Traumatic Birth: Resources for Healing and Protecting Breastfeeding

by Tanya Lieberman
This post was made possible by the generous support of MotherLove Herbal Company.

Young Woman Biting Her Finger Nail

Having intrusive thoughts about your birth?  Flashbacks?  Feeling disconnected from your baby?  Do you steer clear of hospitals, or try to avoid talking about your birth?

Many women experience trauma related to childbirth, and estimates range from 18% to as high as 34%.  One third of women who experience traumatic births go on to develop Post Traumatic Stress Disorder (PTSD).

Yet despite its widespread nature, the experience of birth-related trauma can be an isolating one, as mothers are encouraged to focus on their babies and quickly “get over” their birth experience.  Trauma can affect a mother – and a partner’s – ability to connect with their baby, carry out normal activities, and can also impair breastfeeding.

In this post we’ll discuss traumatic birth – what it looks like, how it impacts breastfeeding, and where you can turn for help.

 

What’s a traumatic birth?

 

According to PATTCh, a birth trauma organization co-founded by noted childbirth author Penny Simkin, a traumatic birth is defined as one in which a woman experiences or perceives that she and/or her baby were in danger of injury or death to during childbirth.

It’s important to note that it is the mother’s experience of the events, regardless of what happened or the perceptions of other people, that determines whether she experiences trauma.

Here are some characteristic features of births that may lead to an experience of trauma, according to the Birth Trauma Association:

  • An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).  [Note that it’s the mother’s perception that is important, whether or not others agree.]
  • A response of intense fear, helplessness or horror to that experience.
  • The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
  • Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of 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 guard all the time).

Some common triggers, according to the Birth Trauma Association, are: lengthy labor or short and very painful labor, induction, poor pain relief, feelings of loss of control, high levels of medical intervention, traumatic or emergency deliveries (e.g. emergency cesarean section), impersonal treatment or problems with staff attitudes, not being listened to, lack of information or explanation, lack of privacy and dignity, fear for baby’s safety, stillbirth, birth injuries to the baby, NICU stay, poor postpartum care, previous trauma (such as sexual abuse, domestic violence, trauma with a previous birth).

How can traumatic birth affect breastfeeding?

Breastfeeding can be healing for many mothers after a traumatic birth, and may also repair the relationship between a mother who feels estranged from her baby.  But a traumatic birth may also cause breastfeeding problems.

A traumatic birth can delay on the onset of a mother’s mature milk (“milk coming in”), known as lactogenesis II, sometimes by several days.  This effect is well documented, and often leads to a cascade of breastfeeding problems including jaundice, poor feeding due to sleepiness, poor milk removal, and low supply.

While research on the independent effect of Pitocin on breastfeeding is not sufficient to draw direct conclusions, according to Linda Smith, author of The Impact of Birthing Practices on Breastfeeding, its effects on factors related to breastfeeding are more clear.  Pitocin increases the risk of other interventions, such as IV fluids and cesarean section, which are associated with breastfeeding problems.  Linda Smith also notes that induction of labor often causes babies to be born earlier, and “early term” babies are known to be at higher risk of breastfeeding difficulty.

 

What are some steps you can take after a traumatic birth to minimize the effects on breastfeeding?

There are many steps a mother and her provider can take to minimize the effects of a traumatic birth on breastfeeding:

Skin-to-skin.  Skin-to-skin contact lowers stress hormones, promotes the release of hormones important to lactation, and helps establish a bond between mother and baby.  Some mothers are too overwhelmed by their traumatic experience to practice skin-to-skin, but for those who can it should be encouraged.

Frequent feeding and in some cases pumping.  Frequent feeding and in some cases pumping, may help to speed the onset of mature milk.  If a baby is not feeding well, pumping can protect a mother’s milk supply and prevent or lessen the downward spiral noted above.

Find support to ensure that breastfeeding is not painful.  In research on the relationship between traumatic birth and breastfeeding, authors Beck and Watson found that mothers who had traumatic births and who didn’t have the emotional reserves to work through breastfeeding pain were less likely to meet their breastfeeding goals.  So finding someone who can help you feed without pain is important.

Focus on your motivation.  Beck and Watson also found that the mothers who were very determined, and those who were motivated by a desire to “make up” for a baby’s less than optimal arrival, were more likely to meet their breastfeeding goals.  They suggest setting short term goals and finding respectful support.

Supplementation when medically necessary.  A brief period of supplementation is sometimes necessary in order to bridge the time before your mature milk arrives.  Ideally this would be donor breastmilk, but it is not often available for these situations.  See the Academy of Breastfeeding Medicine protocol for supplementation.

Know where to get good help once home.  Since mothers are generally sent home from the hospital before their milk comes in, they should plan to seek help if their milk is not in by 72 hours (the period defined as normal for the onset of lactogenesis II).  This may head off further difficulty.

If breastfeeding doesn’t work out, connect with your baby in other ways.  As noted above, breastfeeding can be healing to many mothers after a traumatic birth.  But some mothers are truly too overwhelmed to initiate or continue breastfeeding.  In these cases, consider other ways to connect with your baby, such as infant massage, skin to skin, and babywearing.

 

What are some resources for recovery for mothers and partners experiencing birth-related PTSD?

Connecting with other moms.  Connecting with other moms helps you see that you’re not alone.  There are a number of online communities for mothers experiencing birth-related trauma, including Solace for Mothers, Birth Trauma Association’s Facebook page, and Baby Center.

Self care.  A number of forms of self care can aid in healing, including: getting adequate sleep, exercise, yoga, bodywork and massage.  Getting help with cooking, cleaning, and baby care from family, friends, or a postpartum doula may also help you heal.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is considered by trauma experts, including the U.S. Departments of Veterans Affairs and Defense and the American Psychological Association, to be a front line treatment for PTSD.  EMDR involves thinking about the traumatic experience while experiencing a stimulus engaging both sides of your perception.  This might mean moving your eyes back and forth, listening to a tapping sound in alternating ears, or feeling a tapping on alternating knees.  EMDR typically reduces symptoms after just a few sessions. To find a certified EMDR professional, see the EMDR Institute or the EMDR International Association.

Cognitive Behavioral Therapy (CBT) is a form of therapy which addresses beliefs caused by trauma and helps to counter conditioned-fear responses related to the traumatic experience.  To find a CBT therapist, search the websites of the National Association of Cognitive Behavioral Therapist’s or the Association for Behavioral and Cognitive Therapies.

Medications.  You may want to discuss medication options with your healthcare provider.  A summary of medication options is provided here.

Care for partners.  Partners can experience trauma related to childbirth as well.  Encourage partners to seek help if they are experiencing trauma

For more information, listen to Motherlove Herbal Company’s podcast interview.  You may also be interested in this podcast interview on traumatic birth with Dr. Kathleen Kendall-Tackett, president-elect of the Trauma Division of the American Psychological Association.

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.
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Comments

  1. I just want to say thank you for posting this. I had a very traumatic birthing experience with my twins. While my twins were in the NICU (born at 27weeks) I tried and tried to find resources for breastfeeding while recovering from a tramatic birth/ suffering from PTSD. I could not find much and most of the online resources or social/ breastfeeding groups told me (or it felt like I was being told) to “just try harder” or pay for expensive donor milk. Which did not help.

    This post has really useful information to support woman trying to breastfeed and it acknowledges that sometimes breastfeeding after a traumatic birth experience just doesn’t work out and it’s ok.

  2. This is a really important information for anyone with ptsd, anxiety, and trauma in general. I have a severe needle phobia and had 3 panic attacks in the hospital before my son was delivered C-section. The epidural was the absolute worst experience of my life and the hospital staff was very rude about it. My mom had asked them to give me something to calm me down and they thought I was making a fuss to get *drugs* so they kept yelling “you need to stop!” My son was born healthy but with ‘flaring nostrils’ so they rushed him into the NICU that evening. They fed him a bottle of glucose and a pacifier before I even got permission to breastfeed. They let me BF him 2 short sessions before he wentinto the NICU and started giving him formula without consent. I had to ask them over and over to take the pacifier out of his mouth. And despite the pediatrician’s orders to just breastfeed him on demand to tread the ‘intermittent tachypnea,’ they made me pump for 1.5 days after he was born in order to prove myself to them. It took a good lactation nurse to advocate for me. At first they were only going to give me 15 minutes every 3 hours but she got them to allow 20. And they forced a bottle of formula down his throat after every feeding. One night I went into the NICU to feed my baby and he fell asleep, nursing so I just decided to let him stay at the breast and was enjoying my first real peaceful moment as a mother w/my child. When the NICU nurse realized that I was still there, she got angry and scolded me for breaking the 20 min. rule. She yelled “Don’t you DARE let hm use you as a pacifier!” I think it’s important for new parents to know the hospital they are delivering at. And don’t let anyone tell you how foolish you are, writing up a birthing plan, etc. Put you wishes in writing. Be specific about bottles, pacifiers, when you want to nurse your baby. I didn’t realize how important it would be to have a good pediatrician before my son was born. One that supports BFing! And having a good advocate is important too. And learn as much as you can about breastfeeding before your baby is born. The neonatologist said 15 minutes was more than adequate bc a baby can drain both breasts in 10 minutes. I didn’t know any better. They told me non-nutritive sucking would cause my baby to loose more weight/burn calories, yet they had a pacifier in his mouth constantly. This experience set me up for a multitude of problems. Even trying to use the pump caused extensive pain for months. I was trying so hard to pump more than a few drops and didn’t have proper knowledge on how to use the pump. So I would say it is good to know your rights and advocate or have someone who can.

  3. This article was a great encouragement.

    In my own mind, but to absolutely nobody else, my son’s birth was traumatic. It started a week before with my doctors not listening and stepping overbounds. I had prodromal labor with contractions three minutes apart for two days, and two minutes apart for a week. I was set on a natural birth, but had a doctor try to scare me into an induction with the possibility of a still birth and this doctor was one of the possible delivering doctors. Another doctor, who also did deliveries, spoke to me like a child wondering about going into active labor. As he checked my cervix, he said it was tilted and manually tried to fix it without my consent. I felt absolutely violated and had no trust in any of the delivering doctors except for one, but this hospital was the best medical facility.

    When active labor finally started, I had to fight the nurses tooth and nail for a natural birth even thigh I had been assured for NINE MONTHS that they supported a natural birth…. the reason I wanted a natural birth was because of the possible side effects of the medications, but instead of a natural birth, everything cascaded into a series of interventions with 26 hours of labor because the hospital couldn’t really handle a natural birth. They didn’t know how to help.

    I was stuck at 5cm for four hours and 6cm for five. I couldn’t stand for long because my feet were swollen and painful but it was my only option because of intense back labor that made laying down or squatting unbearable. But they fought me on that too because They wanted me laying down and on the monitor for 45min out of every hour. After three hours, They broke my water, and iI finally accepted morphine, but watched in horror as my baby’s heart rate dropped drastically with every contraction. My husband was my strength and told me often that he was proud of me. I progressed to seven centimeters and the morphine did nothing. In fact, they couldn’t give me anymore after 8 abd I thought it was too late for the epidural I didn’t want. It felt like someone was stabbing me in my tail bone at the start of every contraction and I felt trapped. The contractions were nothing compared to the back labor but I was stuck in this immense amount of pain that i couldn’t escape and it was only going to get worse.

    After finding out I could still get an epidural, and a long internal battle about getting one, I gave in because I hadn’t slept in three days, I couldn’t lay down, sit, or stand, and I couldn’t relax. I gave in with intense pain. Suddenly, with the epidural, the pain started to die down and disappear and I thought I could relax. After 21 hours of active labor, my amazing husband took a much needed nap and I determined to do the same… until my baby’s heart rate kept dropping seriously low with every contraction and I knew it was my fault because I got the epidural which also meant pitocin.

    They lost his heartbeat often because the monitors were junk and it also went low. One time, it took several minutes to find it n I wanted my husband but he was asleep, absolutely exhausted. I blamed myself the whole time and feared losing my baby.

    It came time to push and they couldn’t find my doctor because she had gone SWOLLEN, asleep for two or three hours by the time it was our time to deliver. And there I was, little miss natural birth advocate was on her back Ding “purple pushing” for probably an hour until my little was born, thankfully breathing.

    He developed severe jaundice (I blamed the epidural and this myself), he wasn’t latching on/sucking for three days and I blamed myself. Pumping was awful because he would wake up right when I started and it took time. I had pain where the epidural was and still do six months later. When I would bend over to change his diaper months later, my back would hurt abd I would beat myself up even more. Even after being cleared at 6 weeks by my doctor, my hips hurt so bad that sexual interaction was nearly impossible. In my mind, I had failed and hurt my child, and now my husband as well.

    He had jaundice. Didn’t latch forever and was made worse by the jaundice. I gave up my birth plan and let them put the burning ointment on his eyes and let them bathe him. Overcome with postpartum mood disordErs, I probably changed his diaper once a day. I worried constantly and obsessed over his breathing. I had postpartum depression, ocd, anxiety, and PTSD but it was all dismissed as postpartum blues. People would ask me if it was an easy birth and I just wanted to scream, bawl, and run…. it was traumatic and I wanted people to stop asking because Im sure they didn’t want the real answer. I couldn’t stand hearing about pregnancy or birth and while I loved my baby, I kept feeling like a failure as a parent and I was exhausted.

    There was more that happened afterwards, but I felt silly even talking about possible PTSD because it was supposed to be a happy occasion and I was supposed to fall into this role as a mom… I developed not only anxiety towards pregnancy and child birth, but anger towards my husband. I loved my baby was depression overtook me in my frustration and exhaustion. But I felt like a wimp and a whiner for the scars that his birth left.

    I wish I had known and I wish the doctors had known to ask because to me, it wasn’t an “uncomplicated” birth.

  4. Typo… the doctor had gone AWOL… not “swollen” :)

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