It took me until my son was eighteen months old to work up the courage to reach out to the midwives who delivered my son. I harbored a lot of anger towards the way my labor was managed, the result of my trauma and the near loss of my life and my sons. I knew I needed to follow up with them at some point, but it just never felt like the right time, until it was…
The reason I waited eighteen months was because I needed to find purpose in follow up besides a debrief. I didn’t want to go and just spew anger or blame. What good would that have done in the long run?
I thought a lot about the people I have met and spoken to since this experience, and the problem is real. An article I wrote about ways you are perpetuating birth trauma was shared on social media over six thousand times, which isn’t a pat on the back to me but rather an intense illustration of an unmet need. Women are feeling traumatized by their childbirths and they aren’t getting help.
A lot of natural birth proponents will point to interventions being the cause of birth trauma, and while they certainly can be, it’s a far more deep-rooted issue than that. My birth trauma and PTSD stemmed from a birth where providers took a more natural approach to birth (which was costly) and the interventions saved my life. For some women, previous sexual abuse can make the invasiveness of childbirth a triggering experience with a ripple effect. Many women feel traumatized by the pain or for unexpected medical complications like hemorrhaging and pre-eclampsia. Births with complications that end in child loss or a NICU stay, premature labor or having a complete sense of loss of control are all factors that can play into the why and how of women suffering birth trauma. And that is just the tip of the iceberg.
What I found is that birth trauma often leads to Postpartum Depression and Post-Traumatic Stress Disorder, the second of which is often misunderstood and overlooked. Thankfully, women are starting to get access to better care for Postpartum depression as it is better researched (although we have a long way to go) but women are falling through the cracks with postnatal PTSD.
So what does this look like? Well, it’s different for everybody, but like PTSD from other traumatic events, there can be disassociation, flashbacks, hypervigilance, and nightmares, just to name a few.
When I mailed a letter to the midwife group who delivered my son, I offered up some ideas, and much to my surprise they actually asked to meet with me. We sat down in a coffee shop a few days later, only a couple of blocks from the hospital I last saw them in. When asked what I recommended, I didn’t focus so much on my individual experience but instead of macro level change. Here is what I proposed to help both prevent and respond to birth trauma:
Listen to women.
We know our bodies. Sometimes something can feel off to us much before fetal monitoring or vital signs or other monitoring devices do. Long before machines showed my son in fetal distress, I felt an overwhelming feeling of pain and pressure along my previous cesarean scar. It was largely written off as normal labor symptoms when in reality it was the start of my uterine rupture. So much of why women feel traumatized from their childbirth is because they felt an utter lack of control in a situation where people wouldn’t listen to them when they were advocating for themselves.
Have mental health professionals employed by or partnered with obstetric practices.
It was a reasonable ask of the midwifery group I delivered with; they were affiliated with a sister OBGYN practice that was part of a large hospital, so it seemed more feasible to share the resources. In other areas of medicine, it goes without saying that there are social workers or other mental health professionals employed alongside the providers because of the need for support for patients. In fact, when I take my son to his developmental pediatrician I always meet with a social worker as part of the appointments because they recognize that raising children with higher needs sometimes brings on an emotional toll and additional stress and worry. So why wouldn’t we have people with mental health expertise partnered with a type of women’s health that is so intimate, anxiety-inducing and often traumatic?
More frequent postnatal visits for those that are high risk.
The way it’s currently structured shows how baby-centric our philosophies are. First, you get seen constantly in the third trimester, mostly to monitor your baby. Then you go through childbirth, become responsible for a tiny human, have major physical and psychological change, and the system is all “see you in six weeks and then for your annual!” I’m sorry, but WTF? I had a near-death experience in my birth but was still given the same routine and my mental health concerns were caught by my primary care physician. And how? At my son’s appointment, because we see a family care physician. If I hadn’t had a family care physician, and I wasn’t bringing my child in every couple of weeks for growth checkups, I would have been off of everyone’s radar. That is telling. Women who are at higher risk for postpartum mental health issues, with certain qualifiers being things like traumatic birth, emergency cesarean, NICU baby, premature delivery, preeclampsia, sexual abuse survivors and history of mental health issues should all be seen a few weeks out, three months out, six months out and as needed from there. With the mental health professionals in office as identified in bullet #2, this process would go smoother and the referral process out easier.
A more effective depression, anxiety, and PTSD screening tool.
Right now there are several variations of a depression screen you likely are familiar with if you’ve have had a baby and had a postpartum visit. It goes something like this “Do you want to harm yourself? Do you want to harm your baby? Do you feel helpless? Do you feel this way never, some of the days, more than half the days, almost always” I can say if you are suffering from depression, it’s a pretty abrasive questionnaire and you’re not likely to be very forthcoming with it. If you are suffering from trauma or anxiety, it’s likely not to capture that at all. I’m glad a tool at least exists, but it can definitely be better!
Validate a woman’s trauma.
I often felt in my postnatal care that people were so afraid of litigation that they wouldn’t have a conversation with me. I have spoken to many other people who have experienced traumatic births who have felt this same demeanor toward them. I am so happy that the midwifery group I delivered with agreed to meet with me, but it’s important that those working in obstetrics really do take the time to talk out difficult births with women from day one, so they can feel heard and validated and start to begin their healing process.
I know not all of these options could be done overnight and on a large scale right away, but part of carrying out solutions is first identifying those and then working towards the steps to get there. Women are suffering in silence when they don’t need to be, and as a society, we owe them resources, understanding, and support.