It’s supposed to be one of the happiest days of your life. In Hollywood, it’s a quick push followed by tears of joy and rousing music by Hans Zimmer. In reality, having a baby can be rather different.
One in five women find childbirth traumatic and 30,000 new mothers in the UK each year go on to develop post traumatic stress disorder – a condition typically associated with war veterans. For comparison, 9% of soldiers deployed to Iraq and Afghanistan returned with PTSD – for mothers, it’s 4%. This can be triggered by an obviously traumatic event, like an emergency caesarean, or injuries as the result of the birth. But even so-called ‘normal’ deliveries resulting in a healthy baby can be shockingly violent (one word: ‘tearing’ – experienced by 90% of first time mothers in vaginal births.
This was my experience. After years of fertility treatment, I finally got pregnant and stayed pregnant. For ages. In week forty-two, I was induced but part of me still hoped that the baby might slip out like a Slinky. He did not. Seventeen hours into active labour, I saw a bright light and thought, ‘Oh thank God, I’ve died!’ But they were just examining me in more detail. My ‘birth notes’ for this period read: ‘Helen is very upset that she is not dead.’
Finally, a small, rubbery thing appeared before being whisked away to the special care baby unit. All the books emphasised the importance of instant skin-to-skin contact, but I couldn’t even hold my baby. I knew the benefits of breastfeeding but, instead, he was hooked up to a feeding tube. And a breathing tube. He was given the all clear after three days but my body apparently recoiled so much from the experience that it stopped producing oestrogen. This meant my nether regions turned into the Sahara desert and my stitches didn’t heal for three months. Back in hospital, I had to be cauterised. Internally. The smell of burning flesh will never leave me. I replayed the birth, experiencing flashbacks, nightmares and panic every time I saw a pregnant woman – terrified of all she had in store. When Natalie Imbruglia’s ‘Torn’ started up in the supermarket one day, I broke down in the nappy aisle and was persuaded to get help. I was offered antidepressants and warned that I might have postnatal depression. ‘I’m not depressed: I’m traumatised!’ I told my GP. Turns out, I was right.
PTSD is defined as re-experiencing the traumatic event through flashbacks, nightmares or intrusive memories; avoiding anything that reminds you of the trauma; feeling hyper vigilant, low or unhappy. Dr Elizabeth Skinner, midwife and birth trauma researcher, says: ‘Postnatally traumatised mothers are essentially still in flight-or-fight mode and alert to the threat of danger - with many also experiencing problems bonding with their baby.’
After a difficult birth, it’s not unusual for mother and baby to be separated, either because the mother is ill or the baby is. Having a caesarean under general anaesthetic also means mothers aren’t present for their baby’s birth. Then there are the physical symptoms, which can be distressing and painful however babies are delivered (I’ve since had a C-section. That was no walk in the park, either).
Birth trauma can overlap with postnatal depression (PND) but the two illnesses are different and need to be treated separately. ‘Many women report being wrongly diagnosed with PND and prescribed medication that did little to help,’ says Skinner. While writing this piece, I posted on the Birth Trauma Association Facebook page asking others to share their stories. I received 100 emails in half an hour. Many were from women frustrated at having been ignored for so long.
Bonnie, 29, wrote of her induced birth, ‘Despite the physical injuries, I believe most of my trauma stems from feeling like my pain and feelings were dismissed.’ Eline, 35, talked about extreme loneliness and feelings she’d somehow ‘failed’ after an emergency C-section. And dozens of women who had babies during lockdown talked about feeling scared and alone, with partners absent during delivery or having to leave the hospital an hour after the birth. Many were mistakenly told they had PND, then later diagnosed with PTSD. But with this diagnoses came hope.
‘The first step in recovery is validation,’ says Skinner: ‘If a woman feels she’s not believed, it’s the worst thing.’ Perinatal clinical psychologist Dr Alex Thornton compares the shaming and silencing of birth trauma to gaslighting: ‘This idea of "Put up and shut up" doesn’t help anyone. If you have flashbacks three or four times, that’s PTSD,’ says Skinner: ‘So-called "normal births", if a baby ends up in the NICU and the bonding process is disrupted; if there’s numbing, re experiencing, nightmares: that’s PTSD.’
The UK is leading the way in birth trauma research and Professor Susan Ayers has developed The City Birth Trauma Scale for practitioners to measure symptoms. ‘We now know that the most effective treatment for postnatal PTSD is trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR),' says Ayers: ‘Both therapies are based on the idea that trauma memories remain in an area of our midbrain, which is responsible for stress responses.’ This means memories of distress are often triggered and we feel we’re re-living the trauma.
‘Therapy helps move these memories to a more cognitive level where we can process them,’ says Ayers. With CBT, a therapist explores perceptions and thought processes, then creates a safe environment to process trauma. EMDR involves thinking about the trauma while following a moving object with your eye (it sounds mad but it works).
Getting help for physical symptoms is also crucial. ‘I’ve spoken with women who were in pain for a long time after birth,’ says Thornton. ‘They’ll say “I didn’t know I wasn’t supposed to be”.’
I can relate: I suffered in silence for six years before surgery to repair damage from my first birth. ‘So don’t dismiss your symptoms,’ says Thornton. And then? ‘Spread the word. I’d like to see more realistic education around birth.’
Skinner agrees: ‘We teach about PND in antenatal classes – why not PTSD too? Like what to look out for and when to get help. The narrative at the moment is, “You had a baby! Great! Get on with life!” But it shouldn’t have to be this way.’ As Thornton says: ‘A healthy baby isn’t all that matters. Mothers matter too.’ Amen to that.
@MsHelenRussell is a journalist and bestselling author. Her new book, How To Be Sad, the key to a happier life****, is out in paperback January 20th