The Breakdown
What causes birth trauma? The answer may surprise you
Recently, I met a woman who had a terrifying birth experience. She hemorrhaged so badly after delivering her daughter that she could hear the nurses shouting, “Do you have a living will?” Sounds traumatizing, right? But it wasn’t for her.
I also had a life-threatening complication after my son was born. But I was traumatized by the experience of being strapped to the operating table while doctors shouted around me, refusing to tell me what was wrong.
That’s the thing about birth trauma: Research shows that it’s not caused by what happens in the delivery room, but how it happens. “Most of this trauma occurs in the patient-doctor relationship,” says Leslie Butterfield, a clinical psychologist and board member at the nonprofit Prevention & Treatment of Traumatic Childbirth. The attending doctors and nurses might think everything went well, “and they would be shocked to find that the woman thought it was traumatizing.”
In 2004, nursing professor Cheryl Beck published a landmark article in Nursing Research defining birth trauma as “an event that occurs during the labor and delivery process involving actual or threatened serious injury or death to the mother or her baby, in which women experience intense feelings of fear, helplessness, loss of control, and horror.”
Such trauma, Beck concluded, “is in the eye of the beholder.” In other words, it happened if the mother thinks it happened, regardless of how her doctor views the incident.
At least 1 in 4 women report a traumatic experience during childbirth. Butterfield says a laboring mother can feel traumatized because someone snapped at her, or because she asked three times, Why are you doing this? and nobody answered. Even if nothing unusual happens during the birth process, she may feel mistreated. “That fuels a sense of having been helpless and taken advantage of,” Butterfield says.
Conversely, another patient may feel disappointed if her birth doesn’t go as planned, but not traumatized, because she felt safe and respected.
Here are the four most common reasons women feel childbirth is traumatic, according to Butterfield:
Not being included in decision-making
Not being informed about what is actually happening.
Feeling the subtle or direct threat that they could be responsible for losing their baby.
Feeling that they’re operating on the physician’s schedule.
Women who experience birth trauma can be haunted by it, reliving painful moments as they struggle to feed and bond with their baby, hold their marriage together, and rebuild their lives. Studies show they are more likely to suffer from postpartum depression and may fear having more children.
Which begs the question: How hard would it be for doctors to treat laboring women respectfully and compassionately, and avoid this altogether?
Thank you, Lisa, for this important piece. There are indeed so many layers to birth trauma. Your distinction between the what and how is very crucial, btw for any kind of trauma. We so fast declare something a trauma as it appears to be objectively bad to us. But if something is traumatic depends indeed on how it is experienced. So this goes even beyond how things are done in the birthing suite to how a woman comes to relate to them during and after the ordeal. Which frankly also holds the hope for healing, as healing could be described as finding a new way to relate to my birthing story and experience which has been traumatic. So the how is twofold I suppose, it first depends on the environment we offer mothers pre and post delivery but also the expectations (and previous experiences) a mother carries (there are some yoga-goddess birth philosophies out there which create quite unrealistic expectations, too 😎) .
Btw the how is also crucial for existential approaches to therapy. We say it is not only what happened but how it happened and even more so how some one comes to relate to it in one’s life story. Viktor Frankl famously wrote about it when reflecting on the horrendous concentration camp experiences and why they had different effects on different people.
Surely, there in no question about it that we need to create birthing environments where woman do not feel threatened or scared or helpless but safe and involved and cared for during their most vulnerable moments.
Again, thank you for your inspiration and call to action here 🙏
This.
I had a traumatic birth — my daughter’s heart stopped during labour & I went from a very peaceful, natural labouring period straight into a crash C-section to try to save her life. Holding my stillborn daughter, after waking on heavy anesthetic just a few hours after I’d been admitted to hospital with her alive in my womb, with no prior warning or awareness that this could happen…that was traumatic. There was no avoiding that.
Where my care providers could have altered the trajectory or magnitude of my trauma was in how informed I was on what was happening (understandably, it was an emergency and they had to move as fast as they could). But no one explained what was happening after her heart rate was confirmed 0 on the ultrasound. No one looked me in the eye when they said we needed to go downstairs. No one spoke to me in the elevator down to the OR. I continued having contractions, unable to speak, as my body was stripped bare on the table and iodine was sloshed across my belly. I didn’t know where my partner was. I didn’t know if I would die, too.
And then there were the layers of trauma that came after. Again, mainly from how I was handled by practitioners — and by all means, I still believe we had good care. I’ve heard horror stories, and ours wasn’t like that. But I was only able to hold my daughter for 2 hours before she was taken from me. I was told we’d been “struck by lightning,” that they didn’t know why Nora died & that we probably never would. That “sometimes this happens.” (Turns out, 1 in 160 birthing people will be “struck by lightning,” but I wasn’t told that, I learned this later on my own). I wasn’t given the opportunity to bathe her, diaper her, dress her…take her outside. I wasn’t made aware that I could ask for these things. And I wasn’t warned about her appearance before I saw her…enough time had passed that her skin had changed drastically. When I got back upstairs to the birthing suite, there was a poster on breastfeeding staring me in the face across from my hospital bed. I had to ask my partner to take it down. I was discharged the next day. The only postpartum care I was offered was a phone call from my midwife a few days after Nora’s birth. I was taken off the roster with my maternal care team. Having not been seen after my surgery, I developed endometritis and ended up back in hospital needing nightly doses of heavy antibiotics to save my womb.
All this to say…even in instances where the worst happens, our providers & the environments we create for birthing people have the ability to change our experiences. What happened to me & my daughter will keep happening. But we can create care models and protocol that ensure that birthing people’s stories are different, less damaging, whether they end in a living baby or not. I’m seeking training as a full-spectrum doula to make this possible for families I work with, but we need systemic, top-down change, too 🤍