Birth trauma and the elephant in the room: PAIN!

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Midwives like Hannah Dahlen spend a lot of time discussing birth trauma, but remarkably never mention the elephant in the room: PAIN.

Pain is a known trigger for PTSD. Indeed, uncontrolled pain can be a core trauma.

Research shows that the prevalence of PTSD among injured survivors of stressful events is higher than that of survivors without physical injury, thus suggesting that secondary Stressors (e.g., severe uncontrolled pain, a prolonged state of acute anxiety, uncertainty regarding the immediate future, loss of control, and inability to monitor contact with the environment) may play an important role in the formation of PTSD.

Dr JaneMaree Maher explains the traumatizing effect of labor pain in her paper The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain:

By demonizing epidurals, midwives may be causing the birth trauma they are bemoaning.

… 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.

Furthermore:

… [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 …

Can you imagine discussing the the trauma of a limb amputation without mentioning the pain? How about discussing the trauma of severe burns without mentioning the pain? Ridiculous, right? So why are midwives bewailing birth trauma but refusing to discuss pain, the elephant in the room? Because midwives want to maintain and claw back turf lost to obstetricians and other providers and therefore demonize epidurals, the most effective form of relief for childbirth pain.

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

Coincidentally, another mainstream media article was published recently and may shed additional light on the apparently rising incidence of birth trauma: Almost 70,000 fewer women are given pain relief during childbirth compared to a decade ago, NHS figures show.

The number of women not given pain relief during childbirth has plummeted by 70,000 in a decade, figures show.

Mothers-to-be are often offered anaesthetic, pain-killing injections or gas and air to ease the agony of giving birth.

But a NHS Digital report revealed there was a six per cent drop in women who went into labour without these drugs between 2008/08 and 2018/19.

Here’s the part that had me rolling on the floor laughing so hard I could barely catch my breath:

Experts told MailOnline they were baffled as to why the change had occured …

It was suggested that it could be down to an increase in midwives providing care for women throughout their pregnancy, meaning their birth goes more smoothly.

Seriously? Have these “experts” forgotten the ill fated Royal College of Midwives “Campaign for Normal Birth”?, the Campaign that was abruptly shuttered in 2017. UK midwives relentlessly demonized epidurals, and — worse — interfered with women getting them, telling women they didn’t “need” them.

The Campaign for Normal Birth deliberately subjected women to agonizing pain, compounding that pain by refusing to give women control over how and if they experienced it.

And as for births going “more smoothly” with midwifery care, the Campaign for Normal Birth was ended because it led to a rash of preventable DEATHS. That’s hardly smooth care.

There’s one thing that I have noticed as common to stories of birth trauma; few 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 that involved a woman who planned on getting and got an epidural in a timely fashion. It must happen, but it’s not common.

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, particularly important if an unanticipated complication arises.

The decrease in epidural use in labor suggests that midwives — in a bitter irony —may be causing the very complication that they are bemoaning. By insisting that relieving labor pain is a moral weakness and a danger to the baby (both of which are completely untrue), they deprive women of relief and increase the risk that women will develop birth trauma. Pain is the elephant in the room and midwives need to face up to it.

  • no longer drinking the koolaid

    The difference between pain and suffering. Pain can be tolerated, suffering needs to be dealt with. The difference is how the woman views it and how she wishes to deal with it.
    Pain, when woman are not respected for their choices to manage it, becomes suffering

    • Who?

      This is a perfect explanation. Communication and recognition is key.

  • Alia

    Now imagine that in Poland most women do not get an epidural during birth – the numbers are in the 5-10% range. In theory, every woman has a right to request an epidural and the problem is not with midwives – the problem is with lack of doctors qualified to administer an epidural. In addition, about 60% of women still get an episiotomy and there are no maternal request c-sections (c-sections are limited to medical reasons only).
    What is the result – a lot of pregnant women go to a sympathetic psychiatrist and get a certificate that they suffer from tocophobia (fear of giving birth) – which is a valid medical reason for scheduled c-section.

  • Glia

    I credit my epidural with my second baby as a really important part of why the birth was not traumatic to me. It was scary in some parts, for sure, but the fact that when the shit started to get alarmingly close to the fan, I was in a headspace where I could be alert, rational, and capable of making good decisions for myself and my baby, made a huge difference in how upsetting the whole thing was. I think if I had been in the somatic, pain-focused mindset I was in pre-epidural, not able to really understand the details except that something was going wrong with the baby, it would have been awful.

  • rational thinker

    I would say denying a woman in labor an epidural is ignorance at best and pure sadism at worst.

  • mabelcruet

    “The Campaign for Normal Birth deliberately subjected women to agonizing pain, compounding that pain by refusing to give women control over how and if they experienced it”

    The way the RCM deals with pain in childbirth is deny that it is pain and relabel it ‘power surges’, ‘pressure-waves’, or ‘strong contractions’ as opposed to ‘painful contractions’ (according to this paper here: https://blogs.bmj.com/bmj/2018/02/08/humanising-birth-does-the-language-we-use-matter/

    By denying that genuine pain occurs during birth, they don’t have to ‘medicalise’ birth by offering pain relief. The language we use around birth matters. What matters is that we pay attention to the language that the woman herself uses-if she says her contractions are painful, then denying her experience and perception and telling her ‘it’s not pain, its a power surge’, is patronising, undermining, disrespectful and unethical. The RCM and its socially active midwives are very fond of prattling on about how we are scaring women by spreading exaggerated stories about how there is such awful pain during delivery. What is scaring women the most is the thought that any pain they have will be dismissed, belittled and untreated, and I see absolutely nothing online in the commentaries of social media midwives and their fangirls to reassure me that they are willing to engage with women to address this.

    • The Bofa on the Sofa

      The way the RCM deals with pain in childbirth is deny that it is pain and relabel it ‘power surges’, ‘pressure-waves’, or ‘strong contractions’ as opposed to ‘painful contractions’

      3000 years ago, the pain of childbirth was so severe that it was attributed to being a punishment from God.

      “surges” my ass

  • nata

    I have read at least two stories about epidural being traumatic. One was related to a mistake by anaesthetist and dural tab, another was caused by frightening sensation of numbness in the legs. None of delivery methods are a panacea from a possibility of birth trauma. Effective communication and skilled care seem to be essential.

    • I wouldn’t argue with that, but epidurals are very safe and effective pain relief. I feel helpless and undignified when in pain, and the epidural gave me back agency and dignity.

    • MovingOn

      Mine wore off somehow during my c-section. I’m definitely not the only person I know this has happened to, and so far I’ve never really gotten an explanation.

      Though my epidural was certainly not placed correctly to begin with, I just didn’t worry about it because it *did* work until my baby was out.

    • fiftyfifty1

      Yep. Women need access to epidurals AND great communication.

    • I agree with this. I have a friend who just gave birth and had a pretty bad experience with the epidural. I don’t know if it rose to the level of traumatic, but it made her incredibly itchy and she had some other complications with it, and she still felt pain. She said next time she will probably try without it. I’ve heard other stories of epidurals not taking or only working on one side or causing a spinal headache. I get that the natural birth crowd likes to play up those stories and overstate the risks, but I definitely think epidural births can be traumatic too.

  • Gene

    I’ve got to say I’ve been through three vaginal deliveries. The first, the epidural worked only on my left side. Ouch. The second, the epidural didn’t work at all. He was 5kg/11lbs and it was the worst pain I’ve ever experienced. My third (and last) was the only successful epidural. I had a completely pain free delivery and I have to say, it was hands down amazing! I don’t understand the thought process that a painful delivery is somehow better.

  • fiftyfifty1

    So a woman has excruciating pain and screams and begs for pain relief. Either she is 1) denied it or 2) given it but made to believe that it harmed her baby and proved she was morally deficient.

    How are either of these scenarios not abuse?

  • fiftyfifty1

    Yeah, if pain weren’t traumatic, why would evil regimes use it to torture people?