Pain: the under-recognised cause of birth trauma

This is a stock image, not a photo of the author of this blog.

TRIGGER WARNING: Please read this story with care. If you’re finding the content challenging, please give yourself permission to step away. If you need support click here, if you need urgent help click here. 

Kim Thomas is CEO of the Birth Trauma Association, a charity that supports parents traumatised by birth. She is also writing a book called Postnatal PTSD: A Guide for Health Professionals. In this post she shares the story of Kate, one of the mothers interviewed for the book. 

When Kate first told other people about her experience of having her baby, they thought it sounded like an idyllic natural birth. Labour lasted only a few hours, and her healthy baby girl was born in a pool, with no interventions or pain relief.

In reality, Kate’s experience of labour and birth was deeply traumatising. Labour had begun a week after her due date with some painful contractions, but then they stopped. When they started again the next day, they were intensely, excruciatingly painful – to the extent that Kate thought something was wrong. Even though she was only 1cm dilated, the pain was “off the scale”. The hospital reluctantly allowed her to stay in a room until she was in full labour. After two hours, she was found to be dilated 6cm and admitted to the labour ward. “I can’t really describe how I managed to get through those two hours”, she says.

“That midwife was downright cruel when I never needed so much help in my life ”

Black and blue

She was allowed to get into a birthing pool and was given gas and air, which made no difference to the pain. When she asked for something stronger, the midwife told her: “No, it’s still too early, you'll be like this for 12 hours yet.” While in the pool, the pain “descended into something completely hideous: I just remember my head slamming against the side and couldn’t stop it at all”. She asked for pain relief several times, but the midwife refused to give her any and simply “smirked at me like it was a stupid question”. When she went off shift, an older, more experienced midwife came in. Kate begged her for pain relief. Clearly concerned, she examined Kate and said: “I can’t give you any pain relief now because your baby is nearly out.” After three more contractions, with no pushing, her baby girl was born. Later, Kate says, her head was black and blue where it had slammed the side of the pool. Her trauma comes, she says from “being denied pain relief and thinking you’re going to die because you’ve got a midwife who’s downright cruel and smirking at you when you’ve never needed so much help in your life.”

Pain and trauma

When we talk about the causes of birth trauma, there are certain themes that come up repeatedly: difficult forceps births, emergency caesareans and postpartum haemorrhages, for example. But for many women, pain is an important contributing factor. When the Birth Trauma Association carried out a survey of 800 of our members over the summer, one in three said they’d been denied pain relief. Often, we find, there are excuses: the woman is too far advanced in labour, or not advanced far enough, or the anaesthetist is busy. In Kate’s case, the only reason given was that Kate had a long way to go – which proved not to be true. 

Prevailing belief

Sometimes the attitude of staff feels cavalier: women describe screaming in pain as their placenta was removed manually without pain relief, for example, or of having episiotomy cuts stitched without anaesthetic. One woman in our survey fractured her pelvis in labour, which wasn’t diagnosed until six months later. In other situations  – if someone has severe toothache, for example, or has broken their leg – health professionals generally understand the need for pain relief. Yet there is still a prevailing belief that the pain of birth can – and should – be controlled through methods such as warm water or controlled breathing. Some women do indeed successfully manage their pain this way, but for others the pain is extreme and can leave them traumatised. For a long time afterwards, every attempt by Kate to talk about her birth experience left her in floods of tears.   

“Kate’s experience is used to train midwives on human rights in childbirth ”

The need for woman-centred care

Initially, Kate’s complaint to the hospital was dismissed with a comment about how most women find warm water and massage an effective way of dealing with labour pain. Later, however, a new head midwife took over who was much more sympathetic, and now uses Kate’s experience as an example of what not to do when she trains midwives on human rights in childbirth. What stands out about Kate’s story is that her care was left to a single midwife, who was able to make her own, apparently arbitrary, decision to deny pain relief, without any consequences. It highlights the importance of developing a woman-centred maternity culture where every health professional in the unit is required to respond sensitively to the needs of individual women. 

About a year after giving birth, Kate went to the dentist for a filling, and was struck, while there, by how “nice” they were. They asked her whether she was ready for the injection and whether she was numb yet, concerned to make sure she felt no pain. “It just hit me,” she says. “All you need is the sort of care you get at the dentist.”

For more information about accessing support for birth trauma, go to Birth Trauma Association or have a look at the Finding Help section of our website.