Updated: Aug 9, 2019
Pain, Distress and PTSD
Two years ago, I gave birth to my second baby at a local hospital. My pregnancy and birth were what the hospital considered straightforward. I was booked in for a home birth but when my labour started, when I called the hospital, the midwife said they were short staffed so I had to go in but they offered me use of the birth centre, a “home away from home” experience.
However, upon arrival, another midwife took on my case and declined me use of the birth centre and demanded I had to go to the obstetric unit. I felt like I was put in a position that I had to defend my own choices with people who did not know my history, did not listen to me nor care and just wanted to tick boxes to follow hospital protocols. It was a time that I should have been relaxing, labouring, focusing on birth, receiving support but not being listened to caused me a great deal of distress.
I put in my birth preferences that I did not want to have vaginal examinations (VEs) because they do not help with physiological labour progression. I also knew I didn’t want to have them from bad experience in my first birth. I was deep in labour breathing with gas and air for relief. The midwife kept interrupting my labour every 10 to 15 minutes to demand to do a VE and I kept declining. Every time she asked, I panicked and felt like I had to defend myself. The way she did not listen to me nor respected my choices did not make me feel safe or able to fully relax.
After an hour, she said my baby should have been born half an hour ago. It made little sense to me as my first birth lasted over a day. What she said implied my baby was in danger which made me panicked. Her persistence made me feel like she just wanted to carry out hospital policy to tick a box. She was not really interested in supporting my choices. I gave into her demand to carry out a VE also hoping she would leave me alone after that. She was very forceful. My doula had to tell her to stop when I was feeling uncomfortable. The pain I felt intensified.
A senior midwife came in and introduced herself then went on to take away my gas and air and demanded I push even though I didn’t have the urge to. Without the pain relief, I felt the full blast of the pain and out of control. It was extremely traumatising. I kept begging for my gas and air back but she just ignored me. I felt like an animal dying on the road side.
It is sickening how culturally accepted it is for women to suffer extreme pain in labour when it could be relieved. Women’s requests for relief are often judged, ignored or denied. I'm not surprised that many women suffer PND or PTSD after giving birth as they are normal reactions to traumatic experiences. It's so important to give women choice and sense of control during labour to prevent birth trauma. Giving birth was my most vulnerable moment.
My birth only lasted a bit over two hours but it was an intensely physically abusive experience throughout, the worst moments of my life.
Six months after my baby was born, I was still having anger outbursts, anxiety, flashbacks, intense nightmares and was hypervigilant and hypersensitive. I couldn’t relax particularly around my baby. I could not feel much joy nor love. I was numb. I felt like my life was out of control. Deep down I knew something was not right, I needed help fast.
Women really need to be informed of the possible psychological effects that internal examinations, instrument use, withdrawal of pain relief (including refusal to provide and lack of efficacy) etc interventions can have on them. The unwanted VE made me feel violated. When my gas and air was taken away, I felt my mind and body went into shock. I felt like I was about to die. What the midwife said that implied my baby was in danger filled me with fear. Not being listened made me feel invisible.
How can we relax and not feel angry or depressed? When we are at our most vulnerable at a place that we trust and expected care, we are treated cruelly without compassion and kindness, being ignored by people that are supposed to care for us. I did not feel safe.
I went to my GP and had referral to the local Perinatal Team. However, the mental health practitioner I was assigned was pushing for me to take medication. I knew deep down I didn't have clinical depression. I was going out with friends and breastfeeding my baby. At home, I struggled to control my emotions because they were so strong. I wrote to my GP and the Perinatal Team to request to be seen by a clinical psychologist. A month later, I had an assessment at my local NHS psychotherapy service and had my PTSD diagnosis.
Two months later, I started having trauma therapy. I was one of the lucky few that could access the fast-tracked birth trauma pathway. My condition deteriorated while I was waiting for treatment. My nightmares were frequent and intense. I had difficulty falling and staying asleep. I was exhausted mentally and physically. My mood started to plummet, sinking deeper and deeper into the black hole.
The therapy was a combination of trauma-focused CBT (Cognitive Behavioural Therapy) and EMDR (Eye Movement Desensitisation and Reprocessing). They are recommended by the NICE guidelines. The former was a series of counselling sessions exploring the themes around my fear perception and responses, the latter involved stimulation of my brain to replicate memory processing in sleep. I had four sessions of EMDR processing the flashback images and trauma memories. They were emotionally intense and exhausting, I had severe migraine for days after some of these sessions. I feel they sped up my recovery but the journey was not easy as going through the traumatic birth made me feel disturbed.
The therapy sessions made me realise the feelings or emotional triggers have roots/origins, from how I was treated at the birth.
How we are spoken to and treated during the birth, I would say during pregnancy too, stay with us for a very long time. It’s important for health professionals to be mindful of their words, interactions and impact. We take what they say seriously. We value their advice but our value may not always agree. That doesn’t mean we do not respect them, we have difference in opinion but our choices as women and mothers need to be respected and supported.
We all want healthy and happy mothers and babies.
The instructed pushing left me with nerve damage to my bladder, severe perineum tearing and blood loss. To help with resolving the incontinence issue and painful scars, I requested for physiotherapy specialised in pelvic floor rehabilitation at my local NHS clinic. The service is usually available at Women’s Health Clinics. It took several months of bladder training and regular physio exercises to improve my bladder control. The healing journey is ongoing.
Prevention is key when it comes to birth trauma. If I could have anything in the world, I would have liked to have received care and support when I was birthing my baby, a time that really mattered. The emotional and physical pain the traumatic births have caused me and the time it took to try to recover could have been prevented. They affected the time and dedication I could have given to my baby. I had difficulty bonding with my baby because her presence reminded me of the ordeal. We are still working on repairing the damages.
I feel having the same carer throughout pregnancy and birth could have prevented the mental and physical injuries I sustained. Having someone who was familiar with my preferences, family history and obstetric history would have made me feel safe and understood. The relationship, case knowledge and individualised care are important in minimising errors. Continuity of carer is the answer to many problems maternity services and their uses face. It is proven to improve outcomes and experience. This needs to be the priority in improving women’s health and modernising the NHS to meet the needs of women, babies and families.
Things that have helped me
* Talking about my feelings and thoughts with other understanding people or write them down
* Support from family and friends (help with looking after baby so I could have a break)
* Psychotherapy (EMDR)
* Physiotherapy specialised in pelvic floor rehabilitation
* Swimming and yoga/Tai-Chi (for mental and physical realignment and general fitness)
* Gentle massage
* Breastfeeding and lots of skin to skin with baby
* Relaxation audio (Insight Timer free app)
* Some good advice on night management
* The book How to Heal a Bad Birth