When the trauma of a difficult birth leaves mothers devastated, alone
(Photo by Tina Vega via Flickr/Creative Commons)
Joy Dewing had a healthy pregnancy. But during labor, complications abruptly arose. Machines started going off as nurses rushed into the room, moving her body through multiple positions. One nurse held an oxygen mask to her face. “She was saying, ‘Breathe, honey, breathe for the baby,’” Dewing recalled. “And I was like, what is going on?”
Then Dewing saw the doula staring at the fetal heart rate monitor with a look of horror. The doula gestured at one of the nurses who responded, “We know, we’re dealing with it.”
Dewing found out later the umbilical cord had been wrapped around her daughter’s neck, and the nurses were trying to get her to shift positions to release pressure on the cord. “But no one explained what was going on,” Dewing said.
There has been extensive media coverage looking at the health risks faced by mothers before and after they gave birth, as well as the heavy toll of postpartum depression. But less remarked is the emotional trauma and devastation that mothers can face from a difficult labor and delivery.
These kinds of birth-related traumas may be far more common than realized: 18 percent of mothers report experiencing post-traumatic symptoms from childbirth, according to one estimate from the 2008 national Listening to Mothers survey.
Dr. Cheryl Beck, a professor at the University of Connecticut and a nurse-midwife by trade, is among a small group of researchers studying these traumatic births. “Oftentimes, the birth is considered a success by everyone else’s account,” she said. “Great Apgar scores for the baby. The mother had no major complications. And yet, we tend to neglect the mom’s perception.”
Her research has extensively interviewed mothers about their birth experiences. “This led me to believe that birth trauma truly is in the eye of the beholder,” she said.
In Dewing’s case, the doctor did an emergency cesarean section. Her daughter was born healthy. But her flashbacks to that day persisted for more than six months. “I was just beating myself up, going over and over the events of the day,” she said. Seven years later, she still remembers the birth like it was yesterday.
“I was not diagnosed with PTSD, but it’s how I refer to it because that’s what it feels like for me, with the constant reliving of memories, the panic, and intrusive thoughts,” she said.
A diagnosis of post-traumatic stress disorder (PTSD) typically entails exposure to actual or threatened death or serious injury, and many women going through childbirth fear for their own life or that of their unborn child. But those aren’t the only sources of potential trauma during a difficult birth.
“However, for some women, the traumatic event was the lack of communication and empathy from their health care providers, the way they were treated during their labor and delivery,” Beck said. “Women felt that they were stripped of their dignity. As one woman in my study shared, ‘I am amazed that three and a half hours in the labor and delivery room could cause such utter destruction in my life. It truly was like being the victim of a violent crime or rape.’”
A recent study found that in the United States, one in six women reported experiencing one or more types of mistreatment during labor. This number rises significantly for women of color, with 27% of low-income women of color reporting mistreatment, compared with 18% of low-income white women.
After three miscarriages, Dawnelle Delgado Fallas’ fourth pregnancy had been particularly stressful. Her morning sickness struck five times a day. She had to take leave from work starting during her first trimester. At her last checkup, the doctor told her labor was going to be induced.
Her labor spanned four days. Nurses came and went, some telling her she shouldn’t move or else they would have to keep fixing the baby monitors attached to her. She contracted an infection. The doctor recommended an epidural. “When I got the epidural, I felt like my body was burning from the inside out. They told me, ‘No, you’re just having a panic attack and you need to calm down,’ because my blood pressure is up and the baby’s was low.”
After four days, Fallas had endured enough and opted for a C-section. But during the surgery, the anesthesia didn’t work. “I remember telling the doctor how much it hurt, and he said it was just in my head. But I kept telling him and telling him,” she said. Finally, the anesthesiologist did a sensation test. “She told the doctor, ‘She can feel it.’ So they pumped me up with more drugs, but it didn’t kick in until I was getting stitched up, so I didn’t even get to hold my son, and I didn’t produce any milk. I was so doped up.”
Fallas and her son had to stay in the hospital for another week, as he was born with the infection she had contracted in the hospital. “But other than that, Russell was healthy — 9 pounds, 1 ounce, and 21 inches.”
But when she went home, it hit her. “I would just cry and cry and cry, and have no idea why I was crying. I cried so much, I could barely keep my eyes open, and kept telling myself, ‘Dawnelle, you’re supposed to be happy, this is what you’ve always wanted.’”
“This went on for a year, where I felt like I was there, but I wasn’t really there,” she added. “I didn't feel like I didn't love him, I just felt disconnected. Like I could hear crying in the background and not respond immediately because I was so zoned out.”
Fallas told her doctor about her experience, but it wasn’t until months later that he referred her to a therapist. “The doctor said it was too soon to determine whether I had postpartum depression, and I didn’t know any better, because I’ve always thought postpartum meant you didn’t want your child.”
Both Dewing and Fallas were eventually able to get the mental health care that they needed. But their stories of suffering were not uncommon among the many mothers Beck has interviewed in her research.
Beck recommends that health care providers check in with mom and baby at multiple points. “Health care professionals need more education on traumatic childbirth, because our thoughts currently don’t go to (the idea) that birth could lead to PTSD,” she said.
Luckily, Dewing’s pediatrician checked in with the mother. During a well-child visit, Dewing remembers the pediatrician asking her how she was doing. “I just let it all out for her,” she said. “I was like, ‘Actually, I’m not doing so well. This is kind of a nightmare, I’m not sleeping, and I feel like I’m losing my mind.’”
The pediatrician suggested Dewing she reach out to her obstetrician, which she did. “She gave me a prescription then, which probably saved my life, if not my daughter’s,” she said. “I was able to function and be a mom.”