Birth Trauma Awareness Week
As two people who have experienced very straight forward births Jess and I really don’t know a lot about the depths of birth trauma. A brave mama in our circle has offered to share her story to help us all understand a bit more about what some people experience.
This mama has asked to remain anonymous which is very understandable but we want to say thank you for being so vulnerable and willing to share about something so heavy and personal. I’m sure this will help many other mamas to feel less alone. I hope that sharing about it is healing for you in some way as well.
If you or someone you know has had a traumatic birth there are organisations and helplines that exist to support you through your experience.
- Perinatal Anxiety and Depression Aotearoa (PADA)
- Health and disability advocacy service
- Birth Trauma Support NZ (Facebook group)
- Birth Trauma Aotearoa (Facebook group)
- 1737 helpline
- Healing birth trained practitioners and birth trauma counsellors
Instagram pages
In order to paint a bit of a picture pre-birth, what was your birth plan? Did you have any pregnancy complications that affected this?
We found out we were expecting very early on as I had severe pregnancy sickness almost immediately. This grew worse and I was diagnosed with Hyperemesis in week 11, when I was admitted to hospital for IV fluids and monitoring. It was definitely not the start to things I had hoped for and the excitement about being pregnant soon faded, though we were still so looking forward to meeting our little one. From hearing about some of my friend’s experiences of birth, I tried to go in with a level head, not expecting everything to be perfect but also keen to have as natural an experience as possible. I’m a very private person and it was important to me to have minimal people in the space, no bright invasive lighting and be unobserved. I hated the idea of a hospital birth, but wasn’t confident enough for a home birth, so we settled on St George’s which felt like a good compromise. Plus it was close to our house which meant I could labour at home a little longer.
Sadly it was not to be. At 34 weeks, during my routine midwife appointment, my blood pressure showed up as elevated, so I was sent for further testing at the hospital straight away and they confirmed it was Pre Eclampsia (PET). I was devastated to say the least. My midwife, who I’d come to know and trust, was replaced with the hospital care team and I was admitted straight away, the same day for monitoring.
Talk us through your labour and birth experience
As is standard with Pre Eclampsia, we were scheduled for induction at 37 weeks, and each week prior I would have monitoring at the hospital twice a week, blood pressure checks, CTG monitoring for baby (I came to hate the sound of the machine!), blood tests and additional scans to check baby’s growth. At first baby was showing no signs of being impacted by the PET and things were looking ok, but the Friday before my scheduled induction we had an appointment at the hospital with the OB GYN team, where the doctor told us baby had stopped growing, and they wanted to bring the induction forward. They were concerned she was possibly even losing weight, given how she had been tracking on the growth charts previously. They suggested a c section as an option, however I was keen to at least try for a natural birth if we could. It was very hard to have what remained of my birth plan even further reduced, and I remember feeling incredibly powerless and out of options, like I was just along for the ride rather than having any ownership over it.
At the end of the appointment it was recommended I be admitted to hospital for monitoring over the weekend in case baby went into distress, which we agreed to. We headed home to pack my bag and a bag for baby, and also to pick up our capsule hire early, excited to think we would be bringing our little one home in it the next week. I spent the weekend in hospital, with 4 hourly blood pressure checks and CTG monitoring for baby, and on the Monday morning received the call that they had moved the induction through to that morning and was moved to the birth suite. The recommended induction was the Foley’s catheter, which was put in Monday morning. The procedure itself was incredibly uncomfortable and there was a medical student present with the doctor, even though I did not give consent for them to be there. I started having pains shortly after and these were intermittent throughout Monday and into Tuesday. By Tuesday mid afternoon, I was checked by the same doctor I saw the previous Friday. It was such a blessing to have a familiar face after all the other doctors we had seen, and I was relieved to have someone we knew around as we got closer to birth. She advised the next stage would be to rupture my membranes to hasten things along, which she did with some difficulty. It was incredibly painful and when it was done she advised there was meconium in the waters, and it had likely happened the day before so baby had been in distress. They kept a close eye on the CTG as things got under way and my contractions became regular, but it was my husband who first noticed baby’s heartbeat was dipping. We all watched as with the next contraction, the line dropped off the bottom of the page for what seemed like forever. I remember the midwife on duty and the doctor staring at the machine waiting for it to re appear. The doctor told us to prepare ourselves for a possible c section, as the room filled with people. The rest is a blur, I vaguely recall them saying “looking at a cat 1 section, general required”. We were told if baby’s heart rate didn’t stabilise my husband wouldn’t be able to be present for the birth, and I would need general anaesthetic, though they were hesitant to do this as it would make baby sleepy, and that was a problem considering she was so small. I remember there being just enough time for my husband to send a text to both of our parents and our pastor from church to ask for prayer, even as they raised the rails on the bed and wheeled me out the door. In theatre, it was so calm; I remember being surprised how unrushed they all seemed, even though at this stage we were still looking at a category 1 section.* They got me prepped and it was down to the wire, but baby’s heart rate miraculously stabilised and they downgraded to a category 2 section, so my husband was able to come into the room as well. It shocked me how fast the surgery was, and our little girl was born tiny, but perfect about 10 minutes later. I saw her for a split second before they lifted the curtain again and the NICU doctors assessed her.
*Level of urgency for each Caesarean section can differ. As a way of separating these out, the hospital system uses 4 categories, with 1 being the most urgent and 4 being the least.
Category 1 - Immediate threat to the life of a woman or fetus; Ie a cord prolapse (the cord comes out before the baby). Category one c-sections are generally completed in under 30 minutes from making the decision that one is warranted.
Category 2: Maternal or fetal compromise but not immediately life threatening. Ie, it has been identified that the mothers labour is obstructed (baby is not descending despite having effective contractions). A caesarean will usually be performed within 1-1.5 hours after obstructed labour has been diagnosed.
Category 3: Needing early delivery but no maternal or fetal compromise; eg. A woman had a booked in Caesarean section at 39 weeks, but at 37 weeks her waters spontaneously break. So her caesarean will be brought sooner but there is no concern or rush. This woman could wait hours or even a day provided there is no issues with her or her baby’s well-being.
Category 4: At a time to suit the woman and the caesarean section team. Commonly known as an elective caesarean, the woman will know the date and time this will take place.
Describe the moments immediately after you gave birth, how did you feel, was it what you expected and if not then how was it different?
Utter relief that she was here and that she was safe! Due to the medications I was on for my blood pressure, and the anaesthetic, I was feeling very ill and very shakey, so I opted not to do skin to skin with her in theatre, and instead my husband held our daughter on his chest while they finished up with the stitches. I felt quite disconnected from the whole thing, numb from the chest down, and I kept asking my husband and midwife what she was like, what colour were her eyes, how much hair did she have, because I had only seen her for such a brief time. I was able to hold her briefly while we were wheeled to recovery, before the NICU team came to take her away. Due to her low birth weight they were concerned about her blood sugars and body temperature, so they wanted to monitor her until she was stable.
How did you find postpartum recovery and the 4th trimester? How do you think your experience affected postpartum?
I spent four nights in hospital after the birth, while they monitored my blood pressure and adjusted my medications. My baby spent that time in NICU, on a different floor. It was incredibly hard being apart from her and when we were able to see her, it took a long time for her to feel like my baby. It seemed like I was visiting someone else’s child, just a guest. I didn’t know beforehand that both PET and a C sections can cause delays in your milk coming in, and this wasn’t helped by the fact I wasn’t given a pump to use on the ward until day 3 of my baby’s life. I would spend hours on the pump every day just to eek out 1 or 2mls at a time. It was soul destroying. Every time I would make the painful walk downstairs, when I was able to walk, the nurses would ask if I had any milk for my baby and how many times I had pumped. I am forever thankful to the milk bank donors, whose milk kept my baby fed those first few days and weeks. The hardest day by far was when I was discharged, but our baby was still in NICU. She was gaining weight, but it was slow going and she wasn’t waking for feeds, so was still needing to be tube fed. I felt so torn, I craved the comfort of my own bed, yet felt so guilty for leaving her and dreaded the thought of returning home to an empty bassinette. Driving out of the hospital with our empty capsule in the back seat was particularly emotional. We spent four weeks in NICU with our wee girl. Every day I would make the slow walk into Christchurch Womens’, still sore from my surgery, carrying a little chiller bag with my expressed milk for our baby. I would watch as other NICU mums deposited dozens of bottles of milk into the chiller, and I would carefully place my meagre expressions into our spot. The days in NICU seemed to take forever to pass, and I struggled with the lack of privacy as I tried desperately to learn to breast feed our tiny daughter. The day I was finally able to produce enough milk to cover all her tube feeds was a huge milestone and a big step on the road home. There were other high points too like being able to give her her first bath, and when she moved out of an incubator and we could finally dress her. The day we finally were able to bring her home, we didn’t tell anyone until we had left the hospital carpark, just in case they called us back!
Is there anything you would do differently if you could?
I would have booked the c-section straight away if I had known the trauma the induction would cause myself and my baby. Inductions are often pitched as just helping your body along and it will come naturally after a quick jumpstart, but when your body and your baby aren’t ready to birth, this process can cause severe distress. If I had known our baby would go into shock from the induction, I would have requested the surgery in the first place.
How has your birth affected you since in your day-to-day? Physically/mentally/emotionally?
It seems like there is nothing this experience hasn’t impacted on. Physically it took a long time to heal up post surgery, and I lost a lot of self confidence. The Pre Eclampsia made me gain a significant amount of weight, and I struggled to lose it with the trauma manifesting physically also. I felt disconnected from my body in many ways, like I had no ownership over it, it wasn’t really mine. Because I had had so many medical exams and felt so vulnerable, I separated myself from my body for a while, and told myself the birth was something that had happened to me, rather than something I did, like in a natural birth. I hated looking in the mirror and would actively avoid doing so. Mentally and emotionally I felt empty, I felt like my body had failed me and our baby. I struggled with triggers and flashbacks to various parts of the birth, particularly the induction process or her heartrate on the monitor. Small things would set me off or remind me of moments in our baby’s life we had missed due to NICU or being apart from her. I still find it hard when I hear of positive birth experiences, or see people taking their little ones home after just a couple of days. Even though I wouldn’t wish our experience on anyone, it’s hard to see reminders of things we missed out on. It’s taken a long time for me to feel like a mother to her, with being so disconnected from her birth. I thought I would feel so empowered having had a baby, but instead I felt ashamed of how it happened.
What has been the hardest part to process about your birth?
Even though I know she was given excellent care, I think the biggest heartache for me was being separated from my baby for nearly 12 hours after her birth. Having that first night after she was born in separate parts of the hospital is still something I grapple with, and there is a deep sense of guilt, even though I know there is nothing I could have done differently to avoid it. Knowing her first nappy change was done by someone else, wondering if she cried out for me and I wasn’t there still holds a sting for me. Second would be the induction process itself. The invasive nature of the procedure, feeling no sense of ownership over my body, having the medical student present and observing, feeling so utterly vulnerable and on display. Some of my worst flashbacks were of that moment.
Has this changed how you feel about having another baby?
This has been one of the hardest things to wrap my head around. I never just wanted one child, but I can’t imagine going through a similar experience again. It will be some time before we consider growing our family. For now our little girl is our joy, and she is perfect!
What have you done or are you doing to help you process what happened?
At the advice of my midwife I attended a trauma coaching session with a birth trauma specialist. This has been invaluable to unravelling the layers of emotion connected to what happened. Just having someone validate what I was feeling was such a weight off my shoulders. Even after just one session, I felt lighter and the flashbacks have almost become a thing of the past. I still have a lot of triggers and know I need more therapy to work through everything, but it’s comforting to know it helps and that I’m not alone in my experience.
What would you say to someone else who has experienced birth trauma?
Firstly, it is not your fault. You are not responsible for what happened. Your grief is valid. And second, know that this doesn’t have to define your experience as a mother. There are people who will help you through it. I’m still on my journey, it’s a long road, but it doesn’t need to define you or steal the joy that should be yours with your baby. Also, don’t be afraid to unsubscribe from social media channels or accounts which make you feel less than, or mute pages for a while if you need to!
There are some great organisations around who can point you in the right direction for support. I’ve found this website especially helpful. It’s also worth noting that to my knowledge there isn’t a birth trauma support group in Christchurch and it’s relatively difficult to find a local birth trauma therapist. This is something I’d really love to see improved as it’s so needed!
How did you know that you needed some help to heal from your birth? Are there any signs people can look for in themselves or a friend?
Post birth and NICU I was in survival mode, but I was so focussed on leaving those things behind me, and moving on with real life with our baby that I buried a lot of the emotions and trauma because I didn’t have the strength to face them. It was only several months later when I still didn’t feel like myself and started having vivid dreams and flashbacks at night, that I realised I needed to seek further help. It was my poor husband who bore the brunt of my pain at times and he was the first one to urge me to get help. It also impacted on my ability to bond well with my daughter. Even though she was a very happy little baby, and so easy to love, I struggled to feel a strong connection to her at first. This has changed so much over the months as I’ve worked through what happened. Birth trauma manifests in different ways for everyone but I would say if you can’t seek too much help, even just one session can make all the difference.
Anything else you'd like to add?
For me birth trauma has been largely characterised by grief. Grief around what happened, but also grief around the moments and memories it stole away. Grief that we had hyperemesis and PET as part of our story but also grief that they meant we didn’t get those first moments as we had envisioned. I’m learning to live with the tension of being thankful for the interventions we had, even while I grieve that we needed them at all. C sections get a bad rap sometimes in birthing circles, the ultimate in medical interventions, but I’m thankful we have them available, so that stories like ours, though hard, can have the best possible outcome. If it weren’t for the surgery, we may not have had our little girl with us today, and I can’t imagine life without her in it. The below is a post I found on Instagram in the weeks after we made it home, I still reflect on its words to this day.
“To the one with birth trauma,
Forgive yourself for the choices you had to make.
Forgive yourself for the time babe spent in NICU.
Forgive yourself for not knowing what you know now.
Forgive yourself for freezing and fawning during childbirth.
Forgive yourself for not knowing all the questions to ask.
Forgive yourself for not having all the answers.
Forgive yourself for struggling to breastfeed.
Forgive yourself for not being able to advocate for yourself.
Forgive yourself for not changing providers.
Forgive yourself for how your body gave birth.
Forgive yourself for not bonding immediately with baby.
Forgive yourself for grieving all that you lost.
Forgive yourself for being angry at all you were robbed of.
Forgive yourself for being imperfect.
Forgive yourself for struggling to realise this isn’t your fault.”
Credit to @theteaonbirthtrauma