The two and a half years since the birth of my son have been a journey full of emotions. My recovery from Traumatic Birth has been cathartic. I am a stronger and more empowered Mother, Wife, Woman and Soldier than I ever thought I would be. Thank you all so much for coming with me on this journey!
I have been full of mixed emotions since finding out our exciting news. I feel so blessed to have our family grow, but I am also nervous about what the next few months will bring as I strive to have a vaginal birth. My doctors and midwives have already been so incredibly supportive!
So hang on to your hats as we embark upon our own VBAC journey! I’m going to keep you all updated along the way, with the goal of helping other Mama’s who are hoping for a VBAC know that they are not alone on this road.
Sometimes, it’s hard to believe something that others have told you until you see it in black and white.
This is especially true if you weren’t ready to hear the truth before.
After more than a year and half, I finally requested copies of my surgical notes from my son’s Emergency Cesarean Section. I wasn’t sure how I would react to seeing the medical documentation, but I want to be able to move forward with my recovery. Part of that is facing what happened, and seeing what caused it in order to try to have a different outcome in the future. And what I found, was actually very validating.
You see, after my sons arrival, I was certain that my body had to have been broken. I was convinced that there was something flawed with me that made it so that I couldn’t do the one thing that women are designed by the great Creator to do. I felt like a failure, less of a woman, and on some days unworthy of being a mother.
Over the past year and a half, I have slowly but surely dragged myself out of that hole. I have built myself back up piece by piece; literally step by step as I trained for my first marathon. I felt like if I could just run further, and push harder, and do more – then surely next time I could birth my own child from my womb.
And as it turns out, my body was never broken. I progressed to “complete effacement, complete dilation, and +1 station. The patient pushed for greater than 90 minutes without a change in station. On assessment, [the OB] felt the fetal head to be asynclitic and ROP*. Two attempts at manual rotation were unsuccessful. The patient was counseled regarding the diagnosis of arrest of descent…”
After having been in active labor for more than 20 hours, my body had done everything that it could do to get my DS to come into this world on his own. He just happens to be one stubborn boy. I was exhausted, and he wasn’t budging. As much as I had hoped and wished for a natural birth, it just didn’t happen for me. And you know what? I think I might be getting closer to the point where I’m okay with that.
Sometimes our toughest critic, and our hardest judge is ourselves. I feel a sense of relief after reading the surgical notes.. as if I’m cresting the top of the mountain and now I can see the path ahead of me clearly. It’s looking pretty good from here. Behind me is a tangle of self doubt and unrealistic expectations, ahead of me is the path to full recovery – body and spirit.
*asynclitic and ROP indicates that the head was tilted to the side rather than positioned correctly, and ROP stands for Right Occiput Posterior which means that the baby was “sunny side up” or was facing outward rather than facing back towards the mother.
I have touched upon PTSD in previous posts, discussing how people can be on that path and some of the ways that they can seek treatment. One way that helps many is therapy. In the military, there can be many barriers to a Soldier seeking assistance with Behavioral Health. These include Chain of Command conflicts, mission needs and availability of services.
Seeking assistance at the Behavioral Health Clinic on post can be as simple as calling to find out when their walk in hours are, and then going. But sometimes it isn’t that simple. The walk in hours are usually after the duty day has already started, and this can cause some Soldiers to avoid going because they must then speak with their First Line Leader about why they need to be gone. Sometimes if you get lucky, you can go on a day after Staff Duty or manage to find a day when there’s nothing going on and just let them know that you’re running an errand or two and you’ll be back in about an hour.
So what happens during the walk in? Well, you’ll most likely fill out a survey on the computer. It asks questions about how you’re feeling, if you drink or smoke, if you have any conflicts with anyone, whether you’re thinking about hurting yourself, and other questions as well. Once you complete the survey, you wait until a therapist comes and brings you back to their office. Once there, you talk with them about why you are there, what else is going on in your life, and some general back ground questions. Based on that, they will talk to you about making a followup appointment to speak with someone on a regular basis.
From there, you go to the front desk of the clinic to make your follow up appointment, and get an appointment slip. Here’s where it gets tricky for some Soldiers. In many units, it is customary for them to require you to bring your appointment slip in and then they write it on a calendar somewhere so they can help to decrease the number of “No Shows” that they have to medical appointments. Here’s the thing, posting information about your appointments in a place that can be seen by anyone is a violation of your rights under the Health Insurance Portability and Accountability Act (HIPAA). Frankly, it really isn’t anyones business if you’re going to BH or not. But in the military, it can certainly be a tricky situation.
Your unit, mainly your Commander and your First Sergeant, are responsible for ensuring the health and welfare of all of their Soldiers. As a part of this responsibility, they should permit you to seek the assistance that you desire and/or require to ensure that you recover both mentally and physically from a traumatic birth experience. However, that doesn’t mean that they won’t want to speak with you regarding the situation as a whole to ensure that you are okay. I personally don’t know all the regulations regarding this, and whether they can even ask questions or not. My advice on this would be to confide in your First Line Leader first, and discuss with them whether you have to talk to the 1SG or Commander. Best case scenario, you’ve kept your FLL in the loop so they know where you are at and you avoid an awkward conversation with anyone else.
If you are uncomfortable going to the BH clinic on post, there are other options that you can explore as well. Calling Military One Source is a great way of finding out if there are counselors in your area to speak with, and sometimes they are able to get you in with them for several sessions for free. It can be very helpful to be able to speak to a therapist regarding birth trauma, and make a plan of action to not only recover from your past but to move forward.
Miles came into the world on 9/30, but really, his story starts weeks earlier, on 9/9. I was 36+5 and had my first lovely episode of prodromal labour – but unlike the prodromal labour with my daughter, it would fade after a few hours and in between contractions, I had a stabbing/burning pain near my incision from Lily’s birth, lower left side. It started during contractions and hurt worse than the contraction, then lingered and eventually faded between contractions – but took longer and longer to fade. I was debating L&D when the contractions stopped, and the pain itself eventually faded too.
Over the next two weeks I had two more episodes like that, until 9/22 I contracted consistently every 10 minutes the entire night – and eventually there was no break or fading of the stabbing pain. I was officially freaked out – was this a sign of poor scar integrity? Adhesions to other organs in my pelvis? I’d had bowel injury due to adhesions before I’d ever even been pregnant so I knew my body was prone to them anyway, and the possible ramifications scared the hell out of me. It was funny – I’d spent my entire pregnancy debating VBAC versus RCS, and rupture had never even made it onto my list of pros/cons because the possibility was so rare. But this pain was so, so wrong…and so, fearing the choice had been made for me, we went into L&D after talking to my doctor. We went in fully expecting to leave with a baby – and in all likelihood, a c-section.
To my shock, my doctor decided it was SPD. SPD? You’ve got to be kidding me. I –know- what that pain feels like – this was my second pregnancy with SPD. It does cause significant pain. It does not cause stabbing burning pain localized to one specific small area of my pelvis. We were sent home, after a shot of dilaudid (I blame the shot for not being able to advocate appropriately with my physician – I felt drunk and woozy, and had trouble articulating myself), and I was terrified. What if I went into real labour? I sincerely felt we were ignoring a dangerous sign, and we were far enough from the hospital that I was afraid. I knew how fast my labour began with my daughter – no slow start, contractions immediately long, hard, and close together. If that happened again and I was right, would I bleed out before we got to the hospital? Would I lose my son? These might sound like really dramatic concerns, but I can’t describe the intensity of the pain…or how /wrong/ it felt. I instinctively knew this pain was not normal.
The silver lining was that, in a real way, this really had made our decision clear. I was afraid to labour, which had previously been the only part of the process I’d looked forward to – I had always wanted my son to pick his birthday. I enjoyed laboring with my daughter, being supported by my husband. Yes, it hurt, but…it was the most peaceful part of my daughter’s birth. And I looked forward to it.
Now I dreaded it. And so we chose a date – 9/30, when I’d be 39+3. I became the first heavily pregnant woman praying not to go into labour. In a way, it was a blessing; we were able to fill the weekend with fun events for Lily, Octoberfest and special breakfasts and dinners and lots of time focused completely on her, including Mommy painting her toes and fingernails. (I painted my own toes too, and used a gift certificate from a friend to go get a no-chip manicure. Ah, the strange small advantages to planning the date of a birth…)
Sunday night I barely slept, and I cried some tears that my daughter’s time as my only focus was ending. She woke up hours early because she was afraid to not be able to say good-bye, as much as she was excited the baby was finally going to be born and excited she’d get to spend days with her grandma. This sparked more tears on my part, but finally it was time for my husband and I to leave – so we headed out to the hospital.
The c-section was for 9:30, and we had to be there at 7:30 to prep and be monitored. It was so strange – my doula came, and helped keep me calm, but volunteering to be cut open felt…so strange. It was my strongest fear with my daughter’s birth and was the reason we chose homebirth the first time…and now I wanted to be cut open? I can’t describe the complexity of the emotions that morning. Primarily excitement – my baby was coming, and safely. But odd bits of regret, trepidation, resentment that I felt like my body needed me to sign up for a more painful and difficult recovery, and also peaceful, because as much as there were some negative emotions, I finally felt confident I’d made the right call. Finally it was time for my husband to get into scrubs and my doula to head off for a few hours since she couldn’t be in the OR (I figured out later it’s because the OR was teeny! We couldn’t have fit her there!), and me to head to the OR.
Walking into the OR though…volunteering sitting at the table for the spinal…(which funny enough, they had to bring in a stool…I’m short enough I couldn’t get up there by myself, haha!)…so strange. A little scary. Exciting, but a little scary. I didn’t really remember prep for my first c-section – I was so sick and it was so fast, but this time…I had to actively participate in the prep for slicing my belly open. So odd. So very very odd. Once the spinal was in, my legs immediately felt warm and funny and heavy…I lay down and my husband came in, and after a bit they asked me if I could feel “this” – as I couldn’t, the surgery began.
I was shivering, badly – the anesthesiologist was amazing though. Unlike my first section, where the doc was an ass and ignored me even when I began vomiting all over myself, he was attentive. “Are you in pain? How do you feel?” He spoke to me a lot during the surgery and was great. He held an emesis basin for me the one time I did feel like I was going to be sick (I never was during the surgery this time – hazaa!) and told me how great I was doing. I was just cold, but I was freezing even with warm blankets. (I knew once I started shivering holding my son in the OR was going to be out – I was shivering too badly and wouldn’t have trusted myself, much less expected someone else to trust me when I couldn’t even hold my own arms!)
Finally, at 9:52, with no warning, we heard a strong cry. Miles was born! And surprisingly, I immediately began sobbing. When my daughter was born, I was so sick I got confused at her tiny wet gurgle. The only part I remember from her birth is asking my husband if that meant I was still pregnant or not. Confusion was my only response to her birth – but this time, I was so overwhelmingly happy I couldn’t control the tears. (“Are these happy tears or are you hurting?” “Happy!” “Good!” …I told you the anesthesiologist was awesome.)
Immediately, I heard them say he was “big” and my doctor brought him around quickly for me to see – wet, kinda purple because he was just born, covered in vernix…I got to see him, untouched by anyone except my OB. And he brought him to me and said, “Kiss him, Mommy!” I got to kiss my wet messy baby fresh from my body. I still cry thinking about it…I couldn’t hold him, but I was the first one to touch him, to kiss him. (Me kissing him while he was “dirty” apparently grossed my husband out, hah!) It was only a second because we didn’t want him to get hold, but it is a memory I will forever treasure. This was my OB’s way of compensating since it was clear I couldn’t hold him – and it was more precious than I can ever hope to explain.
My husband followed them around to where they dried Miles off (no bath and they didn’t wipe him down – just patted him dry and swaddled him so he wouldn’t be cold). The nurse brought Miles around for me to touch and kiss while they closed me up, and once my husband finished taking pictures, he held Miles for me to continue kissing and stroking and talking to. Towards the end the shivering got worse, but the surgery was over quickly and it was off to recovery, having never been separated from my son.
In recovery, Miles was weighed and found to be 8#6. (“Big!” Argh, my only regret…if I’d known that would be considered big…I’d been predicting 8#8 since July! Not big in my book!) Skin to skin and breastfeeding were immediately established – my husband went to hand me my son for the first time and got scolded by the nurse. “Blanket OFF!” Hah!
He was so, so beautiful. After getting him latched (oy, same bad latch as my daughter – my kids just can’t open their mouths wide enough when they’re teeny! Like her, it would take days to correct and by then my nipples would be cracked, again, but it was what it was.), I spent time just touching him, stroking him, talking to him, and rubbing any vernix in. Being able to do that was awesome – my daughter had been scrubbed “clean” – literally scrubbed, bleh – by the time I saw her hours after her birth. The staff was respectful – skipped the eye ointment with no problem, and even offered to do the oral vitamin K supplement instead of the shot! We were never hassled over no circ either, even though it’s not a common decision in our area.
n the end, a surgical birth – but an active one, where I really felt like I was a person, where my choices were respected and ironically, got more of my crunchy wishes than I did with my planned homebirth. It was so peaceful and yes, completely beautiful. I was cut open, but I chose to be, and this time, I do not regret it. Recovery sucks, but I’ve been praised for how well it’s going too – by Wednesday I opted out of narcotics and stuck to Motrin for pain. It was strange; I found that in one corner of my room, where the glider was, as I sat nursing my son, I could hear the woman in the next room. She was pushing. I wasn’t trying to overhear, but with where I was even the TV on couldn’t drown her out – everyone there was loud. I heard as her child crowned and as her baby was born. I heard the screams of joy, the “GREAT JOB, MAMA!” and the baby cry. And as I realized what was coming right before the baby was born, I had a moment of – crap, am I going to end up in tears? How am I going to feel when she gives birth and reminds me that that isn’t an experience I can have? But all I felt when it was over was…a slight bit of regret for an experience lost. No more grief, no “I wish it had been me.” More like, “Darn, I never got to go to Ireland.” My son’s birth was exactly what I wanted and needed.
And it was beautiful.
Heather also adds, “Thank you all so much! I am…relieved it was such a positive experience. I do feel it was the right decision, despite also knowing the statistics said that a vbac is safer. I still believe that most of the time vbac is a better choice – it just wasn’t the better choice for me, right now.
And also – I appreciate how positive the commentary is. I know that my choice isn’t necessarily a popular one here, and even knowing how amazing this community is about education versus judging I was a little nervous to share only because…this was such a positive experience to me and selfishly I didn’t want anyone to rain on it, yknow? I still hate that I had surgery. I hate that that was the choice that felt best for me. I believe in natural birth. I believe vbac is safer. It just wasn’t a choice I could make here and now… I know it is tough, don’t feel bad that it isn’t clear cut – for some people it really is. For some people they have to try to vbac. And really, vbac is safer, statistically. For most people it’s the better option. But no birth is right for everyone, so if in the end you decide RCS is a better choice for you, then own that choice and find a provider who will support your choices.”
It was a beautiful day for a race. The path stretched out before me, and mile by mile I conquered it.
It wasn’t about how fast I could run, or how many people were ahead or behind me.. it was about taking in the beautiful journey and challenging my body more than the last race. Pushing past the boundaries that the mind built.
I ran more consecutive miles today than I have since before my son was born. Eleven miles. Slowly but surely my body is healing. My mind is healing. It is not broken, ruined, nor defective. The more that I run, the more I believe that I am capable.
Doing something physically challenging helps me to know that the next time I am faced with immense and overwhelming fear, I can face it with the courage of an athlete who pushes through the hardest part of the race. The miles just beyond our previous accomplishment.
One mile at a time, I am healing from my trauma.
“Keep running the race that is set before you with Endurance” Hebrews 12:1
Over the past few months, I have started on my journey to recover from my traumatic birth experience. During this process I have often struggled on whether to categorize my journey as one of grieving the loss of my birth experience, or as a trauma recovery. I grieve that I did not birth my son, hold him skin to skin, breathe in his scent, and nourish him in the precious moments after he entered the world. Those are moments that I will never have with him, and that makes me feel heartbroken. But I also feel a nearly indescribable and paralyzing array of negative emotions when I think of his cesarean birth, the loneliness of being on the operating table, the crushing intensity of my anxiety as I couldn’t feel my body, and the indifferent conversation of the surgeons as they dissected my body. The overwhelming physical and emotional reaction to my memory of the cesarean leads me to focus trauma recovery rather than grieving.
Trauma recovery is a hot topic in the military. Many soldiers experience trauma while in performance of their duties overseas, and are then prone to Post Traumatic Stress Disorder. According to the United States Department of Veterans Affairs, Post Traumatic Stress Disorder, or PTSD, occurs after experiencing a traumatic event such as combat exposure, physical abuse, physical attack or serious accidents like a car wreck. During the traumatic event you believe that your life or others’ lives are in danger, that you have no control over the situation. Most people experience stress after a traumatic event, but if your reactions don’t go away over time and they disrupt your life, you may have PTSD.
It is not clear why some people develop PTSD and others do not. Many factors contribute to the possibility including whether or not you were injured, how close you were to the event, how much control you had over the event, how strong your reaction was, how much help and support you received after the event, and how intense or long the event lasted for. Some key markers that can indicate PTSD include reliving the event, avoiding situations that remind you of the event, negative changes in beliefs and feelings, and feeling “keyed up” in scenarios that remind you of the event itself.
There are very few resources regarding the recovery of the woman after a traumatic birth experience. According to research done by Kalina Christoff, Ph.D., Professor of Psychology at the University of British Columbia, Vancouver, around 30% of women are traumatized during the birth of their child and between 2% and 6% go on to develop Post-Traumatic Stress Disorder (PTSD) as a consequence. To put this in perspective, according to the same article, the rate of PTSD in the regular Canadian Forces is estimated to be 2.8% overall and 4.7% in soldiers with 3 or more deployments (Christoff).
A birth is defined as traumatic if the woman was or believed she or her baby was in danger of injury or death, and she felt helpless, out of control, or alone, and can occur at any point in labor and birth. It is important to recognize that it is the woman’s perception that determines the diagnosis, whether or not clinical staff or caregivers agree. Even though physical injury to mother or baby often occurs during a traumatic birth, a birth can still be traumatic without such physical injury. Unfortunately, clinical symptoms of full diagnosis of Posttraumatic Stress Disorder (PTSD) can occur for mothers andpartners following a traumatic birth, the effects of which impact attachment, parenting, and family wellness (Karraa).
Treatment options for birth trauma include trauma focused psychotherapy (counseling) and medication. The two most effective forms of trauma focused psychotherapy are Cognitive-Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). CBT includes cognitive therapy, exposure therapy and stress-inoculation therapy. Ideally, this therapy allows the patient to confront your traumatic past without triggering PTSD symptoms. EMDR is highly effective and considered a frontline treatment for PTSD. In EMDR, you are told to think about your traumatic experience while moving your eyes back and forth following the therapist’s fingers as they briefly move across your field of vision (Kendall-Tackett).
There are also several medications that can be used during recovery from traumatic birth including antidepressants and antipsychotics. These should be discussed with a medical provider to see if they are right for you. Antidepressants have been viewed as a key part of treatment for PTSD and can compliment counseling treatment as well.
After gleaning all of this information, it is even more obvious to me that recovery is not just going to happen and that as a patient I must take an active role in my recovery. If I do not confront my trauma, it could cause further problems with future birth experiences.
Have you pursued counseling or medication in your recovery from traumatic birth? How has either helped you in your journey?
“What is PTSD?” United States Department of Veterans Affairs, National Center for PTSD. 12 August 2013 <http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp>
Christoff, Kalina, Ph.D., “Vancouver Birth Trauma: connecting women who were traumatized during childbirth.” University of British Columbia, Vancouver. 12 August 2013 <http://www.vancouverbirthtrauma.ca/home.html>
Karraa, Walker, MFA, MA, CD(DONA). “Traumatic Birth Prevention and Resource Guide,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/>
Kendall-Tackett, Kathleen, Ph.D., IBCLC, FAPA. “Treatment Options for Trauma Survivors with PTSD,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/treatment-options-for-trauma-survivors-with-ptsd/>