Birth Trauma | Stork to Cradle Doula
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Birth Trauma

This month’s ‘Shine On Series’ is shining the light on an exceptional woman working within an invaluable field. I’m talking about Catherine Cloutier, a Registered Clinical Counselor who among other specializations, specializes in working with women and their partners through pregnancy, pregnancy loss and birth trauma.

Catherine has a Kamloops based private practice called Sandstone Centre. Her Masters of Counselling combined with her hypnotherapy experience, yoga teacher history and 20 years in the field, allows her to match her approach to her client’s belief systems. She’s equally adept at working with clients who would benefit from a more clinical approach and those who prefer to look at things from a more holistic manner.

We were pleased to have the opportunity to sit down with Catherine and talk about the knowledge she has to share from years of working with clients around an important and under discussed topic; birth trauma.

As a Doula, I have worked with more than a few birthing families who have experienced birth trauma, either with a previous birth or their most recent. It’s a complex issue that is often misunderstood and in my opinion, occurs way more often than anyone would like.

Birth trauma is a specific type of trauma; it’s a traumatic experience that occurred within the labor and birth process. Between 25 and 34 per cent of women report that their births were traumatic (1-7), however according to Catherine “a lot of people sit silently with trauma and it’s not always captured by follow up” so, those numbers may in fact be much higher. Catherine also adds that “the person’s partner can experience birth trauma and may experience it independently, even if the birthing person did not see their own experience as traumatic.”

Catherine goes on to share that the causes of trauma can vary for each person. She explains that “two people could experience the exact same event and interpret and react to them so completely differently. One person may find the experience extremely upsetting and the other person may not. It’s not the event that defines a trauma, it’s the person’s response to it.” This means that birth trauma is not necessarily caused by any specific birth outcome or experience. For example, two birthing women could both have caesarean births after the same number of hours laboring; one may find it traumatic, while the other does not. Additionally, the entire birth support team could have seen a birth as beautiful and perfect in every way and yet unbeknownst to them, the birthing person could have had a very different perception. The point is that the only perception that matters when it comes to identifying birth trauma, is the perception of the person who experienced the event as traumatic.

Some commonly reported causes of birth trauma (1) include: a perceived lack of communication by medical staff, fear of unsafe care, lack of choice regarding routine medical procedures, lack of continuity between care providers, and care being based solely on delivery outcome. Catherine adds that “one of the challenges in childbirth is to expect to be in a safe place with choices and then not feel safe or have choices. Other people present could also contribute to birth trauma by the decisions they make or comments said. It again comes back to the birthing person or partner’s definition of what feels upsetting to them”. It’s important to note that whatever the cause or causes of the traumatic birth, there is no reason for a person with birth trauma to feel ashamed, guilty or at fault, although these feelings can often accompany any trauma. With the proper help and support, a person with birth trauma will eventually be able to explore and process these feelings, but first, they need to be able to recognize the trauma in the first place.

It’s not uncommon for a new parent to not realize that they have had a traumatic birth or recognize how it is affecting their current reality. According to Catherine, the following list of symptoms are associated with unprocessed birth trauma:

  • Intrusive memories and flashbacks
  • Feeling the need to re-tell the story over and over
  • Sleep disturbance/early morning wake ups
  • Excessive worry
  • Unregulated emotions
  • Irritability and angry outbursts
  • Concentration problems
  • Memory problems
  • Withdrawing from others
  • Refusal of help
  • Not getting out of bed
  • Lack of attentiveness

After reading this list of symptoms, it’s easy to see how birth trauma can linger and affect the postpartum and early parenting experience – a time of life that really needs no added challenges. While most parents are adjusting to life with a newborn and swelling with love, those with birth trauma might be pre-occupied with intense feelings of sadness, anger and fear.  Therefore, it’s important to identify and seek help for birth trauma, when ready.

Seeking help for birth trauma can help you process it, move past it and feel better, although it likely won’t become a forgotten experience. Catherine shares that “Trauma is like hot red lava. When it’s unprocessed, it’s hot and red and bubbly. Once it’s been processed, it continues to exist but it turns to dark stone and does not overtake everything else around it.” Some ways to access support to process and move past trauma include; speaking with a qualified Counselor, having a witness and listener who listens deeply and meaningfully (without trying to deny your process or hurry you through it) and journaling. Catherine also suggests accessing your birth records from your caregiver. She explains that “one of the things that can happen during trauma is memory problems. Having another party’s written notes of the events can be helpful”. You can request these notes from your birthing institution or care provider. It is a good idea to request that your care provider process the notes with you, this would provide the opportunity to explain the notes and provide context.  Notes can be interpreted in many ways, the processing of the notes together provides the opportunity for questions and clarifications and avoids potential harmful misunderstandings.

Catherine’s last piece of advice was aimed at reducing the likelihood of experiencing a traumatic birth and setting your relationship up to be able to address it if needed: “Really pay attention to your communication as a couple. Work on creating an open and trusting relationship, if that’s not what your current norm is. Be open to frequent  check ins during the postpartum period and to talking about your birth experience. Also, if you know you have some form of unprocessed trauma moving towards your birthing time, and are ready to process it…. move through it,  rather than avoid it. Do not deny, package up and put away. Emotions, when they’re allowed to flow are beautiful and necessary. Lastly, know that it’s natural to have triggers, memories and feelings.  It’s a perfectly natural thing for these things to come up and there is no room for shame or guilt.”

Another way you may help reduce your likelihood of a traumatic experience is by preparing for birth in some way; physically, mentally and emotionally (reading about birth, discussing your birth, taking prenatal education classes, hiring a Doula, etc…)  As we have addressed, trauma is an individualized experience and as we can’t tell the future, it’s impossible to predict your experience. We also don’t have a magic formula for avoiding birth trauma. However, learning about childbirth and paying consideration to your own upcoming experience, may help reduce the likelihood of those commonly reported causes of birth trauma previously mentioned. Some topics you may chose to explore include (but are not limited to): what to expect in your birthing environment, normal expectations of childbirth, coping with special circumstances, fear and it’s effect on the birth experience, your available choices, your rights in childbirth, communicating your choices and preferences with your birth support team and labor support options.

If you’d like to learn more about birth trauma, please visit our Resources Page. Of course, if you’re looking for a local and experienced resource, contact Catherine at the Sandstone Centre to book an appointment.

Do you have resources to share for birth trauma or a topic to add to our birth preparation suggestions? Let us know in the comments!

References

  1. Beck CT, Indman P. 2005. The many faces of postpartum depression. J Obstet Gynecol Neonatal Nurs 34(5):569-76
  2. Cigoli V, Gilli G, Saita E. 2006. Relational factors in psychopathological responses to childbirth. J Psychosom Obstet Gynaecol 27(2):91-7.
  3. Czarnocka J, Slade P. 2000. Br J Clin Psychol 39 (Pt 1):35-51.Prevalence and predictors of post-traumatic stress symptoms following childbirth.
  4. Declercq E, Sakala C, Corry M, Applebaum S. 2008. New Mothers Speak Out: National Survey Results Highlight Women’s Postoartum Experiences. Childbirth Connection: New York
  5. Gross MM, Hecker H, Keirse MJ. 2005. An evaluation of pain and “fitness” during labor and its acceptability to women. Birth 32(2):122-8.
  6. Soet JE, Brack GA, DiIorio C. 2003.Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 30(1):36-46.
  7. Szalay S, 2011. Post-Traumatic Stress Disorder after Childbirth in an Out-of-Hospital Birth Population. Presentation at Annual Conference of Midwives Association of Washington State, Seattle, Washington (unpublished).
  8. Nicholls K, Ayers S. 2007. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol. 12(Pt 4):491-509.
  9. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: APA.
  10. Ayers S. 2007. Thoughts and emotions during traumatic birth: a qualitative study. Birth 34(3):253-63.
  11. Beck C. 2004. Post-traumatic stress disorder due to childbirth: the aftermath. Nursing Research 53(4): 216-24.
  12. Elmir R, Schmied V, Wilkes L, Jackson D. 2010. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing 66(10): 2142-53.
  13. Stramrood C,Huis C, Van Pampus M, Leonard W, et al. 2010.  Measuring posttraumatic stress following childbirth: a critical evaluation of instruments. Journal of Psychosomatics in Obstetrics and Gynecology 31(1): 40-49.
  14. Goer H. 2010. Cruelty in maternity wards: Fifty years later. Journal of Perinatal Education 19(3): 33-42.
  15. Johnston-Robledo I, Barnack J. 2004. Psychological issues in Childbirth. Women & Therapy 27(3-4):133-150.
  16. Simkin P. 2011. Pain, suffering and trauma in labor and prevention of subsequent posttraumatic stress disorder. Journal of Perinatal Education 20 (3): 166-176.
  17. Breslau N, Lucia V, Davis G. 2004. Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychological Medicine 34(7): 1205-1214.
  18. Creedy DK, Horsfall J, Gamble J. 2002. Developing critical appraisal skills using a review of the evidence for postpartum debriefing. Aust J Midwifery 15(4):3-9.
  19. Gamble JA, Creedy DK, Webster J, Moyle W. 2002. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 8(1):72-9.
  20. Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P. 2005. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Birth. 32(1):11-19.
  21. Skibniewski-Woods D. 2011. A review of postnatal debriefing of mothers following traumatic birth. Community Practice 84(12): 29-32.
  22. Rothschild B. 2010. 8 Keys to Safe Trauma Recovery: Take Charge Strategies for Reclaiming Your Life. W.W. Norton & Co. Inc.: New York.
  23. Cori JL. 2007. Healing from Trauma: A Survivor’s Guide to Understanding Your Symptoms and Reclaiming Your Life. Marlowe & Company: Cambridge, MA
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  25. PATTCh (Prevention and Treatment of Traumatic Birth). 2012. PATTCh Resource Guide on PTSD After Childbirth. Available at PATTCh.org.
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