Counselling psychologist Niamh Delmar shares her insights into how traumatic births can affect women and their partners.
For the majority of women pregnancy, giving birth and early motherhood is a positive experience. However, the perinatal period can have a detrimental impact on others.
According to the HSE Specialist Perinatal Mental Health Services, one in five women experience mental health problems in pregnancy or after birth. Partners and fathers may also be affected.
Another, less talked about, contributing factor is postpartum post-traumatic stress disorder, which is often under reported and misdiagnosed. Symptomatology includes flashbacks, nightmares, avoiding reminders of the traumatic experience, hyper-vigilance, negative cognition, feeling low, panicky and consumed with guilt and self-blame.
Research has uncovered risk factors among women for PTSD following childbirth. Pregnancy complications, prolonged and painful labour, the woman feeling her life was in danger or her baby was at risk, newborns rushed off to neonatal intensive care or perinatal loss are all associated with the onset of symptoms.
Women who have experienced PTSD after childbirth, also report feeling a loss of control, a lack of empathy and communication and a loss of dignity during labour. Some describe feeling violated during the birthing process and may suffer injuries, physical distress or extreme pain with episiotomies, incontinence, weakened pelvic floor, bladder prolapse and other birth injuries. It is hard for some women to talk about such graphic details about the most intimate parts of their body.
Societal assumptions of birth being a joyful and 'natural' experience may influence women’s expectations. Social media stories from mothers often depict ‘happy’ births and mothers feeling content and well. Many celebrity mums portray an image of having had a ‘birthing success’ and appear to be coping well and in top shape physically.
In therapy, women open up to me, feeling they ‘should’ be able to cope and express disappointment with themselves. They describe a sense of ‘failing’ at childbirth and bonding. If there are difficulties breast feeding, these feelings are compounded. This type of maternal pressure can prevent mothers from accessing early intervention.
Birth expectations may be shattered as hopes of a home birth, birthing pool delivery or a vaginal birth are replaced by an ER situation. Another risk factor for postnatal PTSD is having a pre-existing psychiatric condition. Studies also indicate that women who have experienced a previous trauma, such as rape or sexual abuse, are at higher risk of postpartum PTSD.
Trauma opens up all past traumas in the person’s life story. Returning home with a newborn baby is a life changing and overwhelming experience and, combined with extreme sleep deprivation, pain and perhaps limited support, a woman’s resources are drained, leaving her psychologically vulnerable.
The impact on a woman’s lives can’t be underestimated. A study conducted by the University of Sussex found childbirth-related PTSD can have lasting effect on women, their relationships and careers. Avoidance of sex and psychological inability to have another child may feature. Some research also reveals partners developing PTSD symptomatology after witnessing their loved one in emergency situations during labour.
Women who have come to me for therapeutic intervention describe feeling overwhelmed, inadequate and being robbed of the birth and bonding they had yearned for. They describe feeling alone and different to other mothers. In the midst of flowers, baby presents and messages of congratulations, they often are detached as they try to smile the smile expected of them. Many women replay graphic and gruesome birth scenes in their heads.
So how can risk be mitigated? Feedback I have received from women concurs with the research findings. All express the importance of consultation, clear communication, explanations for interventions and being informed every step of the way. Facilitating women with a sense of control can make a significant difference in the outcome.
Empathy and compassion can buffer the traumatic aspect of the difficult delivery. Women need to be listened to and empowered. Wide recognition and validation of birth trauma will help more women to seek help.
Assessing women postpartum who are deemed at risk with tools, such as the PTSD Screening questionnaire, ensures early intervention. Psychological preparation and psycho-education can prepare women if adverse situations or responses arise. Evidence based therapy and medication can reduce long-term fall-out. Partners can also be included in postpartum care.
Women at risk can be screened before giving birth and provided with wrap around support. Maternity care can be improved, training updated and midwifery resourced more. Research shows that increasing positive emotions, control and coping may increase resilience and prevent postpartum PTSD. According to Psychologist Susan Ayers at the Centre for Maternal and Child Health Research at the University of London, it is important to examine both risk and resilience in the understanding of postpartum PTSD.
Support groups, such as the Birth Trauma Association in the UK offer specific support to mothers, while ‘Make Births Better’ advocate for better maternity services. The focus has to be not only on the delivery of a healthy baby, but keeping intact the mental and physical health of the mother.
Positive support and interpersonal connections throughout labour impacts birth outcomes. Society can move further away from the fairytale image of birth and keep a close monitoring of relatives and friends who may be suffering. Communicating messages such as "You must be over the moon" or dismissed with "you have a healthy baby and that’s all that matters" is not helpful.
And expectant mothers need to be educated more on the realities of difficulties at birth, signs of birth PTSD and assured of care, if needed. We need to acknowledge giving birth is not always a ‘natural’ experience and to encourage women not to suffer in silence.
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