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Birth - The Silent Trauma

A woman with her hands on her pregnant belly. Another woman with her finger over her lips saying "shh", and a woman holding her baby after giving birth with her hand over her face.

Content warning: this article discusses, in medical language, a variety of things that can occur during birthing experiences and the topic of sexual assault. Parental discretion is advised for readers under the age of 13.

When working with pelvic health patients, you have to ask some pretty personal questions. While asking if a patient has a history of sexual trauma or abuse is part of the standard intake process, I often find that some women are trauma survivors and don't even recognize it. Instead of discovering this trauma on an intake form, I sometimes uncover it when I ask women about their pregnancy and delivery.

There are types of trauma have become so normalized by society that we don't realize just how significant of an impact they have on our lives. Some women who develop problems with pain during intercourse after having a baby are left wondering why. They don't realize just how similar to a sexual trauma experience giving birth can be.

It bears mentioning the cliche: "Expectation is the root of all heartache." Culturally we come to labor with expectations of what birth will look like. Our experience of birthing is usually based on high school health classes, watching movies, or pictures of the newborn photo-shoots that people post on social media platforms. Most of us don't develop our mental picture of labor by witnessing actual births. This is anxiety producing for many mothers because their first experience in the labor and delivery room is when they are the one having the baby.

As a disclaimer to expecting mothers, not every birth experience goes awry. There are many deliveries that go smoothly as planned. You should not read through the situations below and assume that a terrible birth experience awaits. This article is intended to validate the experiences of women who have already had traumatic deliveries. It will discuss the things that can happen; that does not mean that they will happen.

Even in the best of circumstances, giving birth is anxiety producing for moms-to-be, and reasonably so. Some of this is normal, and healthy. It is a healthy attitude to not be eager for experiences we expect to be painful. After all, we consider masochism where people intentionally seek to inflict pain on themselves to be a mental health disorder that warrants treatment by a trained professional.

Pain is typically the body's alarm system. It's meant to protect us from harm. Pain sends us a message to quickly move our hand if we put it on a hot stovetop in hopes of minimizing the burn damage to our skin.

So when it comes to having a baby, while pain during labor is "normal", it is understandably a complicated experience for women. They have to be willing to set aside everything their body has known and been programmed to think about pain. Your body's entire life it's been taught to avoid pain, and now, you are intentionally asking it to embrace it. The idea that this pain will lead to a joyous occasion, the birth of a child, may be "normal", but it is still a neurological paradox for your nervous system to wrestle with.

There is a reason that birthing classes and maternal education regarding what to expect in labor are recommended. Unfortunately however, they can't prepare you for everything, and some lessons in life are learned by experience.

Birth trauma can take many forms:

1.) Being Seen

  • Someone came into your delivery room against your wishes (i.e. a mother-in-law)

  • Your doctor wasn't available, and although you had signed something saying you'd accept care from whoever in the practice was on call, the person you ended up overseeing your delivery was someone you didn't want to work with.

  • Students were allowed in to participate in your care, and you felt pressured to accept, but didn't feel comfortable working with them.

The reality is, that during the labor and delivery process, women are vulnerable, and their bodies are often exposed to multiple people. They are anxious, exhausted, and often lose a lot of blood. They are dependent on doctors that they may or may not know and trust to make decisions to balance their own health and that of their baby.

In any other context, strangers walking in on us naked would be seen as a violation of our privacy, but in a labor and delivery room it seems like anything goes. Different nurses, doctors, medical assistants and family members are often in and out.

While this may be different than a sexual assault in that it isn't being perpetrated maliciously, we have to admit that there are some similarities to the experience.

2.) Being Touched

  • Maybe you really wanted a vaginal birth, but developed complications at the last minute and needed an emergency C-section that you didn't want.

  • An episiotomy was done without your knowing it (or without your consent).

  • The baby went into fetal distress and the doctors had to make quick decisions about what to do to your body that they didn't have time to explain. You may have been repositioned, forceps may have been used, etc.

In some instances, the doctor may have done these things for the right reasons, but it is still confusing to your body. Ideally, as human beings we grow up with a healthy sense of boundaries around our own bodies. We have a right to decide if someone is allowed to touch us or not. We have also spent our lives signing consent forms to give permission for any medical treatment we receive, so naturally, we believe we have rights to decide what kind of medical touch we receive also.

In a labor and delivery room however, this gets complicated. When having a baby, because two lives hang in the balance, these boundary lines can become blurred. What is necessary to protect the baby can be at the mother's expense. In the heat of the moment, doctors assume that the mother's desire for her baby to live is consent. They make quick decisions and often don't have time to communicate empathetically that they are sorry it has to be this way.

While the insertion of forceps to quickly get your baby out may have been necessary, and rationally, you probably would have agreed if asked, in the moment, it is shocking. It is still penetration that you didn't have time to process was going to occur to your body and agree to.

Again, while it was not maliciously intended, there are some definite similarities to the idea of penetrative sexual assault.

C-sections and episiotomies are surgical procedures that you may not have wanted, but been helpless to prevent. They are touch to your body which may have been necessary, but this also brings us to the third issue of consent.

While you may have given consent out of necessity, it may not have been with a full desirous agreement. In reality, for many women it comes more often in the form of not having said anything at all.

It bears mentioning, that in a court of law when it comes to sexual assaults, if a person freezes during an assault, their inability to communicate does not grant consent.

Labor is different, because in emergency situations, doctors are given legal protection to make the decisions they believe to be in the best interest of their patients. However, understanding the similarities to an assault can help us to understand why some women experience pelvic pain and problems after having a baby.

3.) Loss of Control

  • You tried to tell your doctor something that was happening in your body and they didn't listen. (i.e. that you were further along in the process and needed a room to deliver NOW and they didn't believe you, or that the pain medicine didn't work, and they didn't believe you)

  • In the fatigue and anxiety of a long labor, you didn't understand what you were being asked to consent to, and ended up with an episiotomy scar.

  • The doctors did things they didn't explain to you because they were worried about stressing you out and jeopardizing your health more if you knew what was happening and they needed you to remain calm.

  • You passed out from exhaustion or a medical complication during labor, and woke up not knowing what happened.

  • You wanted an epidural for pain control, but the epidural didn't take, and you felt everything.

You may have heard it said that rape and sexual assault are crimes about power, not about sex. With this in mind, (though again, it isn't malicious) it's important to recognize the loss of control that women can experience during the labor and delivery process.

This is especially true for women who have experiences they didn't anticipate. Birthing classes center around trying to prepare women for potential outcomes. They help women to know their options in advance, and therefore help them feel more in control.

Unfortunately however, it's just not possible to prepare them for every situation. Their doctors spend over a decade in school studying to be doctors, and even then, they learn and gain experience on the job. Most good providers are humble enough to tell you that even when you work in labor and delivery every day, you've never seen it all.

Sometimes there is little choice but to deal with the consequences of the situation afterwards as they come.

4.) Pain:

  • Your labor was longer than expected.

  • The pain management strategies weren't effective.

  • The pain management strategies were effective temporarily. Everything was fine until they wore off and your body was in shock, not understanding why it was in so much pain and hadn't been able to protect itself.

Labor is different than our other short-lived pain experiences in the medical field. It's true that we have asked our bodies to endure brief episodes of pain in the past for medical benefit. For example, most women by the time they are having children, have submitted to blood tests, vaccines, pap smears, and other medical interventions that involved some level of pain and discomfort. This however, is wholly different than a 30 hour labor experience.

The difficulty of a long labor is especially true if your pain management strategies don't work as planned. Continually asking your nervous system to submit itself to a prolonged pain experience forces you to engage in that neurological paradox we mentioned earlier. Pain is the body's way to tell you about danger, so you are essentially asking your body to live in a state of feeling threatened, and anxious for a long time. To make matters worse, you can't control just how long that will be. Despite your best efforts to give them the eviction notice and push them out into the world, babies come on their own time.

The one that often surprises people, especially first-time mothers, is that you aren't off the hook just because the pain management strategies work during labor. Consider for a moment what anesthesia does to your nervous system. It pleasantly keeps your pain alarm system from sounding, but we are using it to cheat the system. During labor, changes are happening to the body that should be painful; there are demands placed on your pelvic muscles far beyond the everyday.

As a result, when the alarm system comes back on, your body feels cheated. Pain was robbed of it's ability to do it's job and protect itself. This can be confusing to your body. Something "dangerous" happened to your body, and pain missed it.

It can cause our pain system to overzealously attempt to protect us. If your body experiences pain and it knows the source, you learn to avoid it. In the hot stove example, by the time you've reached adulthood, you've learned to be careful to avoid touching hot stoves. This is true even if you've never touched one, simply because you know that if you did, it would hurt.

The trouble with numbing the body to the labor experience is that sometimes, because it seemed like you weren't doing anything in particular, the pain system doesn't know what to blame. As a result, in some cases, it decides that it needs to be on a higher alert level all the time. Any touch to the pelvis can become painful, and in some cases, the pain can be present even when nothing is touching the pelvis and you aren't doing anything at all.

What Can I Do About It?

The good news is that you've already taken the first step to healing if you've experienced some of these things. The first step to addressing the problem, is recognizing what the problem is.

Identifying the elements of your story that are traumatic can help you gain valuable insight and understanding. This can help to re-establish a sense of control.

You may still want to process through your experience with a trained counselor. They can often help to draw you out and ask questions to help you better understand your experience, as well as suggesting potential treatment strategies to help you heal psychologically.

If you are still having physical symptoms, pelvic floor physical therapy may be able to help. If your gynecologist says that everything looks good, but you're still having problems, it may not be a structural problem. The way your muscles are functioning may be to blame. Physical therapists are movement specialists; they are experts in function.

If you are experiencing problems with bowel or bladder function like pain or incontinence, or if you're experiencing pain during sex after having a baby, you are not alone. While this article is intended for educational purposes, and is not a replacement for individual medical advice from a licensed healthcare provider, it can be the start of your journey.

If you are interested in learning more about pelvic floor physical therapy or scheduling an evaluation with a pelvic floor physical therapist, click to book online, or contact our office to schedule an appointment.

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