The process of healing (1) generally proceeds in three stages:
Stage 1: Remembering the birth and reconstructing it mentally
This can be difficult and can take many months and some times years. Remembering, at least at the beginning, often makes the mother feel worse. But remembering what happened and being able to share it with trusted others or express it in some other way (in writing or painting), is one of the most powerful ways to recover. By re-associating the traumatic memories with an environment of safety, the sense of terror and panic they bring about will gradually lessen. Psychological counseling including therapies such as imagery re-scripting can aid this process (see Online resources for counseling in Vancouver).
The initial memories of a traumatic birth are likely to be fragmented and disconnected. Frightening feelings and images of the birth may be remembered with no time or context attached to them. It may be difficult, if not impossible, to remember the sequence in which they happened and there may be huge unaccounted gaps of time between them. This is normal and is how all traumatic memories work (2, 3). The process of trying to connect these memories, fill in the gaps, and mentally construct a coherent story of what happened is healing in and of itself. Although each newly recovered element or connection may temporarily raise the levels of anxiety and stress, in a few days or weeks the anxiety and stress will subside and a slightly improved coherence of the birth story will be achieved.
One of the biggest sources of help in mentally reconstructing the events of the birth is hospital records. These records are usually very detailed and for the most part accurate, but can be difficult to read due to excessive use of abbreviations and obscure medical terminology. Help with reading these records is readily available from other women who have gone through birth trauma and are further along the recovery process (see Connect). It is important for the mother to obtain these records (see Online resources section for links on how to do that) as soon as possible after she realizes she may need them to help her remember what happened. Some hospitals destroy these records few years after the birth and then this powerful memory aid for traumatized mothers is lost irreversibly.
Talking to trusted others (e.g., birth partners, doulas) who were present during the traumatic birth can also be very helpful. Any other methods of prompting one's memories (objects used at the hospital, photographs) can also be used. The most important thing is to allow as much time as necessary for this stage of recovery and to keep in mind that remembering and reconstructing the events of a traumatic birth takes a huge toll on the mother’s emotions. To succeed with this slow, incremental and often painful reconstructive process the traumatized mother needs a lot of determination, patience, and deeply supportive personal interactions with other trusted, understanding individuals.
Stage 2. Feeling the feelings associated with the birth
To heal completely, trauma must be reconstructed not only on the mental level, but on the emotional level as well. First, the feelings generated by the trauma that were not felt at the time of birth need to be identified. And second, these feelings must be experienced, at least in part, on a gut level. This can be difficult and the feelings may get worse, before they get better. But only by experiencing and letting them into awareness will the mother become free of their all-consuming presence in her life. The goal is to find balance, a point where the feelings are neither suppressed nor all-consuming.
One of the ways to find this balance is to face the feelings at times when the mother feels strong enough, but to also take breaks from the feelings when needed (4). It is natural to want to move through the healing process as fast as possible; after all, who wants to be in pain for the rest of their life? But dealing with trauma in manageable doses may be the only way to prevent the flood of original feelings that can be as traumatizing, or even more traumatizing than the traumatic birth itself. Also, expressing feelings (verbally, artistically, or through physical action such as dance or exercise) allows them to be accepted more easily and will eventually diminish their charge and intensity.
One of the most common feelings associated with trauma is fear. In fact, fear for one's own life or a loved one's life is one of the defining aspects of a traumatic event. Mothers are often made to fear their baby's life during the birth, and it is only natural to fear for one's own life during major risk-associated procedures such as emergency C-section or the administration of epidural analgesia. Unfortunately, health care practitioners do little to dispel this fear. Instead, much too often, they use it in order to render the mother compliant with hospital protocols.
In the aftermath of trauma, fear can be continuously present. The mother may feel a persistent sense of fear that does not seem clearly related to the present. It may also seem unrelated to any particular memory or traumatic event. Unless the mother identifies the origin and source of this fear and understands for herself how the traumatic events during the birth came about, the fear will probably remain nebulous and undifferentiated, causing her a sense of constant anxiety and vigilance.
Another common emotion is anger. Anger at what happened and the suffering it caused is one of the most natural reactions to trauma. But many people fear anger and women, in particular, often "forbid" themselves to feel anger because it is generally not acceptable in our society for women to be angry. Needless to say, suppressing anger does not make it go away but only makes it stronger. Women traumatized by childbirth often turn this anger towards themselves, blaming themselves for not being able to prevent what happened or for not being able to protect their child from the traumatic birth. Anger turned towards oneself is, of course, the stuff depression is made of, and not surprisingly many mothers do end up developing depression and being diagnosed with post-partum depression, without being aware of how that depression came about and of its possible connection to trauma and anger. It is important for traumatized women to connect with other women and to realize that it is circumstances beyond their control (e.g., the over-powering medical system) that are responsible for their trauma, and that objectively speaking, there is not much they could have done to prevent it.
At times, a traumatized mother may turn her anger towards her own baby. This is one of the most frightening emotions a mother can experience, frightening for the mother first and foremost. Mothers are often reluctant to acknowledge or tell anyone about this anger for fear that their baby would be taken away. It is important to remember, however, that feeling anger is very different from taking aggressive action to hurt the baby; in fact, the more aware a mother is of her anger, the better able she will be to prevent this anger from affecting her behavior and attitude towards her baby. After all, such anger is only a natural response; the baby serves as a constant reminder to the mother of what happened and it is the baby's wellbeing that health care practitioners give to mothers as the most frequent explanation of why she had to go through trauma. If the mother believes these explanations, it is inevitable that she would feel some degree of anger towards her baby for putting her through trauma. But such explanations may or may not be truthful. Health care practitioners rarely admit to making errors and would never explain to the mother that they did unnecessary interventions that eventually led to, or significantly contributed to her trauma. So it's important for the mother to seek her own truth and explanation for what happened.
Another major emotion after birth trauma is grief. It is also a natural, necessary response to trauma, because trauma inevitably involves a big loss. The grief needs to be experienced at a deep, profound level, in order for it to eventually subside and allow the mother to move beyond it.
All emotions serve an important function: they tell us what action we should take. Fear makes us run away from whatever is threatening our existence; anger makes us want to fight against an aggreessor. By letting herself experience any feelings she has, the traumatized mother will be better able to understand their sources and will be able to take an active role in her own life through actions motivated by these emotions. It is only through such action and understanding that she will eventually become freer from the overwhelming and life-consuming trauma-related feelings.
Stage 3. Achieving empowerment
This is the process of finding meaning in the traumatic birth and developing a survivor rather than a victim mentality. Achieving any degree of recovery, as slow or as partial as it may be, is hugely empowering in and of itself. It is easy to neglect the progress that has been made and, instead, look at what remains to be done until "full recovery" is reached. There is no such thing as "full recovery" in the sense that the traumatic experience will always be part of the mother's past. At the beginning, it may seem as though the traumatic birth defines her and her existence, but as the healing process progresses, she will eventually be able to look back at it as part of her personal history – that is, as one of the things that happened to her, alongside others.
Harnessing one's rage about the traumatic birth is empowering too. The mother is entitled to feel rage at whatever pain, injustices or abuse she may have suffered during her traumatic birth. She can use this rage as an energy mobilizing her to do something to change the societal or medical system that contributed or led to her own birth trauma and to try to help other women recover from their own birth traumas. Many women start working as doulas after going through a traumatic birth, in an attempt to help other women avoid going through the same kind of trauma.
Any action the mother takes is empowering because it counteracts the sense of helplessness that was part of her trauma in the first place. By definition, during trauma a person is rendered helpless and becomes immobilized in a "freeze" response. By helping others, or oneself, to achieve recovery, the traumatized mother can successfully counteract the sense of helplessness and immobility left over from the traumatic birth.
A sense of empowerment also comes from doing things we have mastery in. By returning to activities that she is good at, be that professional activities or gardening, the traumatized mother will make further progress towards recovery, especially if she can combine her skills with action towards helping others avoid the trauma she had to go through.
A sense of empowerment will also be achieved by accepting the psychological and physical scars of the traumatic birth trauma. As much as they are reminder of the trauma the mother went through, they are also a reminder that this trauma did not kill her; she survived it.
There are many ways to deal with trauma. Finding the way that works best for each individual mother and trusting herself rather than others who may advise her on "better" ways, is part of the process of her empowerment. She must be able to control every aspect of her recovery and to get back in control of her life and environment. She must also arrive at her own explanation of how and why the trauma occurred, and trust her own explanation more than any other, regardless of what authority the other accounts may claim. She may or may not choose to confront the people who were responsible for the trauma, pursue lawsuits or file formal hospital complaints. Whatever she chooses to do, the fact that it was her choice and she decided on this without succumbing to pressure or guilt from others will counteract the powerlessness that was forced on her during the traumatic birth.
The healing process
The stages of healing tend to be progressive. For example, feeling the feelings (Stage 2) will be more intense and meaningful if the mother remembers some or most of what happened during the birth, than if her memory is hazy. But the healing stages do not always flow in a neat progression. For example, women may find empowerment and mastery without recalling the traumatic event. Similarly, a recovering mother may already be in the mastery stage (Stage 3), when suddenly she remembers a highly significant aspect of the birth that changes almost everything she previously thought or felt about it. Much to her surprise, the new revelation may put her back in the role of a helpless, hopeless victim.
It's important to remember that the process of recovery from trauma is a lengthy one and highly unique to each individual. Every woman needs to deal with the consequences of her negative childbirth experience in a way that works for her. She must control every aspect of her recovery. She needs to somehow get back in control of her own life and to be able to feel safe again in her environment.
Before the healing process can begin
There are enormous societal pressures on women to be happy with their birth experience and to put the baby's health and needs before their own. Many new mothers with clinical symptoms of PTSD frequently disregard their own symptoms and are reluctant to admit to a negative birth experience (5) . When they talk about their birth, they often have difficulty discussing its negative aspects and feel that it's necessary to follow each negative comment with assurance that they were happy to have a healthy baby.
Overcoming these societal pressures and admitting to the reality of one's traumatic birth experience is the first step on the road to recovery.
It is also tempting to avoid dealing with the trauma and try to just "move on" and forget about it. In fact, this is the most frequent advice the traumatized mother is likely to receive by well-meaning but poorly informed relatives, friends and health-care providers, who may become impatient and even angry with her for "dwelling on the past too much". But there is no way to begin the healing process without thinking about the trauma (6) . And without healing, the trauma will remain unresolved, which can be devastating. Unresolved trauma can lead to depression and addictions. It can take a big toll on family life and interpersonal relationships. It can trigger real physical pain, symptoms, and disease. And it can lead to a range of self-destructive behaviors.
Only when the mother has acknowledged her traumatic birth experience will she be ready to start on the road to recovery.
1. Matsakis, A., I Can't Get Over It: A Handbook for Trauma Survivors. 2nd ed. 1996, Oakland, CA: New Harbinger Publications, Inc.
2. van der Hart, O., et al., The treatment of traumatic memories: Synthesis, realization, and integration. Dissociation, 1993. 6(2/3): p. 162-180.
3. van der Kolk, B.A. and R. Fisler, Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. Journal of Traumatic Stress, 1995. 8(4): p. 505-525.
4. Madsen, L., Rebounding From Childbirth: Toward Emotional Recovery. 1994, Westport, Connecticut: Bergin & Garvey.
5. Soet, J., G. Brack, and C. DiIorio, Prevalence and predictors of women's experience of psychological trauma during childbirth. Birth, 2003. 30(1): p. 36-46.
6. Levine, P.A., Waking the Tiger: Healing Trauma. The Innate Capacity to Transform Overwhelming Experiences. 1997, Berkeley, California: North Atlantic Books.