My experience of post childbirth trauma

Anne shares her experience of post childbirth trauma following the elective caesarean birth of her triplets.

I gave birth to triplets in March 1999 by planned caesarean section. The birth was clinically straightforward and the children were fine weighing in at 6lb 12oz, 4lb 9 oz and 4lb 1 oz. I had reached 36 weeks gestation with ease and, whilst not 100% happy to deliver so early, I decided to trust the medical advice.

Trauma for me was largely caused by staff thoughtlessness and my own passivity induced by diamorphine - given without my knowledge. Both meant I was barely involved in the birth, not even as a spectator. It was further exacerbated later when I read the relevant research. It shows the caesarean to have introduced significant risk to my babies and to me contrary to the advice of the obstetric staff. I had always wanted to deliver vaginally and changed my decision on safety grounds.

My exclusion from the birth and separation from the babies within 30 minutes of their birth gave me a sense of overwhelming loss. Four days after the birth I became very distressed and sought help from the obstetrician whom I had seen throughout my pregnancy and who performed the caesarean. His response, sadly, was unsupportive and defensive. So, instead of starting to heal the pain worsened. Over the subsequent eight weeks or so I learned about the diamorphine and the very personal procedures carried out without my knowledge on the other side of the screen. The screen itself had been erected despite agreement weeks beforehand that it wouldn't be. The resulting sense of being manipulated and demeaned brought emotional pain, shock, and anger that I struggled to deal with.

As well as feeling traumatised I felt guilty. I had three healthy babies, there were no physically horrendous aspects of the birth to describe, I was fine, so how could I complain? This was clearly the view of the medical staff and showed in their comments and behaviour towards me. Their reaction to my distress exacerbated it.

The main feeling at first was exactly like mourning for someone close. I was deeply sad, this was expressed as a pain in the gut and a permanent lump in my throat. My brain whirred thinking about what had happened and together with caring for four small children, left me exhausted.

Ridiculously in retrospect, I spent a lot of money thanking the staff, donating hundreds of pounds to the SCBU and writing personal thank you cards. I felt a need to recover the good relationships I had with them before the birth. In my confusion this seemed to be a good idea. For a long time I was convinced that one of the staff would turn up at my home to apologise having realised how poor the care had been. This never happened of course.

I lived in two worlds, the videotape of the birth and the 'real' world. The videotape felt more real. I lived in an air bubble, not quite connecting with anyone. I could hear and communicate, but experienced interaction with others as a spectator. The 'videotape' ran constantly for four months, I finally took control and stopped it running when the children were eighteen months old. Over two years later I continue to have days where I struggle to control it.

In the first months I would wake up for the night time feeds and not go back to sleep, despite the exhaustion. Reliving the experience was more powerful than my fatigue. I woke each morning drenched in sweat. It was March but I began to believe that the weather at night must be hot because the sweats went on so long. Sometimes I would wake experiencing painful emotions and curl up into a ball so no one could get close to my stomach.

I avoided anything that reminded me of the birth. Undressing (difficult one), seeing the scar, lying on my back, road signs for the town where I gave birth, pregnant women, happy birth stories - especially caesarean.

I felt uncomfortable with most people including friends, and said the wrong thing a lot. Talking about childbirth made me intense, angry, and I cried a lot. The relationship I had with my two-year-old daughter fell apart. I failed to meet her emotional needs - we're just about mended 22 months later. Close personal relationships became difficult and strained.

Until very recently powerful seething anger would overwhelm me without warning. There was no single trigger or frequency. To manage it I would go still and quiet, then eventually 'come to' realising that one or all of the children were crying and I had no idea for how long.

I presented a coping face to the world. I painted my toenails. I smiled, was a good mother, my children were always well dressed and fed, and happy. The obstetrician had said I was at risk from postnatal depression, which could involve child abuse. It was crucial that no one could point that finger at me.

Driving was frightening. I was on automatic pilot in tears when alone in the car. I worried about crashing. A series of motivational tapes I played in the car were a major source of support. I woke up many mornings thinking about two things - the birth and how quickly I would be able to get to the car to listen to the tapes. This dependence, almost addiction, continued for a year. I was totally disinterested in anything outside my family and my emotions. When I began to listen to the news again twelve months later it was clear I was beginning to heal.

When the babies were nine months old I contacted a counsellor, she recognised my symptoms as those caused by trauma. This was an enormous relief, at least I wasn't going mad. Eight months later, still looking for help, I saw an obstetrician who runs post childbirth stress clinics. It was good to read her letter later saying I wasn't depressed at all. This had been the initial diagnosis at the hospital where I gave birth and had always felt like an excuse for the staff and an accusation for me.

For some time I was desperate to be pregnant believing it would heal the pain. I love, even now, imagining having a home birth with only my husband, children and a midwife present and no intervention of any kind. The cathartic benefit of this would of course turn into the reality of (at least) five children, which we have decided is not what we want.

To help me cope in the early months I would take the babies to town on my own and sit in a café enjoying hearing people say how wonderful I was to cope with three babies. I would return home exhausted but happy.

I also had an almost desperate fear that it would happen to another woman. I was especially concerned that it would happen to a very young woman who wouldn't be able to cope, and I became fired with a wish to protect others. This started my work in childbirth research and with the local maternity unit user committee when the children were about a year old.

Support for me has come mainly from people I didn't know, from Belinda Phipps CEO of the NCT, Gina Lowdon the NCT Caesarean Birth and VBAC Coordinator, now a friend and colleague on the local MSLC, and Beverley Lawrence Beech, all of whom have been able to handle my, at times, highly emotional and inflammatory comments and support me to a point where I can even cope with meeting the obstetrician again. Thank You to them and to everyone else who has listened to me - with each airing it gets easier to handle.

May 2001

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