Overcoming birth trauma

Giving birth is often portrayed to be the most magical thing in the world and, for some women, it is. For others, giving birth can be complex and extremely traumatic, both physically and emotionally. I should know. I pressured myself into two home births. The first was extremely traumatic and the second was magical. I have indeed experienced both ends of the spectrum.

The Birth Trauma Association estimates that one in 25 women experience some form of birth trauma. This amounts to 30,000 women a year, but they suspect the unrecorded figures are much higher. The long-term effects birth trauma can have on millions of new mothers are still largely ignored, underreported or not diagnosed.

Not only can the event be traumatising if the birth does not go according to plan, but expectations can have a lot to do with how traumatised a woman may feel. Lots of information on medicalisation being bad, meaning women have failed if the birth needs intervention.

Furthermore, The British Journal of Midwifery argues that birth trauma is caused not so much by the physiological process but by the quality of the care they receive. PTSD is often misdiagnosed for PND, and mothers should be informed of the difference. Many mothers can feel invalidated by their experience. Institutional denial of women's experience can also be a problem when it comes to post-natal care, and this is reflected in the lack of women speaking out.

So how does birth trauma occur and what are the symptoms?

Psychological effects during the labour:

• powerlessness 
• loss of control 
• frightened
• panic 
• confused
• abandoned
• hopeless
• lonely
• disrespected
• unheard
• disregarded
• disappointment
• feelings of failure
• worthlessness
• pain and physical wounding 

 Symptoms of post-partum post-traumatic stress disorder:

• Intrusive thoughts re-experiencing of the traumatic event.
• Flashbacks and nightmares (often involving blood), symptoms of PTSD.
• Anxiety and panic attacks.
• Psychological sensation of pain (in her uterus).
• Avoiding anything that reminded her of the trauma. This meant refusing to go into hospital and avoiding meeting other women with new babies.
• Feeling hyper-vigilant, to the point of OCD. Constantly worrying that something terrible is going to happen to the baby.
• Loss of confidence (stop going out of the house).
• Sense of constant fear, shame, guilt, and failure and feelings of not being a "good enough" mother.
• Feeling low and unhappy, which leads to post-natal depression (PND).
• Problems bonding with their newborn, and developing either an anxious attachment or an avoidant one.

What is the path to recovery?

Every mother will respond differently and, with trauma, you must be very careful not to re-trigger the past event back to the present time. As a therapist, you need to explore what will suit each individual the best. Below are various therapeutic methods that have helped women overcome their trauma.

Talk therapy 

• Validating the mother's experience.
• Listening to the story without judgment.
• Reframing narrative.
• Compassion and acceptance, by addressing any guilt and shame and working towards the "I am a good enough mother".
• Deconstructing society's norms around birth and the unfair expectations put upon mothers.

Mindfulness

We all know the body and mind and intrinsically linked. Mindfulness helps with grounding, anchoring, and self-regulation techniques to maintain balance in the nervous system.

• Guided meditation and visualisation - This mindful practice works on eliminating fear, tension and self-doubt and transforming to confidence, calm and control EG: visualisations of letting go mentally and physically.
• Controlled breathing - Grounding techniques to keep your body out of the fight-or-flight mode to enable you into a window of tolerance thus enabling the parasympathetic nervous system to regulate on an even keel.
• Positive affirmations - The power of positive thinking is very important it helps you to trust, stay calm and open and allows for self-compassion and acceptance.

CBT 

• Trauma-focused CBT begins by exploring the traumatic memory together focusing specifically on the meanings that were made at the time and the parts of the memory that feel particularly emotionally raw (called 'hotspots').
• They will then work together to create new meanings and go through the memory together (called 'reliving').
• In this way, the old traumatic memory is updated with new information that affirms the person's safety and begins to make the memory feel less powerful. 
• TF-CBT may also include exposure, such as taking small steps to visit the hospital in which the trauma occurred. This can be particularly useful when any avoidance symptoms are stopping the person from living their daily life.
• Other CBT models include mindfulness and shame-focused interventions.

EMDR (eye movement desensitisation and reprocessing) 

EMDR is a structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.

The experience is still remembered, but the fight, flight, or freeze response from the original event is resolved. The experience can now be processed and managed enabling functional communication between the amygdala (the alarm signal for stressful events), the hippocampus (which assists with learning, including memories about safety and danger), and the prefrontal cortex (which analyses and controls behaviour and emotion).

Instead of experiencing PTSD whereby the client is frozen in time, constantly experiencing the past trauma in the present. EMDR will 'ground' a mother into the here and now, reminding them that they are safe.

Somatic experiencing (SE)

Based on the work of Dr Peter Levine (2012), somatic experiencing helps to stabilise the mother's nervous system, so that her capacity to be with difficult and painful emotional and physical experiences is expanded. When she meets these parts of herself from a grounded, solid, and resourced place, she has the possibility to re-negotiate energy that is bound up in the body, to release and free up - bringing with it a sense of empowerment, relaxation, and wholeness.

Speaking to a midwife who uses somatic experiencing, she told me that:

"I build a relationship with the mother and gain mutual trust; I get to know her triggers and her tolerance levels. Working very slowly on the edges, so that the mother's system doesn't get overwhelmed, we very gently work to discharge activation and eventually get to the core."

To conclude, birth trauma is debilitating and there needs to be more awareness, less stigmatisation, and more help. When experiencing PTSD, a new mother is thrown into looking after a newborn, trauma can be suppressed. Often new mothers are exhausted, the last thing you want to do is research and fight for referrals. More resources should be given for support. I hope this article shows that new mothers do not have to suffer alone, as therapists we are here to listen, support you and guide you back on the road to recovery.