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/>
Finding the right VBAC provider is a daunting task for me. As my husband and I start talking about trying for baby #2, this decision weighs on my mind a lot. Even putting aside the fact that I am not currently stationed in the same area as we will be when we do start our second pregnancy, the enormity of the task is intense. The more birth stories that I read, and the more resources that I find, a common thread is that it is absolutely positively essential to have a supportive team that you trust and can depend on to be there for you during your VBAC experience.
I usually try to be as impartial and methodical as possible when I pick our medical providers, but finding a VBAC supportive provider is so much more than that. Of course, there are checklists that I can use and questions that I can ask like:
How many VBACs have you attended? What is the success rate? How many uterine ruptures have you seen?
What is your philosophy on going past 40 weeks? If I were to go post date, what options would you offer and at what time? 41 weeks? 42 weeks? 43 weeks?
Do you have any standard VBAC protocols that you follow that differ from non-VBAC birth?
What kind of pain management techniques do you encourage? Do you support water birth? Will you support a home birth?
But I think the biggest factor in picking my VBAC provider will be how well we “click” together. This is why I am nervous. During my first pregnancy, I participated in a new program offered at my hospital called “Centering Pregnancy” where appointments were held in a group setting (aside from the height and weight check, checking the fetal heartbeat and fundal height). During these appointments, I felt relatively comfortable. The same midwife, OB and nurse were there each month as well as four other couples participating in the program. We discussed different topics each month, and while I felt like I learned a lot during these appointments, I didn’t establish a good enough relationship with the Midwife. She did happen to be the one on duty during the second half of my labor, and she wasn’t as supportive or present as I thought she was going to be. In fact, I can only remember for sure seeing her twice during my labor and in both instances she was insisting that my baby was too big but I could “go ahead and try to push.” Followed by her walking out of the room.
So, I worry that my ability to pick a supportive provider might be weak. Fortunately, there are a few organizations available to help find supportive providers for mothers who are seeking VBAC. The first one that I learned about is called the International Cesarean Awareness Network or ICAN. ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). There are ICAN chapters all over the world, and each one has mothers that have experienced VBAC and can provide recommendations of midwives and obstetricians in the area. Connecting to a local chapter on Facebook, I have been able to interact with other moms from that area. I’ve learned more about the providers, what their quirks are, who they work with well, who they don’t work with well, what hospitals are more supportive than others and much more.
What did you look for in your provider? What resources did you use to find a provider?
In the weeks, and months, that came after my sons birth day, we went through a lot.
Because he had breathed in amniotic fluid and muconeum following the cesarean, my son was in the NICU for a week while his breathing stabilized. He battled jaundice, dehydration and failure to thrive. We had trouble breastfeeding because of the delay after birth, the CPAP machine, the monitors, and the horrid nurses who had no patience to help me at all. Although he was 9 pounds, 15 ounces when he was born, he was down to 8 pounds 2 ounces before my milk finally arrived on day five. The antibiotics that they had pumped into me during labor (since I was GBS+), had not only delayed my milk for five days, but also triggered a massive case of thrush in both of us.
But at least we were both healthy.
It took eight weeks to rid of us the thrush. It’s taken a lot longer to to not sob when I think of his birth. The nightmares began to wane, but with the recent talk to TTC again, they have returned a couple of nights each week.
It took me ten months to admit to myself that I had PPD. That it wasn’t my Thyroid, or stress at work, or adjusting to a routine, or lack of sleep. Even when I did finally talk to the doctor, I was too embarrassed to admit to the nightmares. The military takes mental disorders very seriously. It could have a very serious impact on my career… What if they think I am unfit to continue serving? So I stayed quiet.
But at least we are both healthy.
I started reaching out to others. Slowly breaking my silence. Taking bittersweet comfort in the stories of others facing the same birth demons. There are so many of us out there. Many who have friends, colleagues, family, and even spouses who just don’t understand. How do you put into words the craving of birth? How do explain the disconnect of your child being born, but not birthing them, if they haven’t felt it themselves?
But at least we are both healthy.
Most people wouldn’t associate PTSD, or Post Traumatic Stress Disorder, with child birth. In fact, it’s so uncommon that I don’t even mention it to people. Ever. Who would believe me? Most people I know with PTSD have it from combat, from fighting for our country. Or maybe a car accident. But birth? No one would believe me.
But that’s what it feels like. I can’t escape it. I love my son and he is my entire world. Most people think (and usually say) that isn’t that what’s important? A healthy baby? But there is so much more to birth than that!
During my pregnancy, I did everything that I could to get ready for my birth. As a Soldier, I did PT with the other pregnant Soldiers even running up until I was 28 weeks. My husband and I went to prenatal classes. I went to all of my appointments. I watched my diet and my weight. I even did a birth plan. It was full of every detail that I hoped my birth would be. Quiet and dark room, the midwife helping me find positions to help, no epidural, no pitocin, no drugs, delayed cord clamping, immediate skin to skin and breastfeeding. It didn’t seem like too much to ask. I longed for feeling connected to my child and birthing them, holding them close, feeling the birthing high as I embrace the very thing that a woman is made to do!
As soon as we arrived at Labor & Delivery, I excitedly started telling the nurses of my birth plan. They smiled and nodded, “uh-huh” “that’ll be nice dear”.. and then it all went out the window. They constantly wanted me monitored, I felt apprehensive but they are the experts, right? They wouldn’t do it if I didn’t really need it, right? I did labor naturally until about 1am. I started to feel tired, I started to think that maybe I couldn’t do this. And that was really the turning point. Knowing what I know now, I was entering transition! I was nearly there! But at the time, I asked for the epidural.. even using the safe word that I told my husband I would only use if I were desperate.
And that is when the “If only…” things start to take over. If only he had encouraged me and told me how strong I was and that I could do it, then maybe I wouldn’t have gotten the epidural… If only I hadn’t gotten the epidural, then maybe DS wouldn’t have turned sunny side up with his head slightly tilted.. If only they hadn’t started pitocin, he wouldn’t have gotten stressed out… If only they hadn’t tried to manually turn him (um, ouch!!) then maybe he wouldn’t have had meuconeum…have come down on his own.. If only, if only, if only..
But those things did happen.
So I was told I had no choice, they had to do a Cesarean. I remember DH holding me close as I sobbed into his shoulder when they told us. The contractions still wracking my body because the epi didn’t really work for me anyways except that it made my legs tingle and feel limp. The nurse quickly shaved me, DH got a gown, and they wheeled me through the bright hallway to the OR. From there it is a blur. It was so bright, they made a joke about us not knowing whether it was a boy or girl. The anestheziologist changed out my epidural for something stronger, it made my lower half disappear, my arms felt cold and tingly, i could hardly breathe. I couldn’t see DH, but I know he was there. I was crying. I could feel them tugging on me, it was moving my whole body. This wasn’t right, this wasn’t supposed to be how it was. This wasn’t supposed to be how I met my.. son. It’s a boy! The surgeon holds him high above me so I can see before he is whisked away. I asked to hold him, to see him. No one was hearing me, it was hard to talk because it was so hard to breathe. There was something wrong with DS. They brought him next to my head, wrapped tight in a blanket and with a cap on. I ask if I can nurse him. But some doctor is there telling me that he has to take him and that something is wrong. So DH goes with him too. And I’m alone.
The surgeon is closing me up. There’s a student there too, so he’s explaining as he goes.. “put the intestine there.. the appendix looks good.. no just place that on there.. now we stitch the next layer…” I can tell when they get to my skin, as the conversation changes.. “it was nice enough to golf this past weekend… yeah we were able to go up to the mountain…” It felt like forever, laying there with my arms tingling, tears streaming down my cheeks.. it’s probably the worst thing you can do to a claustrophobic. Strap them to a table and make it impossible to move or feel anything.
In recovery, the spinal began to wear off. I desperately wiggled my toes and legs to get it to go away.. they wouldn’t let me see my son until I was able to stand and then sit in a wheelchair since he was in the NICU.. Six hours after my amazing son came into this world I got to hold him in my arms. He was beautiful. He was amazing. And that’s the first time I heard it, from the nurse, “well as long as you and baby are healthy, that’s all that matters.”