Last fall, Tiziana Severse found herself weighing her options in a hospital room as she prepared to bring her second daughter into the world.
Despite her intention to deliver her baby without medical interventions, Severse’s doctors advised her to consider an epidural that would help mitigate pain should complications arise. Feeling anxious after the premature birth of her first daughter just two years earlier, she reluctantly agreed. The medical team then recommended she start doses of Pitocin, a synthetic version of oxytocin, to help speed up her labor.
But when Severse showed minimal progress after several hours, her doctors made the decision to deliver the baby through a cesarean section, a surgical procedure by which babies are birthed through an incision in the mother’s abdomen.
“It was literally my worst nightmare,” she remembers. “I didn’t want an epidural; I didn’t want Pitocin; I didn’t want a C-section. I didn’t want any of it.”
After a flurry of doctors and consent forms, the baby was out in what felt like five minutes, Severse says. But then “everything got really quiet.”
“I was like, ‘What’s wrong? What’s going on?’ And my doctor said, ‘There’s just more blood than there should be.’”
Feeling sick from the medications and helpless on the operating table, she anxiously waited as the medical team tested and examined her for signs of internal injuries. After four grueling hours, her doctor finally concluded that she was safe to be reunited with her baby.
While both Severse and her baby were deemed healthy, the medical procedures and health scare left her with feelings of guilt and regret in the weeks that followed. As many as 1-in-5 women experience mood changes or anxiety after experiencing trauma while giving birth, with roughly 9% being diagnosed with post-traumatic stress disorder, according to Postpartum Support International, an organization that provides support and education to new parents. The psychological and physical impacts of birth trauma can manifest in a range of symptoms, including depression, sleeplessness, shame, fear and more.
“I was sitting on the couch with my newborn and a cup of coffee by myself, and I just burst into tears. All the feelings of foreboding — all the feelings that this was a punishment — just came tumbling out of me,” she explains. “I was walking around every day with this intense sense of guilt, as if there was a great big cosmic finger being wagged at me for not just trusting my body.”
The mind-body connection
Caroline Hall, an Asheville-based licensed clinical social worker with a background in women’s health and postpartum trauma, describes the condition as the real or perceived trauma experienced during labor, delivery or the postpartum experience. Trauma can be either physical, such as a health emergency for the mother or baby, or emotional.
“Women with emotional birth trauma will sometimes describe feeling powerless during delivery, which can have a lot to do with the medical providers or support people around them. Some will describe poor communication between the provider and themselves,” Hall explains. “Women who’ve had a history of rape, sexual assault or physical assault are more likely to have this kind of traumatic response in their body to what’s happening during delivery.”
Postpartum traumatic responses can manifest as intrusive thoughts that replay the birth over and over again, as well as flashbacks, nightmares or feelings of hypervigilance and anxiety, says Hall. New parents might also experience mixed feelings about the baby or about their partner because of the event. Some mothers might feel a sense of “unreality” or not feeling like themselves after giving birth. They might feel afraid to have another child later in life, even if they desire one.
Part of Hall’s work involves helping new mothers process their trauma by listening to their birth stories and using techniques to help them understand the mind-body connection, because “trauma,” she says, “is stored in the body.”
For example, therapeutic interventions like eye-movement desensitization and reprocessing therapy, or EMDR, are sometimes used to help reduce the emotion and intensity of a painful memory over time. During EMDR, patients are encouraged to focus briefly on a traumatic memory while experiencing bilateral stimulation, usually created by eye movements.
Hall adds that although some women and medical professionals seem wary of them, there are plenty of safe medications that can also play a role in treating anxiety and depression experienced during pregnancy or the postpartum period. She says health care providers can contact the free N.C. Psychiatry Access Line at UNC Chapel Hill regarding medication safety. “When [the] mood is stable, processing a traumatic birth is more possible.”
Physical injuries or health emergencies may seem the most obvious source of trauma. However new mothers can also experience trauma symptoms due to their own expectations surrounding birth and pregnancy, says Kelly Moore Spencer, a licensed clinical mental health counselor trained in perinatal mood and anxiety disorders and associate psychology professor at Mars Hill University.
“A lot of birthing folks go into the experience with an idea of what the birth should be like, particularly in Asheville,” says Moore Spencer, who uses birth-story processing as one form of therapy for new parents. “There are expectations around the ways babies should be born or how people should give birth, and then around how we should parent afterwards. And I think there’s just not enough talk around the struggles.”
Media portrayals of pregnancy and birth often depict unrealistic ideals while leaving out the sometimes unpleasant but authentic realities that can occur during labor and delivery, like needing medical interventions or feeling negative emotions.As a result, some pregnant people may feel the need to control their own experience according to fixed ideas around their pregnancy, she explains.
While Moore Spencer says that pregnant people should feel empowered to choose the way they give birth — choosing to have an unmedicated birth or to deliver a baby at home instead of in a hospital setting, for example — care needs to be taken to manage feelings of inadequacy or shame that can arise if someone gives birth differently from how they initially planned.
“Birth plans can be both good and bad. There are so many unknowns. We don’t know how our body or the baby is going to respond. That’s why we oftentimes will shift into talking about birth preferences,” says Moore Spencer, who is also a certified birth doula.
Postpartum traumatic responses stemming from unmet expectations can sometimes be harder for friends, family — and even new parents themselves — to identify, Moore Spencer says, because the experience is subjective. One of the best ways for friends and family to offer support is to allow new parents to share their experience without rushing to reassure or judge, but instead acknowledging that “my baby can be healthy and I can be healthy, and I could have experienced a traumatic birth.”
Part of the tribe
Connecting with friends, family and other new parents to share birth experiences can be one of the most therapeutic ways to cope with feelings of isolation, mood changes or traumatic birth, and adjust to parenthood. Both therapists advocate for postpartum support groups like the ones offered through Perinatal Emotional Health Network of WNC, which offers in-person and online groups and resources for new parents locally.
“It’s a way to bond with others on one of the most unique physical and emotional experiences of one’s life,” says Hall. “Whether it’s a group of women who weren’t necessarily traumatized but want to support each other, or those who have had trauma during birth or experience postpartum depression or anxiety, being in a group with other women who are experiencing some of those challenges in addition to caring for an infant can be powerful.”
For her part, Severse chose to share her experience through her online blog. She’s received positive feedback for recalling her pregnancy and postpartum experience with authenticity, and for providing a sense of belonging to other parents with less-than-perfect birth experiences.
“When you have a birth that’s traumatic, you feel outside the tribe of women. You feel on the outskirts of those successful bodies that were able to give birth naturally, which is incredibly lonely,” Severse says. “And when you tell your story, you realize that in the dark outside that circle there are so many women leaning against the fence who also can’t get in. And all of a sudden you realize that you are still part of a tribe, it’s just not that tribe.”
She says the act of sharing her story, along with therapy and faith, helped her process her pain and have compassion for herself.
“Now when I start to feel guilt, I express it as grief. And the cosmic finger being wagged at me transformed into a cosmic hand on my shoulder, saying, ‘I know that was really hard.’ That was when I knew everything was gonna be OK.”
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