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Birth Grief

January 28, 2016 by president

Guest post submitted by Natalie Short of ICAN of Birmingham, AL.

Sadness, anger, disappointment, anxiety – sometimes our emotions postpartum are unexpectedly heavy. A lot more has been written in recent times about the legitimacy of birth grief and birth trauma, and, increasingly, women dealing with these emotions postpartum don’t have to suffer alone. But how does disappointment differ from trauma, and how might it matter?

Imagine these two scenarios – Katie was planning a home birth, but she ended up transferring to the hospital for an epidural. A couple hours later she gave birth vaginally to a healthy baby girl. In another state her sister, Dana, also transferred for an epidural and gave birth to a healthy boy. When they spoke on the phone later that week Katie expressed some disappointment about her birth but seemed otherwise pretty happy about her situation. However Dana seemed rather disjointed and upset on the phone. In the following weeks Dana would rehash her experience several times and seemed to be having some trouble coping with the stresses of new motherhood whereas Katie who, although tired and occasionally moody, seemed to be coping well. Despite their close bond, both sisters were having trouble understanding each other. What happened?

Despite their close bond, both sisters were having trouble understanding each other. What happened?

Here’s one possible scenario: Because midwifery is legal in her state, Katie’s midwife accompanied her to the hospital to provide continuous care, and hospital staff respected that Katie had wanted to birth out of the hospital and only came to the hospital because it offered something she couldn’t get at home – spinal pain relief. Despite her midwife’s support, Katie ended up feeling disappointed in herself for not having her daughter at home where she could curl up in her own bed instead of dealing with IVs and people constantly coming in and out. She occasionally second guesses her decision and cried after seeing pictures of her best friend’s home birth but otherwise appreciates that she was supported and encouraged throughout her labor.

Contrast this with Dana’s story: In Dana’s state, home birth midwifery is illegal, so her midwife wasn’t able to support her in the hospital. Despite having a healthy baby and labor, the doctors and nurses pushed a highly interventionist protocol on her, and the anesthesiologist made disparaging remarks about the women who decide they “don’t want to be a hero.” In the end, Dana felt bullied into accepting several unwanted and unnecessary interventions and had to talk her way out of the OR when her doctor tried to call for a cesarean after only two hours of pushing. Post birth her wishes were again ignored when her son was whisked away for “routine checks.” Now Dana finds herself spending a lot of emotional energy going over what happened and what she or her midwife could have done differently. When talking with Katie she struggles to express her frustrations and wonders if there’s something wrong with her since Katie seems pretty okay with her own hospital transfer.

You could imagine a variety of other possibilities – perhaps one mom had been sexually abused or suffered from anxiety. Maybe she had an emergency transfer for cord prolapse. It’s even possible that one of them experienced obstetric violence. Multiple factors go into making a birth peaceful, disappointing, or traumatic and those factors include the woman’s history, temperament, birth process and outcomes, her support network, and how she’s treated by her medical team.

As a general rule grief or disappointment in birth comes up when our experiences didn’t match up with our expectations, or our expectations were otherwise thwarted. Maybe you had to transfer. Maybe your VBAC wasn’t the peaceful, smooth birth you’d envisioned. Perhaps your doctor wasn’t on-call, or your husband/mother/doula didn’t make the birth. You either got the epidural, or you got there too late for it. In some respect, the birth you anticipated didn’t happen, and you’re sad about it.

Sometimes moms need to hear that no one is at fault and that their less than ideal birth doesn’t reflect on their preparation, choice of care provider, or expectations. In a normal birth it’s okay to have moments where you feel overwhelmed or scared or frustrated.

We need to remember that birth reflects life, and minor disappointments aren’t something to fear. When the ice cream shop is out of rocky road you might well discover how much you enjoy strawberry. Now, if they lied about having rocky road or if you’re allergic to strawberries that’s a much bigger deal, but in birth as in life we should be prepared to encounter and navigate minor disappointments. Sometimes moms need to hear that no one is at fault and that their less than ideal birth doesn’t reflect on their preparation, choice of care provider, or expectations. In a normal birth it’s okay to have moments where you feel overwhelmed or scared or frustrated. For many moms this won’t be a problem, and they can expect to handle these emotions if and when they occur.

Trauma, on the other hand, comes largely from outside ourselves. You were bullied in birth or ignored or had medical procedures done on you without our informed consent. An emergency arose that had you flying down the halls towards a swift and certain surgery. You hemorrhaged or tore badly. Perhaps your baby required immediate and extensive medical care. Your birth story suddenly became one of those stories no one wants to hear, and it has affected you deeply and inescapably. Of course, many women come out of traumatic birth incidences with a healthy mental outlook because they were respected, involved, and nurtured, and women with otherwise healthy deliveries can be traumatized simply by being bullied and ignored. There isn’t a hard line between the two experiences, but it’s valuable to make some sort of distinction even if we acknowledge that it’s partly artificial.

For instance, when speaking within the birth advocacy community many of us understand that emotions around birth can flow in very interconnected and complex ways, and we are comfortable just sitting with those emotions and not trying to categorize them too specifically. However, when we’re speaking to medical professional or people outside the birth community it’s crucial that we hammer again and again that birth trauma largely comes from a truly scary birth incidence or from disrespectful and callous birth care. As has been pointed out repeatedly – if birth is so scary and dangerous that it has to be closely managed in the most medical and restrictive of settings, no one should be surprised if women are traumatized by it. People who do scary and hard things do occasionally get scared and worn out, and people who have to put up with bullies or hostile experiences are often traumatized. It’s that simple.

When speaking to birth trauma skeptics, it’s important to make plain how those experiences are truly traumatic, arising from circumstances outside our control and not attributable, falsely or not, to us creating some “fantasy” about “how birth should be.” A medical provider bullying or coercing a laboring woman is something that is wrong no matter your birth philosophy. A cord prolapse is a scary medical emergency even if it occurs while driving to the hospital for an elective cesarean. In other words, it’s not about her. It’s about the care she receives and/or the statistically rare events that can make birth a difficult or even heartbreaking experience. When we group traumatic experiences with disappointing one we can lose this very important distinction.

By focusing on the human elements of compassion, respect, and informed consent we highlight the one thing we can give all women regardless of how or where they birth or any other circumstances – respectful, compassionate care.

The human element in maternity care can have a dramatic impact on whether a mother feels traumatized. To return to our original scenarios – the primary difference between Katie and Dana is that one woman received compassionate care based on evidence and informed consent, and the other one did not. By focusing on the human elements of compassion, respect, and informed consent we highlight the one thing we can give all women regardless of how or where they birth or any other circumstances – respectful, compassionate care.

Sifting out the exact differences between disappointment and trauma isn’t as important in communities that routinely validate, support, and comfort birthing women, but it is important when speaking into communities that dismiss women’s voices in and around birth. So long as women are scolded and shamed for having negative feelings after birth, there will exist the need to confront people with the realities of birth trauma in a very plain and bald manner. Birth trauma isn’t something confined to hypothetical over-privileged, ungrateful birth hippies and can affect women of various birth philosophies across the socioeconomic spectrum and impact their mothering and mental health for months or years, and our stories should reflect this.

Natalie Short is a wife and mother of two – her first born via a traumatic emergency cesarean and her second via a peaceful cesarean after a long trial of labor. She’s also chapter leader for ICAN of Birmingham, Alabama. When she’s not volunteering in her community, she enjoys knitting, photography, and not cleaning until the kids are in bed.

Filed Under: Uncategorized Tags: Fear, Guest, Recovery, Support, Trauma

She Wants a VBAC, But Her Partner's Not So Sure

March 1, 2011 by blog 1 Comment

ICAN’s Education Director Krista Cornish Scott has published an article on About.com called, “Planning a VBAC When Your Partner’s Isn’t Sure.” Krista provides tips for dealing with this situation such as acknowledging fear, asking your partner to listen to how your cesarean affected you, and approaching your partner with their learning style.

Krista writes, “Getting your partner to understand or at least be supportive of your birthing plans, whatever they are, can reduce a great deal of prenatal stress. Trying these tips can help open the door to better communication as well as a better birth for the entire family.”

Read the full article here and share it with women you know who might need these valuable tips!

Filed Under: Uncategorized Tags: Education, Fathers, Fear, Support, VBAC

Increased risk of home birth is "pure fiction"

July 7, 2010 by blog 2 Comments

The Big Push for Midwives released a statement today in response to publicity surrounding a forthcoming article in the American Journal of Obstetrics and Gynecology that claims to show home birth is unsafe. From the press release:

As New York and Massachusetts moved to pass pro-midwife bills in the final weeks of their legislative sessions, the American Journal of Obstetrics and Gynecology fast-tracked publicity surrounding the results of an anti-home birth study that is not scheduled for publication until September. Described as unscientific and politically motivated, the study draws conclusions about home birth that stand in direct contradiction to the large body of research establishing the safety of home birth for low-risk women whose babies are delivered by professional midwives.

The release further quotes Dr. Michael C. Klein:

“Many of the studies from which the author’s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.” said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. “The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.”

Several days ago, Amy Romano at Science and Sensibility expressed her own doubts about the study, highlighting these points:

1. The meta-analysis is compromised by the inclusion of a deeply flawed study that relies on birth certificates and includes preterm births, unplanned home births, and home births attended by unqualified providers. In the only analysis in which the researchers excluded this study, the significant excess of neonatal mortality disappeared.

2. The meta-analysis also includes studies that report on births that took place as early as 1976.

The Big Push notes that the timing of publicity initiated by AJOG is questionable, at best:

“Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”

Filed Under: Uncategorized Tags: Fear, Homebirth, Maternity Care, Media, Research

Scare tactics & women of size in childbirth

June 12, 2010 by blog 1 Comment

The New York Times recently published an article titled “Growing Obesity Increases Perils of Childbirth.” The article’s lead states:

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

Several bloggers, including ICAN’s own Kmom have blogged in reaction to this piece, highlighting the ways that it misrepresents the risks and evokes fear surrounding childbirth for women of size.

An excerpt from The Well Rounded Mama‘s response:

It’s not that the possible risks of “obesity” and pregnancy should never be discussed with women of size.  Of course they should.  Women deserve to be informed of the possible risks.

However, this article was full of distortions and worst-case scenarios, and it implied that experiences such as stroke during pregnancy are extremely common in fat women.

Anyone reading these types of articles might well conclude that virtually no fat woman has ever had a healthy pregnancy or a healthy baby, that the only way to have a healthy pregnancy is to lose vast quantities of weight first, and that the vast majority of fat women experience major complications and have unhealthy babies. And that simply doesn’t jibe with the experiences of most fat mothers.

Yes, women of size are at increased risk of some complications. But the article distorts the magnitude of that risk and presents weight loss and highly interventive care as the only paths to a healthy pregnancy.

In fact, many women of size have healthy pregnancies and healthy births…..you can read many of these stories on my website.  I was one of them. I somehow managed to have four healthy babies at a much higher starting weight than the woman in the article. Despite being larger than her, I never had diabetes, I never had pre-eclampsia, I never had kidney problems, and I never had a stroke. And I know many more fat women just like me, in all sizes of fatness, who had healthy pregnancies and babies, in all sizes of fat. But THAT part of the obesity story doesn’t get publicized.

It’s not that you cannot discuss the possible risks of obesity in pregnancy with women. But it needs to be done in a fair and balanced way. This article was not well-balanced, it didn’t discuss the possible risks in a reasoned and calm manner, nor did it acknolwedge that many women of size can have healthy pregnancies and babies.

Sensationalistic articles like this are done to shame and scare women out of pregnancy, or into compliance with draconian interventions like weight loss surgery, lack of weight gain during pregnancy, extreme prenatal testing, unnecessary inductions, or planned cesareans.  Postpartum, they try to shame women into emphasizing weight loss at any cost, despite the fact that long-term research shows that nearly all diets will fail, many of the women with weight loss surgery will experience nutritional complications, and that weight loss attempts are one of the major factors in weight gain over the long run. Approaches like this will likely just worsen the problem, not improve it.

Please visit Kmom’s blog to read the full post. She very thoughtfully and methodically addresses the article’s misleading information.

Filed Under: Uncategorized Tags: Cesarean, Fear, Media, Risks

Best of the Birth Blogs – Week Ending December 20th

December 20, 2009 by blog Leave a Comment

Your weekly one-stop for highlights from the birth blogosphere. Visit weekly for the latest on childbirth, especially related to cesarean prevention, recovery, and VBAC. To nominate a blog post to be featured here, email me at blog@ican-online.org

Birth Activist – Loyally Devoted to Doctor: Jennifer shares some thought-provoking reflections on why women might feel bonded with birth providers who do them wrong.

Spinning Babies Blog – Where Fear is Seen as Competency: Gail Tully on fear of breech and trusting birth.

Birth Sense – Your OB (or midwife) Still Does WHAT? #1: Birth Sense is on a roll with a new series about non-evidence-based techniques used routinely on maternity wards everywhere. Amniotomy, anyone?

Stand and Deliver – Emergency Deliveries: Rixa rounds up and comments on some recent stories of “emergency births”.

Reality Rounds – Empowered Patient or Entitled Patient?: Who knew a news story’s title could mean so much? RR does!

Filed Under: Uncategorized Tags: Best of, Breech, Fear, Maternity Care, Media

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