I am a survivor of traumatic birthing. When my daughter was born in March of 2011, my normal low-risk pregnancy became a medical emergency when I was diagnosed with preeclampsia. Preeclampsia is serious, but happens often enough that doctors know how to handle the situation. The fact that my birth was medicalized wasn’t what was traumatic. What was traumatic was the way I was treated, the things that were kept from me, and the ongoing struggle for someone, anyone to listen to me and my needs.
The formal definition of emotional birth trauma, used by Carol Beck (my favorite researcher on the subject), is that birth trauma is, “an event that occurs during the labor and delivery process that involves actual or threatened serious injury or death to the mother or her infant. The birthing woman experiences intense fear, loss of control, and horror”1. After additional research, Beck later revised the definition of trauma to include an “event during labor and delivery where the woman perceives she is stripped of her dignity”2. This can be summarized as “feeling unsafe” — both socially and physically.
Collective international research shows that 33-45% of women perceive their birthing experience to have been traumatic3. I believe that if you’re still thinking about your child’s birth with anger, guilt, or shame, you experienced emotional birth trauma. But it’s sometimes hard to explain that to the people around you, or even explain it to yourself.
Pregnancy and birth take place within a complicated power structure that does not care for a woman’s well-being. A pregnant or birthing mother’s sense of safety is often violated in the name of “what’s best.” But what’s best doesn’t always serve women. Safety should be of the utmost concern, for both physical and emotional reasons, but we fail one-third to just under one-half of women who give birth. Here are five reasons we fail.
1. Women’s autonomy is questioned in public.
Autonomy is your right to choose what happens to you, your body, and your baby, based on the information that you have, and on your own risk/benefit analysis. Autonomy isn’t about doing whatever you want, autonomy is making the right decision for YOU based on what YOU know and believe. And more importantly, because decisions are not made in a vacuum, it’s about those AROUND you TRUSTING you to make those decisions.
The easiest example to see of how a pregnant person’s autonomy is curtailed in public is when you think about the long list of things that pregnant women “aren’t supposed to eat.” Alcohol, caffeine, soft cheeses, deli meat, raw sushi, etc. are all things that we are supposed to avoid. However, each substance/food listed actually aren’t black or white/yes or no – they’re decisions that come with benefits and risks. The risks of caffeine are an easy example. While the official recommendation to avoid miscarriage is to consume less than 200 mg a day (about the same amount of a 12oz cup of coffee), there are numerous anecdotal stories on the internet about servers refusing to serve pregnant women caffeinated drinks.
This is infantilization — strangers feel empowered to comment on a pregnant women’s choices, completely ignoring a woman’s ability to make decisions for herself as an autonomous person. This is a form of social violence, when strangers “know what’s best.” Judgement is something that we are afraid of encountering — we want to be liked, to be valued, and we go out of our way to please people as a result. Everyone feels unsafe when we expect to be judged, and in this case, pregnant women are particularly aware of this kind of public judgement. (There is also a dimension of race and socioeconomic status here — women of color and poor women have additional judgements to face from strangers, which can make them feel even more unsafe.)
When I got pregnant with my daughter, people publicly questioned me about my career prospects, comments like, “Usually people build their career before they have children.” While this kind of remark that questions my ability to make my own decisions regarding my career and family doesn’t seem like it would be part of the trauma story (many would think of it it as merely annoying), it was the first step in alerting me that pregnancy is a potentially dangerous situation emotionally. Think of it this way — if I were a gazelle on the Savanna, this kind of social judgement would be like seeing something out of the corner of my eye, and then becoming very still to observe if the threat really exists.
2. Women’s autonomy is questioned in private.
Rarely is medical care, especially during pregnancy, seen as a partnership. Instead, it becomes a paternalistic relationship — the doctor is the parent, and the patient the child. Behind closed doors, there are medical care providers who see themselves as knowing what’s best, even though modern medicine is based upon the model of informed consent, perhaps even into shared decision making.
Women are supposed to be the last decision maker when it comes to medical treatment for themselves and their babies. The doctor can continue to inform you, but you have the right to make a decision about the course of treatment, or what you put in your body. This means that you have the right to say YES or NO for any reason. You can say no to an episiotomy. If a doctor does it anyway, that’s obstetric violence and highly unethical if not illegal.
During the birth of my eldest daughter, I was given a drug to ripen my cervix as her birth needed to be induced preterm. However, the doctors did not inform me of the cost benefit analysis of that particular drug, and it turned out that the drug was used off label and had been associated with uterine rupture. Later, they turned on pitocin, a synthetic labor drug, while I was sleeping. They had previously told me they would wait until morning — and instead did it without my knowledge. Still later, they forced an oxygen mask on me, without informing me why they wanted me on oxygen.
These actions — not telling me what medical risks and benefits existed — scared me. They activated my sense of fight-or-flight, where I got angry in the moment because of the poor treatment, and would have considered changing providers, but I was trapped and vulnerable because I was in labor — I ended up needing to freeze into place, and became a compliant patient. Out of control, and compliant as a survival mechanism. This is a crucial step in the creation of birth trauma, when women feel forced, through fear or lack of autonomy, to simply comply with commands and to allow anything the doctors and nurses want.
Doctors, midwives, dietitians, etc. are service providers, not dictators with absolute power. They do speak with authority, because they have a lot of education, and they’re also charged with providing you the best care. I am not saying that you should not listen to your doctors. I am saying that If you have the ability to choose your provider (and women who live in rural areas and have medicaid do not necessarily have that choice), you should choose a provider on the ability to trust them to do their job in a way that is respectful to you, and protects your autonomy.
3. Genuinely scary situations can happen during pregnancy and birth.
As a society we focus so much on the narrative of birth as a joyful event that we don’t talk about pregnancy and birth as potentially life threatening. Yes, our bodies are made to birth, and the overwhelming majority of women have low-risk pregnancies — but some women are high risk, and some complications of birth (hemorrhage, infection, cord accident) cannot be foreseen. And because we don’t talk about it as a society, as a community interested in birthing, when it’s experienced by parents in the birth of their children, the prevailing narrative silences them. They sense that did pregnancy and birth “wrong” — a source of shame.
If a woman and her family are lucky, they’re informed of what the complication is as it’s happening and potential choices (or lack of choice) in treatment. If they aren’t informed, their power and potentially their ability to cope is stripped from them. They lose their autonomy. In these instances, perhaps the medical personnel always had things under control, but the family doesn’t usually know that’s the case (unless they work in health care themselves). Either way, bodily danger puts the body into fight or flight mode, potentially leading to trauma. Trauma happens when we’re frozen into simply complying, hoping that by doing so we’ll survive.
Trauma comes in both physical and emotional forms. When genuinely scary things happen, this might include physical trauma — c-sections are very physically traumatic. Vaginal birth with its stretching and pressures and bruising is physically traumatic in its own right. With interventions like forceps, vacuum extraction, and episiotomies the physical trauma of vaginal birth is intensified. The physical trauma I’m talking about here does not necessarily cause the emotional trauma I’m talking about more broadly, but they do go hand-in-hand. Feeling out of control, humiliated, and intensely afraid cause you to emotionally shut down, and try to keep yourself as safe as possible as you ride out what’s happening around you.
4. Women are taught to blame themselves when bad things happen to them.
Here’s a paraphrased sentiment that I’ve heard brokenhearted women speak: “I took a birthing class, and the technique didn’t work for me. When I spoke with the instructor, she said that I must not have practiced enough. I thought I practiced so hard!” Here’s another: “Nothing went according to my birth plan.”
Women write birth plans and take childbirth classes that promise an exact outcome to ease a fear of the unknown, and give a sense of control.
More than that, birth plans and childbirth education classes with promised outcomes create a sense of expectation, or a sense of what the “right” outcome will be. When expectations aren’t met, we begin looking for the reason everything went “wrong” — and the answer is usually ourselves. When we judge ourselves, we end up in a place of defensiveness, vulnerable to attack from the person who is supposed to be our biggest supporter (you know, ourselves).
When my daughter was two, I was telling someone about my birthing experience at an event full of women. She was not a medical professional, but someone very aware of birth and it’s many potential complications. When I told her about how I had preeclampsia, she immediately shut the conversation down by saying, “But preeclampsia is so easy to prevent!” She moved on in her mingling.
This sent me down a spiral of self-doubt and recrimination. What did she mean by that? Was it because I didn’t follow the rules society sets for pregnant women? Did I have too many coffees? Too much sugar? She suggested that I should have had control over an event that was actually completely out of my control: preeclampsia is not easy to prevent, as we don’t actually know all of the disease mechanisms. But I was catapulted into a renewed sense of fight or flight — because I was prompted to (and expected to) blame myself.
5. Women are not supported through difficult parts of their lives, particularly parenting related.
To quote an essay about big questions, “Why is raising children considered an expensive hobby?”
It is impossible to return to work immediately after giving birth. Not only is birth physically demanding, and can include major abdominal surgery, but the baby — the desired result! — requires intense 24 hour care on a cycle of sleep, eat, poop, sleep, eat, poop. Bringing a baby into the world requires emotional and physical healing, as well as a steep learning curve and adjustment.
But, we rarely give women this time. Parents are only entitled to job protection under the Family Medical Leave Act, and employers who are required to provide job protection (and not all are!) don’t have to pay the new parents. How can you afford to take the time off to heal and adjust to your new family constellation when you’re worried if you can pay the bills? Paying the bills is a matter of survival — and when survival is threatened, trauma can follow.
Any time off of work is treated as a vacation, time to visit with new moms and newborn babies, instead of time to bond. Moms are expected to play host. This can be entirely overwhelming for new parents, who have to put on a positive social face (no matter their true emotions) and do what’s expected of them (no matter their desire to focus on baby). This performance of propriety’s sake is trauma too — stuck in a situation without escape. Emotional trauma, where we feel out of control and trapped, can therefore happen AFTER birth, associated and linked to the intense emotional period around birth and the immediate postpartum period.
We can heal from our past traumatic birth injuries.
We fail at protecting pregnant and birthing women because we judge them. We disregard their autonomy and their decisions regarding their medical care. We don’t let them express their true emotions regarding their fear, disappointment, and confusion regarding birth and shame them for feeling that way in the first place. We give them no time off from work or social performance to process privately or regroup. We fail birthing women because we judge them.
But women who have experienced birth trauma don’t have to carry that pain indefinitely, and they don’t have to try to unravel it alone.
If you believe you’ve had a traumatic birthing experience, and you want to know about how to move forward, I invite you to get a free excerpt of my soon-to-be-released eBook, Transforming Birth Trauma. The sample contains two tests to determine if you’ve experienced Trauma, and the most important next step. AND you’ll be among the first to know when the whole book is available for purchase.
Click below to receive The Transforming Birth Trauma Excerpt and start reframing your pain into something positive today.