Warning: This article contains stories about difficult deliveries that some readers might find disturbing. All interviewees’ names have been changed to protect their privacy.
When I was in college, I read a short story by John Cheever about a character who was on a business trip. His plane crash-landed in a field. Everyone survived, but it was described as a harrowing, terrifying experience. Because there were no casualties, the crash wasn’t even mentioned on the evening news. The character went home to his family but couldn’t seem to make them understand or even care about what he had just gone through.
I think about this story frequently, especially when we talk about birth, and more specifically when we talk about traumatic birth. There is a tendency for friends and family to say, “You’re fine, and your baby is healthy.” But is the new mom really fine? For women who experience trauma at birth, this is a common and irritating response. They may try to just “focus on the baby,” as their friends and family suggest, but they can’t shake the feeling that something hasn’t been acknowledged about their birth story. This can lead to postpartum depression and anxiety. Not all emotional pain that lingers after childbirth need stem from dire medical incidents. Birth trauma is in the eye of the beholder.
Take Laura, a Hoboken mom. While she was pregnant, she was ambivalent about her obstetrician. She didn’t like the way he spoke mainly to her husband during their prenatal exams, often chatting about football and sports, which annoyed her. Laura would have preferred the extra chit-chat during their prenatal visits be spent answering her many pregnancy questions. But she let it go, remembering her doctor had come highly recommended.
Later on Laura’s conflicted feelings about her doctor bubbled to the surface. “I did not like the way he spoke to me in labor. He treated my pushing the baby out like it was some endurance sport, like he was a personal trainer at the gym. Because I’m a Pilates instructor, he sort of weaponized that detail to bully me into pushing more effectively. I felt like he was intimidating me into getting my baby out by making me feel like a failure because I wasn’t doing it ‘right’ or ‘good enough’,” she explained.
“When my baby was born, I felt emotionally drained and bruised. I wasn’t even thinking of my baby; instead, I was seething with annoyance about how he spoke to me. He robbed me of the beauty of bringing my baby into the world by forcing me to focus on his intimidation tactics. Every time I thought of my beautiful daughter’s birth, I heard his callous voice berating my efforts.”
Laura cried every time she spoke of her birth. Anxiety bubbled to the surface along with regret and fury. “I just hated him,” she said. “I decided not to go to him for my postpartum follow-up visit, and I wrote him a letter telling him exactly what I thought of my experience.”
Nicole felt similarly disrespected during the pushing stage but ultimately turned her anger toward her partner. “After the birth I was furious with my husband,” she said. “I felt like he should have protected me and told the doctor to stop speaking to me so roughly.” Yet Nicole realized that both she and her husband were taught “follow doctor’s orders,” and that’s what they did.
“It’s weird,” she continues, reflecting on the moment. “He’s not doing surgery in that moment. He’s supposed to guide and coach me through a physiological effort. I’m allowed to criticize his approach while still respecting his medical knowledge. To me, they are two separate things.”
The takeaway? Trust your instincts. Ask your support person ahead of time to speak up on your behalf should you feel disrespected during labor. Choose a practice not only for its reputation, but because it feels right to you. Check your hospital’s c-section rate before you select your provider. Put yourself in the most favorable position long before you go into labor.
Aubrey had a more extreme experience.
“Everything about my first birth was the opposite of what I wanted,” said the mother of three. “I was having twins, which should not have been perceived as such a medical crisis. Every step of the way my doctor and the hospital staff refused to listen to me or respect my wishes. I had one procedure after another, which led to an emergency c-section.”
Though Aubrey’s surgery in itself did not constitute a medical crisis, her lack of agency during delivery left her disillusioned and depressed. “I felt like my body was broken, like I wasn’t allowed to let it do its job.”
In the weeks that followed, several visits to her doctor for an oozing wound yielded no response other than there’s nothing wrong with you. Eventually Aubrey’s sister flew to Jersey City and brought her and the babies back to their mother’s house in the South. Once there, the family’s doctor treated her for a festering infection that her own doctor’s office had overlooked.
But Aubrey’s story doesn’t end there. At the start of the pandemic she got pregnant again. This time she wanted a less medicalized labor, so she shopped for a midwife who would do a home birth. This approach is not very popular in the U.S.—less than one percent of pregnant women plan to deliver at home. For Aubrey it was impossible because New Jersey prohibits midwives from attending home deliveries following c-sections. It’s considered too risky. But this didn’t stop Aubrey.
“I was having panic attacks at the thought of even visiting a doctor’s office. So, I just decided to have my baby at home, on my own. My husband wasn’t exactly on board with the idea, but I did it. It was incredible and exhilarating. It proved to me that my body was not broken; it worked perfectly fine when given the opportunity to do so.”
Aubrey took a huge risk. While it cannot be condoned medically, her decision illustrates how extreme stress can push a mother to make a radical choice.
Ina May Gaskin, considered to be the “mother of midwifery” observes women experiencing a wide range of emotions during pregnancy and labor. Often, she sees women robbed of self-confidence particularly during childbirth. In the documentary “A Birth Story” she asks, “If they take it all away from you, how do you get it? Where do you get it?”
While many recent birth traumas reflect over-taxed practitioners experiencing burnout during the pandemic, COVID alone doesn’t explain the phenomenon. The medical profession has needed sensitivity training for a long time. For women to have positive birth experiences, they don’t need deliveries that are pain free. They don’t even need to delivery vaginally. They simply need to be to be listened to, to be validated. To be respected and supported.
“I’m still angry at my husband,” says Robyn, a local mother of two. “I had my first baby without him because he went out of town too close to my due date. I became suddenly and severely preeclamptic and had to deliver early. Thankfully my mother was able to get there in time.”
After a difficult induction that ended in a c-section, Robyn was haunted by the fact that her doctor’s office had nearly missed her preeclampsia. Her life had hung in the balance.
“After my second birth, the baby had to go to the NICU, and my husband stayed with her the whole time. I’m recovering from yet another c-section and completely unable to move. A social worker at that point decides to grill me on why I’m not bonding and visiting with my newborn. It was so insensitive and clueless. She made me feel worse, not better,” Robyn reports.
It’s not just the women who have a tough time. “I was enduring a very scary emergency c-section, and my husband started to feel faint, so he asked if he could sit down,” explains Sabrina, a first time mom. “He was escorted out of the operating room into recovery, which was a safer place to be. A male nurse sidled over to me, leaned in, and said, ‘I guess there’s more than one baby in the room.’ I’m literally hemorrhaging on the operating table after a long and difficult labor with tons of awful side effects, and this is what he chooses to say at that moment? Everything went wrong during my labor that preceded the c-section. No one would listen to me. If I said I was allergic to a drug, they forgot about that. The epidural didn’t work well, they didn’t believe me. I was shaking, vomiting, my skin was on fire from the Fentanyl that I asked not to get. It was unreal.”
Sabrina is also a cancer survivor. Hospitals and self-advocacy are second nature to her, yet she found herself constantly deflecting insensitive comments. “Because of my double mastectomy and birthing at a ‘baby-friendly’ hospital, I was dreading being approached about breastfeeding. Of course, a lactation consultant comes in the middle of the night when I’m trying to sleep. She starts talking about something to stimulate my milk supply, and I’m just beyond exasperated at that point. All she could offer to me, a brand-new mom with no ability to breastfeed, was a lack of formula knowledge and a warning that my baby doesn’t become obese from bottle feeding.”
Shafali is a Jersey City mom who started to bleed heavily after delivering. “Upon discharge from the hospital they tell moms to look out for clots that are bigger than a golf ball,” she explains. “But mine were much larger and just kept coming. I was instructed to go to the emergency room, but this was at the beginning of the pandemic so I did not want to bring my baby with me. I had to wait for my mother to arrive to stay with my newborn, so my husband could take me to the hospital.” Once there, Shafali learned she might have to have a hysterectomy. Fortunately, she didn’t, but due to COVID, she spent the rest of her hospital stay by herself without her husband and newborn. “I had tubes down my throat, no family, no phone, no visitors,” she says, reliving those five days. “I was terrified.”
But Shafali wasn’t alright, it turned out. Shortly after she went home, she started bleeding again. She wound up back in the hospital (via the ER), where doctors told her that, in order to save her life, they might have a hysterectomy after all. Shafali woke up in recovery alone again and learned the surgeon had removed her uterus. How she was spoken to afterward sunk her deeper into despair.
“The doctor who did the surgery made a comment about going through my c-section incision so I’d be ‘back in a bikini in no time’,” she said. “Then the other doctor said something about me never being bothered by periods again. I wanted to burst into tears, but I held back my emotions at that moment. I had no family around to comfort me.”
Could it be Shafali’s doctors were just trying to make her feel better? Of course. But a woman of child-bearing age who has just lost her ability to have more children is not thinking about wearing a bikini on the beach next summer; nor is she comforted by the prospect of losing her “pesky periods.” Hospital staff do their best to accommodate a patient’s feelings, but a typical new mother is extremely vulnerable, like an exposed nerve. Her normal protective layers have been peeled back and her psyche is laid bare. It is during this raw emotional experience that words and actions leave an indelible imprint.
According to mental health experts, Shafali did not receive “trauma-informed care.” Trauma-informed providers are advised to assume that their patients have experienced some form of trauma in their lives—and that how you speak to them can trigger painful memories. Yet, this standard of care is hard to come by.
That’s getting attention.
Both Beyoncé and Serena Williams had very difficult deliveries. Indeed, Williams nearly died of a complication that might have gone undetected had she not vocally advocated for herself. To help publicize the need for better care from the medical community, Beyonce and Williams went public about them. “It may be time for women to be comfortable with having uncomfortable conversations,” Williams told the press after her recovery. By sharing the darker and often traumatic sides of birth, women can raise awareness and legitimate concern about the issue.
In the end we can’t always prevent birth trauma, but we can certainly take steps to minimize it. While pregnant, learn as much as you can about your provider and the hospital you’re choosing. Seek education, support groups, online forums; hire a birth doula, and consider choosing a midwife or a birthing center. Should you experience a postpartum mood disorder or simply want to share some negative experiences you had, get help. (Local therapy practice MindfulPower regularly holds birth trauma workshops and support groups for women to share and process their stories.)
It comes down to support and knowledge.
“Birthing is like a leap that is not optional,” says Deborah Robbins, a former labor nurse. “The baby has to get born one way or another. So, you line up the people below who will hold the net while you let go. The fall may be scary (or not), but if you trust the folks who are there to catch you, there is an implicit sense of calm, even peace.”
Jayne Freeman is a certified childbirth educator, breastfeeding counselor, and postpartum doula based in Jersey City. Please see her website for providers specializing in birth trauma and perinatal mood disorders.