We Need to Talk about Birth Trauma

I’ve been seeing an interesting tension in the birth space on social media recently that I’d love a chance to talk about. On the one side, you have birth doulas and physiological birth advocates who believe, very strongly, that pregnant persons should be sheltered from all talk about traumatic births. On the other side, you have birth trauma survivors who argue that talking about birth trauma – including to people who are currently pregnant – is essential. The former argue that birth is a natural, beautiful process and that the fear that may be triggered by listening to others’ traumatic birth stories can set people up to experience challenges in their own labours that, perhaps, might have been avoided. The latter argue that not talking about birth trauma honestly sets people up for failure, in that if they experience it for themselves, they feel isolated, alone, and like their bodies have failed them. I’d like to talk about these two positions and what I see as a realistic, nuanced middle-ground space that we might occupy instead, and why I think it’s important to do so.

A person balances, walking across a fallen tree.

Birth trauma is an astonishingly common experience, with some reports suggesting its occurrence for up to 45% of birthing persons (Alcorn et al., 2010). While birth trauma can occur on a spectrum, from milder experiences of post-birth distress to diagnosable post-traumatic stress disorder (PTSD), ‘birth trauma’ is an umbrella term that describes the wide range of trauma symptoms that are present in birthing persons following their birth experiences (Birth Trauma Association, n.d.). There are many different experiences during one’s labour and birth that people may find traumatic, including but not limited to: medical interventions such as the use of forceps, very long or very short and intense labours, medical emergencies for the birthing person or the infant, and poor communication and/or neglect from health care providers – including inadequate informed consent practices prior to medical interventions of any kind (Birth Trauma Association, n.d.).

As a birth doula, I see a lot of conversations happening in doula spaces about birth trauma caused by health care providers, either through their failure to obtain consent for medical procedures, the use of unnecessary medical interventions in a birth that is otherwise progressing well, or their use of coercion to manipulate birthing persons in the choices they make. These are undoubtedly distressing experiences, and it makes sense why birth doulas focus on them so much – they are preventable. As birth doulas, we often work as buffers in the birthing room, helping to facilitate conversations between birthing persons and health care providers, using advocacy skills to avoid undesired and unnecessary interventions, and serving as a witness to whatever unfolds in a way that may encourage people to be on their best behaviour. This is an important part of what doulas do. But often, this is where the conversation around birth trauma – at least with our pregnant clients – seems to end. And, sadly, not all birth traumas are preventable. This is where this tension that I described at the start of this blog post comes in.

Many, though certainly not all, of the people who believe we shouldn’t ever talk to pregnant folks about traumatic births situate birth trauma as something that health care providers and the medical system are solely responsible for. And certainly, the over medicalization of birth is a worthwhile topic of discussion, particularly in those cases where trauma is caused by health care providers’ attitudes, coercion, or malpractice. For folks in this camp, the solution to birth trauma is a simple one – normalize birth as a natural, physiological process and have more homebirths. If that’s all there was to preventing birth trauma, we could leave the discussion there – people could have beautiful, unmedicated, supported homebirths and waltz into their parenting journeys feeling empowered. I’d love that for people. If this was possible for all birthing persons, then it would make sense that talking about these traumatic hospital births could instill unnecessary fear in birthing persons and, as doulas, we know that fear can contribute to a fear-tension-pain cycle in the birthing person’s body that may contribute to a more difficult labour and perhaps more medical intervention. That is a fair and reasonable concern.

However, there are certainly experiences that birthing people have that fall within the umbrella of ‘natural’ that can contribute to the experience of birth trauma. Precipitous labours that progress very, very quickly are within the scope of natural birth, yet may – because of their intensity and unpredictability – contribute to birth trauma. Births where the birthing person’s or baby’s life are at risk due to conditions like pre-eclampsia, amniotic fluid embolism, or cord prolapse are also ‘natural’ experiences that sometimes happen and that can be traumatic. When we equate what is ‘natural’ with what is ‘good,’ not only do we fail to acknowledge that there are plenty of natural phenomena (death, disease, tornados, earthquakes, etc.) that we would prefer to avoid as much as possible, we also situate those pregnant folks who require or choose medical intervention as having ‘bad,’ ‘unnatural’ births. And before people jump to conclusions, I’m not for an instant proposing that birth is inherently dangerous and I’m not a proponent of overmedicalization. I am, however, I realist who acknowledges that while nature is awe-inspiring and inspirational, she can also be a powerful force that sweeps us up in ways that we’d rather not get swept up. I would never propose that someone stand directly in the path of an oncoming tornado because it’s natural; it would make sense, if we foresaw that something was coming, that we would take reasonable precautions to avoid putting ourselves in harm’s way. That doesn’t mean that weather is innately dangerous and we all need to leave our houses each day in fear that things might turn nasty, but recognizing that such things do exist and we might have to change our behaviour if a storm comes is realistic. Likewise, birth is not innately dangerous, and I am in no way suggesting that it is wise or helpful for most pregnant persons to be living in fear of what could go wrong in their pregnancy. But pretending that birth trauma is solely caused by medical mismanagement and failing to acknowledge that sometimes natural processes aren’t inherently benevolent sets us all up to fail.

Picture of a dark, stormy sky and the funnel of a tornado touching down in a grassy, tree-lined field.

So why is it important to acknowledge this nuanced and complicated truth? First and foremost, I think it’s important to talk about this because there are many, many birthing people who deeply desire a ‘natural’, unmedicated, and empowering childbirth experience who do not end up having the experience that they wanted. As doulas, we hope to help support people in having the birth experiences they want by planning with them, advocating for the kind of care they want to receive, and supporting them with the tools we have at our disposal to make this more feasible. However, even when parents do everything “right” and doulas do everything “right,” there are sometimes situations that arise that aren’t under anyone’s control but require our plans to shift. When we promote an overly simplistic narrative that birth is natural and normal and that people’s bodies innately know what to do to birth their babies, this leaves very little room to acknowledge that sometimes bodies need help. This can leave people feeling like there is something wrong with their body and their birth if things didn’t go according to plan. It’s hard to imagine a scenario in which this doesn’t contribute to birth trauma – trauma that may seem like it is being caused by the medical interventions that were required but may in fact be largely due to the pressures and expectations that pregnant persons face to have particular kinds of ‘good’ births.

Secondly, this kind of narrative also does a disservice to the kinds of work that birth doulas do every day. Birth doulas’ role as witness to whatever unfolds is also valuable in birth traumas that aren’t preventable – providing comfort, acknowledgement, and debriefing to the birthing person so that their experience of trauma does not have to isolate them. Validation is not just important, it’s essential. Yes, we can plan and prepare for the kind of birth that people would like to have. It makes sense to do so. Our plans and preparations do make a difference in improving the experience that birthing people have. And also, we need birthing people to know that if things happen that are not under our control, that does not mean that their bodies have failed to do the ‘natural’ thing. Their bodies are nature doing natural things. And it’s okay to acknowledge when nature is doing something that isn’t in alignment with where we want to go. It’s okay to use the resources available to us to improve outcomes. And it’s also okay to feel grief, sadness, anger, disappointment, and any other ‘negative’ emotion when our hopes and plans get derailed. Birth doulas should be able to provide space for those feelings and most of the doulas I know do a wonderful job of exactly that.

It's complicated. Birth is complicated. Life is complicated. And it’s fair to ask the question: how do we talk to people about birth in ways that set them up for success? What does real success even look like? How do we make space for people to feel excited and empowered and truly ready for the transformative experience that is childbirth while also ensuring that they are adequately supported and held in the unknown? I wish I had all the answers lined up for you. I wish I had them even for myself. The work of a birth doula is itself transformational, asking us to grow and shift and evolve with each birth that we attend. For now, I am comfortable in this in between space: planning for and rejoicing in each sunny day while also being ready and able to act for the occasional, unexpected storm.

A photo of a rainbow in cloudy, grey skies, perched above pine trees. 

References:

Alcorn, K. L., O’Donovan, A., Patrick, J. C., Creedy, D., & Devilly, G. J. (2010). A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine, 40(11), 1849–1859. 10.1017/S0033291709992224

Birth Trauma Association. (n.d.). What is birth trauma? Retrieved September 17th, 2024 from https://www.birthtraumaassociation.org/what-is-birth-trauma.