Despite medical advancements, childbirth is a major cause of post-traumatic stress disorder – and yet nobody talks about it. Leah McLaren tells the harrowing story of the arrival of her second child – and her fight for treatment and support
The seconds that stretch between the act of giving birth and waiting to hear a baby cry are the most harrowing moments in an otherwise privileged life. My second son, Frank, didn’t cry.
Late last summer in a London hospital, he was born semi-conscious. His pulse was faint and he was floppy as a rag doll, a pale bluish grey in colour. There were angry red indents on his nose and skull that would later turn into deep purple bruises. According to his hospital notes his Apgar score at birth (on which 10 is hale and zero is non-responsive) was two. Just before emerging, Frank turned to the left and got stuck in the birth canal – no amount of pushing could make him budge. He was wrenched out of me, first ineffectively with a vacuum and then later, definitively, with a pair of giant metal salad tongs called forceps. The midwife briefly placed his limp little body on my chest and then scooped him up again and over to the opposite side of the room where the doctors began their work.
At first, still dazed from the birth, I didn’t fully understand what was going on. I remember thinking how strange it was that for hours on end all the focus had been on my body, and the monumental effort to make it do what it was supposed to, and now everything had shifted. It was like I’d been split in two and what was left of me – the remaining husk – seemed almost incidental to the scene.
I heard an alarm wailing in the corridor outside our room and I thought, vaguely, that there must be an emergency on this floor. Residents and interns in scrubs began streaming through the door, craning to see the patient – our motionless, minutes-old son. Before long there was a standing- room only crowd around the baby. My husband squeezed my hand as I processed the silent revelation that the emergency was us.
We watched the doctors placing a toy-sized oxygen mask on our son’s face and heard them fall silent as their movements became quicker. We scanned their faces for panic or relief and saw nothing, only blankness. We waited for the baby’s cry, but it never came.
Hours later, to our immense relief, we were told Frank was fine. The resident paediatrician made it clear he wasn’t concerned – or even particularly interested – in Frank’s case. He could offer no real explanation for why our son was born “flatline” (his term) apart from the obvious deduction that he’d been knocked out by the grip of the forceps on his head. “It happens,” the doctor said. “We don’t know why.” He had a touch of jaundice, but there had been no evidence of oxygen deprivation.
By contrast, I was worse for wear. In addition to the forceps, I’d had internal and external tearing as well as an episiotomy – cut open and stitched back together. As one doctor later put it: “It’s like a truck drove through your pelvic floor.” I was given transfusions for blood loss and paracetamol for the pain, which didn’t help much.
When I was finally taken up to the neonatal unit in a wheelchair and able to hold him, my son was so bashed up he looked like he’d been in a bar fight. “You should see the other guy,” the nurse joked. “You already have,” I said. “The other guy is me.”
This is not the story of a personal tragedy. I’m conscious while writing this of the many mothers who have experienced far worse. Pregnancy and childbirth, when it goes wrong, can result in all manner of horrors, including the loss of a child – an experience I cannot pretend to understand.
Instead, this is a story about what’s been written out of Britain’s official birth narrative. Frank’s birth, as described, would be classified in our maternity system as a success. For a system that prides itself on being female-centred, the NHS maternity care system is failing post-natal women. Not only has the physical and mental health of new mothers become secondary, it sometimes seems inconsequential. This is the untold story of the suffering our maternity care system ignores.
It’s difficult to admit this now, eight months after Frank’s birth, but in those first weeks I did not feel the exhilaration that comes with a baby. I cared for my son dutifully, feeding, bathing, burping, swaddling, soothing him through the night, but much of the time I felt weirdly detached, like a zombie shuffling through the motions.
The sound of his cry induced black thoughts, a darkening of my already dull mood. I remember looking at him and registering the fact he was beautiful, but being unable separate his body from the horror of his birth. I obsessed over the idea that something was wrong with him, that he’d been deprived of oxygen and the doctors had hidden it from me. I took him to see the community midwife twice because I was convinced his eyes were crossed. When I demanded to know if the midwife thought he looked like he had brain damage she looked at me oddly.
In those first few weeks I had flashbacks every day. I’d be standing in the queue at Sainsbury’s and suddenly I’d be back in the madness of the delivery room, blood pooling on the floor beneath my bed wondering if my baby was dead. I ruminated over the details of what happened for weeks, unable to think about little else. Some days I told the story to anyone who would listen; others I could barely speak at all. Finally I went to see a psychiatrist who diagnosed me with trauma. Not post-partum depression – she was very clear on this point – but post-traumatic stress, as a result of the physical and emotional ordeal of Frank’s birth.
Physically I was also struggling. As Frank grew bigger and bonnier, lighting up the world with his first gummy grins, I wasn’t bouncing back. Every time I found myself alone in the room with a doctor, health visitor or community midwife I’d demand they examine me to determine whether or not I was healing properly. Again and again I was told everything looked fine – the stitches had healed and I was given the all clear for exercise, for sex, for life. But something was amiss.
Like many new mothers I was suffering from stress incontinence (urinating when I coughed or sneezed) and a weakened pelvic floor, but there was something else. A strange dragging sensation, a heaviness that wouldn’t abate. I described these symptoms over and over and was ignored by health professionals until one day, over a cup of tea, a girlfriend suggested I might be suffering from a pelvic organ prolapse. The next day I booked an appointment with my GP who referred me to a gynaecologist who confirmed that, indeed, I had a moderate-to-severe case of a condition called cystocele, otherwise known as a prolapse of the bladder. What this means is that my vaginal wall was so badly damaged giving birth that my bladder was spilling out into my vagina. The best course of treatment, he told me, was corrective surgery. It’s something I can’t have until I’m three months clear of breastfeeding, which is some months away yet. In the meantime I’ve been prescribed a course of post-natal physiotherapy, which involves performing pelvic floor exercises under the supervision of a doctor and having vibrating wands shoved up my nether regions in order to reverse tissue damage.
This is not as fun as it sounds.
In spite of all this, I’m one of the lucky ones. Most women who experience birth injury and trauma never get properly diagnosed or treated. It’s hard even to get any one to recognise there might be a problem. My husband, astonished there was no routine follow up for me after such a traumatic birth, tracked down the obstetrician who’d delivered Frank to seek guidance from her. She did not respond. We found out later this sort of contact is not encouraged; no comment or advice could be offered. A hospital collectively delivers.
The Birth Trauma Association, a peer-to-peer support group, estimates that 10,000 women in Britain are treated for post-traumatic stress disorder as a result of birth each year. That’s the largest single cohort of PTSD sufferers in the country. They estimate as many as 200,000 more women may feel traumatised by childbirth and develop untreated symptoms of PTSD.
On the physical injury side, the British Journal of Obstetrics and Gynaecology in 2015 found that 24% of women still experience pain during sex 18 months after giving birth. The same year researchers from the University of Michigan gave 68 women MRIs seven weeks after having babies. Of the admittedly small sample, they found 29% had fractures in their pubic bones, which all of them were unaware of, and 41% had tearing and severe damage to their pelvic floor muscles that had remained undiagnosed. Another recent US study, published in the journal PLOS One, found 77% of mothers still suffered from back pain and 49% experienced urinary incontinence a year after having their babies.
It’s obvious that childbirth is deeply traumatic for many women’s minds and bodies. Just over a century ago almost 7% of pregnant women in England and Wales died from it. But birth is much safer now – so why are so many women still suffering its after-effects undiagnosed and untreated?
Part of the reason is that the conversation around birth trauma and injury is steeped in shame and institutional sexism. I’m not just talking about the general prudishness surrounding women’s reproductive health issues. There is a prevailing attitude I encountered among many health professionals which is that new mothers should basically learn to suck it up. As one GP said to me in semi-exasperation: “You’ve had two children. Your body’s changed. You can’t expect to feel the same as you did before.”
Rebecca Schiller, chair of BirthRights, an organisation that seeks to promote human rights in childbirth, told me that institutional denial of women’s experience is a huge problem, especially when it comes to post-natal care. “There is a general attitude of ‘Your experience doesn’t matter, all that matters is a healthy baby.’” When, of course, the two are inextricably related.
Part of the problem, I have come to believe, is that pregnant women are not properly informed of the risks of birth trauma and injury in advance.
With my first pregnancy I was determined to have an all-natural, drug-free, at-home water birth. I rented a birth pool at the urging of my NHS homebirth midwife and when labour began I went around the house lighting scented candles. But seven hours in, when my baby turned out to be an undetected breech, I was rushed to hospital in a wailing ambulance. Once it was determined my son would be born via emergency caesarean, a doctor talked me through all the risks in advance and asked me to sign a surgical waiver. And yet, with my second son, when I waived my right to an elective C-section and opted instead for a “normal” birth, I was assured by several midwives that opting for a VBAC (vaginal birth after caesarean) was the safer, better option and would result in an easier recovery than a surgical birth.
As I found out later, women in my age group (40), especially those who have had a previous C-section, have much higher rates of assisted births – and assisted births often lead to injury and trauma. The NHS and the NCT have very little to say on birth trauma. There are no birth trauma or injury counselling services and after care, as I found out, is difficult to come by. There are private options (like my psychiatrist), but there are private options for everything if you can afford it.
To get state-funded care, you have to fight for it, which many birth-injured and traumatised new mothers are in no state to do. Complicating matters further is the issue of post-partum depression. Just look at the postnatal chat groups online and you will find women frustrated at being told they simply have a hormonally induced case of “baby blues” when what they’re actually feeling is a normal reaction to a profoundly distressing experience. Diagnosing a birth-injured or traumatised mother with post-partum depression is the healthcare equivalent of asking a justifiably irate woman if maybe, just maybe, she’s about to get her period? And yet it happens all the time.
There is a reasonable explanation for this apparent state of institutional denial. Birth trauma and injury conflict with the NHS’s dominant maternity care ethos, that “natural” births are safer and more empowering for women. This despite the fact that the UK has one of the highest infant mortality rates in western Europe and, according to the NHS litigation authority, pays out hundreds of millions in maternity negligence claims each year.
As the NHS continues to pay scant attention to the issue, rates of birth injury and trauma continue to rise, due to a confluence of factors including ageing mothers, obesity and larger newborns. But why isn’t more attention paid to the routine psychological and physical harm endured by so many post-natal woman?
This is a question Maureen Treadwell, chair of the Birth Trauma Association, has been asking for nearly two decades. She founded her organisation in response to the number of women she knew who’d been refused pain relief during labour and ended up traumatised by the experience. “If a man underwent dental surgery having begged for anaesthetic and not received any, we’d recommend therapy – yet if the same thing happens to a woman we tell her she’s a good girl, well done. It’s madness,” she said.
According to Treadwell, birth trauma is exacerbated by a culture that celebrates only one kind of birth. “The system, as well as the dominant culture, fills women with false expectations. It deludes women into thinking that birth ought to be this wonderful, empowering experience and when it isn’t women feel terribly ashamed.”
Last year when Jamie and Jools Oliver had their fifth child, Oliver tweeted about his wife’s “unbelievably composed natural birth”. It sounds ridiculous, but I cried reading that tweet. New mothers are deeply susceptible to guilt and it often begins with not having performed birth in the circumscribed way.
Eight months on, Frank and I are muddling along in an exhausted state of contentment. The trauma of his birth is fading, superseded each passing day with the marvellous reality of him. My body is now the body of a mother – battle-worn, cosy and intimidating in its accomplishments. I am grateful for my boys and for the fact that I got help for a condition many mothers experience but for which few ever seek acknowledgement, let alone treatment.
Like I said, I’m one of the lucky ones.