You are about to go through something really intense. And you’ll be at your most vulnerable while you do it. If it goes well it will be the most incredible and glorious thing you’ll ever accomplish. But, birth trauma could destroy the joy and awe you should have when you remember the birth of your child.

Birth trauma is something some birthing people experience during their births. They may not realise they’ve experienced trauma until days, weeks or months afterward. And birth trauma has a way to destroying a person’s normal mental and emotional resilience and leading to postpartum depression, anxiety, OCD, PTSD and psychosis.

How does birth trauma happen?

Trauma can grow from a number of situations during birth.

When the expectation is different from the reality.

One of the simplest ways birth trauma can happen is when the expectation or desire for a single kind of birth does not match what actually happens. Some examples of this are when a person believes taking a hypnobirthing course will make their birth easy and it is not easy after all, when a person only prepares themselves for an epidural but cannot get an epidural due to a fast birth or anesthesia staff that are working with other birthing people, or a person who believes medical interventions are bad but needs many interventions for a safe birth.

The wider the gap between the expectation and reality, the bigger the chance a person has of experiencing trauma.

When birth becomes high risk.

The best way to keep birth safe is to use medical interventions judiciously. When a baby shows signs of distress, midwives, doctors and nurses spring into action. It might be an otherwise normal birth that requires the use of a vacuum tool to help expedite delivery. Or, if a baby continues to show signs of stress no matter what steps doctors, nurses and midwives take and an expected vaginal delivery becomes a surgical birth.

Unexpected circumstances can destabilize and scare us leading to birth trauma.

When medical staff are disrespectful.

Disrespect is used here as a catch-all term. We’re including racism, ageism, sizeism, homophobia, transphobia, ableism and classism here. And “disrespect” is definitely a far more mild term than those things deserve. They are vile and dehumanizing.

We’re also including lying to clients about what is and is not a protocol (for instance, while you are recommended to only drink clear fluids when using certain medications, a coloured sports drink is still clear!). Disrespectful treatment also includes refusing to discuss recommendations, failing to ask for permission in non-urgent situations, speaking unkindly to clients, refusing to honour reasonable requests for tools or medicine or procedures, and belittling a client’s stated feelings, needs and desires.

How HFD helps reduce birth trauma?

Some clients hire doulas as a protective barrier between themselves and medical staff. We don’t recommend that. Doulas just do not have the clout nor the right to legally advocate for clients in that way. But we do help in other ways.

Your Hamilton Family Doulas team works well with the staff in the hospital. In many cases they have built relationships with midwives, doctors and nurses for well over a decade. When you have a professional support person from our team by your side they are respected by staff and that can reduce any potential friction that may arise.

We know what’s really going on behind the scenes. We know what protocols and rules are real and which may be made up. Your doula will help you understand where the wiggle room is within the rules and help you diplomatically advocate for yourself. And we also know why things are the way they are, such as why you may not be able to have an epidural as quickly as you want it.

Don’t understand what is happening, why it’s happening and what it could mean for you? That’s the doula’s sweet spot. We have plenty of time – we don’t need to rush off to assist with other patients – to explain and contextualize why your doctor or midwife may be recommending certain medical strategies. And it will be in simple language you can easily understand while under stress.

Your HFD doula will make sure you understand and fully participate in the decision making process. If there is any time when you struggle to fully process changes in your birth plan and preferences, we know how to get you a calm window to discuss what’s going on. You can then be more fully present for decision making instead of feeling pressured and overwhelmed.

The core strength of your doula is helping you cope. Working with you, through both physical and emotional support strategies, your doula will help reduce fear and that will greatly reduce your perception of your birth as traumatic. We’ve observed that when clients are calm through their birth they are more able to participate in their health care and those things help them feel they have some control in their birthing circumstances, even when labour and birth are not straightforward.

You will not be alone. Of course, you’ll never be totally alone during a hospital birth. Even when you do not have a partner or other support person with you, you will have a nurse who is dedicated to supporting you during active labour. However, if you have an epidural that nurse will not remain in the room with you continuously. Shift changes at 7am and 7pm will mean a new nurse, midwife and doctor. But, a doula remains. They will be with you continuously except for very short breaks, and they will remain with you until after your baby arrives and you and baby are settled.

What can you do if you experience birth trauma?

First, we want to say, if you have experienced birth trauma we are so incredibly sorry. We want you to remember the birth of your child with as much joy as possible. You deserve to be respected during and after your birth, plain and simple.

The first thing you should do is talk to a trusted individual about what you experienced. Your doula can be a compassionate witness to your story. They can also help you document what happened and prepare a letter with you.

Why a letter? Medical systems are very slow to change. They are huge institutions that thrive on routine. Giving feedback on mistreatment and your experience of birth trauma is the only way to change the culture of maternity care and the only way to help the personnel who caused the mistreatment to get the help they need to be better care providers.

You should send that letter, by mail, to the following (all of these parties, whichever are appropriate):

You can contact a trusted medical professional who is not directly connected to any experience of trauma. This could be your family doctor or your OB or midwife who were not in attendance at your birth. It is important to reach up to qualified professionals.

Finally, treatment is an absolute must. Birth trauma may not impede your life and may not have a negative impact on your postpartum recovery and parenting experience. There is, however, good evidence to show that birth trauma increases your risk of postpartum mood disorders. So, talk to someone who specializes in women’s health concerns, especially those connected to birth and postpartum.

On the whole, we see wonderful care provided by the nurses, midwives and obstetricians who practice in Hamilton, Ontario. We do not see widespread mistreatment of our clients, but it does happen. Knowing what birth trauma is and how to avoid it, where possible, can help you have a joyful and awe-inspiring birth experience.

This article was written by Leanne Palmerston. Leanne is a co-owner of Hamilton Family Doulas and has been a doula in Hamilton for over 14 years. She and her team are experts on providing compassionate, empowered support during pregnancy, birth and new parenting.