DEAR DR EVE
I feel like a terrible mother. I recently gave birth to a healthy baby and I know I should be
happy and excited. But I’m not. I planned to have a natural birth, it was really important to
me and ended up having an emergency C Section. I was not prepared for it so everything
about the birthing experience was shocking for me. I am sore, I can’t hold my baby for long
periods of time like I’m supposed to do and breastfeeding is so difficult.
Do you think I have post-natal depression?
Jill

DR EVE REPLIES :
Jill, you reached out !! Thank you !! You did so good not to sit in silence with your confusion
but rather recognize that you are struggling and need assistance.
From get-go I want you to know 2x things :

  1. YOU ARE NOT ALONE in experiencing some form of
    childbirth trauma
  2. There is no need for shame/blame/guilt.

As we begin to unpack CHILDBIRTH TRAUMA, let’s be very clear and differentiate between a
birth that is Big T traumatic as compared to a birth that is a Small T “normal” trauma.
“Little t trauma” refers to events that typically don’t involve violence or disaster, but
do create significant distress.. and as time passes over. Positive Childbirth is one of
these Little T trauma experiences.

You may be curious as to what is a “Positive childbirth”. A research study found
these results: “ Two themes and six sub-themes were identified that described the
meaning of a very positive birth experience. Women related their experience to
internal (e.g., their own ability and strength) and external (e.g., a trustful and
respectful relationship with the midwife) factors. A woman’s sense of trust and
support from the father of the child was also important. The feeling of safety
promoted by a supportive environment was essential for gaining control during birth
and for focusing on techniques that enabled the women to manage labour. “

In other words, Positive childbirth is when you felt present and heard and that you
had personal agency, you felt supported by the birthing team and you had
support from the father.
By its very nature, the beautiful experience of Childbirth is a short sharp Little T
trauma .. no matter how positive, unexpected, or challenging it felt.

‘Capital T’ traumas are overt, extreme, and fit the common conception of trauma.
Natural disasters, diseases, physical, and sexual harm, witnessing death, witnessing
abuse, and experiencing neglect.

So when is childbirth Big T? and did you have Big or Small T trauma?
Childbirth really is a very personal experience. and most of all, however, you define
it, if it feels overwhelming for you, if you feel stuck and unable to shake off certain
feelings, then reach out, as you have done.

BIRTH TRAUMA :

Birth trauma is widespread yet poorly recognized.
Recently there is a growing interest in the potential psychological impact of
childbirth as a traumatic event.
Greenfield et all defines traumatic birth as “the emergence of a baby from its mother
in a way that involves events or care that cause deep distress or psychological
disturbance, which may or may not involve physical injury, but result in
psychological distress of an enduring nature” 

In other words, Jill, even though your baby is healthy, your personal experience of
childbirth has resulted in psychological distress. And this is what matters most: your
own personal experience of your birth. Even a seemingly “normal birth” may be
interpreted by the woman as traumatic. And so her distress can be overlooked and
support that is necessary may not be offered. You can see the great need for
clinician awareness and education!

Welcome to the club of motherhood, a silent club in which 45% of women experience
traumatic birth events … but out of shame, stigma, ignorance, lack of professional
and social support, remain silent and never reach out .. perhaps not even when they
have signs of either post-natal depression or PTSD.

Here is what the literature says about Traumatic Births :
“ Women who are traumatised by childbirth have an increased incidence of
developing a number of psychosocial difficulties in the postpartum period. For
instance, relationship breakdown, difficulty bonding with their baby, parenting stress
and a loss of self-identity. A traumatic birth experience can also leave women with
symptoms such as flashbacks, nightmares, feelings of anger, anxiety and isolation.
In addition, some women report avoiding reminders of their traumatic birth
experiences. This may begin with evading conversations about birth and sometimes
avoiding a future pregnancy”
(entirelyhttps://www.sciencedirect.com/science/article/abs/pii/S1871519220303346)

To break it down, following a traumatic birth women may experience distress with
some mild changes in her mood, whilst others can develop symptoms of PTSD.
Symptoms of PTSD include strong and overwhelming emotions of fear and horror,
intrusive thoughts, flashbacks, sleep disturbances and hypervigilance, with
symptoms lasting longer than several weeks and causing significant impairment in
psychosocial functioning.

Women who have experienced Childhood Sexual Abuse, or early childhood trauma
, are at higher risk of experiencing childbirth as traumatic, even triggering some of
these original traumas. Ideally, these women need to be identified pre-delivery by
their health care providers and given the needed childbirth support to prevent further
trauma.

In summary, provocatively I think that childbirth is unique, and unpredictable on many
levels. I mean who ticks off their entire Childbirth wish list ??! For example who has
their baby on the exact given date, or has the natural birth for which they spend
months preparing only to end up needing a C Section?

In conclusion, the trauma is trying to “normalise” what cannot be normalised.. You
can be guided but be prepared for your own unique experience. Not meeting
expectations that are supposedly normal can leave the woman feeling
shame/guilt/blame.

That is trauma…
By labelling this as BIRTH TRAUMA, she may see the baby as THE TRAUMA
leading to detachment from the baby.

And that would be tragic!