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The Real Causes Of Birth Trauma

By Jessica Austin

A study indicates 1 in 13 women experiences PTSD after childbirth. Why are we being told that it’s the mother’s fault?

There has been increasing awareness about childbirth-related post-traumatic stress disorder (PTSD). Several years ago, the National Post in Toronto published an article headlined “Childbirth Can Be as Stressful as War.” This article refers to a study that indicated 1 in 13 women experience PTSD after childbirth. This number is unacceptable, and is why I participate in the Vancouver birth rallies and focus part of my doula practice on supporting women who’ve had previously traumatic births.

This is an important topic to address because it is so widespread, and because there are many misconceptions about it. I want to address two of those misconceptions here.

Creating New Trauma

The first misconception is that childbirth-related PTSD occurs mostly in women with traumatic histories. The study in the Post suggests that women with a history of past trauma, such as childhood sexual abuse, are more likely to have PTSD as a result of childbirth. And it’s true, sexual abuse trauma can be triggered during the birth process. I have seen this happen firsthand as a doula, and have been trained on how to best support women with a history of sexual abuse.

However, there is a difference between childbirth triggering past trauma issues and childbirth creating a new trauma of its own. According to the DSM-IV, the psychiatric manual for classifying mental disorders, it is not true that women develop PTSD because of a history of past trauma or anxiety. It states that “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.”

Dr. Kalina Christoff is a research psychologist and professor at the University of British Columbia. She studies birth trauma extensively, and points out on her birth trauma resource website that “the causes of maternal birth trauma are primarily situational,” just like any other trauma. She also states that “the primary determinant of trauma and PTSD is the severity of the traumatic event, and not the history of prior trauma. Any person, even the strongest, healthiest individual, can be traumatized by a sufficiently strong traumatic event.”

Although women with a history of past trauma may have symptoms of that trauma come up during childbirth, it is important not to confuse this with childbirth itself causing a new traumatic event in a woman’s life, regardless of her history. When childbirth causes a new trauma, it is very often directly related to feeling bullied by care providers, a lack of informed consent, and experiencing unnecessary medical procedures which lead to complications in childbirth.

Traumatic Interventions

The second big misconception is that childbirth-related PTSD happens because birth can be unpredictable and frightening. The National Post article quotes Dr. Gail Robinson, a University of Toronto psychiatry professor, as saying, “Sometimes people go along and they think they’re going to have a normal delivery and all of a sudden there’s a crisis, and they’re rushed into the OR and there’s great fear.” She also says, “There are things that can happen in the birthing process that can make a woman feel like her life or her baby’s life are in jeopardy. She experiences helplessness, fear, horror. That’s enough for an experience to be traumatic.”

I believe the real question is, why aren’t women having normal births? Why are so many sudden “emergencies” occurring that the number of women suffering PTSD from childbirth is comparable to soldiers after a war?

The answer lies not in how dangerous birth is, because in a well-nourished, healthy population, birth is generally quite safe. However, nearly 1 in 3 women are “rushed into the OR” for what seems to be an emergency cesarean birth.

The truth is, unnecessary medical interventions often lead to the dramatic birth situations that ultimately feel traumatic to women. In our attempt to control birth and make it efficient, many women are not informed of the risks of induction, epidurals, and continuous electronic fetal monitoring. Although studies consistently show that less intervention leads to better births, hospital practices often stick with the status quo of heavy monitoring and attempts to control the very complex process of birth.

Not only that, but women who know and understand the risks of medical intervention are often pressured by medical professionals to comply with their recommendations by being told that their lives or the lives of their babies are “in jeopardy.”

I have seen a father ask, “What might happen if we don’t induce today?” and get told, “Your baby might die.” This, instead of the doctor giving appropriate information on the risks and benefits of induction. Yes, your baby always might die. But what are the actual statistics? What are the risks of induction (fetal compromise, uterine rupture, increased risk of cesarean birth) as compared to the risks of not inducing? Why wasn’t this couple offered this information, as required by informed-consent law, in order to make an informed choice about their birth?

According to Dr. Kalina Christoff, two of the biggest reasons women experience childbirth-related-PTSD are unnecessary medical interventions and feeling mistreated by their care providers. These two factors are very often what lead to the traumatic birth crises mentioned in the National Post article.

Informed Consent

Based on the work I do as a doula with women who have had previously traumatic births, informed consent is likely the easiest first step in the solution to lowering rates of childbirth- related PTSD in institutional birth settings. Although I’ve been to some births with great nurses, midwives, and doctors in our hospitals, I’ve also been to births and heard firsthand accounts from my previous-birth-trauma moms where the informed-consent practices were inadequate, to say the least.

Some medical professionals may believe it’s inconsequential to skip over parts of informed-consent practice, or maybe even think it’s a helpful way to get a patient to do what they think is best. But spending a little extra time really following those informed-consent laws can make all the difference to a birthing woman and her experience during childbirth. 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.” Dr. Robinson is right: That is enough to make a birth experience traumatic.

Blaming the Victim

When speaking about birth trauma, people often say things like, “A woman suffering childbirth-related PTSD is traumatized because she is prone to anxiety.” “She is traumatized because she has not recovered from her past traumatic history.” “She is traumatized because she was not properly prepared for how unpredictable birth is, and how quickly it can turn into an emergency situation.” Why is our culture so tempted to blame the mother?

Let’s instead look at the real problems of unnecessary medical interventions that lead to more challenging birth circumstances, and at the responsibility of medical professionals to provide accurate information and honor a woman’s right to make an informed choice about her health without pressure or scare tactics.

If we focus more on encouraging healthy births to progress normally, without interference, we can reduce scary fetal heart rate drops after inductions or epidurals. We can reduce instances of violent forceps deliveries if we stop doing cervical exams at every opportunity to convince a woman her birth isn’t happening on the hospital’s ideal timeline. If we start focusing on the importance of providing women with real information to make decisions on instead of bullying them, even unintentionally, by using threatening statements like “If you don’t consent your baby might die,” then we might get somewhere in reducing these tragic numbers of childbirth-related PTSD.