What Exactly is a “Traumatic Childbirth” and Why Do We Care?

In this post, I am referring to psychological trauma and not necessarily physical trauma.  Though physical trauma can also hold psychological trauma.  First some simple statistics according to PATTCh (Prevention and Treatment for Traumatic Childbirth) 25 – 34 % of women reported their births were traumatic.  While the percentage that then develop PTSD (Post Traumatic Stress Disorder) is between 1.5 – 9%.

“A birth is said to be traumatic when the individual (mother, father, or other witness) BELIEVES the mother’s or her baby’s life was in danger, or that a serious threat to the mother’s or her baby’s physical or emotional integrity existed” – PATTCh

In other words, it is not up to a doctor or other provider to determine if a birth was traumatic to the mother or father.  If the birth was deemed traumatic, it was.  If the doctors pulled out the forceps and the mother felt like they were going to pull the babies head off… then it was traumatic.  But a mom in the same situation might think it was amazing that she was able to avoid a csection.  Most of us might view fourth degree tears as traumatic (ouch and holy recovery period!) but mom might feel empowered at what her body was able to do.

“One’s perception of the event is what defines it as traumatic or not. As it pertains to childbirth, “Birth trauma is in the eye of the beholder” and whether others would agree is irrelevant.” – C. Beck

Events that MAY be associated with a traumatic childbirth:
-Stillbirth (death of baby prior to birth)
-Infant death soon after birth: major organ deficits, trisomy 18, “diagnosis incapable with life”
-“High risk pregnancy”
-CODE O
-Mom stay in Antepartum Unit or the ICU
-Prolapsed cord
-Uncontrolled pain
-Unplanned C-section
-Use of vacuum extractor or forceps to deliver the baby
-Baby going to NICU
-Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery
-Women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD.
-Women who have experienced a severe physical complication or injury related to pregnancy or childbirth, such as severe postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia, perineal trauma (3rd or 4th degree tear), or cardiac disease.

So, why do we care??

“Birth Trauma NEEDS to be talked about. Post-Natal Depression (which, according to the American Psychological Association, affects approximately 1 in 7 women) is now widely known and accepted as a reality that many mothers experience. It’s time now for our awareness and vocabulary to expand once again. The fact that 25-34% of women come away from their birthing experience feeling some degree of trauma means that at least twice as many women struggle with this as with PND. And because of the lack of awareness about Birth Trauma, these thousands of women often struggle in silence. It’s time for that silence to end, so that through awareness and preventative measures, the risk of trauma occurring can be greatly reduced.” – Jen Hannah – Advocate

Having a traumatic childbirth is more prevalent than Postpartum Depression or Postpartum Anxiety – but we can assume that a correlation is present.  If we are able to support the women or fathers to get the care or education, they need after a traumatic childbirth we might be to avoid some of the negative consequences for the family when these things go untreated.

What are the Effects:

Potential Effects on Mother –
Feeling out of control, irritability
Shorter lactation period
Reduced sleep due to fear – not just baby not sleeping
Difficulty with family relationships (avoiding family that might not understand)
Avoiding friends and supports with small children
Difficulty with ‘motherly’ roles: acting the part but feeling overly anxious/ protective OR detached / avoidant
Difficulty with attachment to baby
Feeling misunderstood, abandoned or isolated.
Less likely to have more children
Clinical Effects of: Postpartum Depression, Postpartum Anxiety, Postpartum OCD, and Postpartum PTSD

Potential Effects on Father –
Similar to the effects on Mother, Anxiety and OCD symptoms tend to be higher.
“I felt like I was watching a car crash with the most important people in my life, and I could do nothing to protect them.  She was screaming in pain – she was dying.  Twelve doctors ran into the room.  They wheeled her out and I knew nothing.  I stood there (in the labor and delivery room) shaking, sweating, and then sobbing.  I was terrified. She was dying and she was scared and alone and I was helpless.  I couldn’t help her.  I am supposed to be her person to help her… my job was not to leave her alone.”

Potential Effects on Baby –
We still have a lot to learn on how a traumatic childbirth effects a baby and their nervous system.  Most of the research over the last decade has been contradicted with newer research.  What we DO know is that attachment to a parent is key to reverse any upsets that might have happened.  New research also suggests that the bond between baby and traumatized care giver is healing for both mom and baby.  The attachment helps to reduce cortisol levels and help the nervous system regulate. (This is very exciting and empowering.)

We also know the side effects of untreated caregivers can create developmental delays for the baby along with additional behavioral issues as they age.  In my county (and hopefully the state of PA with Senate Bill 200), we can send a referral to early intervention and they can evaluate from birth to age 3 and set up for quarterly tracking to make sure any delays are caught early.

What now?
If you are a mom or dad struggling with the after effects of a traumatic birth, please know there is help and you are not alone.  What you are feeling is normal.  There are some ways to support: adequate sleep, message, brisk walk, exercise, support groups, psychotherapy – trauma focus, Smartphone Apps: PTSD Couch/ PPD ACT, self help guides to trauma recovery, Medication.

There is help.
You are not alone.
You can get better.

Other resources:
Penny Simkin video on Birth Trauma: https://www.youtube.com/watch?v=IkVHUrhh_vY
PATTCh: http://pattch.org/
Postpartum Support International (Learn more and utilize their supports): http://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/
Jen Hannah, Advocate: http://jenhannahspeaks.com/

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