Standing in the delivery room where she would be giving birth to her second child, Gabriela Pezo felt a familiar sense of dread start to take over her body, causing her to hyperventilate. With her hypnotherapist, Jasmine Collin of Love Parenting UAE, at her side for support, she managed to breathe through the panic and let go some of the fear attached to being in a hospital.

It was all part of the exposure therapy she was receiving to help process the traumatic birth experience she’d had with her first son. “It was only when I stopped breastfeeding him when he was around two-and-a-half years old, that I acknowledged that I’d had a traumatic birth,” says Gabriela.

“It didn’t go the way I’d hoped for, as I’d needed an emergency C-section. I wasn’t just the physical drama that affected me, however, but the fact that I was mentally unprepared for surgery. Later, it became apparent that there was a spider’s web of emotion attached to it. For me, it was linking giving birth in hospital to visiting my sick mother in hospital when I was pregnant.

“Unfortunately, she passed away before my son was born and it had such an impact on me that going to the hospital was scary. I didn’t trust myself or the medical staff around me. Although, after having some fantastic fear release and exposure therapy, I went on to achieve a VBAC with my second son, the lack of aftercare was another source of trauma and this is something I am trying to process now.”

Thankfully, Gabriela was able to spot the signs and seek help but, for many women, it can be something that goes untreated. Indeed, birth trauma – Post Traumatic Stress Disorder (PTSD) that occurs after childbirth – affects many women but isn’t often talked about. While we may be more used to linking PTSD to those who have witnessed someone close to them nearly dying or being seriously injured – a person who has survived a fatal car accident, for instance – it can also affect new mums who’ve had a traumatic birth and felt as if their baby was in danger.

PTSD, which can show itself in the form of anxiety, panic attacks, nightmares and sleep issues, may sound severe but it is actually a set of normal reactions to a bad experience. Sufferers often re-live the event through flashbacks and feel a genuine anxiety and fear that is beyond their control. This is essentially the mind’s way of trying to make sense of an extremely scary episode.

While there are no official statistics for the UAE, the Birth Trauma Association estimates that in the UK alone, up to 10,000 women a year may develop PTSD as a result of having a traumatic birth experience, and as many as 200,000 more women may feel traumatised by childbirth and go on to develop some of the symptoms of PTSD.

The topic is all too familiar for Nicki Anderson, who had a traumatic birth with both of her children and is still feeling the effects almost 20 years later.

“I feel I re-lived the birthing experience when my eldest son was leaving home recently. I felt very stressed about letting him go and realised that it stems from the mindset around the birth,” says Nicki, who is a psychological occupational therapist with a background in child and family mental health, and an advocate of conscious parenting.

Having to process a difficult birth and the lack of care and support around it set the tone for her journey as a mother and is ultimately what led her to offer counselling services to others – she now works out of Breath and Health Alternative Medical Centre on Dubai’s Al Wasl Road.

“I had the most amazing first pregnancy. I was ridiculously healthy and ran 5km a day, so there was no reason to expect anything but a smooth birth,” she recalls. “I was one week late and, when I finally went into labour, I wouldn’t dilate. I hadn’t had any pain relief for the 14 hours I was having contractions and the baby got to the crowning stage and got stuck, which meant I was in agony. The anaesthetist who was supposed to be doing the epidural had gone home and I just remember screaming ‘I can’t do this!’.

“My OBGYN tried a ventouse and forceps delivery but the baby still wouldn’t come so I went for an emergency C-section. I had lost a lot of blood and, as I was coming round, one of the hospital staff said, “Twenty years ago you both would have died.” I didn’t realise it was that bad but, as I was feeling so fragile, the words stuck and had a major impact on me. There was so much drama in my body due to the birth that it was physically difficult for me to care for my baby during the first few weeks, which was very stressful. Like many women, however, I just muddled along.”

When it came to getting pregnant the second time, Nicki believes her anxiety about having another traumatic birth not only delayed the process, but had a knock-on effect on the pregnancy and birth – another emergency C-section.

Taking on trauma

Birth trauma can be felt by any woman, but those who are more sensitive to it may have been through some sort of childhood neglect, don’t feel supported and have a fear of being alone, or have a history of abuse. In the UAE, a number of other factors come into play that can make us more vulnerable.

“The caesarean rate in this part of the world is very high, whereas in many other developed countries it is only carried out when it is needed to save the mother and the baby’s life,” says Dr McCarthy, a clinical psychologist at Counselling & Development Clinic on Jumeirah Beach Road, Dubai (drmccarthypsychologyclinic.com). “Doctors are scaring women into thinking they need a C-section when it may not be essential and this can be extremely difficult to come to terms with and recover from. Linking to this, women don’t always feel supported by medical staff.

“One of the worst stories I’ve heard is of the doctor complaining that he had to go into another room to talk to the nurse as the woman in labour was ‘wailing too loudly’. As a result, the woman lost all her self-confidence and felt as if no one was respecting her birthing experience or her privacy.” While medical intervention during childbirth is a common thread among patients who come to see Dr McCarthy, trauma can be triggered by a number of different factors.

“It can be especially tough if the baby is separated from the parents by going to ICU, for instance, as they can even be sent to a different hospital,” she adds. “Another trigger is gaps in the support system, like if the doctor you are planning on delivering with is called away at the last minute. Similarly, women can often find themselves alone if the husband is travelling and doesn’t make it back in time.”

Dramatic deliveries

Coming to terms with a bad birth experience, and the feelings of disappointment, resentment, sadness, grief, frustration and anger that surround it, can be an extremely complex journey. “Often women are left with painful memories and feelings about their first birth and don’t get a chance to process them,” says Jasmine Collin, a hypnotherapist and childbirth and parenting educator at Love Parenting UAE.

“As long as the baby is healthy, the mother’s experience often gets ignored and her feelings are not validated. In fact, sometimes she is made to feel selfish that she has these feelings in the first place.”

It’s something that’s important to address, however, as the birth experience sets the template for the entire relationship between mother and child.

“If you go through birth trauma, it can show in the way you handle the baby,” says Nicki. “You may be bringing a sense of fragility to the bond, for instance, which can impact on the way you hold your newborn. If you are feeling anxious, your baby can pick up on this and react to it.

“Later on, when the child goes through transitions, such as going to nursery, it might prompt a dramatic reaction from you,” she continues. “Handing over your child to someone else may bring back all those feelings of the birth. You may not even realise it is happening or that there is a link.”

The first step to recovering is to accept that it is OK to feel this way. The healing process, however, can be a tough nut to crack.

“Severe trauma can be difficult to overcome emotionally, as the experience is tagged in the subconscious as a potential threat to safety, so the sufferer will go into flight-or-fight mode as soon as the autonomic nervous system detects any experience that is similar,” explains Jasmine. “It’s trying to protect you from a potentially dangerous situation and is a programme that the subconscious will be running indefinitely unless it is removed.”

Characteristics of PTSD:

  • An experience involving the threat of death or serious injury to an individual or another person close to you, such as your baby.
  • A response of intense fear, helplessness or horror to that experience.
  • Persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. You may feel distressed, anxious or panicky when exposed to things that remind you of the event.
  • Avoiding anything that reminds you of the trauma. This can include talking about it, although sometimes women may go through a stage of talking about their traumatic experience a lot so that it obsesses them at times.
  • Bad memories and the need to avoid any reminders of the trauma will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper-vigilant (feel jumpy or on their guard all the time).

Source: The Birth Trauma Association
birthtraumaassociation.org.uk/what_is_trauma.htm 

Therapies that can help

Ideally patients should be seen as early on as possible and there are a number of techniques that can prove useful.

“In my counselling sessions, I work to bring awareness to everyday parenting issues and how these can be managed in the best way possible, rather than being affected by past patterns of behaviour or emotions,” says Nicki. “Doing early work on how to process our feelings and thoughts, with healthy ways to release them, helps guard against future issues taking root. It helps parents realise they do have a choice and that our past experiences don’t need to rule our decision making.”

Dr McCarthy uses eye-movement desensitisation and reprocessing (EMDR) – a form of psychotherapy that uses the patient’s rapid, rhythmic eye movements to weaken the power of emotionally charged memories of past traumatic events.

“I help my patients go to a safe place where they can process the trauma and, after three or four sessions, we usually find the negative feelings will reduce,” says Dr McCarthy.

Hypnotherapy can also be useful, as it helps sufferers bypass the conscious critical part of the mind. Jasmine sees lots of expectant parents turn to hypnobirthing after experiencing a previous traumatic birth.

“They want to feel empowered and in control and they want a few more tools and techniques that they can count on when the going gets tough,” she says. “They also normally want a more natural approach with fewer interventions, but even if they choose to have an intervention they want to feel good about the fact that they made their own informed decision to have it.

It’s not normally what is done that’s the problem – plenty of women have interventions and they are fine – it is how they are done and the mother’s internal experience of it that matters.”

Hypnobirthing breaks the cycle by allowing women to acknowledge their fears – simply by writing them down and discussing them openly – and to release them before the next birth.

As for the future, a whole care approach that helps women spot the signs of PTSD while pointing them toward support would be a game changer for the country.

“The private healthcare system in Dubai appears to be very disconnected,” says Nicki. “There is no clear line of communication between the OBGYN or the hospital to support groups and educators to help raise awareness of how to look after your emotional wellbeing post birth and where to seek help, if needed. You wouldn’t see a leaflet about birth trauma counselling in the waiting room on the maternity ward, for instance. As a result, new mums need to be very self-seeking when it comes to aftercare. There are various Facebook groups set up to help women in this situation but you still need to go research them and you may not have the energy to do it at that time. What women really need is a referral.”

Risk factors for PTSD:

  • Lengthy labour or short and very painful labour
  • Induction
  • Poor pain relief
  • Feelings of loss of control
  • High levels of medical intervention
  • Traumatic or emergency deliveries, for example, emergency caesarean section
  • Impersonal treatment or problems with the staff attitudes
  • Not being listened to
  • Lack of information or explanation
  • Lack of privacy and dignity
  • Fear for baby’s safety
  • Stillbirth
  • Birth of a damaged baby (a disability resulting from birth trauma)
  • Baby’s stay in SCBU/NICU
  • Poor postnatal care
  • Previous trauma (for example, in childhood, with a previous birth or domestic violence)

Source: The Birth Trauma Association
birthtraumaassociation.org.uk/what_is_trauma.htm

Photos by Istock