After having 3 amazing c section experiences I never would have thought how terribly one could go until I had my 4th C-section at 31 weeks. I was transferred from my established practice at a community hospital to the city’s large high risk hospital with the expectation I was going to continue to be monitored with pre eclampsia... that day my blood pressure had been a lot lower than a few days prior.. my baby was fine and moving as he should and I thought things were moving in the right direction. After meeting my new drs at the new hospital, I was given the impression that delivery was more than likely happening that night and that was that. I had a slight headache after being in the hospital for 3 days at that point and the drs said if my headache still didn’t go away after getting meds through my iv that was it, they were delivering. Not once was I given an alternate option or told what my chances of putting off delivery even one more day would be... the dr asked me if I had eaten that day and I said yes I had a full lunch.. he looked at me and said what? Why would they feed you?! I was confused why he was shocked about that... I said no one was expecting me to deliver today?! Soon after it was official I was delivering that evening I had a flood of physicians come to my room over the next hour or so talking about what to expect with a nicu baby, the chance of ppd being higher with a nicu baby and I was just given so much info to take in all at once I couldn’t wrap my head around it to think of questions to ask.. but I figured they were the professionals .. Who was I to question them? Knowing now what I didn’t then, I wish I had asked why couldn’t we wait just one more day? Would it have lowered the chances of my baby developing pphn and needing to be intubated at only 2 days old? I had already been on the iv magnesium so why couldn’t we wait another day or so and just monitor everything closely? I have so much anger and regret for not asking enough questions or even being given more time to process things.
Before taking me back to the OR a dr came in and asked me if I wanted my tubes tied.. I couldn’t believe they were asking such a life changing question to someone who was just told her baby could be born not breathing or crying. That I should expect him to stay in the nicu for the next two months until closer to his due date. I felt they had such little hope for my baby and weren’t expecting much from him. I felt what was supposed to be an exciting time was sad/depressing and I didn’t understand why. The whole point to him being delivered that day was not because he was in any distress. It was solely for my safety given my preeclampsia with severe features diagnosis, anywho.. after telling the dr I didn’t want the only tube I had left tied and that was something I already discussed with my ob/gyne he accepted my decision. Moments later my nurse came in after that dr left and she proceeded to ask if I was going to have my tubes tied because it’s “actually recommended after 4 c sections.” I told her no and that decision was made with me and my ob/gyne who agreed it was not a necessity and my decision.
During my C-section I felt like I was invisible. It was so important to me to get as many pictures as I could just as I did with my other c sections and I wasn’t told when the procedure started or when they were about to pull my baby out. I felt as if since I was an outsider I was treated as such. As if they were just trying to get the job done so they could be done for the evening. After my baby was born they took him over to clean him up and let my support partner get a few pictures.. wrapped him in plastic then let me see him for one moment in passing as they were taking him to the nicu. I didn’t even get to kiss his face or touch his hand. A baby who was a part of me for 31 weeks was taken just like that and I was supposed to just accept it. I then was told since I was on iv magnesium I couldn’t go see or even touch my baby for 24 hours and was given a link to go to to watch him on my phone screen. A hospital that is so supportive of antepartum care you'd think would do more to help with difficult transitions like this and help make it possible or push for just 2 minutes of skin to skin after birth (given the baby wasn’t in serious distress). Hell I would have settled for one minute of skin to skin. I feel that that first 24 hours was so crucial to be with my baby and could have helped benefit him so much, but no one seemed to care about how I felt or what I was experiencing mentally, not one of my nurses helped in any way get me to my baby any sooner. I kept getting told he is in good hands but that meant nothing to me in that moment. I just wanted to hold my baby for the first time.
The day of discharge for me, my nurse came in at 7am and was ready to push me out the door. She was so kind but was in such a rush to discharge me, meanwhile I was leaving and my baby had to stay. I wasn’t ready to leave him just yet. So she started my discharge stuff - was wheeling me downstairs and said “are you okay? You seem sad” ... again I was baffled to even be asked such an odd question given the circumstances... I think about this every day since it happened. Every detail. Every question I wish I asked. Every mom who also experiences the same thing and is too struggling with birth trauma and PTSD from something that could have been done differently or handled in a better manner.
My goal is to simply give whoever is reading this a look into what it’s like on the other side of the table. And hope to get just a little bit closer to overcoming my birth trauma so I can celebrate my son’s 1st birthday and not spend the day with regret and anger. The last few weeks I have been having nightmares and trouble sleeping because I am struggling to cope with the trauma from my son's birth. As health care professionals who take an oath to serve with compassion I can’t help but to feel as though not one doctor, not one nurse in my most vulnerable moment showed me an ounce of compassion and here I am almost a full year later still suffering the consequences. While I am grateful for the doctors and nurses that kept my son and I safe physically. I have yet to recover from this experience otherwise.
A negative subjective experience of childbirth is one of the strongest predictors of postpartum childbirth-related post-traumatic stress disorder (PTSD) (1). For Starr, loss of autonomy and feeling like she had no voice and offered no choice in her care were at the core of her negative experience. Voice and choice are part of the six pillars considered essential in trauma-informed practices. They are also part of what all providers should think of as universal precautions (2) - practices that should be offered to every patient.
I am so grateful that Starr reached out to share her narrative. She shared the following about the writing process itself: “I will say it felt good to get it out although it was tough reliving every moment all over again. I know it helped more than I was expecting it to. That night I was able to sleep just a little bit better too.” My hope is that she is better positioned now to manage the upcoming anniversary of the trauma.
The anniversary of the birth trauma, which also happens to fall on her child’s birthday, can be a very difficult time for individuals (3). The negative events that occur during childbirth can have lifelong repercussions, but with the right education, support and intervention, individuals can heal from trauma and find joy and peace during these special times.
– Dr. Vogel
6 Guiding Principles for a Trauma-Informed Care Approach
The following guidelines are the result of a collaboration between the CDC's Center for Preparedness and Response (CPR) and SAMHSA's National Center for Trauma-Informed Care (NCTIC). Adopting a trauma-informed approach requires constant attention, caring awareness, sensitivity, and possibly a cultural change at an organizational level.
References
Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors https://doi.org/10.3389/fpsyg.2017.00560
Hall S, White A, Ballas J, Saxton SN, Dempsey A, Saxer K. Education in Trauma-Informed Care in Maternity Settings Can Promote Mental Health During the COVID-19 Pandemic. J Obstet Gynecol Neonatal Nurs. 2021 May;50(3):340-351. Doi: 10.1016/j.jogn.2020.12.005. Epub 2021 Jan 9. PMID: 33493462; PMCID:PMC7836903.
Beck CT. The Anniversary of Birth Trauma: A Metaphor Analysis. J Perinat Educ. 2017;26(4):219-228. doi: 10.1891/1058-1243.26.4.219. PMID: 30804657; PMCID: PMC6372883.
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