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Childbirth as Traumatic as War?

Can childbirth for women be as stressful as war? According to the National Post, the answer is yes. 1 in 13 women in America experience Post Traumatic Stress Disorder after childbirth.

In her Pathways to Family Wellness article, Jessica Austin examines the source of birth trauma in women stemming from:

  1. Unnecessary medical interventions and
  2. The feeling of being mistreated by care providers.

According to a prominent birth trauma expert and research psychologist at the University of British Columbia, Dr. Kalina Christoff, these are two of the biggest reasons women experience childbirth-related-PTSD.

Austin discusses a misconception about childbirth PTSD which claims that it mostly occurs in women with “traumatic histories.” But according to the DSM-IV manual for psychiatric illnesses, “The severity, duration, and proximity of an individual’s exposure to the traumatic event are the most important factors affecting the likelihood of developing PTSD.” In the words of Dr. Christoff, “Even the healthiest individual can be traumatized by a sufficiently strong traumatic event.”

There’s another cultural misconception highlighted by Austin which says that birth is inherently unpredictable and frightening, and therefore inherently traumatic. While emergencies are a part of life, the question Austin raises is: why are so many sudden “emergencies” occurring, enough to make birth as traumatic for women as war is for soldiers? Or, to put it another way, “Why aren’t women having normal births?”

Unnecessary Medical Interventions.

Rather than blaming birth as fundamentally dangerous or blaming women’s prior history or abilities, perhaps the spotlight should be on institutional practices that fail to honor and respect women’s normal physiological function. In the U.S. and around the world, practitioners tend to administer far too many interventions and monitoring devices. Outcome-based measurements and comparative studies are leading researchers and parents to the conclusion that it is these interventions themselves which are leading to negative birth outcomes, including traumatic emergency situations.

In an all-out attempt to enact full control over the dynamic and incredibly complex process of birth, hospitals and practitioners have thrown caution of their own interventions to the wind. The result is “emergency situations” becoming the new normal. Interventions which hasten, halt, augment, or sidestep birth physiology often precipitate the need for further, more intense, interventions. Evidence based studies consistently show that less intervention leads to statistically safer births. There are real risks posed by inductions, epidurals, and continuous electronic fetal monitoring, says Austin, which are kept secret or downplayed by birth authorities and institutions.

It’s easy for people to say things like, “a woman suffering childbirth-related PTSD is traumatized because she is prone to anxiety, or has not recovered from her past traumatic history…or was not properly prepared for how unpredictable birth is.” But if birth trauma in women is exogenous, or due to external causes, as Austin, Dr. Christoff, and many other researchers are claiming, then the above lines of thinking are not only shallow and insulting, they are quite useless in helping to improve the situation.

Mistreated by Care Providers.

Despite the potential from escalating interventions and emergency situations, there’s really one issue that exceeds all others as the ultimate cause of birth trauma in women: Lack of informed consent.

Informed consent, or asking for permission and giving relevant evidence-based information to make a choice, is a basic ethical practice in medicine. It should only be overlooked if the patient is unconscious and no one is there on the person’s behalf. Sadly, birth is often treated as an emergency of this caliber right from the start. Informed consent practices are overlooked as if the birthing woman were unconscious, or as if they would “get in the way” of necessary care.  In Austin’s words, “Having medical procedures done without proper informed consent or the opportunity for refusal is commonly what leads to women’s feelings of helplessness, fear, and horror.”

Often, even highly informed parents—educated on the risks and benefits of medical interventions—will recount being bullied and pressured after refusing certain procedures. Following informed consent procedures and ethics can do a lot to help make birth less traumatic.

“Let’s instead look at the responsibility of medical professionals to honor a woman’s right to make an informed choice about her health,” says Austin, “and at the real problems of unnecessary medical interventions.” With informed consent practices brought back into the fold and a critical eye on interventions, normal physiology will have a greater chance to function and perform. When given the time, space, and autonomy to give birth the way nature designed it, safer and overall better outcomes will follow women into early motherhood. A dignified beginning in birth defines the family and can even reshape the culture at large.

Lauren is a childbirth educator (Birth Boot Camp) and the author of the Breech Baby Handbook. She owns Better Birth Graphics, a shop full of practical, intuitive birth media for professionals. Her work has been published in Mothering, Holistic Parenting Magazine, Birth Issues, True Birth, Mama Birth, and elsewhere. She lives in Maryland with her family of five.