How do you feel on your child’s birthday? Proud, happy — or wistful for the baby years long since passed?
While Jo Page, 49, a mother of two from Kent, is nothing but proud of her son, Elliot, 24, each year his birthday is a difficult occasion for her.
Why? Because Elliot’s birth was a devastating event, causing her not only distressing physical injuries, but much emotional anguish.
So much so that today, over two decades on, Jo still suffers from psychological trauma over what happened, enduring terrible flashbacks as well as crushingly low moods.
These feelings often reach their peak on her son’s birthday, she says. ‘On Elliot’s birthday, I feel grief for the carefree woman I lost when he was born. I still feel I failed at birth. I feel like I’m not a proper woman.’
Jo Page, 49, from Kent, and Caroline Moore, 36, from South London, (pictured left to right) opened up about their traumatic births, as one in 25 women experience Post Traumatic Stress Disorder post-pregnancy
The rawness of the emotions Jo expresses is heart-breaking. So, is it possible to be psychologically traumatised by a birth that occurred so many years before?
As a clinical psychologist who specialises in the perinatal period — around pregnancy, birth and the first years of parenthood — I often hear disbelief in people’s voices when I say giving birth can be a cause of trauma.
Many of you reading this may be thinking: ‘Well, of course birth is hard — why can’t these women just get on with it and stop making a fuss?’ Not to mention that other oft-repeated sentence many of my patients say they’ve been told: ‘You have a lovely healthy baby — what are you complaining about?’
Yet, despite such scepticism, it’s certainly the case that birth can cause long-lasting psychological trauma. Indeed, research has found a third of women suffer some symptoms of trauma after having a baby.
Psychologically speaking, trauma means feeling unsafe, aware that you or a loved one are in grave danger. Crucially, it’s entirely subjective. For one in 25 women, their birth trauma is so acute, it leads to Post Traumatic Stress Disorder (PTSD). And it can last for decades.
Symptoms of trauma may include nightmares about the birth, avoiding any reminders of the birth and feeling highly vigilant or like you’re ‘back there’ when triggered by things like hearing others’ birth stories. (Before reading further, if you do feel you have been through a difficult birth, I’d urge you to make sure you read this with someone you can talk to afterwards.)
All traumas have causes and triggers — and birth trauma is no different. Where it’s distinct is that its causes are often preventable. Meanwhile, its triggers are often associated with a woman’s everyday experiences — deciding whether to have another child, giving birth again, being intimate with your partner or even becoming a grandmother.
Jo (pictured with her son Elliot) was left with a fourth-degree tear after a forceps delivery, she revealed the experience impacted her finances, social life and mental health
These sorts of events form the broad canopy of so many women’s lives, and with this in mind, it’s not surprising birth trauma can last for many years.
For Jo, her trauma is deeply triggered by her son’s birthday. And it isn’t difficult to see how she was left with PTSD from this, her first birth. Ending in a forceps delivery, she was left with a fourth-degree tear — the most severe kind, which extends far beyond the vagina.
‘I remember thinking, “No baby can survive this” as they tugged his head so hard to get him out, but the real problems came afterwards,’ Jo told me.
‘The forceps left me with damage to my urethra so I needed to be catheterised. My episiotomy wound also became severely infected.
‘I had to look after a newborn baby while showering numerous times a day and having saline baths. It was like that for 18 months while I waited to see if it would heal. When it didn’t, my mood plummeted.’
Left in anguish
About 30,000 women experience birth trauma in the UK every year, says the most recent research
And the consequences have been far reaching. Having previously worked as a make up artist, her lasting physical injuries mean she prefers to be near home, cannot eat out of the house and worries about travelling or going to events. This has taken a profound toll not only on her finances and social life, but on her mental health.
‘It’s so sad as it’s entirely due to my injuries. I’m confined to home due to an obstetrician’s mistake. I experience self-loathing and self-harm with binge eating, which makes me very poorly due to my injury.
Such was her emotional pain that for 23 years, Jo didn’t talk about her birth to anyone outside her immediate family. When she eventually opened up, doctors and therapists brought little relief. She felt no one truly understood what she’d been through.
‘Even family members just said: “But look, you’ve got such a beautiful baby.” What you really need is someone to say: “I’ve been there and it can get better.” ’
Today, Jo is a parent ambassador for Make Birth Better — an organisation I set up with perinatal psychiatrist Dr Rebecca Moore in 2018 to raise awareness of birth trauma, provide support and campaign for changes to maternity services. Jo contacted us during our first campaign and has become a backbone of the organisation. She now feels her trauma symptoms have improved, although there are still difficult moments.
Caroline (pictured with her daughter Esther) was unexpectedly cut by an obstetrician and made to use a ventouse to deliver her baby, the experience left her angry and anxious
Hearing stories like hers is vital to helping women who suffer birth trauma, as research in this area is relatively new.
Even when a traumatised woman is aware of her symptoms, she will often find them misdiagnosed as post-natal depression — which is characterised by low mood and a lack of joy or pleasure, rather than the heightened sense of threat we see in trauma — or dismissed entirely.
What we now know is there are a few factors which make it more likely you will have symptoms of trauma. Some concern the birth itself — an emergency caesarean, for example, has been linked to an increased risk. Others involve your social situation or previous history of other traumas.
Meanwhile, society is constantly telling us that birth can be magical, life-affirming and blissful.
So when it turns out to be different, we can often blame ourselves. Birth becomes something we have failed at, rather than something we have been failed with. This self-blame can make it hard to seek help.
All too often, we try to move on, wanting to get on with the task of parenting our new baby. Finding the attention of those around you, including healthcare professionals, is on the baby, rather than how you feel, means many shut away their experience.
Caroline learnt there was no need for medical intervention to take place during her birth, after visiting a Birth Reflections session (file image)
All this combines to create a recipe for avoidance. Your traumatic memory can be pushed aside — until it’s triggered in the form of a flashback or nightmare, or re-emerges as you plan for a subsequent child.
Strong links exist between trauma and how you were made to feel at the time of the birth. Midwives and other medical professionals can have a significant impact on a mother’s future mental health.
Caroline Moore, 36, who lives in South London, certainly agrees with this. The birth of her daughter, Esther, now two, started off in a straightforward way, but was derailed by medical decisions which may have been unnecessary. ‘The early stages of my labour were intense but manageable,’ she remembers today. ‘I had a lovely midwife who reassured me and gave me a lot of confidence.’
Then her midwife changed shift, and she was left with an agency midwife who left her feeling unsupported and unsafe. Suddenly, Caroline was told her ‘time to push’ was up and she would need an assisted delivery, using a ventouse or forceps.
‘At no point was any of this explained to me. The sudden urgency meant I assumed I or my baby must be at risk,’ she says.
Terrified and confused, Caroline’s emotions shut down while an obstetrician cut her and used a ventouse to deliver her baby.
Following Esther’s birth, the team realised Caroline was haemorrhaging. She was taken alone to surgery — leaving her partner holding their new baby. Caroline was then left on a postnatal ward with Esther, barely able to move and feeling as though she had been assaulted.
Caroline says the relationship with her daughter was impacted by the trauma of her birthing experience as it took nearly a year to feel overwhelming love (file image)
Ten weeks later, she attended a Birth Reflections session with the supervisor of midwives at her hospital — and was astonished to hear there had been no medical need for any intervention to take place.
‘I had been progressing well in labour, I still felt energetic and Esther and I were both fine. All that we went through, and the long time it took me to recover, was for no reason.’
She began to notice symptoms of trauma. ‘I was filled with anger and anxiety. I felt I had to take extreme control over everything in the house to give me the sense of control I lacked from the birth.’
Her relationship with her daughter was affected, too. ‘It took me nearly a year to feel that overwhelming “being in love” feeling,’ says Caroline. ‘I felt sorry for her that she had this angry, sad mess of a person as a mother. I cried a lot and would hold her and whisper “sorry” into her ear.’
Physically, Caroline felt disconnected from her own body. ‘Every mother finds it difficult to adjust to their new post-pregnancy body, but layered on top of that was ten months of pain, a daily reminder of the horrible wound from my episiotomy.
‘I felt angry at my body for not doing what it should have been able to do and I felt like its maiming during the birth was almost punishment for that.’
It’s stories like Caroline’s that have led us at Make Birth Better to question whether many standard maternity procedures and environments can feel traumatic to those experiencing them, especially when coupled with an uncaring or hostile manner.
Jo who would’ve love to have three children, says her experience made it difficult to imagine something going right after things went so wrong (file image)
While physical pain contributed to Caroline’s difficulties after Esther’s birth, it was the lack of kindness and communication which she sees as key to her lasting problems.
Increased training and meaningful support for healthcare professionals are vital if we are to see a reduction in trauma.
Birth trauma has a deep, painful impact on many families. Both Jo and Caroline’s other relationships were affected by their birth experiences.
Jo’s husband was so traumatised by what he witnessed, and their relationship so shaken by what they’d been through, that they separated for a time.
Esther may now have a brilliant bond with her mum, but Caroline still thinks about how she came into the world.
And while Jo would have loved three children, she considers herself lucky that she managed to give Elliot one sibling — Hugo, now 19.
‘My anxiety was awful throughout, as it’s hard to imagine something can ever go right after it going so wrong.’
One can only hope that, one day, stories like Jo’s and Caroline’s won’t be seen as ‘just’ another part of being a mother.
Why Birth Trauma Matters by Emma Svanberg is published by Pinter & Martin at £8.99. See makebirthbetter.org or @birthbetter on Instagram for more information.