by Tanya Lieberman

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

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.