How was it for you? Birth trauma…

Bridget Hargreave - 23 Oct 15

I like talking about postnatal depression. I’ll talk about it to anyone who will listen. The interesting thing is that in the six and a half years since PND came into my life, what was once taboo is slowly becoming a much more common topic of conversation. What isn’t talked about to the same extent, or understood so well – yet – is birth trauma. Most of us have heard of Post Traumatic Stress Disorder (PTSD), but not everyone realises that PTSD following childbirth is commonly misdiagnosed as PND.

Birth is natural – yes. But natural doesn’t mean easy. The spectrum of births is as diverse as the children they produce. And with that comes trauma: trauma from a horrendously difficult birth, trauma from a tragic outcome, trauma from mother or baby or both being seriously ill. And – sometimes – trauma for no obvious reason.

Subjectivity is king in the land of trauma. One woman’s easy birth is another’s nightmare. I had two births which, depending on who describes them, were either medically straightforward and unremarkable – or dramatic, seismic and rocked me to the core.

In medical appointments following giving birth, the stock question “was it a normal birth?” made me pause. What the hell is normal in this context? I sought debriefs with the midwives who had been present during both births. But it still didn’t answer all my questions. My first baby got stuck. Actually, the second did too. I have snapshot memories of my first labour. My husband’s face peering over me in theatre, momentarily unfamiliar beneath the disguise of the scrubs. The midwife exclaiming “your baby has black hair!” and me crying out. But why, I asked the midwife, why did he get stuck? Would I need a C-section next time? She couldn’t really answer me (and that’s not to say that she should have been able to) – other than to dismiss any idea of lobbying for a C-section if there was a next time.

Of course, healthcare practitioners (HCPs) are in an impossible situation when it comes to debriefing. Understandably, a midwife might be nervous about liability when it comes to going through a woman’s notes. Ironically, I couldn’t have cared less about whether procedure had been followed. I just wanted to know, basically, was it really awful? Because, to me, it seemed REALLY awful.

Consultant obstetrician Mr Raja Gangopadhyay told me that debriefing serves several purposes, both medical and psychological. But crucially, he cautions “staff should have adequate training, experience and expertise…debriefing could have a negative impact and a woman may feel let down if staff fail to give proper explanations, or give defensive opinions.” And I have friends who certainly feel their debriefs were very disappointing.

Mr Gangopadhyay advocates senior staff handling any labour debrief, but acknowledges that this is “a very neglected area in our ‘modern’ maternity care”. More generally, he comments that “it is sad that psychological wellbeing has little recognition in the care of women during pregnancy, delivery and post delivery…It is women’s perception that matters most and not the judgement of the HCP based on the medical records. Possibly this is the key to success in debriefing.”

Second time around I felt I was trapped in a déjà vu nightmare when the baby got stuck again, and once more my carefully practised techniques to manage the pain unravelled as the agony increased. An eleventh hour epidural didn’t work (nobody believed me until I stood up to prove I could feel my legs). That baby was yanked out with ventouse, after a brusque registrar made his impatience with my inability to push very clear. Despite these details, the midwives were right in a way – the births weren’t medically traumatic. We all got out ok.

Like Raja Gangopadhyay, Dr Rebecca Moore, perinatal psychiatrist at Mile End Hospital in London, thinks perception is key. She described to me, with great sympathy, a patient’s birth experience, which she said was “subjectively traumatic”. She said that trauma is about the perceived experience. This was a complete revelation to me. I could almost hear the click as it dawned on me that trauma doesn’t always arise from obvious places. There is a scenario, one which sadly health care professionals and our friends and family may not always be sympathetic to: sometimes, for whatever reason, a birth which looked fine on paper leaves its mark too. A counsellor I once spoke to said it could be something as apparently tiny as a negative remark – made at a critical time. I had many of those. The phrase “you can’t afford to cry”, tutted at me by a midwife during one of my first interminable nights on the postnatal ward stands out. Not “are you ok?” Not “how can I help?” Not even simply “Why are you crying?”

People of my mother’s generation might scoff at this. But it certainly spelled out to me that the detail of those enormous things Facebook calls “life events” is sometimes just as significant as the big moments themselves.

I don’t know if I had PTSD. But something I found useful, and others might too if you want to discuss birth trauma in an environment where nobody is wearing judgy pants, is the very receptive and supportive #BirthTraumaChat on Twitter.

Bridget Hargreave

Bridget Hargreave is a counsellor, writer and communications consultant based in London. Her first book "Fine (Not Fine): Perspectives and Experiences of Postnatal Depression" was published by Free Association Books in November 2015.

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