***Warning, angry midwife speech. Profanity a plenty.
Birth trauma is a big deal. It is estimated that 6-8% of women experience serious psychological harm potentially resulting in PTSD relating to childbirth trauma (1). We are not just talking about a woman a little freaked out by giving birth. We are talking about serious psychological sequele that can be both short and long term (2). Approximately 3% of women are estimated to exhibit symptoms of post traumatic stress disorder relating to birth which often correlates with postnatal depression (2). Feelings of detachment, extreme fear, flash backs, insomnia, nightmares, agitation, hyper vigilance or loss of interest or enjoyment in life are just some of the things these women will face while trying to raise their new child. This psychological harm can be the effect of the physical birth itself or complications with their baby (2). Birth trauma can impact on a mother’s ability to bond with her child, affect familial and social relationships. In fact evidence suggests that birth trauma can be the catalyst for poor attachment and can cause unique intimate partner relationship challenges which have long reaching effects for mother, child and family (3).
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It seems that some health professionals are not as up to date as they should be. Birth trauma is a very real. As a midwife I think that you can understand that from just being there when traumatic events unfold. For god sake WE are traumatised, why wouldn’t the woman be?! Midwives and obstetric doctors (the good ones) recognise this potential and always endeavour to mitigate the potential for further harm through woman centred care and acknowledgement each woman’s experiences. I cared for a woman with known previous birth trauma and was absolutely appalled by the complete dismissal of her previous experience with the words “everyone is stressed in this situation”…. Ah no mate, this is some complex multi layer shit that you clearly have no fucking clue about because IF you did those ridiculous words would not have just leaked out of your mouth that were clearly not connected to a relevantly educated brain!
And yes I am going to go there! You don’t have kids, you don’t have a vagina, have never and will never carry a child in your womb and then literally be prepared to put your life on the line to spare them if you had to. (Ps you don’t need to have a vagina if you have an empathetic bone in your body) YOU have NO IDEA the complex emotions at play when a mother has been faced with trauma around birthing her baby. For women who experience birth trauma it can be so terrifying to face giving birth again regardless of how it happens. Having a baby under intense and traumatic circumstances shares many similarities with rape. Sounds extreme? Stay with me, there is often loss of control, procedures done against your will, often involving your vagina, or cutting open your body, there can be injury, loss of blood, terror, fear of losing your own life or someone you love, shame, failure, defeat. You cannot tell me that one of the most brutal acts against any woman does not share these similarities. It is a massive and growing issue, so why as a health professional caring for pregnant women – don’t you know about this phenomenon? Why won’t you acknowledge her and help her?
You can be a specialist and good at your job but guess what, when I am with woman and caring for her as a midwife – I am a specialist too. I know deeply the cries of a mother in pain both physically and emotionally. I have sat with, held and supported women in times of extreme euphoria and the gutter of sadness. I far from know it all but I am deeply embedded in humanity and can see psychological suffering. You just passed off one of the most horrible experiences of her life like it was nothing more than another day at the office. And now she is here in front of you, shaking with fear and has not stopped crying since she set foot in this place and you wash your hands of your duty of care that extends beyond the physical.
So I have to ask… what the fuck are you doing here? Is it to fill your pockets? Stroke your ego? When another health professional asks you if you can do anything to help this woman to settle her sky high anxiety so she might be able to enjoy the process of meeting her next baby more than the last time – do it. Or if you wont, tell the woman that you understand she must be so scared and that you are there for her too. Acknowledge that she is NOT everyone else in that moment. She is uniquely herself with her story and experiences. I have been in quite a few situations where women have been given medication during a caesarean to help overcome extreme fear. This was no different. And don’t you dare use the excuse that you don’t want it to cross the placenta when I have seen your colleagues do it AND you will be prescribing a cocktail of opioids to this breastfeeding mother that will be going in to her breast milk. It’s a cop out. If that was your wife, your sister, your daughter, your mother – would you watch her suffer? Would you just ignore her crying and shaking? Would you ignore her previous birth and trauma? NO, probably not. This is not a post about advocating for the use of pharmaceutical management of anxiety – far from it. The less we use this kind of stuff obviously the better. BUT I believe there is a time and a place for everything and we are talking largely about benefits far outweighing the risk. And much more importantly my aim is to discuss that absolute cold dismissal of birth trauma here.
It is our job collectively, as a team to listen to each other and to see each woman and her story. To acknowledge and help them in the best way possible with the tools we have which may be medication, words, presence. Whatever, who cares. Just show UP for her!! Stop talking about your insignificant bullshit, trying to change the subject when she is obviously so scared she can barely hear you over the blood rushing in her ears. Be a carer and care or at the very least trust the judgement of someone who does.
We need to talk about this stuff otherwise we are at risk of losing sight of why we are here and who we are here to protect. The last thing I want anything to do with is creating trauma on top of trauma!
Rant complete. I would love to hear your stories about these kind of experiences, how do you handle them?
- Howard, L. M., Molyneaux, E., Dennis, C., Rochat, T., Stein, A., & Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775-88. doi:http://dx.doi.org/10.1016/S0140-6736(14)61276-9
- 2. Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134. doi:http://dx.doi.org/10.1017/S0033291715002706
- Taghizadeh, Z., Irajpour,A. & Arbabi, M. (2013). Mothers Response to Psychological Birth Trauma: A Qualitative Study. Iranian Red Crescent Medical Journal. 14(10). 1-7. DOI:10.5812/ircmj.10572
the moderate midwife 