Studies are showing 25%-35% of women within the United States are reporting that their births were traumatic. This indicates that approximately 1 in 4 women report their birth as traumatic. That is 1,400,000 women a year in the United States are suffering with trauma symptoms after childbirth. Between 1.5% and 9% of those women develop the full blown symptoms of Post Traumatic Stress Disorder or PTSD. That is somewhere between 60,000 -360,000 American women who develop PTSD after childbirth. Between 1.5% and 3% of women who experienced a ‘normal’ ‘non-traumatic looking’ birth develop Post Traumatic Stress Affects which a milder form of PTSD. 3.2% women who get PTSD symptoms after childbirth that do not have any history of mental health and do not fall into any high risk categories for developing PTSD. To differentiate even further, there is a real difference between PTSD and Postpartum Depression. Treatments are different. PTSD is an extreme form of anxiety disorder and treatments for Postpartum Depression are not successful for PTSD.
A Traumatic birth is a birth or an event where the individual believes that her life or her baby’s was in danger. Trauma is in the eye of the beholder; meaning that no matter what the outside perception is around the trauma if a woman feels she was traumatized than it is a real event. Some of the feelings that contribute to a traumatic experience are: feelings of helplessness, feeling out of control, alone, and un-supported.
Some of the risk factors for PTSD development after child birth are: unresolved trauma from the past, pre-existing PTSD, history of depression or anxiety, current depression or anxiety, history of sexual trauma, a severe fear of childbirth, being an immigrant or new comer to the country where she is unfamiliar with the cultural practices present within the hospital, being of low socio-economic status. All these factors are associated with negative birth experiences.
Some things the doula might be able to pick up on that might indicate a woman is at risk for developing PTSD after childbirth are: unexpected medical problems, emergency C-section, instrumental delivery, if the baby has to go to the NICU, mal-positioned baby, long labor, poorly controlled pain, overwhelmed by pain, lack of control over herself or feeling the events of labor are out of her control, poor support from her partner, poor interactions with the staff, feeling powerless or alone, if she had expectations that were not met, if she disassociated or panics during labor, extreme anger or emotions, regression, mental defeat (giving up participation of the birth), overwhelming fear of death. Some of the repercussions around a traumatic birth are increased negative dynamics between parents, rejection of the baby, affect on bonding with the baby, overly anxious around the baby, severe depression, intrusive thoughts, nightmares, extreme anxiety, flashbacks. Symptoms of PTSD may be delayed due to the euphoria of birth.
What a Doula can do to support a woman who has a traumatic birth?
She can keep calm, be honest with the mother. Don’t lead her along a garden path if the situation is serious. Doulas can use their words to help her find a place to focus. Saying things like, ‘we need you’, ‘I just want you to focus on one thing’, ‘just focus on finding a rhythm, only’, ‘just focus on the breath’. Doulas might be able to identify scenarios early enough and may be able to take steps before the mother gets emotionally overwhelmed. Acknowledgement after the birth ‘this was a really difficult labor you might want to talk about it’. We can acknowledge and recognize the difficulties of a difficult birth, while opening dialogue with the mother in the days and weeks after the birth. One of the most important jobs of a doula is to reflect and protect the mother’s experience of birth. We can help her put her experience into words, coherence and understanding through listening. We can ask the mother what she needs around her experience. It can be very helpful for any woman to square up her inner experiences with her outer experiences around birth. Doulas can help this by listening. Encouraging chart review can also help with trauma resolution and doulas can remind her of this option as a part of the healing process. When a woman is not clear, sometimes they can work it out through their hands by doing painting and artwork. Processing the story around birth can reduce symptoms of PTSD which is a big part of our role as doula. Processing may prevent a mood disorder and help the woman feel more positive. As her doula we can share with her something that impressed us about her birth. If the PTSD is very severe a doula can help her gather other resources in the community and help her to select the right kind of trauma therapist.
Postpartum Doulas can be very helpful after a traumatic birth. They can ask open ended questions about the birth and give space for the mother to tell her story and express her feelings around the birth. Support around getting enough sleep and eating well. Exercise can also be a helpful tool when dealing with trauma.
Best of all, having that continuous emotional and physical support that only a doula offers in labor and delivery may create a space for the woman, so that she may not feel so alone and unsupported if things become overwhelming. Some studies do show that continuous emotional support lessens the incidents of PTSD.
A doula’s job is important for the birthing process in general but it is especially important to women who may have traumatic birth. As a doula it is important to also get support. If the doula has any kind of unresolved trauma it can sometimes come up during birth. It is important to get support around our own stories and experiences around trauma. As doulas we may absorb the trauma around birth for a woman so that they do not have to. Sometimes a doula will support a traumatic birth but the mother is completely happy with her birth, even if there was medical trauma. Continuous emotional and physical support during a traumatic birth may take a toll on the doula while sparing the woman for PTSD. Our job is to nurture and protect her memory of the birth. Adequate support for the doula and de-briefing with a psychotherapist or other trusted doulas in the community are an important part of our process of supporting birth.