A question people find hard to ask me is ‘what actually is birth trauma’? The reason they find it difficult to ask is because they dont want to get it wrong. There’s a misunderstanding and general consensus that for something to have been traumatic it has had to be gory and grim. In reality, this assumption - that birth trauma looks like a horrific birth, resembles a murder scene or is a near death experience, is false. Whilst these descriptions are most definitely within the category of birth trauma they are not the defining descriptors of the trauma I see and hear in my practice. To put the vastness of birth (and post natal) trauma into perspective, let’s have an overview of some of the elements of what makes a birth experience a traumatic one. 

What makes a birth traumatic? 

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A traumatic event is one where the person who is experiencing the trauma feels a threat to their existence (Physically or emotionally). Emotionally they may have felt abandoned, humiliated, scared, unsupported or unsafe (https://www.mind.org.uk/information-support/types-of-mental-health-problems/trauma/about-trauma) Very importantly, there does not need to be physical trauma in birth in order to have had a traumatic birth. Any threat to physical or emotional integrity that is difficult to process can be a trauma. Emotional injuries can occur in labour and birth through feeling unsupported, coerced or not listened to for example. 
 
Trauma response 
A threat, physically or emotionally to ones survival can be perceived or real. Either way, the body and brain, inextricably linked will respond in a protective manner and express an activated nervous system. Trauma responses include fight or flight or freeze and a dysregulated system. This looks like sadness, anxiety, poor sleeping, hypervigilance or withdrawing, isolation, shame and guilt. Understanding this alone, many people gain a better understanding of whats happening for them and some reassurance that birth trauma is real with many different presentations.  
 
Healing birth trauma starts with awareness 
Often, people feel more comfortable describing their birth or loved ones experience as difficult or not so easy. Somehow, this takes the sting of being ‘dramatic’ out of the equation. For clarity, let me be very clear – a traumatic birth is one where the birth giver feels traumatised. To compare is to despair. It is how the birth is experienced, regardless of how it looks that matters. A physically traumatic birth can be a positive experience whilst a birth that looks ‘textbook’ and serene may have been a traumatic one. If trauma resonates with you then that’s enough. The first step is awareness. Awareness of what birth trauma is and secondly that there is help and resolution is possible.  

Doesn't everyone experience a level of birth trauma? 

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But birth is a huge deal -everyone experiences a level of trauma during birth? 
The enormity and sacredness of birth is unacknowledged and undervalued in our society today. Birth is a huge deal and the transition into motherhood can be a bumpy ride. However, 30% of women recognise their birth experience as a traumatic one - I suspect that in reality this figure is higher. The majority of women will recognise the process of labour and birth as a big event and have a multitude of feelings about their experience. In the first few weeks after birth there are a host of feelings and challenges and let’s be honest, little time to assimilate the experience. But very often there is a settling period, an integration on various levels that happens during the first 6-8 weeks (providing there hasn’t been major postnatal or feeding issues to contend with). Of course, the integration process is ongoing. 
 
The woman who has experienced birth trauma 
For the woman who has experienced a traumatic birth, she may feel like she is telling someone else’s story, she may feel very disconnected from herself and her baby. She may avoid talking about the birth or feel silenced by well -meaning friends and family who encourage her not to dwell on it., or 'to get over it'. The symptoms of birth trauma can wax and wane or they can progressively increase in intensity. For many though the symptoms are invisible to many, and thrive in the darkness of isolation and shame. 

What are the symptoms of birth trauma? 

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The symptoms of birth trauma are many and can come and go. They may not become obvious until months down than line. Symptoms of birth trauma and PTSD, left untreated can develop into low mood and postnatal depression. For the purpose of this blog I am focusing on the post trauma symptoms of birth trauma. For information on postnatal depression visit https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/about-maternal-mental-health-problems.  
 
Birth related trauma, anxiety and PTSD symptoms 
Women describe experiencing anxiety. They may experience racing and intrusive thoughts, excessive planning and fretting. Thoughts and feelings can include feeling like a failure, feeling scared and overwhelmed. A heightened sensitivity to perceived criticism may result in angry outburts or contribute to heightened levels of anxiety and tension. A spectrum of hypervigilance symptoms may look like overprotection of your baby, perfectionism and controlling behaviour. Other symptoms can include difficulty sleeping, sometimes nightmares and flashbacks and sadness. Memories can be evoked by the body or the mind through words, sound, activities or smell. A common associated behaviour therefore is the avoidance of anything that triggers memory of the traumatic experience(s).  
 
Physical and emotional disconnect 
Women very often describe feeling cut off from their body, either physically, emotionally or both. They may feel numb, not wish to look at any physical scars if present or even touch their body. This disconnect can impact intimacy, partner relationship and the willingness to experience birth again. 
So many women trudge on in the acceptance that this is what motherhood must be like. They keep up a façade of trying to do what a good mother does and many come to the conclusion on the inside that they are somehow a failure. 
 
The legacy of birth trauma 
With the symptoms I have described of a dysregulated nervous system there is little wonder that birth trauma affects so many areas of a new mother’s life. The legacy of a traumatic birth is like dropping ink into a bowl of water – it colours all of the water. The impact is felt in social situations, in relationship with family, friends and partners. The disconnect she feels from herself physically and emotionally can affect her sexual relationship, usually by avoiding any intimacy (for the record this is also a very normal postnatal experience for lots of women!). The biggest impact is with her relationship with herself in terms of self esteem, how she views herself and often how ‘good’ she is as mother to her baby. The bonding experience may feel tainted. She may feel a disproportionate desire to compensate and protect her baby or on the otherhand feel a block to really connecting and loving her child in case she gets it wrong further or something else happens. There is also often a great sense of grief and loss for who she was and the way she had hoped and dreamed birth and motherhood would be. 

Healing Birth trauma is possible 

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Can you heal from birth trauma?  
The answer is a resounding yes. Healing through resolution is not erasing the memories. It’s not going through the mechanics and understanding any proposed logic to what happened (this often happens at hospital ‘debrief’ sessions). The healing happens when a woman can share her truth, her birth story and experience, in the absence of anyone elses agenda. This can only happen in privacy and within a sacred and safe space. Here, she gets an opportunity to safely unpack and start to understand what happened to her and for her. 
 
Where the trauma lies is a personal experience 
This is not about the mechanics and chronology of the birth but her emotional responses, uncovering what was traumatic for her. She can experience a sacred space to heal, to unpick and rebuild. Time and time again, I witness women visibly soften and let go a little, even in the first half hour when they recognise that they are not alone, they are not ‘making it up’ or ‘being dramatic’ and that there is a very real reason behind the traumatic symptoms they are experiencing after a difficult birth.  
 
What can you expect from birth trauma healing? 
There are various healing modalities out there for birth trauma – CBT, EMDR, REWIND HYPNOSIS. The sense of safety and elationship is imperative. It is many womens experiences that they are afraid to share whats going on for them with the P or health professionals. Some, who are courageous enough to do so find themselves on a waiting list or with a prescription. Unfortunately, it can be a challenge to get the necessary support and suitable therapy within the overstretched resources of the NHS. Birth trauma healing sessions I offer at Big Steps Little Feet usually involve 4-6 sessions, starting with an initial assessment and birth story listening appointment. Together we explore the individual experience and work with various modalities to reset and regulate the nervous system including using simple breath and body exercises and very often rewind hypnosis. Recorded relaxation exercises support recovery between sessions.  
 
Resetting and repair - attachment focused session(s) with baby 
This is an area overlooked for many mothers in healing the birth trauma they have experienced. 1-3 attachment focused repair sessions support healing for both mother and baby. These sessions are very special and offer another special 'start' and connection between mother and baby.  
 
In Summary 
There are so many reasons why birth related trauma is not understood and difficult to understand. Awareness is the first step in reducing this invisibility, not just for the woman but for society as a whole. There are common themes but many symptoms and manifestations of birth trauma. If any of the symptoms and legacies described resonate with your experiences, remember the first steps in healing is awareness, speaking up and reaching out. Making space and creating sanctuary for body and mind is where healing and resolution happens. Healing is very possible and recommended by many - Bryony experienced healing from her first birth experience says 
'If you are suffering after a traumatic birth or post-natal period and feel it is affecting you, then please consider this process'.  
 
The bottom line is that resolution of birth related trauma is possible and imperative, as is supporting a reconnection with the self, baby and others.  
If you would like to find out more please don’t hesitate to contact Melanie  
Tagged as: anxiety, birth trauma, ptsd
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