Making Peace with Your Birth Experience
By Kathleen Kendall-Tackett, PhD, IBCLC
From: New Beginnings, Vol. 29 No. 5-6, 2009, pp. 50-55
Angela dreamed of an unmedicated birth. She was managing her labor well when suddenly the umbilical cord prolapsed. Her dream birth ended in an emergency cesarean under general anesthesia. Both mother and baby are fine, and Angela is grateful that she has a healthy baby. She feels deeply sad, however, that she wasn't awake to see her baby's entry into the world.
Sheila planned a home birth with her family all around her. Her labor was progressing well until her midwife could not detect a fetal heartbeat. Sheila was rushed to the hospital in an ambulance, and delivered a healthy baby boy. She was able to deliver vaginally, but the fear that surrounded her delivery still lingers. She keeps replaying the events over and over in her mind.
Monique was in labor for 23 hours. When things weren't progressing, her labor was augmented with pitocin with no anesthesia. She was confined to her bed during her labor and in a lot of pain. When her labor still hadn't progressed, her doctor decided to deliver the baby by a cesarean. In talking about her birth later, she expressed her anger that no one helped her deal with the pain, and her frustration that it seemed as though everyone else made all the decisions for her.
Every woman's experience of birth is unique. After giving birth, many women share a sense of disappointment, anger, or fear. This may have happened to you. Despite your best efforts, your birth may not have turned out the way you planned. You may have been frightened. You may be angry. You may think about your birth experience a lot. Fortunately, if you have had a troubling birth, there are some positive steps you can take to identify your feelings, learn from the past, and accept the outcome.
What Makes a Birth Experience Difficult?
Some births seem miserable to outside observers, and yet mothers feel positively about their experiences. Other mothers are deeply troubled after birth even though the objective aspects of their birth experiences seem fine, or even great, to others. What makes the difference?
Births may be defined as "good" or "bad" in terms of objective characteristics such as the length of labor, use of pain medications, medical interventions, or the type of delivery. There is an assumption underlying much of the research on birth experiences that vaginal deliveries are usually positive, which is certainly not always the case, and that cesareans are usually negative (also not always the case). In addition, different people have different ideas about how long labor should last, or whether anesthesia in labor is desirable. The facts of a case may not give a clear indication of an individual woman's reaction.
When considering women's reactions to their births, I have found it more useful to consider women's subjective experiences. Did they feel safe? Did they feel supported and cared for? Did they feel in control? Were they convinced that they were going to die? These aspects of birth are much more likely to predict if a woman is going to perceive her birth negatively than length of labor, birth interventions, or type of delivery.
Psychologist Charles Figley describes the subjective aspects of traumatic experiences in his classic book Trauma and Its Wake. In looking at the whole range of potentially traumatic events, he suggests that an experience will be troubling to the extent that it seems sudden, overwhelming, or dangerous. Let's examine these characteristics in relation to birth.
- Sudden: Did things happen quickly? Did things change from "fine" to dangerous in a short time? Did anyone explain what was happening to you?
- Overwhelming: Did you feel swept away by the hospital routine? Were you physically restrained? Did you feel disconnected from what was happening? Did you have a general anesthetic?
- Dangerous: Was your delivery a medical emergency? Did you develop a life-threatening complication? Was your baby in danger? Did you believe you or your baby might die?
These three characteristics may be present for either vaginal or cesarean deliveries. When you are trying to understand your reactions after the birth, the objective aspects of your birth are less important than your feelings about those aspects.
Not surprisingly, your birth experience can impact your relationships with others. You might be angry or disappointed that people who were there to support you weren't able to protect you, particularly your partner. Like you, your partner may have felt powerless and swept away by the experience. Partners might feel guilty because they couldn't protect you, and react to their bad feelings by being angry with you. If they had heard stories of births that went more smoothly, they might worry that you did something "wrong." Or they may not be upset about the birth and wonder why it's bothering you.
When you try to talk about your experience, others may not respond as you expect. Kelly describes the reaction of her friends and family when she continued to be troubled about her birth:
"Once you are past a certain number of months postpartum, people don't want to talk about it any more. It's like you have an ego problem or something. But I need to talk about it. It's been too important an experience for me not to talk about it. It's changed my life."
Not being able to talk about your birth can compound your negative feelings. In the research literature on psychological trauma, this is known as "sanctuary trauma." Sanctuary trauma occurs when a person has experienced a traumatic event and turns to those whom he or she usually counts on for support. Instead of offering the support that the person is expecting, these people either ignore or dismiss the issue, further contributing to a person's sense of isolation and trauma.
Unfortunately, a difficult birth can also influence another important relationship: the one between you and your breastfeeding infant. Over the years, I've worked with several mothers who had breastfeeding difficulties following a traumatic birth. These mothers felt that they had to breastfeed because they had "failed" at birth, but had babies who resisted breastfeeding. (Oftentimes, these babies were traumatized by their experiences too, and care providers may have continuously shoved their heads toward your breasts. Babies react by becoming upset when it's time to feed.) Sometimes, these mothers were able to move out of this destructive downward spiral, and they were able to nurse. Other times, it was too late and breastfeeding didn't work out. When that happened, these women felt worse than ever about their births, and their ability to mother their infants.
A Tale of Two Births: One Woman's Story
Below, I share the second and third birth stories of a woman named Kathy. Each birth was difficult, but for different reasons. The subjective factors I described above are important themes in both stories; there is fear of dying, overwhelming pain, and a feeling of being trapped. Kathy also experienced replaying of events after her births.
"When Peter was born, the birth itself was pain free. He was small, especially his head and shoulders, and it truly didn't hurt at all. I kept insisting I wasn't really in labor up until two minutes before he was born, when the doctor abruptly told me to lie down and push! He was born at 9:30 am, they told us he had Down syndrome at noon, and by 4 pm, I was hemorrhaging so badly that I came within two minutes of death. I had to have an emergency D & C with no anesthesia (talk about pain!) and a blood transfusion.
That night, they told us Peter needed immediate surgery and had to go to a hospital in another city. It was a very traumatic day. They sent me home the next day with no mention at all that I might want to talk to somebody about any of this -- the Down syndrome or the near-death experience. I can still call up those memories with crystal clarity, particularly whenever I hear about another couple who had a similar experience. Interestingly, other people seem to empathize most with the experience of hemorrhaging and having a D & C, not with the Down syndrome. For me, they're all tied up together. Maybe it's good to remind myself every so often of how precious life is.
My third birth was excruciatingly painful. Alex was a bigger baby (nine pounds, three ounces), and his shoulders became stuck in the birth canal. His head was delivered 20 minutes before his shoulders emerged. I had some Stadol in the IV line right before transition, but that's all the pain relief I had. I believed I was going to die, and lost all perspective on the fact that I was having a baby. I just tried to live through each contraction. Of course, I was flat on my back, with my feet up in stirrups, and watching the fetal monitor as I charted each contraction. I think that watching the monitor made it seem even worse than it was. Since then, I've read that positions such as kneeling on my hands and knees or squatting might have eased the delivery of his shoulders.
I could not sleep at all that night because every time I tried to go to sleep, my brain would start re-running the tape of labor, and I would feel the pain and the fright and the fears of dying all over again. I stayed up all that night and the next day, and didn't sleep until I was home in my own bed."
Kathy's birth stories are representative of ways in which a difficult birth experience can continue to affect a mother long after the birth. Her reactions illustrate some classic symptoms of a post-traumatic stress response. Even though Alex's birth involved fewer complications, she still experienced the fear of dying, the reliving of the birth, and the sleeplessness. Kathy did eventually come to a place of peace over her experiences; however, the memories of those two episodes of labor have remained vivid. She told me that having the opportunity to share her stories was therapeutic, and helped her put her experiences in perspective.
Reactions similar to Kathy's can occur any time a complication happens suddenly or unexpectedly during labor and birth. Each woman reacts differently depending on her health history and temperament. If you have had a difficult birth experience, you cannot change that fact. There are, however, a number of positive steps that you can take to help you resolve your experience, and heal from it.
Keep in mind that coming to terms with a negative birth experience is a process that can take months. Don't be discouraged if it doesn't happen overnight. Here are some things that other mothers have found helpful.
Process Your Experience
You may find it helpful to contact support organizations for women who have had experiences like yours. Talking to someone who has shared similar experiences provides validation of your feelings, just as breastfeeding mothers find validation at La Leche League meetings. Sometimes, just talking about your feelings with a good friend can help you sort things out and calm any fears or anxieties.
Talk to other people who were present either during or after your birth. They may provide information about what happened that helps you understand it better. They may just empathize and assure you that they felt afraid or overwhelmed by the situation, too. Even if they were not frightened, their perspective may still help you sort through events.
Your partner may or may not want to talk about your experiences. It's important to be honest with him or her about your feelings and let him/her know what you need. Some couples find outside support together.
If, however, your partner is not willing to work with you to resolve your birth experience, seeking support on your own will still help. Finding a good counselor to talk to helps many people, whether they have other support or not. A good counselor is trained to help others talk about emotionally difficult topics, and it may be easier for you to talk to someone who didn't live through the experience with you.
Another option is to write about your experience. Some women find writing in a journal to be very therapeutic. Others might write letters to the people involved, even though they may not plan on delivering them. In either case, writing gives you a chance to express your feelings without fear of censure. The book, Writing to Heal, by James Pennebaker is a good resource for this.
Learn about It
I always encourage mothers to get copies of their medical records. If possible, talk with your health care provider or someone else who can help you understand the events that occurred during your birth. It is also helpful to read books that might put your birth experience in a broader perspective. This type of reading will do much to validate your experience, and help you understand it. You may still be angry, or you may get angry for the first time, but eventually the experience will not dominate your thoughts.
If you plan to have another baby, the information you gain during this stage may make you a wiser consumer. Knowing what you want in a future birth can help you have a better experience. If complications arise with a subsequent birth, the added knowledge can help you feel more confident about the decisions you must make.
Birth is only the beginning of a life-long relationship with your baby. Motherhood is a role you gradually grow into. A difficult beginning does not need to be the blueprint for the rest of your mothering career. It is important to realize that a negative birth experience can affect your relationship with your baby, but it does not have to. This is why it is vital for you to get the support you need as soon as possible. I have seen mothers who have had difficult births try to make up for it by trying to be a perfect mother -- to everyone's detriment. It is difficult for any mother to be responsive and giving toward an infant or child when she is hurting emotionally.
If breastfeeding came easily to you and your baby, you may find it a healing experience. Mothers express the relief that at least one part of their body seems to work "right." However, if you have trouble with breastfeeding, remember that complications in birth can lead to several factors that may interfere with breastfeeding. Your baby may have had his mouth suctioned vigorously or been offered artificial nipples, which can cause nipple confusion. Anesthesia during labor can interfere with establishing breastfeeding. If you or your baby were ill or required surgery, you may have been separated from each other for long periods. Fortunately, even if you missed those important hours immediately after birth, all is not lost. Spending time with your baby skin-to-skin can help you and your baby get back on track. Breastfeeding specialist, Dr. Tina Smillie, has had babies in her practice start breastfeeding for the first time at 6, 8, or even 12 weeks after birth. Even a partial breastfeeding relationship can be healing for you both.
Some mothers who were unhappy with their birth experiences may quickly become pregnant again in the hope of having a better experience "this time." Every mother needs some time to put her experience into perspective, get to know her new baby, and recover physically. Adding another pregnancy to the equation makes things more complicated, and may even aggravate the fear and anxiety a mother feels.
On the other hand, resist making a hasty decision about not becoming pregnant again. This is not the time to make such a decision, particularly if you or your husband elects to use surgical methods. It's understandable to want to avoid repeating what you've been through, particularly when the experience is fresh in your mind. It's better to give yourself time to heal both emotionally and physically. Then you'll be able to make a deliberate decision about having another baby or avoiding further pregnancies, rather than simply reacting to a negative birth experience.
At first you might balk at this suggestion, thinking "I have nothing to forgive myself about." If you still feel this way after you've thought about it, great! However, I've talked with many women who blame themselves, and feel as though they somehow failed. "If only I had been stronger." "If only I had checked out the doctor and hospital more carefully." "If only I had gone to a different prenatal class." The "if onlys" are endless, and the reality is that you can't control all the circumstances of birth, no matter how much reading and checking you do.
Recognize that you had to make quick decisions, probably without much information about what was happening. You may not feel as though you were allowed to make the decisions. Active labor can blur your sense of reality and time, as can pain medication. You did the best you could under the circumstances and with the knowledge you had at the time. Let yourself off the hook!
Angela, Sheila, and Monique: Their Road to Recovery
For Angela, recovery took a couple of years. Fortunately, she has a great relationship with her doctor and was able to talk through some of her concerns with him. She also appreciated meeting another mother who had also had a cesarean birth while under general anesthesia. Just talking to someone else who had had a similar experience helped her see she was not alone.
Sheila's recovery took about a year. She had a supportive midwife and family members who were present when she was taken away by the ambulance. Talking with them gave her perspective about what had happened, and they empathized with her grief about not having the home birth she had hoped for. Sheila also found that writing about her experience was healing.
For Monique, recovery was actually a very long process because her birth experience brought up some unpleasant memories from her past, and highlighted problems she and her husband had between them. But there were many bright spots along the way. Monique had completely stopped breastfeeding in the hospital because there had been so much to cope with all at once; she was able to relactate several months later and nursed her child for over a year.
If you ever find yourself in a similar situation, remember to take care of yourself. Find support that works for you. Remember that most mothers tell the story of their births over and over to whoever will listen, no matter how they feel about the circumstances. It's a part of new motherhood and helps a mother make sense of how the new baby fits into her drastically changed life. Birth is only the beginning of the rest of your life with your baby.
It's okay to be happy about your healthy baby but sad about your birth. "Unresolved birth memories have a way of gnawing at your insides, affecting your sense of who you are. What happened at your baby's birth can influence your feelings about yourself during the postpartum period and for the rest of your life. Unpleasant memories from past births often resurface to infect subsequent births. It's healthy to confront the fact that you failed to have the birth you wanted rather than pretending it doesn't matter, so you can deal openly with the feelings of loss."
-- Sears, W. and Sears, M. The Birth Book. Boston: Little Brown, 1994.
"Every woman has her own set of ideas and hopes about what her pregnancy and birth experience will be like. To the extent that yours was different from what you expected, you may be more likely to have a postpartum reaction."
-- Dunnewold, A. and Sanford, G. Postpartum Survival Guide. Oakland, CA: New Harbinger Productions, 1994.
Figley, C. Trauma and its Wake: The Study and Treatment of Post-Traumatic Stress Disorder. New York: Bruner/Mazel, 1985.Freedman, L.H. Birth as a Healing Experience. Binghamton, NY: Harrington Park Press, 1999. Madsen, L. Rebounding from Childbirth: Toward Emotional Recovery. Westport, CT: Bergin & Garvey, 1994.
Adapted from an article in New Beginnings, March/April 2002; 44–47.