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 planned to get and did get a timely epidural in labor?
Good question!
Chronic pain here, too, which is part of why I’m so adamant about why women need proper and effective pain relief during labour – it’s available and it WORKS! So why not use it? So many times, my chronic migraines cannot be relieved – why would anyone reject effective pain relief out of hand? Boggles the mind.
A horse stomping on your foot.
Yep!
I have chronic severe migraines. It’s terrifying when my meds can’t control it. That is when I feel the most “out of control”.
I bet Jordan’s god never gave birth, either.
Actually, a good part of my trauma came from being bullied into an epidural that I did not want (for various reasons, including a complete terror of paralysis), after a doctor who I can only assume was bored decided to “hurry things up” despite the baby being in no distress and me having no problems coping with labour. After fifteen hours of being tortured with syntocinon, and the baby having had at least eight potentially catastrophic decelerations, I ended up with an emergency Caesar for deep transverse arrest because the waters had been broken with the baby’s head in occiput transverse position. Quite frankly, you can take your ideas for interfering with birth and shove them.
You would have ended up with a C/Section anyway with a transverse arrest. I never buy the “I was bullied into an epidural, pitocin, C/Section” garbage either. After 15 years in L&D, I’ve seen pretty much everything and that is BS. You can take your “story” and shove it.
Hear, hear, Samantha!
I came into labor with a very (I think) reasonable approach. I wanted to try and have no epidural, but I would get one if it hurt really bad. So it went, “do you want an epidural, lady?” “no, I’m feeling fine for now… fine for now… still fine (I was actually surprised. I expected it to hurt much more). HOURS LATER – midwife, do you care to check how much I’m dilated? Because I don’t feel my contractions getting any stronger, and I’m a little tired, so if I haven’t progressed much perhaps I’ll get the epidural so I can rest a while.” “Oh, dear, you’re 9 cm dilated!” . Once I knew it won’t be much longer, I got a fresh energy boost.
I wasn’t a “rational creature” during labor, exactly, but not because of the pain. It was because I was entirely inner-focused on what was happening to me, and only dimly aware of what was going on around me. I feel labor is very aptly named, because for me it was exactly that: work. Hard work. It was not anything like dropping a heavy iron on my toe (yikes!). It was the feeling of incredibly intense work my muscles were doing deep inside my body. As long as I was allowed to freely move, I was fine.
Then it was time to push. I DID scream then, but not from pain. What I felt was indescribable pressure building inside of me, and an urge to push nobody could have stopped. I will tell you what WAS somewhat traumatic. With my second child, the pushing stage happened so quickly I just wasn’t prepared to handle it yet. *I* wasn’t pushing. My body was pushing, while I yelled.
You want to know what I yelled? It was the word “NO”. “NO”. If I had command of more articulate phrases just then, I would have said, “please make it slow down at least a little bit. I don’t want it to happen so fast, I’m not ready.” The entire pushing stage took about two minutes, literally.
I know this will sound enviable to women who pushed for hours and experienced, perhaps, various complications because of that, but I do wish I could have a little less intense pushing stage. It did make me lose control of my body entirely. For only 2 minutes, though.
Is it better to get an epidural next time to avoid that lack-of-control feeling? That will depend, of course, on the circumstances. I think that if I have what I had before – baby in good position, and myself in good shape – it will be no-epi again.
I have to disagree with you. The pain wasn’t why I am now suffereing from PTSD. The PPH, bleeding to death (I am lucky to be alive today) Thinking my baby was dead, being treated like a piece of meat, is what caused mine.
The doctor was very rough, She used a suction cup to try and get my daughter out, she pulled it so hard (without me having a contraction) that she literally and I kid you not, had one leg up on the end of the bed and the suction cup came off my daughters head and she flew across the room. I went white and thought my daughter had flown across the room as well. I will never forget that feeling, not ever. She then tried to use forceps but didn’t give me an episiotomy or any anestitic down there before she shoved a forcep in, i screamed so loud she had to remove it. In the end my daughter was delivered via ventousse. After three tris with different things, when she came out they took her straight away with her back turned to me, she didn’t make a noise. about 15-20 midwifes and doctors were in the room at that point, i begged to see my daughter i begged and pleaded for someone to tell me something but all i got was blank faces and no response. I understand that it was because I was dying right there but I wish some one would have just explained it to me. I also had the doctor with her arm up to her elbow inside my body (I had NO pain relief beside gas, so you can imagine how that felt) trying to get my placenta out as it hadn’t come out whole. I felt like I was a dead animal that they had to gut, they were horrible, I have never been treated so badly in my life. I felt like a ragdoll. I got rushed away, ran through the hospital with 5 nurses on each side of my bed running me to theatre, i looked up and saw there faces. I remember saying “Am I going to die?” Thats when I realised I was in trouble and how bad it was. I was put to sleep and so thankful to say I woke up 3 hours later when I got to meet my beautiful daughter. I didn’t bond with her for a few weeks. I was so disconnected and it lead me to feel like I wasn’t worth being a mother. I am happy to say she is now 1 on the 23rd of this month and she is so amazing. We have the best bond and I would go through it all again to have her here with me. I really couldn’t care less about the pain. Its about what happened to me. Epidural or not it still would have happened.
It makes so much sense why you would have developed classic PTSD after an experience like that! Both you and your daughter really did almost die. You are right- when the situation contains both severe pain AND near death experiences, it puts the pain in perspective because the very real fear that you will die is even worse. (But I do believe that women who only experience pain, without ever really being in danger might develop PTSD too, especially if they had preceding risk factors like previous trauma, and I don’t want to dismiss their experiences. For *these* women, an epidural might have prevented it all. For you, it couldn’t have.)
I do agree with you on that one. I would never dismiss another womens experience even if it was a natural, smooth delivery but they still had feelings of going through something traumatising. I think that all women are brave and amazing to be able to birth a child, and no matter how our babies came into the world we all should be proud of ourselves. Just for me personally, an epi would not have changed anything that happened. And I did try to get one but they wouldn’t let me. (natural birth advocates!)
I had an epidural and have suffering with PTSD for 21 years after a birth experience that no one seemed to think was abnormal. I died that day and now am just a shell of my formerly joyful and happy self.
Very sorry that happened to you.
Have you considered seeing a professional? PTSD untreated for this long, from ANY cause, isn’t good. You don’t have to suffer alone.
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.
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.
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.
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.