When I went in for my first appointment for the new baby with my Midwife, I found myself in tears in her office as we talked through my first childbirth with Eli. She had asked me what I was worried about for this pregnancy and I told her I wasn't worried about pregnancy at all, but I was terrified of labor and delivery. As we talked, I broke down. Crying harder than I could have imagined, I blubbered about my fears and anxiety and I think my Midwife quickly realized that I had a lot to work through before I should have another baby. By the grace of God, later that day, I happened across an article about traumatic births and found myself nodding along with the feelings many women with traumatic births have. As I clicked through some of the articles and resources linked in the article, I couldn't help but lose it again. Was this really me? Do I really fall into the category of suffering from Postnatal PTSD from childbirth?
I always wondered why it was so difficult for me to write down Eli's birth story. Why it took me so long to get over birth. Why it took me a while to bond with Eli, and even truly like him. Why I didn't feel the "joy" of meeting him immediately or even within a few days after birth. Why I was scared of him for so long. And why even sometimes today I see him and I have flashbacks about childbirth and how difficult it was.
I typically try to push these thoughts from my mind, chalking it up to not being a kid person and needing to adjust to motherhood. And while I think those things are true, I'm starting to think (with the advice and help of both my Midwife and my husband) that it might be because I experienced a traumatic birth. It helped so much when I read that a traumatic birth is based on the "mother's experience of the events, regardless of what happened or the perceptions of other people, that determines whether she experiences trauma."* I know on paper, that it doesn't really look like I had a traumatic birth. The thing was, I was never near death while in labor or delivery, my son's life was never in jeopardy, there was no dramatic moment where they rushed me into an operating room, or the nurses freaked out, or alarms went off - as far as I know, there was no reason to really call my childbirth traumatic. I've heard much, much more terrifying, scary and literally life-threatening stories from my friends and family as they delivered and none of them ever talked about their labor and delivery as traumatic, or even hinted at the fact that it scared them when thinking about having another baby. So how could I say that my birth was traumatic? What right did I have to be scared of giving birth again? How could I explain my inability to bond with my son after childbirth?
I think I tend to use humor for a lot of things that I'm struggling with. And after childbirth I found myself joking about the experience and the things that happened. But when I force myself to truly look back on it, I find that it has a lot of commonalities with the triggers the Birth Trauma Association lists: "Lengthy labor, poor pain relief, feelings of loss of control, impersonal treatment or problems with staff attitudes, not being listened to, and lack of information or explanation." There are other triggers of course, but those are the ones that I identified with.
Overall, my labor was 32 hours, for 10 of those hours I was stuck in "transition," at 7.5 cm. My Midwife was unable to be at my birth because she was traveling, so I had two OB's care for me whom I'd never met before. To their credit, they knew I was a "midwife patient" and so they didn't push a lot of intervention, and they were very gentle and patient with me - although I felt that overall, they were elusive and didn't offer a lot of information. After four hours of being stuck at 7.5 cm, I was starting to feel fairly inadequate and wondering what I was doing wrong. After they asked me three times, I agreed to let them break my water - just to see something happen, but it did nothing to move my baby - because as I found out later, Eli was posterior, which explained all the back labor and why breaking my water was ineffective. But no one told me this at the time, making my feelings of inadequacy that much stronger.
By 6 a.m. or eight hours after being stuck at 7.5 cm, they told me I needed pitocin because my uterus was too tired, and would never be able to push the baby out on its own. I refused and told them I could (I can be a little bull-headed at times), so they inserted an IUPC (Intrauterine Pressure Catheter) to prove to me that I couldn't. My contractions were 50 percent of what they needed to be, and were only getting weaker. Which basically meant that I was experiencing a whole lotta pain for no reason, the contractions were doing nothing but causing hurt and making me more tired. I hadn't slept in about 27 hours and I remember I started sleeping between contractions I was so tired: Falling asleep as soon as one was over, sleeping for about 30 seconds to a minute, then waking to another contraction. My husband would say it looked like I passed out after every single one. When I agreed to the pitocin, they asked me if I wanted an epidural, and since my birth plan was already no where to be found, I agreed.
When the anesthesiologist came in, I was elated to see him. I was so excited for the relief everyone said it brought. I could tell he was in a hurry from the get-go and I felt somewhere in the back of my mind that he wasn't being very kind, but I didn't care because he had the miracle drug. While I don't feel it's appropriate for me to list some of the things he said here, he said some things that were quite hurtful and snarky, although at the time I wasn't sure if I was dreaming or if it was real because of how tired I was. But later my husband confirmed what I thought I heard and told me how he didn't like the anesthesiologist, he was pompous and brisk and rude the entire time, and many of his comments were unprofessional and inappropriate. It didn't help that the epidural never worked.
The anesthesiologist left and the nurse anesthetist took his place. I told her I wasn't feeling relief (except for in my left leg, which was completely numb and I couldn't move it on my own), and she told me that it was working and I should be feeling relief. We went back and forth like this for literally a couple of hours. She rolling me around on the bed, telling me we just needed the right angle, me telling her I'd like a new one and but feeling too tired to really fight for it and just trying to get through each contraction. I felt like she wasn't listening to me, like I was unheard and discredited, and that no one was advocating for me. I felt crazy, like I must be making up all the pain in my head and it was my fault I was hurting because she kept telling me it was working. By this time they had given me quite a bit of pitocen, so they apparently couldn't redo the epidural. I had to survive and I literally wanted to die. And I am in no way joking or exaggerating when I say that. I have never felt so helpless, hopeless and ready to give up in my life.
When they removed the needle later, the nurse said to me in a very nonchalant manner, "Oh, there was a kink in the needle, that's why it didn't work for you." I wanted to cry and have her shout it to the room to validate me so they would all know I wasn't crazy for saying it wasn't working, but I didn't even have the energy to let a tear fall.
Finally, with the help of the pitocin, I moved from a 7.5 to the prized 10 in about an hour, and it was time to push. I found out later that the OB that delivered Eli was apparently "incredibly patient to let me deliver on my own, simply because I was a 'midwife patient'" and that I likely should have had a c-section because of how long everything took. While I'm grateful now that I was able to deliver vaginally, I sometimes can't decide if it was worth going through so much. While I had some wonderful nurses and I loved the hospital I delivered at, for the next birth, I will request that that particular anesthesiologist and nurse anesthetist do not see me. I have their names written down, and my Midwife knows that I do not want them in my room if I end up needing that type of service.
It took me a long time to come to terms with the birth, and today, I still think I have a lot work to do to get over it. I have nightmares about the pain, and there have been a few times where I've gotten a stomach ache or sharp abdominal pain that have given me flashbacks from the birth and I'm sent into a tizzy of tears and I am paralyzed with fear. I'd like to think I'm a fairly rational and logical person, so much of me tells myself that I'm overreacting, lots of women have had it much worse than me, I have nothing to be afraid of and I'm being a wimp when I get panicky and distressed when thinking about childbirth. I've never admitted how hard it was for me except to Mike. I make jokes here and there, make a comment or two about how I'm nervous to give birth, but I've never said anything that truly shows how petrified I am of it. I'm terrified. I don't want to do it again. I'm scared that I'll stall out again and if I choose to have one, the epidural will not work again. I'm scared of that hopeless, helpless feeling, and feeling like I'm alone. I'm scared that I can't do it. That my body won't work again. Like it won't do what it was made to do. I'm scared that it will be hard and I won't like my next baby for a while either. I'm scared of the guilt that comes with not liking my baby and I'm scared of having more nightmares and flashbacks. When I think about it too much, I can't sleep. I have anxiety. I'm terrified.
But I don't want to talk about it, because I feel like my birth doesn't compare to a truly traumatic birth. I feel like I'm being overly sensitive and that maybe my expectations of the care I'd receive were too high. I feel like I can't really say anything because I can't truly decipher between what's from having a traumatic birth, and what's just from not really being a kid person and just someone who didn't like childbirth. I didn't want to talk about it, because logically I knew all the answers. That I wasn't a failure. That there's no perfect birth story. That birth is hard and difficult. So I covered it all up and hid my true feelings.
But I think it's time that I finally come to admit that these feelings are real and that they are okay. My Midwife told me that I have to "leave Eli's birth behind." That this baby will be an entirely new birth story and nothing that happened in my first one will affect the second. She reminded me that I did birth my son. I was not inadequate. I didn't do anything wrong, It wasn't my breathing techniques, mental state, ability to "let go," laboring positions or inability to perform any of the other birthing tips you read about in books. I did the best that I could, and I successfully birthed my son. I wasn't crazy, I wasn't stupid or wimpy. My feelings are valid, but I have to leave them behind for my next baby. She told me to write a letter to the hospital and in particular to the anesthesiologist practice to help me move forward and close a chapter. I wrote it and sent it a couple weeks ago.
My midwife and I talked about how crazy it is that every woman remembers her births so well and so distinctly. Over a year later and I can remember nearly every detail of those hours in the hospital. And even more distinctly, I remember the actions of my caretakers like they were yesterday, still feeling the pain of a flippant comment or misguided attempts to help me. It's not likely that the anesthesiologist and nurse anesthetist remember me at all, and it will sound silly to them to receive a letter from a woman 14 months later about her birth experience, but it was therapeutic for me to write and to know that they now know too, and hopefully can learn from my experience. While they both may have just been having an off day, I think it's important for them to know how deeply and profoundly their words and actions have on a woman in birth.
While I can't say if I truly have Postnatal PTSD - and I would likely tend to error on the side that says I don't - I do think I show some of the symptoms that have made some long-lasting impacts on my feelings about childbirth. Which means there's definitely something there that should be dealt with before I have this next baby. Overall, I'm working on getting through it. More tears fall as I battle another feeling, another memory, but each tear brings healing. I'm considering getting a Doula, just in case my Midwife can't be there, and we even discussed scheduling an induction, just so I can know she'll be there. (Which says a lot when a Midwife suggests it!) I'm grateful for the amazing support of my husband, who has validated all my feelings and told me time and time again that I'm not crazy, and for a Midwife who has seen women like me before and has been able to help me, counsel me and point me to solid resources.
While I never meant for this post to become a PSA, if you're struggling with similar feelings as I've shared, I'd encourage you to find someone to talk with about it. I honestly didn't even realize how deeply I was affected by this until I knew I would have to face my fears again with another baby on the way, and now I'm twice as hormonal as I normally am so the feelings and emotions are twice as strong. :) Take time to read up on what it is - most people associate PTSD with natural disasters, military combat and thing of the like, so it can be hard to understand how PTSD can be associated with something as natural as childbirth. But really PTSD is just a reaction to a scary, traumatic or bad experience, which can certainly happen in childbirth. Finding articles and other people who are experiencing similar feelings as I am was enormously helpful and just realizing how common it is (it affects 25-34 percent of all births) helped me feel much less alone.
It's a messy topic and one that can seem made up, exaggerated or embellished, but the fact of the matter is, the feelings are real, no matter how they are perceived by other people. Childbirth is an incredibly personal, emotional and life changing experience. By working through my feelings, I'm hopeful I can begin to view my first birth experience in a more positive light, and put it behind me so I can give my next birth a fair shake. As my Midwife said, Eli's birth is not an indicator of what this next birth will be like, and I must play that truth over and over in my ears as I prepare for our next baby. I am hopeful that just by talking and writing about it, I can not only know that, but believe it.
Update: Here's a follow up post I wrote about the response I received to the letter I sent and my continued journey to find healing.
*Birth Trauma Association