safe motherhood

New Beginnings

Making Peace with your Birth Experience

Family Research Laboratory, University of New Hampshire

Angela dreamed of a natural, unmedicated birth. She was managing her labor well when suddenly the cord prolapsed. Her dream birth ended in an emergency cesarean under general anesthesia. Both mother and baby survived, and Angela is grateful for that. But she feels deeply sad that she wasn't awake to see her baby's entry into the world.

Sheila planned a home birth with her family all around her. Her labor was progressing well until her midwife could not detect a fetal heart beat. Sheila was whisked to the hospital in an ambulance, and delivered a healthy baby boy. She was able to deliver vaginally, but the fear that surrounded her delivery still lingers. She keeps replaying these events over and over in her mind.

Monique was in labor for 23 hours. When things weren't progressing, her labor was augmented with pitocin with no anesthesia. She was confined to her bed during her labor and in a lot of pain. When things still hadn't progressed, her doctor decided on a cesarean section. In talking about her birth later, she was so angry that no one helped with her pain, and everyone else made all the decisions for her.

Every woman's birth is unique. But after giving birth, many women share a sense of disappointment, anger or fear. And this may have happened to you. Despite your best efforts, your birth did not turn out the way you planned. You may have been frightened. You may be angry. You may think about your birth a lot. Fortunately, if you have had a troubling birth, there are some positive steps you can take to resolve your experience, and move on with your life.

What Makes a Birth Experience Difficult?

Some births seem really bad to outside observers, and yet mothers feel positively about them. Other mothers have births that seem "perfect" on paper, yet they are deeply troubled. What makes the difference?

We frequently define "good" and "bad" birth experiences in terms of objective characteristics: length of labor, use of pain medications, medical interventions, and type of delivery. There is an assumption underlying much of the research on birth experiences

that vaginal deliveries are usually positive, which is certainly not always the case, and that cesareans are usually negative (also not always the case).

When considering women's reactions to their births, I have found it more useful to consider the subjective characteristics. Psychologist Charles Figley describes these subjective aspects in his classic book Trauma and Its Wake. In looking at the whole range of traumatic events, he notes that an experience will be troubling to the extent that it is sudden, overwhelming and dangerous. Let's examine these in relation to birth.

Sudden: Did things happen quickly? Did it change from "fine" to dangerous is a short time? Did anyone have time to explain what was happening to you?

Overwhelming: Did you feel swept away by the hospital routine? Were you physically restrained? Did you feel disconnected from what was happening? Did you have general anesthetic?

Dangerous: Was your delivery a medical emergency? Did you develop a life-threatening complication? Was the baby in danger? Did you think you or your baby would die?

You can see that these three aspects can be present for vaginal or cesarean deliveries. In terms of understanding your reactions, the objective factors of your birth are less important than your subjective experience of it.

Your Relationships with Others

Not surprisingly, your birth experience can have an impact on your relationships with other people. You might be angry or disappointed that people who were there to support you weren't able to protect you. When you try to talk about your experience, others don't want you to. Kelly describes the reaction of her friends and family when she continued to be troubled about her birth.

Once you are past a certain amount of months postpartum, people don't want to talk about it anymore. It's like you have an ego problem or something. But I need to talk about it. It's been too important of an experience for me not to talk about it. It's changed my life.

Not being able to talk about your birth can compound your negative feelings. In the research literature on psychological trauma, this is known as "sanctuary trauma." Sanctuary trauma occurs when a person has experienced a traumatic event and turns to those whom he or she usually counts on for support. Instead of offering support that the person is expecting, these people either ignore or dismiss the issue, further contributing to a victim's sense of isolation and trauma.

Unfortunately, a difficult birth can also influence another important relationship: the one between you and your breastfeeding infant. Over the years, I've worked with several.