Prevent birth trauma: get an epidural

In natural childbirth circles there are endless tales of birth trauma that occur in hospitals. Indeed, there are cases where women claim they are suffering from PTSD and even women who really are suffering from PTSD. Natural childbirth advocates like to claim that birth trauma is the result of a lack of supportive, respectful care and lack of feeling in control, but I suspect that there is something else entirely that is to blame: PAIN.

There is one thing that I have noticed in all these stories; none of the women had epidurals except as a last resort or for C-sections. Moreover, I’ve never read or heard of a story of birth trauma or PTSD (real or otherwise) that involved a woman who planned on getting and got an epidural in a timely fashion.

It’s not surprising when you think about it. Let’s look at post traumatic stress disorder (PTSD), the most severe form of birth trauma. What is the cause of PTSD? According to pyschiatrist Roxanne Dryden-Edwards, MD:

Posttraumatic stress disorder (PTSD) is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal)…

Virtually any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict.

A lack of respectful care or even a lack of feeling in control does not fit that those criteria, but severe pain and overwhelming fear certainly do.

Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia explains the effect of labor pain in her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain:

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged. This is due, in part, to our inability to understand and talk about pain.

As she explains:

… [W]hen we are in pain, we are not selves who can approximate rationality and control; we are other and untidy and fragmented. When women give birth, they are physically distant from the sense of control over the body that Western discourses of selfhood make central …

So epidurals, as the most effective form of pain relief, give women control over their own bodies and control over the way in which they behave. This allows women to represent themselves to others in the ways in which they wish to be seen, instead of pushing them into a “non-rational” space.

In other words, it is the excruciating pain that is traumatic, not simply because of the agony, but because being in agony makes it almost impossible to advocate for oneself, to make important decisions, and to exert control over your care.

Imagine if labor were painless, or nearly so. Would it be as traumatic? Would it render women unable to advocate for themselves or exert control over their care? Of course not. A woman who is not in excruciating pain can have reasoned discussions with her providers about her preferences, which is particularly if  an unanticipated complication arises.

Natural childbirth advocates are not entirely wrong in pointing out that a lack of supportive care and a lack of feeling in control contribute to birth trauma and PTSD, but they are looking at downstream effects of the real problem, pain. The support is needed to cope with the pain; the feeling of not being in control is because of the pain.

Ironically, natural childbirth advocates are actually promoting the very complication that they claim to prevent. By insisting that relieving labor pain is a moral weakness and a danger to the baby (both of which are completely untrue), they encourage women to forgo relief of the excruciating pain and increase the risk that women will develop birth trauma and PTSD.

These are just my observations, but I’d be curious to hear of the experiences of others, both personally and of people you have known and read about. Has anyone ever heard of a case of PTSD after childbirth that occurred in a woman who plan to get an did get a timely epidural in labor?

  • Rigi Vbac Saunders

    I requested an epidural if I were to be induced or augmented; I kept requesting and being denied by all including midwife, male student ob and female ob. I feel my PTSD was caused from fear for my child and my own life and the fear of the unknown. I’m having trouble confirming my suspicion on possible HELLP syndrome as well as to much amniotic fluid – the ob’s insistence in the actions she took indicate she suspected HELLP but I was never consulted about risks.
    My other part of my PTSD is from having to argue about anesthesia before surgery followed by two other events. 1 the anesthesiologist telling me he’d under dosed me as he didn’t put the whole amount in. 2 moments after my son’s birth the anethesia peeked and I couldn’t breath without concentration.

  • swissmom

    I’m just so happy to read your article. I thought i was the only one who had symptoms of PTSD after giving birth and i experienced excruciating pain during both my child births before i got an epidural (too late unfortunately, although i entered the hospital the second time and said from the beginning that i wanted one). I was screaming an begging in pain and it felt horrible, completely loosing your dignity. So i’m most grateful to read that it’s not me that’s wrong, but the pain that is just excruciating. Thank you ever so much.

  • ngozi

    All I can say is that I have given birth 5 times and have never had an epidural. I am about to give birth again, and don’t plan to have one, but wouldn’t rule it out. I had some experiences during labor that I didn’t like, but I don’t think they had anything to with having or not having an epidural. Only exception is when the nurse yelled at me for not getting an epidural. I was shocked by her behavior.

  • ptsdmom

    What an ignorant article! Having an epidural does not protect a woman from birth trauma. I had an epidural (planned all along) but have PTSD due to birth trauma. Eight months later I am still dealing with it. My epidural was wonderful when it worked. Then it failed, and I was forced against my will to give birth with no pain control at all. Staff refused to ‘fix it’. I had faith in my epidural, had been told that it would give full pain relief and all I would feel was ‘some pressure’. No one ever told me there was the possibility of it failing and not being corrected. No one ever told me that the epidural would not in fact cover the pain of transition and delivery. While I do not understand why anyone would choose ‘natural’ childbirth, putting blind faith in an epidural like I did causes trauma.

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