Episode 199 Birth Trauma

Series – BIRTH MATTERS

In this series, You are learning that birth can have a direct impact on your breastfeeding experience.Whether it is where you birth, how you birth, when you birth and with whom you birth – BIRTH MATTERS all of this can have a direct impact on your breastfeeding experience.

Today’s show we will talk about breastfeeding after a traumatic birth – If you listened to this week’s interview Episode # 198 with Christine Shepherd she also talked about her birth trauma and detailed how she felt it made breastfeeding more challenging. This totally took her by surprise as she was a birth educator and had counseled hundreds of moms on the early days of breastfeeding. She never anticipated having any problems with breastfeeding and was really thrown off when this did happen to her. Today we are going to hear about another couples story of birth trauma and how it affected their early days of breastfeeding.

A birth is defined as being traumatic if the woman was or believed she or her baby was in danger. She perhaps felt helpless, out of control, or alone at any point during her labor or birth.
Suffering from birth trauma is not something you have on your list of what to expect when planning your pregnancy and awaiting the birth of your baby. Parents typically have beautiful and loving pictures in their head on what pp life will look like and how they will feel. Sure, we expect to be tired and wonder if we will have a colicky baby like your best friend did. There are feelings of worry and concern about having one of those babies you have heard about that never sleep. You may have expected some learning curve related to breastfeeding. For the most part, your plan was to be at home, relaxing with your baby, with your family and enjoying new motherhood.

For some moms, it just does not turn out that way. They have suffered through some degree of birth trauma and it is making breastfeeding more difficult for them. Moms might connect with this fact right away OR it may never occur to them that their birth trauma is having an impact on their ability to breastfeed.

In my private practice, I work with this issue all the time. I have shared some stories of anonymous parents experiences on this show before. There was one family that I worked with about 8 years ago that I have just been reminded about that fits this topic so well.

Dad was Jason and Mom was Erica. Jason was about 6 ft. 5 and Erica was about 5.4 or so. Their big difference in height has always stood out to me whenever I think of this couple. I think mostly because I still have very clear memories of Jason holding his little, so fragile looking newborn baby girl in one arm. Alexis weighed weighed 4 lbs. 12 oz. and was 9 days old when they came to see me. I remember when he picked his newborn up out of the car seat, he held her in the crook of one arm and thinking how sweet it was. As a mother of 2 daughters it made me think…. if only we could always keep our babies so close, so safe.

Their plans of a full term vaginal birth with healthy mom and baby, took a dark turn when her bag of water burst at 35 weeks. It was a weekend, they were both home and given instructions to go to the hospital right away. Their chosen hospital was 15 minutes away, they were greeted by staff who did not know them, did not address them politely as they separated mom and dad so he could fill out paperwork in another area of the hospital. Erica tells me that she felt faint and nauseous as her anxiety rose, when Jason left her. She thought her Dr. was going to meet her there, but this was not the case as her Dr. did not show up for several more hours. During that time, she was told she had a fever, she was hooked up to monitors, she could not be mobile for several hours and now some pretty heavy duty contractions set in. She had a forceps delivery. Her baby was not placed in her arms like she expected and dreamed of. The staff was working quickly to get her baby breathing. Her daughter, whom she barely got a look at, was quickly taken out of the room and Jason had to make a quick decision, whether to stay with his wife or go with their baby. He followed the baby, which Erica to this day says was the right decision, but it left her feeling alone and vulnerable and scared. She tells me that she cried uncontrollably during her episiotomy repair, all while she worried about her babies safety. She said to me: I didn’t know if she was alive or dead and I didn’t believe the Dr. when he told me that she would be fine. My birth was suppose to be fine and it wasn’t. Why would I believe that my baby was fine?

I expected my husband to come back and at least tell me she was fine, but after what seemed like forever, I still had not seen my husband yet.

In the end, her baby was fine. She was being taken good care of in the nursery and her husband, who she did not blame at all, just lost track of time and it wasn’t until he was told that his wife was in her recovery room, did he leave the baby for the first time. After a 5 day stay in the NICU, baby Alexis was discharged. In those first 5 days though, there was mom/baby separation. No one got her pumping until the 3rd day right before she was discharged. Being new to all this, she did not know to ask for a pump. On the 5th day, the day of discharge, she was encouraged for the first time to breastfeed her baby. She said that it did not go well as she was nervous and one of the staff told her that she should pump first, to “perk” up her nipples. This left Erica feeling like she didn’t have good nipples for breastfeeding. She had not yet held her baby for too long of a time and was just scared and shaky herself, not really having fully processed her birth experience yet.

During our consult, I just could not get Erica to do much more than hold her baby who she placed on top of her breastfeeding pillow, on her lap. She only wanted the baby to remain in the tightly swaddled blanket she put her in, after I weighed her baby. Erica kept saying when they take her out of the swaddle, she cries and she could not bear to hear her cry. Jason gently tried to prompt her to try and relax and let me work with her with breastfeeding. This meant she would need to lift her shirt and unlatch her bra. She literally shook both time it was suggested, once by me and once my Jason. Her eyes welled up and her overall behavior was a strong signal to me to be respectful and let her just be there and hold her baby on her lap.

I evaluated the situation as best I could, took a history as best I could and determined that since there was nothing else in her previous history that would cause her to be so fragile herself, I suspected major birth trauma was playing a huge part in her fear to even try and breastfeed. While still quite anxious, she at least felt comfortable and confident about bottle-feeding Alexis. Jason told me that they both were quiet and calm people and had almost finished their childbirth classes and were very much looking forward to new parenthood. The thought never occurred to either of them that they could ever go through something like this.

In my opinion, Neither Erica or Jason realized that they had suffered through a major birth trauma. They were told by family and friends – this is what happens sometimes and thank goodness they have a healthy baby. How many of you have been told this? How does it make you feel? Better? Usually not. You return a smile and typically say: you’re right and that that.

When I asked Erica if she discussed her feelings at her pediatric visit, she said no one asked and she did not bring it up because she did not want to cry. They had 2 pediatric visits since coming home and they were so anxious each time to learn if their baby was fine, was healthy and could not think of much else. They both seemed to have adopted the ” thank goodness you have a healthy baby story. This is the same story they told themselves, but clearly their actions said something gravely different.

I knew that my role at this particular time was to let go of my agenda (Personally, I really wanted her to leave this consult breastfeeding her baby. I wanted to her to try and try and try again. I felt that if we could get the baby latched on and breastfeeding… well that This alone would be healing.) I know you might be saying to yourself…. but she came to you for help with breastfeeding. However, she was clearly not ready for that and I had to let go of my agenda, of my ego and respect Erica.

As an IBCLC who has been doing this work a long time, but is not a certified therapist, I could not and would not diagnose here, however, she sure seemed to be acting depressed and suffering from major birth trauma. There was no given history of anxiety or depression and she described an otherwise happy and healthy pregnancy with no health issues and no medication other than prenatal vitamins and some other vitamin supplements.

As I discussed this possibility of birth trauma with them, they both said the thought never occurred to them and they never thought this was part of their breastfeeding problem. I learned that they thought the breastfeeding problem stemmed from the babies inability to be quiet whenever they unswaddled their baby – to change the diaper, to even think about breastfeeding, to wash with a cloth. Anytime their baby cried, they just wanted to wrap her back up and keep her happy and peaceful, and this is how she has been bottle-fed and held most of the time. How could Erica possibly bring a crying baby to her breast?
They had a lot going on – premature birth, the shock of going into labor much earlier than they were mentally prepared for, laboring for quite a while without her trusted dr.,,the heightened fear that perhaps something happened to her baby when they were separated, Jason’s guilt about choosing to go with his baby, particularly when he learned about Erica crying for him and their baby during the episiotomy repair. ON top of that, not getting help with breastfeeding during her whole hospital stay until the last day created fear about her trying once she got home.
I am sad to say that I lost track of her after that visit. This, unfortunately, is the reality in my job. Sometimes in like situations, parents start talking to each other or friend or family member and open the door to discuss birth trauma and are very soon ready to work on breastfeeding. I get to follow through, work with her on breastfeeding and she comes through the other side. A happy breastfeeding mom, who recognizes she suffered a severe trauma and is working on that with another specialist. Other times, things get worse before they get better. In this case, Erica did not respond to phone calls or emails. I could only hope that they followed up with the referrals I gave them. After sending a report to her physicians and after several weeks, I closed her case.

I will never know what happened, however, I am sure, this otherwise young and healthy and happy pregnant mom, had suffered a severe birth trauma and this was a direct impact on her ability to breastfeed.

I have worked with many other moms who suffered somewhat similar and very different birth trauma. If they are willing to work at it, seek professional psychological help, in addition to lactation support, enough moms I work with do go on to happily breastfeed their baby. However, there are enough moms for whom the healing and recovery does not happen, at least in a timeline that works for breastfeeding their new baby. They suffer flashbacks about their birth. Rather than be incredibly attached and not wanting their baby to even cry a little bit, some moms are quite detached from their baby as a way of dealing with their birth trauma. Their are moms for whom the first try at breastfeeding does not go well and their fear of something else not going well or having no control over it, is too much for them and they have no emotional reserves left to try.

Birth trauma is not limited to, but can include:
*pain related to labor and birth
*unscheduled/ emergency cesarean birth
*feelings of loss of control
*dissatisfaction with care and support
*extended separation from your baby
*giving birth in war zones
*natural disasters

As I am reviewing my notes for this show, we are in the midst of Hurricane Harvey, which is devastating parts of Texas. I am hearing beautiful and such heartfelt stories of regular citizens, along with firemen and paramedics, who are helping bring laboring women to safe places to give birth. The repercussions could go either way for these moms. Are they feeling so incredibly blessed they made it to a safe place to birth their baby, their baby went to the breast shortly after birth and was just born to breastfeed. Or are they worried to death about other family and loved ones they left behind, on the roofs of homes in their neighborhood, hoping to be rescued. Does bringing their baby to their breast give them comfort and help calm them, or are they experiencing high anxiety and no sleep whatsoever, are they being medication to calm them down. All this has the potential to affect their breastfeeding.

For Erica – she needs help. Her husband Jason, while seeming to be okay, also suffered from the affects of birth trauma. His response might be different, but he was surely affected by the whole experience. He should take the opportunity to talk about his experience with a professional also. In my experience, it is the lack of not making the connection between the birth trauma and breastfeeding issues that causes moms to get off to a very difficult start. So, what can we do for moms in these types of situations. What can you and your family do? What can your IBCLC do?

Everyone who knows me, knows that I am a huge supporter of education and prevention.
1. Hearing this information is a great beginning because it raises your awareness and it is something that you can share with your partner
2. Recognizing you have suffered from a birth trauma increases the likelihood that you will work through this difficult time. Progress may be slow, however, determination and motivated and good support will go a long way in helping you breastfeed your baby.
3. You will be motivated yourself or encouraged by your partner to NOT invalidate your feelings. Of course you are happy that you have a healthy or live baby, however, that fact does not invalidate the emotional roller coaster you find yourself on. You do need to talk about it and you do need to seek professional help.
4. Meet with an IBCLC. Talk openly about your experience. Be willing to set short-term goals and simple goals. I wished I could have worked with Erica and just gotten her to the starting point of having her s spend time skin to skin with her baby, connecting in this way.

Understand that while I surely hope that you receive the help and support you need for breastfeeding purposes, there is another reason to seek professional/mental health help. Studies have shown that the effects of unresolved birth trauma can lead to attachment and parenting difficulties.

I am happy to report that with a greater awareness of this health issue, many moms we work with are able to work through their difficulties and create a very happy and fulfilling breastfeeding relationship with their baby.

For more detailed information on this subject and learning about PTSD associated with birth trauma… post-traumatic stress disorder, please listen to Episode #147, where I interviewed Kathleen Kendall-Tackett, a fellow IBCLC, who through her own experience of birth trauma, led her on a path to study the connection between birth trauma and PTSD. In the show notes for #147, there is a list of actions that you can take to help you deal with your emotions and work through your trauma. Check out the show notes for this episode #199 and you will find a nice list of helpful resources also.

Additional Reading

Walker Karraa, MFA, MA, CD(DONA), Former PATTCh Board Member
Breastfeeding After a Traumatic Birth

Teri Shilling, MS, LCCE, CD(DONA), IBCLC, PATTCh Board Member
Treatments Options for Trauma Survivors with PTSD

Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA, PATTCh Board Member
Living Through Traumatic Birth: Loss, Grief, and Recovery

Katie Rohs, Doula, PATTCh President
Having a Baby after Traumatic Birth

Suzanne Swanson, PhD, LP, PATTCh Board Member
No “Typical” Birth: NICU Experiences and Post-traumatic Stress Disorder (PTSD)

Leslie Butterfield, PhD, PATTCh Vice President
Trauma and Personal Growth: New Frontiers in Research

Walker Karraa, MFA, MA, CD(DONA), Former PATTCh Board Member
Birth Trauma Poetry: “answer/no”

Suzanne Swanson from What Other Worlds: Postpartum Poems, Ytterli Press, 2013
Risk for Traumatic Birth for Women with Pre‐Existing PTSD

Julia Seng, PhD, CNM, FAAN, Advisory Board Member, PATTCh
Trauma‐Informed Care during the Childbearing Year

Mickey Sperlich, PhD, MSW, MA, CPM, Advisory Board Member, PATTCh