because every time I talked to her she sounded like she had a lot of unresolved issues with her past two births which ended up being emergency caesareans. But she wouldn't come to the workshop. I think she might be thinking she's not traumatised. When I first heard of the workshop I also thought I didn't need to go because I pictured birth trauma in my mind as someone who nearly died at birth or baby died at birth. So I thought maybe the title itself sounded like it's for those who had experienced really extreme births. As kiwis we have the attitude of "she'll be right" even towards ourselves so that we never feel like we need to discuss things and just get on with it.
The point that Katie raises about our cultural belief that we don’t deserve support when it comes to our emotional or mental health is something I feel strongly influences a woman’s beliefs about her traumatic birth experience and how she feels about herself in relation to it. Much of the self-blame, guilt, and sense of failure that so many women hold on to during their incredibly challenging foray into motherhood, could be rightfully curbed if women believed they were worthy of trauma support.
In my survey report, Birth Trauma in New Zealand: Some Major Concerns (2015, p.33), I described how women frequently respond to a traumatic birth experience:
…when a woman has a medicalised birth that is hideously painful, frightening and disempowering, she is experiencing that which she expected of birth. Rather than registering her experience as unnecessarily traumatic, she concludes that it was disappointing but ‘normal’. When she struggles to bond with her baby, finds herself experiencing extreme anxiety as a new mother, and begins having nightmares and flashbacks about her birth, it doesn’t register that these are reasonable responses to a traumatic birth experience. Instead, she feels like a failure, she feels isolated, she feels hopeless to know how to cope, and she has no idea why she feels the way she does.
When we describe a traumatic birth experience as disappointing, difficult, or challenging, rather than traumatic, we silence the mother’s expression of, or beliefs about, the severity of impact that such an experience had on her (and probably the father, too). Instead of the woman feeling justified in accessing the support she needs, she downplays the harrowing emotional and psychological toll that her birth experience is taking. After all, she’s convinced that, “That’s just how birth is, who am I to complain? There are loads of women who have had it much worse than me.” This, of course, is not helped by the woman's GP or well-meaning friend saying, "At least you've got a healthy baby, that's what matters most," or the inconsiderate neighbour who is set on convincing her that, "I had it way worse than you!
They said I'd have died if I they hadn't got me into theatre as quickly as they did!"
The short of the matter is that if a birth experience causes ongoing emotional, physical or psychological issues, then it is worthy of being called a traumatic birth. A traumatic birth is one that you can't seem to 'move on from.' There are no caveats to that; a birth can be traumatic even when the baby is completely healthy, the birth was short and painless, support was awesome, the woman got the home birth she was seeking, there was no episiotomy, or tearing, or forceps, or needles, or surgery, because trauma is an utterly personal experience. What may be an incredibly traumatic birth for one woman, could be a perfect birth for another. Comparing ones own experience to another’s is therefore pointless and may even be harmful.
I think, for now, we'll stick with the name 'Birth Trauma Support workshop'. We need to be talking about birth trauma more, not less, and we need to acknowledge our own and others’ experiences for what they are. I hope that as more women and men feel comfortable to share about their traumatic experiences of birth, that others will feel encouraged to bravely seek the support they need, too, even if that’s simply sharing their story with someone they trust. Birth trauma is not a dirty word, it is nothing to be ashamed of. Every new mother needs to know that during her birth she was strong, she was brave and, given the support and information she had at the time, she made the best choices she possibly could for herself and her baby. She also needs to be reminded that if birth was damaging for her, that she absolutely deserves some support to heal.
This is the first of a series of posts that will be written around themes associated with the findings of the Birth Trauma survey we conducted in 2015. We encourage those who feel able to read the report in full, as the information shared provides important learning for health workers and consumers alike. Click here to access the full report.