Birth Crisis

Sheila Kitzinger

• Publisher: Routledge
• Year: 2006
• Print ISBN: 9780415372657
• eBook ISBN: 9781134193028
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

One new mother in twenty is diagnosed with traumatic stress after childbirth. In Birth Crisis Sheila Kitzinger explores the disempowerment and anxiety experienced by these women. Key topics discussed include:

• increasing intervention in pregnancy
• the shift in emphasis from relationships to technology in childbirth
• how family, friends and professional caregivers can reach out to traumatized mothers
• how women can work through stress to understand themselves more deeply and grow in emotional maturity
• how care and the medical system needs to be changed.

Birth Crisis draws on mothers' voices and real-life experiences to explore the suffering after childbirth which has, until now, been brushed under the carpet. It is a fascinating and useful resource for student and practising midwives, all health professionals, and women and their families who want to learn how to overcome a traumatic birth.

1 BIRTH SHOCK

I LOOKED FORWARD to childbirth and though I felt a kind of stage fright before the first birth, I was never really anxious. I enjoyed giving birth. But then, all my babies were born at home, and I had one-to-one midwife care.

For many women it isn’t like that. Research shows that one in every twenty new mothers is diagnosed with traumatic stress after childbirth.¹,² Many others suffer but feel that doctors won’t be able to help them, so they either don’t tell their General Practitioner (GP), or seek help from a doctor but never get any medical diagnosis, or are mistakenly diagnosed as clinically depressed. Immediately after birth they are stunned, relieved that their ordeal is over. They may even be euphoric and thank the obstetrician who, they are told, rescued the baby from disaster. But after a few weeks or months this is followed by inner turmoil, with flashbacks, nightmares and panic attacks.

Many women avoid getting pregnant again because they can’t face going through the same ordeal. Then panic subsides with time, and they think they have come to terms with the experience. They start another pregnancy, and after a few months it all comes rushing back and they are in a state of terror.

The next birth may be only weeks away. Why is birth traumatic? It is not only a matter of pain. Women are traumatised by being treated like machines that are at constant risk of breaking down. They are traumatised by feeling that they are sucked into a medical system that deprives them of any control over what is happening to them.

In northern industrial countries – and increasingly all over the world – our culture of birth is heavily medicalised. On TV, birth is presented as a medical event that is safe only in the hands of doctors, and if women obey the doctors, everything turns out all right. Those who ask questions or opt for home birth are setting themselves up for a medical emergency.

We also have to deal with a stereotyped and romanticised image of new motherhood. Think of the photographs of shining, starryeyed women cradling their beautiful (usually sleeping) babies. How many of us really feel like that? And even if there are wonderful moments, what about the times in between? A woman who is distressed often thinks she must keep it a dark secret. No one wants to hear about her feelings of panic and failure. She believes she is different from all other mothers. They are coping. She is not. Look at the photographs of pop stars and ‘celebs’ who zip into shape and glisten with success within weeks of having an elective Caesarean. Why can’t she be like them? What is wrong with her?

If she goes to her doctor, she may be told she is depressed and prescribed anti-depressants. But this is different from depression. Someone who is depressed wakes in the morning feeling unable to face the day. There is a terrible lethargy. Yet this woman is tense and anxious – constantly on ‘red alert’. She is suffering from posttraumatic stress.

In the First World War the diagnosis was ‘shell shock’. Veterans of the Vietnam War were first diagnosed as having post-traumatic stress disorder (PTSD) after being in situations where they were helpless and trapped. They had no physical injuries, but they were emotionally damaged. Soldiers on both sides of the conflict went through this, as have many others in wars since then. It can be the same for women after childbirth. It is a normal reaction to insensitive care when a woman has no choices and no means of escape.

In professional journals – psychiatric, medical, midwifery, for example – distress after birth is often discussed as a disease that strikes women who are especially vulnerable because of a preexisting mental state. Their unhappiness has psychiatric labels stuck on it, and suffering is medically framed and individualised as an illness to be treated without any reference to the social context in which it occurs. One psychiatrist has pointed out that:

Any psychiatric diagnosis is primarily a way of seeing, a style of reasoning, and (in compensation suits or other claims) a means of persuasion... The medicalisation of life... tends to mean that distress is relocated from the social arena to the clinical arena.³

When this happens, the way women are treated in childbirth, the failure of the maternity services to give humane care, can be ignored.

I have heard from so many women going through emotional trauma after birth that I set up and run a Birth Crisis Network, a phone line for women who need to talk about their fear of birth and their experiences of unhappy birth. I have learned that the important thing is to listen rather than give advice. This enables them gradually to find the power within themselves to deal with the trauma. They may say, ‘You are the first person I have told.’

As we have seen, a GP may dismiss their distress as so common that it must be normal:

My GP said, ‘What you are describing is quite normal. Be glad your baby’s OK. Don’t worry about it, dear.’ So I asked to see the consultant and I complained about my treatment. He was very patronising and only got in touch with my GP, who told me I had post-natal depression and sent me to a psychologist. When she heard all about it, she said, ‘You are justifiably angry.’ I asked my GP for a second opinion. He said, ‘What do you expect to gain from that? Don’t be silly!’ I feel I have been cheated of a normal birth, and they have all hidden things from me and deceived me.

Women have often said they have tried to talk to their partners, family and friends, who have switched off because they have felt unable to help and are tired of hearing about it: ‘You are not on about that again, are you?’, ‘Be thankful you have got a healthy baby’, ‘You expected too much’, ‘You were unrealistic about the birth’, ‘Put it behind you! Get on with your life!’ But they can’t. The events of the birth go round and round in their minds like a video that cannot be switched off.

Panic overwhelms them when they happen to see a pregnant woman, when they switch on a TV programme in which there is a birth or when they drive past the hospital. They withdraw into themselves, feeling stigmatised, turned into outcasts by their experience. A woman whose child is now two years old says, ‘Everyone thinks I should be over it by now. I ask myself, “What is wrong with me? Why can’t I cope like other women?”’ They have sudden panic attacks and this, together with an intense sense of isolation, may make them feel they are going mad.

HOW IS BIRTH TURNED INTO AN ORDEAL?

Women in childbirth are treated like products on a factory conveyor belt. Technocracy distorts the birth experience. Their labours are obstetrically ‘managed’, and they feel they are not cared for as human beings, but are like ‘meat on a table’, ‘an oven-trussed turkey’ or ‘fish on a slab’. They suffer from institutionalised violence. This has far-reaching consequences. It is likely to affect the way a woman feels not only about herself but also about her baby and her partner. It may have catastrophic effects on relationships.

A woman gave birth in a hospital where she was required to lie in a supine position throughout labour, had to deliver with her legs in stirrups, and had a large episiotomy that was badly sutured. She needed surgery to repair her perineum, and is still in pain months after. She is being advised to opt for a Caesarean with the next birth. But she says:

I will never have any more children. I will not subject myself to that again.... I remember exactly what was done and said and by whom. I have the relentless torture of re-living this experience daily, especially at night.... The videotape is always going on in my head.

She went on to say: ‘This experience has so traumatised me that I did not even speak about it for six months. I knew that it was totally out of character for me to bottle things up or deny that something was very wrong.’

This videotape image recurs again and again in women’s accounts. Professor Cheryl Beck lists it as a major theme in PTSD and quotes a woman who said:

I lived in two worlds, the videotape of the birth and the ‘real’ world. The videotape felt more real. I lived in my own bubble, not quite connecting with anyone. I could hear and communicate, but experienced interaction with others as a spectator. The ‘videotape’ ran constantly for 4 months.

Another woman had a labour in which she said, ‘I was just a case to them. They didn’t speak to me, only about me.’ That labour ended in a Caesarean section. Afterwards she told me:

My baby was next to me but I didn’t want to touch him or look at him. I was mourning the loss of a child who never came through me. I was unable to give birth. He was stripped from me. Eight hours after the operation, the nurse came and asked me if I had touched my son and I said ‘No.’ She was worried that he hadn’t had any milk and she put him straight away onto my breast which I found a bit of a shock. It was like meeting a man for the first time and even when you do not fancy him people make you kiss him on the lips.

In the UK over a third of women have an operative delivery, and most of these have epidural anaesthesia. They may not know why this has happened and feel that they have failed to achieve a normal birth.⁴ Almost one woman in every four has a Caesarean. There is a 21 per cent induction rate, and 11 per cent of deliveries are instrumental. These high rates of obstetric intervention often make women feel helpless and disempowered. But it does not follow automatically that a woman who has an intervention will be distressed after birth. The quality of relationships with her caregivers is what matters most. When that is poor, even an apparently straightforward labour and a normal vaginal delivery can be traumatic. One woman said:

No one believes me. My GP thinks I am neurotic. She says, ‘That’s what happens when you have a baby. Millions of women all over the world have babies.’ And I know what she means is ‘And don’t make this fuss.’ Sometimes I feel I must be going out of my mind.

This book explores the way in which childbirth is managed in the twenty-first century, and the effect it has on women, couples and families. I look at how care needs to be changed, suggest ways in which post-traumatic stress after birth can be prevented and, when it does occur, how it can be healed.

2 BIRTH CONTRASTS

TWO WOMEN DISCUSS THEIR BIRTHS. For one it was among the happiest experiences of her life. The other looks back on it with horror, haunted by images of being trapped, helpless and in pain. She says that anyone who talks about birth as if it could be enjoyed must be either a masochist or a liar. She feels the ordeal endured is trivialised and dismissed by the woman who puts on an act of being radiant and triumphant. The two are unable to communicate other than through claim and counter-claim.

Birth experiences are often in such startling contrast that women learn not to talk about them, or make seemingly casual, throwaway comments in case they trigger hostility. One woman feels personally blamed for having a traumatic birth. Another feels accused of romanticising the reality in order to assert a kind of female superiority. For each of them the narrative they offer is real. For each the birth story becomes part of their lives and an important element in their identity.

The woman for whom birth was deeply satisfying was in an environment that she could control herself – not just the room and things in it but the people caring for her – and she laboured without interference. The one whose birth was distressing was denied all control, and was subjected to many interventions that started as induction or acceleration of labour and led to what was virtually a landslide of other interventions. Just as a landslide begins when one stone is dislodged and hits another, and then the second one begins rolling, and a third, until the earth disintegrates and crashes down the mountainside, so a medical act such as induction, or harpooning a woman to an electronic fetal monitor, may trigger an inexorable process that finishes with instrumental delivery or Caesarean section.

Only, of course, it isn’t finished. For the woman is left with the impact of the birth experience that changes her self-perception and relationships. This may last a lifetime – women in their seventies have rung me because they needed to talk about a birth that occurred more than 50 years earlier.

In a study of women’s long-term memories of their first births Penny Simkin revealed that:

Women’s memories of the events of their births are generally accurate years later despite some lapses or errors in memory of specific details. The significance they attach to negative events seems to intensify and increase over time whereas the positive aspects remain consistently positive in most cases.⁵

It is often claimed that women vie with each other over the awful births they had and that they contaminate pregnant women with fear. In fact, one who has had a traumatic experience is often unwilling to discuss it in front of other women, especially those who are pregnant at the time. She feels isolated, a sort of pariah, who might not only frighten them but, as if from a contagious disease, visit a similar fate on them.

The opposite may happen when members of an antenatal class meet after they have had their babies. Depending on the proportion who have had active management of birth, instrumental deliveries and Caesarean sections, some may compete over the lovely...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• ACKNOWLEDGEMENTS
• ABBREVIATIONS
• 1 BIRTH SHOCK
• 2 BIRTH CONTRASTS
• 3 INSTITUTIONAL POWER IN A HIGH-TECH BIRTH CULTURE
• 4 MANAGING THE REPRODUCTIVE MACHINE
• 5 SEXUAL ABUSE AND BIRTH
• 6 FLASHBACKS, PANIC ATTACKS AND NIGHTMARES
• 7 PAIN
• 8 OTHER WAYS OF HANDLING PAIN 8
• 9 ‘IF ONLY I HADN’T’
• 10 THE BABY
• 11 THE PARTNER
• 12 MOVING FORWARD
• 13 PREGNANT AGAIN
• USEFUL ADDRESSES
• NOTES