Birth trauma is not a failure. It doesn’t happen because you’re weak or you didn’t prepare correctly. You are not being ungrateful or needlessly focusing on the negative. You are not a bad or inadequate parent. And your birthing experience matters, whether it was positive or negative, or had some components of both.
So if it’s not a lack of resilience or some personal inadequacy, what does cause birth trauma?
First of all, it’s important to note that birth trauma is subjective, not objective. What is important is the birthing person’s perceptions. Even a birth which a medical professional would describe as routine can be traumatizing if the birthing person experiences one or more of the following:
1) Fear for their own life or their baby’s life
This might or might not be related to a medical event, such as a sudden deceleration of baby’s heart rate, a hemorrhage, or an emergency C-section. The perception of being in terrible danger is a prime ingredient of trauma.
2) Unexpected events
It’s nearly universal to go into birth with hopes or ideas about how the experience will feel. You spend months thinking about how it might go, that incredible moment when you deliver your new family member into the world. This is a place where trauma can creep in, particularly if the birthing person experiences more physical pain than expected6. And whether expected or not, unmanaged pain (that is, pain that isn’t managed by the birthing person’s coping strategies and feels inescapable) is a risk factor for birth trauma10.
This kind of defiance of expectations can be related to a postpartum experience of grief, in which the birthing person must mourn the experience they had hoped to have in birthing their baby8.
3) Medical complications
Medical complications which increase the likelihood of birth trauma include emergency cesarean birth, significant blood loss, and pre-term birth2. Additionally, any medical complication which requires the baby and birthing parent to be separated after birth increases the risk of birth trauma6.
It’s important to note that race is a huge factor in medical safety, particularly in the birthing process. See below for further exploration of race as a factor in birth trauma.
4) Disempowerment
A feeling of helplessness is another crucial component of trauma9. And that feeling is often a product of how a birthing person is treated during the birthing process. Whether by a support person or a medical professional, social behaviors which can contribute to birth trauma include:
Talking about the birthing person as if they aren’t in the room
Touching the birthing person without permission
Using belittling or dismissive language
Not providing sufficient information about proposed interventions
Providing misinformation
Not listening to the birthing person’s ideas or concerns
Not providing informed consent
Experiencing any of the above can feel dehumanizing.
Negative interactions with medical providers during the birthing process is a very significant risk factor for birth trauma6. Informed consent in particular is key to respectful and safe care. Assuming it’s not an emergency situation, the following behaviors by medical providers are ethically unacceptable:
Failing to introduce themselves and explain their role
Performing any intervention without first explaining associated risks and benefits
Rushing the birthing person through a decision
Treating a birthing person with disdain if they disagree with a treatment recommendation
Performing an intervention without consent
Medical providers have every right to recommend the course of treatment they think is most advantageous; in fact, they’re ethically obligated to do so. This should be done respectfully, while honoring the birthing person’s perspective and autonomy.
Feeling as if you have choice and ownership of your own body is necessary to avoid birth trauma.
5) A history of trauma
A history of a mental health disorder of any kind increases the risk of experiencing birth trauma7. In particular, a history of Posttraumatic Stress Disorder (PTSD) increases the likelihood that birth will be perceived as traumatic1.
6) Race
It is simply more dangerous to give birth while Black. Black people are at greater risk of experiencing most of the above risk factors. In particular, Black people are at greater risk of experiencing preterm birth, infant mortality, and adverse medical outcomes during birth2. This country has a long and grim history of medical abuses on the Black population, and implicitly and explicitly, racism still happens frequently in the medical system4. Nearly two-thirds of Black people report that they have experienced discrimination in their interactions with medical providers3.
7) Gender
There isn’t enough research on the impact of birth in trans or non-binary populations. But there is good research to suggest that for trans or non-binary folks, medical experiences (and particularly those involving reproductive health) are often associated with feeling disrespected, invisible, discriminated against, and isolated, all of which are risk factors for traumatic experience5.
Experiencing any of the above doesn’t necessarily mean that the birthing person will feel traumatized. These are just risk factors. Birthing is an incredibly vulnerable time, and every birthing person deserves to feel safe and respected during the process. If you’ve experienced any of the above and came away from your birth feeling shaky, sad, frightened, or traumatized, you’re not alone, and you don’t have to feel this way forever.
But how to change it? We’ve discussed what birth trauma is and what causes it. See my next blog in the series for a discussion of overcoming birth trauma. And if you’d like to discuss birth trauma with me, you can reach me at DrKress@EnrichCenter.org
Sources:
Ayers, S. (2017). Birth trauma and post-traumatic stress disorder: the importance of risk and resilience. Journal of reproductive and infant psychology, 35(5), 427-430.
Adegoke, T. M., Pinder, L. F., Ndiwane, N., Parker, S. E., Vragovic, O., & Yarrington, C. D. (2022). Inequities in adverse maternal and perinatal outcomes: the effect of maternal race and nativity. Maternal and Child Health Journal, 26(4), 823-833.
Bird, S. T., & Bogart, L. M. (2001). Perceived race-based and socioeconomic status (SES)-based discrimination in interactions with health care providers. Ethnicity & disease, 11(3), 554-563.
Dovidio, J. F., Penner, L. A., Albrecht, T. L., Norton, W. E., Gaertner, S. L., & Shelton, J. N. (2008). Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Social science & medicine, 67(3), 478-486.
Greenfield, M., & Darwin, Z. (2020). Trans and non-binary pregnancy, traumatic birth, and perinatal mental health: a scoping review. International Journal of Transgender Health, 22(1-2), 203-216.
Rodríguez-Almagro, J., Hernández-Martínez, A., Rodríguez-Almagro, D., Quirós-García, J. M., Martínez-Galiano, J. M., & Gómez-Salgado, J. (2019). Women’s perceptions of living a traumatic childbirth experience and factors related to a birth experience. International journal of environmental research and public health, 16(9), 1654.
Simpson, M., & Catling, C. (2016). Understanding psychological traumatic birth experiences: A literature review. Women and Birth, 29(3), 203-207.
Tsakmakis, P. L., Akter, S., & Bohren, M. A. (2022). A qualitative exploration of women’s and their partners’ experiences of birth trauma in Australia, utilising critical feminist theory. Women and Birth.
Van der Kolk, B. (2018). The Nature of Trauma [PowerPoint slides].
Waller, R., Kornfield, S. L., White, L. K., Chaiyachati, B. H., Barzilay, R., Njoroge, W., ... & Elovitz, M. A. (2022). Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression. Archives of Women's Mental Health, 25(5), 985-993.
A post-script about inclusive language:
If you’re wondering why in this article, I talked about “birthing people” instead of mothers, good question! A person with a uterus may or may not identify as a woman and/or a mother. As noted above, gender complicates how people interact with the medical system. People who don’t identify as women still conceive, still give birth, and still feel the impact of that complicated life event. It’s important that they aren’t erased from a conversation about the psychological impacts of giving birth.