Birth Trauma – The Neurological Landscape & Finding Your Way Home

Author’s note: Before you read this, please begin to take some slow, deep breaths. This article is both saddening and potentially liberating. My intention is to raise awareness for what is often disregarded, and to offer solutions so women can find a sense of confidence and be empowered – before or following birth. 

SHE’S PREGNANT AGAIN…

Her eyes brim with tears then glaze over as the flashbacks begin. I’ve just asked her to tell me about the birth of her baby. Her midwife has referred her to me because she’s pregnant again, due shortly – and she’s having nightmares, to boot. She can’t face the thought of going through any of it again. I watch her breath quicken then stop completely as she dives into a pool of panic. Her skin changes colour from red to pale, and she gathers herself inward towards the knot in her body, to protect from that which she is experiencing, as if it’s happening again now... because in her unconscious mind it is. 

As Ronald Ruden1 states in his book The Past Is Always Present, “During an event that becomes traumatized, the emotional content and the associated sensory and cognitive content become bound into an unforgettable moment.”

The combination of this sensory and cognitive accessing has an effect on the woman’s physical body, and she responds by reliving the event in this moment. She’s right there with a racing heart, feeling trapped and alone, and when she talks, it’s in the present tense: “They’re telling me that my baby’s heart rate is dropping,” she says, her voice choked by fear. 

PTSD + THE TRAUMA SPECTRUM

This is what we see in Post Traumatic Stress Disorder (PTSD) and many other psychological challenges relating to a specific event, or an accumulation of traumatic events. Even when a woman is labelled with Post Natal Depression (PND), and on psychopharmaceutical medication (e.g., anti-depressants/anti-anxiety meds), or considered a harm to her baby, the Ministry of Health mental health budget and primary care service providers simply can’t cope with the numbers affected by birth trauma. Whilst the New Zealand Government2 are apparently committed to increasing mental health expenditure on suicide prevention, Maori and Pacifika Health, and focus on our under-24-year-old population, there continues to be no obvious plan addressing women’s mental health and wellness around birth trauma.

FROM BEHAVIOUR TO EVENT 

I’m online, working with the mother of two teenagers. We track her current behaviour (aggression, insomnia, anxiety) back to her experience just two weeks into parenting, where she felt most isolated, despondent, and unable to eat or sleep. Her husband was back at work. When she’d called him within minutes of his van pulling out of the driveway to say, “Please come home, I can’t cope”, his reply – “You need to call the doctor, you’re a f*#king mess!” – sent her into a wild spin. The resultant shame further disconnected her from her baby girl. More than a decade on, she still felt a sense of guilt about how she wasn’t able to parent in the way she’d hoped. She said, “It took four years to find the courage and support to come off the anti-depressants, and even then I was still guilty”. Such statements are common.

BEYOND THE OBVIOUS

The Birth Trauma Spectrum extends beyond the obvious. When a woman is asked about the birth of her baby, if she is less than empowered, unable to recall the events with a sense of strength, personal pride, and awe, I believe she is holding trauma in a way that denies her the rite of passage from the archetypal Maiden to Mother. This trauma is potentially a barrier to her relationship with her physical body, mind, and sense of connection to the world around her. It can affect her parenting and, of course, ripples into the stories she shares with other women, thus perpetuating fear. This is the unrecognised and largely untreated blanket that drapes across the birthing culture of modern women. 

WHY MODERN WOMEN?

Because our ‘new normal’ lifestyle and the resultant landscape of neurological stress hormones set the scene for the encoding of this trauma. We know the World Health Organisation considers ‘stress’ the new epidemic of the 21st century, so it’s no surprise that as a midwife I see women moving through life like a high-speed freight train, almost until they’re ready to labour. However, the body requires the parasympathetic nervous system (you know, Rest, Digest, and Repair) to be reasonably available during the time of gestation in order to adequately grow a baby. We have inadvertently set an internal landscape of hormones from our brain to body through a lifetime of experiences that serve to shape our brain. The more marred our landscape, the more vulnerable we are to experiencing birth trauma.  We are wise to understand that this shaping feeds into our baby’s genetic coding. In utero we are building our baby’s body and brain. In a nutshell, a stressful pregnancy is like trying to pour concrete foundations onto quicksand. When the time comes for the house of birth and parenting to be built upon this ground, it’s already begun to sink. All, however, is not lost because later in this piece we will share how to prepare or repair your ground…

SINKING AND LINKING

The correlation between stress and poor pregnancy outcomes such as hypertension (high-blood pressure), gestational diabetes, pre-term labour, babies small for their gestational age, PND, and infection (to name a few) are significant. Our health system is underfunded and largely set up to treat disease rather than prevent it. For example, if PND affects fifteen percent of women3  (and I believe this is likely an underreported statistic), we must aim to increase resilience by addressing the shape of a woman’s neurological landscape prior to birth and reducing her likelihood of encoding birth as traumatic, leading to an experience such as PND. 

BIRTH TRAUMA MISCONCEPTIONS

Misconception #1: Type of birth correlates to likelihood of birth trauma

Our society can inadvertently assume that because a woman has had a normal vaginal birth, with little to no medical intervention, that she couldn’t/shouldn’t have birth trauma. Conversely, as a midwife and therapist I’ve had hundreds of conversations with health professionals who make assumptions that a woman, following a clinical emergency …

• “will be a mess” 
• “will need help debriefing” 
• “isn’t likely to feed her baby after that”, etc. 

There is some truth to that, but not always. We must understand that birth trauma is a subjective experience determined by the woman herself, and does not necessarily correlate with clinical outcomes of birth. Sometimes women have birth trauma when their birth has appeared clinically quite straightforward.

I recall a session with a woman whose midwife couldn’t make it to her planned homebirth. When the back-up arrived and suggested she conserve her energy by breathing rather than making so much noise, she was thrust into feeling alone, not good enough, and quickly rageful at the midwife’s expectation of her birthing expression. This affected the rest of her birth experience.  

Midway through our session, she realised this feeling (of alone, disempowered, and rage) first occurred following a sexual assault in her teens where she’d been told to ‘shut up’ whilst she called for help. By the end of our session she knew she was strong, powerful, able to navigate her world regardless of what she heard others say. She was looking forward to the birth of her second baby. Get this – she went on to have a very fast homebirth where the midwife didn’t have time to arrive and her husband caught the baby on the toilet floor. She later wrote to me that she felt elated.

Interestingly, I had a session with a woman the following week who’d had an unplanned homebirth. The baby was caught before midwife had time to arrive; however, the mother was traumatised. This demonstrates that the clinical outcomes don’t necessarily correlate to perception of trauma.

Misconception #2: Time heals all wounds

Although time can be a factor in any process of physical healing, the traumatic encoding of the brain is held in the unconscious mind, and this encoding has a way of bypassing the linear sense of time.  In many ways, the longer the trauma has existed, the more we have potentially created other behaviours due to neurological pathways linking to that trauma. 

Examples I have seen:

• Woman told by her salt-of-the-earth farming family that she just needs to get over it, so she doesn’t seek help and refuses to take medication. One year later her marriage breaks up. He says, “After the birth of our baby she wasn’t the same”.

• Fear of hospitals resulting from a birth “we didn’t want in a hospital”. 

• Anxiety around seeing another baby being fed in public, due to her own perception of whether she was able to feed her baby in the way she’d originally chosen. 

• Generalised mistrust for all health professionals due to a perception of mistreatment during labour.

• Woman becomes overly agitated and snaps back, “That’s none of your business!” when someone asks her, prior to a subsequent pregnancy, “Are you guys planning on having another one?” 

HOW DOES BIRTH TRAUMA AFFECT WOMEN?

This is further demonstrated by Sargent’s report4 on Birth Trauma in New Zealand (2015), following a study of 319 women. She suggests that approximately half of all respondents have some or all the following symptoms: 

• Fear of becoming pregnant again
• Depression
• Difficulty breastfeeding, or were unable to
• Mistrust of midwives and/or doctors and/or the maternity care system
• Difficulty bonding with baby, at least initially

FINDING YOUR WAY HOME TO WHOLENESS

If we were all queens of the world, we’d address this landscape prior to pregnancy; however, I mostly meet people who are pregnant in our workshop settings and consider our interactions preventative. As a result we receive constant feedback that our graduates experience positive births. 

CALM AND CONFIDENT 

As midwives and educators, we aim to set the scene for a calm and confident birth via Birth Skills workshops. We do so in part by addressing what causes stress, and how stress affects us physically, mentally, and emotionally.  We plant seeds by sharing positive birth stories and many ways to introduce mindfulness as a therapeutic intervention, while teaching specific skills that support pregnancy, labour, and birth. 

The intention is to begin to reshape the neurological landscape so that pregnancy benefits from a reasonably calm environment. When these practices and principles are employed, a woman and her whānau have a chance to bring a whole new nervous system to their birth journey. 

FAST PACED TO SLOW EMBRACED

When families begin to understand the journey from a fast-paced to a slow-embraced lifestyle, they can feel empowered to make changes, supported by WHY they must consider this essential to their whole health and wellbeing.

We include Neurolinguistic Programming +hypnosis-based audio files into their toolkit, because anxiety/fear/trauma are beyond the conscious mind, so we must be able to reach the unconscious to make changes. 

As a midwife who was taught to ‘debrief’ a client post-birth, I’ve never found talk therapies to be truly effective when dealing with real trauma. Most of my clients understand clearly why they are the way they are. They can rationalise all they like, but this doesn’t reach where the trauma is held, which is a space in the brain beyond rationale. In fact, trauma encoding bypasses any rational responsiveness. Hence, for some women, panic attacks that are seemingly unprovoked and symptoms that can appear unrelated were, in fact, triggered by something unconsciously related to their birthing experience.

Post-birth, in private trauma-release sessions, I consider the toolkit of psycho-sensory, body-based therapies alongside talk therapies, other complementary therapies, and hypnosis to be very valuable. Pre-birth, I consider mindfulness, slow movement practices, nutrition, and a gathering of knowledge that supports the neurological landscape towards calm and confidence to be preventative. 

May your pregnancy and birth journey be empowering, and may you cross the bridge from Maiden to Mother with strength and grace.

KeiShana is an entrepreneur whose path includes the co-creation of Opti-mum (Antenatal Education Programme) using a neurophysiology + mindfulness approach to the birth continuum. Supporting families as a midwife provides a wealth of experience observing and working with the powerful physiological and neurological pathways that inform perception and therefore behavioural response. KeiShana gets most lit up when seeing people traverse from anxiety or fear into calm and confident. She provides Birth Trauma Release sessions privately face to face or via Skype/Facetime.

Resources:

1. Ruden, Ronald A., When the Past Is Always Present: Emotional Traumatization, Causes and Cures. New York: Routledge, 2011.

2.   Robertson, Hon Grant, Budget 2019 Policy Statement, December 2018, https://www.budget.govt.nz/budget/pdfs/bps/bps-2019.pdf 

3.   https://depression.org.nz/is-it-depression-anxiety/depression/postnatal-depression/

4.   Sargent, Carla, Birth Trauma in New Zealand: Some Major Concerns, July 2015. http://static1.squarespace.com/static/54d7dbb0e4b0340f2fb95ab6/t/55c996f9e4b0d192035a735c/1439274758983/Birth+Trauma+Survey+Report+2015.pdf