Meet Mandy.  She is mother of a four-month old baby whose entry into the world was dramatic.  After nineteen hours of labour in hospital her baby’s heart rate dropped causing serious concern.  Mandy was rushed to theatre for a Caesarean section and her little boy needed resuscitation at birth.

Mandy now struggles with anxiety, panic attacks and wakes from sleep with fear coursing through her body most nights.  She often has flashbacks to the moment of her baby’s birth and constantly checks her little one as he sleeps.  She avoids driving past the hospital where her baby was born.

Susie was a vivacious, life-of-the-party kind of person before becoming a mother. She engaged in a lot of self-education to prepare for her baby’s birth and was completely set on having a natural birth with no medical intervention.  Susie had a sixteen-hour labour in hospital and gave birth to a healthy baby daughter with minimal intervention.  During labour there were two shifts of obstetric staff on a busy night in the birthing suite. She was mostly left to labour on her own with her partner supporting her. The midwives and doctors would rush in and out, at times failing to speak with her directly or meet her basic requests for extra pillows or filling the bath. Susie felt like she was on a birth conveyor belt and labouring on borrowed time.

Susie’s birth experience has left her feeling not-quite-right though she can’t put her finger on why. Eleven months on she continues to feel flat and just not like her old self.  She describes herself going through the motions of mothering her baby as if she were sleep walking. She feels disconnected from her baby, her partner, and even her own body. She stopped breastfeeding her baby at two months.

Brigitte is a new mother who shared frankly with her obstetric team that she had been sexually abused as a teenager.  She was fearful of the impact this may have on birthing her baby and hired a doula to support her through the birth of her first baby.  He is now seven months old and his birth unfolded naturally even despite Brigitte feeling panic-stricken many times in labour.

Breastfeeding lasted for three weeks and Brigitte now swings between being highly anxious to feelings of inertia and physical and emotional numbness.

 

Defining Trauma

What the three mothers have in common is their symptoms of trauma.

From the outside looking in, they’ve all ended up with healthy babies though the first of the mothers clearly had a birth experience which would predictably lead to a level of trauma.  But what of the others?

Trauma is classically defined under a psychiatric framework as a mental health disorder. However, if we broaden our definition of trauma as being a normal physiological response to a situation arising outside of our ability to cope, then any situation that places an individual’s nervous system on high alert has the potential to precipitate trauma.

The diagnosis of trauma is often elusive given that the symptoms of trauma, post-natal anxiety and post-natal depression overlap significantly with one another. The criteria for Post-Traumatic Stress Disorder at the more severe end of the spectrum are even more stringent when assessed within a mental health framework, the DSM-5.  In reality the experience of trauma is highly subjective and lies on a full continuum.  What may trigger symptoms of trauma in one person may be an experience that the next person completely breezes through. Many symptoms can persist well beyond six months which is often used as a reference point in diagnosis.  So how does one categorise and support the mothers in the cases above?

In all of the cases described, the symptoms point to a nervous system that is stuck at some point in the defensive survival response and has the high energy sympathetic charge (“flight” and “fight”), the more primitive and energy-conserving parasympathetic response (“freeze”), or swinging between the two extremes. The mothers’ symptoms point to a fixed way of responding and a lack of flow and resilience within their nervous systems.

The physiological mechanism of how trauma develops especially in the sensitive zone of birth will be discussed in a later post.  But it is enough to know here that trauma will at times be triggered by a specific event, and at other times it is cumulative throughout a person’s life and experienced as “trauma by a thousand cuts.”  Unresolved past traumas will often be amplified by new overwhelming experiences. It has been found that our body memories for these events are accurately even if our conscious memories may fade, become distorted or are non-existant.

 

Prevalence

Australian research suggests that birth trauma rates are at 34% or one in every three mothers who give birth. The rate of PTSD at the more severe end of the trauma spectrum for women in relation to birth is quoted at 5.6%. A study being currently conducted in Victoria is pointing to figures that are closer to an alarming 50%. This in itself may represent the tip of the iceberg given that trauma is often insidious and there is a lack of awareness of its symptoms. Self-reporting rates in mothers are also likely to be below true levels due to a focus on getting on with the job of mothering, self-judgement, shame and guilt which often go hand in hand with trauma.

 

Symptoms

The symptoms of birth and other traumas are many and varied, including some that are not normally associated with trauma. They can also be difficult to detect and go under the radar as normal for a mother in the post-natal period.

Physical symptoms of trauma in general may include:

  • hypervigilance or being constantly braced for threat
  • anxiety
  • panic attacks
  • flashbacks
  • insomnia / nightmares / night terror
  • dissociation / numbness or a sense of being disconnected from one’s body and/ or feelings
  • depression
  • changes in memory, attention and other cognitive abilities
  • chronic fatigue
  • chronic or unusual pain patterns
  • addictions of any kind
  • sexual dysfunction
  • auto-immune disorders
  • gastro-intestinal disorders

Behavioural patterns can also emerge that impact on interpersonal relating such as:

  • avoidance of thoughts, feelings, people, places and details associated with the event
  • feeling detached from others
  • irritability, hyper-reactivity or angry outbursts
  • shame
  • guilt
  • helplessness
  • over-riding personal limits or boundaries
  • reduced ability to detect danger

 

 Predisposing Factors  

There are certain known conditions in a mother’s history that make it more likely for her to experience a traumatic birth. These include:

  • previous unresolved trauma of any kind including her own birth, childhood attachment trauma, physical, emotional or sexual abuse
  • previous stillbirth or miscarriage
  • history of anxiety and/ or depression
  • lacking a support network of family or friends
  • substance abuse
  • poverty

 

Precipitating Factors

The factors within birth environments that are likely to trigger a protective survival response which may lead to trauma include:

  • life-threatening situations for mother or baby
  • instrumental birth such as a Caesarean section or forceps
  • inadequate pain relief when requested
  • prolonged and intense feelings of physical and /or psychological overwhelm in labour and birth
  • lack of knowledge and understanding of the process of birth
  • lack of psycho-emotional support in the birth place
  • being stripped of dignity, respect, choice and decision-making in the birth place

 

Surgery and anaesthesia can by themselves be fertile grounds for feelings of disembodiment, distress and overwhelm and thereby lead to trauma, especially in the delicate territory of birth.

Sanctuary trauma is a term referred to trauma that is precipitated in a place such as a hospital where a person would expect attuned care and healing as opposed to wounding.

 

A lack of support for mothers in the early months of their babies’ lives and the stigma that remains attached to not feeling okay or managing as a new mother add to the likelihood of distressing experiences becoming entrenched trauma responses. Minimising the potential for this to occur will be the subject of another post.

 

There are many approaches to healing trauma from talk therapies to more body-centred therapies.  It is important that those with symptoms engage a qualified trauma therapist for support so as to not become re-traumatised and have the underlying basis of their trauma reinforced.

My preferred way of supporting mothers through birth trauma is via a combination of counselling and Somatic Experiencing®, a  specialised approach to healing trauma which addresses it at its source in the nervous system.

I offer 1:1 personal or Skype sessions from my suburban sanctuary in Melbourne.

Call 0402 039 341 for a free 20-minute discovery session or refer to the Frequently Asked Questions about trauma on this website.

 

Resources

American Psychiatric Association (2013)  Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (R))

Alcorn KL et al. (2010) A prospective longitudnal study on the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine; 50: 1849-1859

Boorman, R et al. (2014). Childbirth and criteria for traumatic events. Midwifery. 30, 255-261

Buckley, Sarah J (2014) The Hormonal Physiology of Childbearing Report

Fernandez, O (2013) PTSD and obstetric violence. Midwifery Today. 48(3), 105-109

Levine, Peter A  (2008)  Healing Trauma: A Pioneering Program For Restoring The Wisdom Of Your Body

Levine, Peter A  (1997)  In An Unspoken Voice: How The Body Releases Trauma And Restores Goodness

Levine, Peter A (2008)  Healing Trauma

Levine, Peter A (1997) Waking The Tiger

Levine, Peter A (2010) In An Unspoken Voice

PATTCh (Prevention and Treatment of Traumatic Birth). 2012. PATTCh Resource Guide on PTSD After Childbirth. Available at PATTCh.org.

Porges, Stephen W (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication & Self-regulation

van der Kolk, Bessel  (2014)  The Body Keeps The Score: Brain, Mind and Body  in the Healing of Trauma

Yates, A.  2017 Women’s experiences of emotionally and psychologically traumatic birth; hegemony and authoritarianism in Victorian public maternity settings. Masters by Research, Health and Biomedical Sciences, RMIT University.

 

PATTCh (Prevention And Treatment of Traumatic Childbirth)

HELD (The Austn Birth Trauma & PTSD Treatment Centre)

PANDA (Perinatal Anxiety & Depression Australia)

Birthtalk

 

 

Nisha Gill is the founder of Feminine Instincts ~ Melbourne Wellbeing & Birth Services.

She works holistically in the fields of childbirth education, bodywork, counselling, Somatic Experiencing® (body-centered trauma therapy), pre- & post-natal yoga, and supporting women in birth as a doula.

 

 

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