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?
Several women recommended Cut, Stapled and Mended by Roanna Rosewood to me in the past few months. It is a deeply moving book for those of us that have encountered Cesarean Birth and long for a natural birth. She tells her story in a very relatable and realistic tone. Her description of the fear and pain of cesarean were detailed and helped me to know that I am not alone in how I feel about my birth experience.
But more than just telling her Cesarean Birth story, she tells the story of how she explored her options and did anything possible to try to have a vaginal birth. Including going to a natural healer who used magnets and put his hand down his pants (um, yeah you read that right.. and she thought it was just as strange!) She shares her fears and doubts with the reader as well as her joys. Her quest was to accomplish what many thought would be impossible, a VBA2C!
My emotional response to this book was very strong. It helped me to think more about how I felt about my sons birth, as well as ways for me to start healing from my emotional scars. Just knowing that there are women out there who were as traumatized as me, and went on to have a VBAC, made me feel incredibly connected and hopeful. This is the first book that I read after starting my recovery journey and I am so glad that I did.
I highly recommend this book to anyone who has experienced a Cesarean Birth!
Today as I started off on my first run after a month long, self-imposed “break” from running.. one of my first thoughts was… bug spray. I forgot to use bug spray. As I swatted away the bugs that convene along the rural Virginia road at dusk, I started to imagine myself as She-Ra, fighting my way through them. Weird? Yes. Empowering? Absolutely.
This was my first run of many that will come to prepare for my first marathon next January. A bucket list item, that at 29, I started to worry that I wouldn’t get to. Despite reports of 93 year olds completing them “all the time.” I wonder most days if I am crazy. But a few years ago, before my son was born, I ran a half-marathon. And I still remember that absolute elation as I crossed the finish line, tears streaming down my face as I quietly celebrated finishing as well as finally feeling the massive blisters and my bruised toes.
It’s the same elation that I had hoped to feel after birthing my son. You see, in the next six months, I’m not only training for my fist marathon. I am also embarking on a journey of healing my soul after a traumatic birth experience. I am preparing to try to have another child, and I desperately want to birth the way that millions of women take for granted every day. My fears of another cesarean make me paralyzed sometimes. Nightmares of my birth experience haunt me, and until I can face my fears and my experiences I won’t be able to move forward and embrace pregnancy and birth again.
This is going to be my journey.. It’ll probably get rough. It’ll probably get emotional. But I hope to emerge as a She-Ra, battling my way through fears and comfort zones to be a marathon runner and a kick ass mama who’s ready for anything.