Shattered Dreams

Today, more than ever, there is a growing awareness of the negative impact childbirth may have on many women1, which has brought attention to the way women experience birth and what implications this experience may have on their lives.  They enter the realm of childbearing with a romantic idea of what it would be like and float in a bubble of euphoric anticipation2.  For many of them that bubble bursts when reality sets in and they realize that birth is nothing like they imagined it to be.

When a woman becomes pregnant she, most often, begins to imagine what pregnancy, birth and mothering would be like.  These fantasies create certain expectations that may, or may not, be realistic.  Women with history of abuse or a negative previous birth experience may have negative expectations of the birth itself.  They may anticipate pain and fear based on their past experience3.  Most women, however, develop high hopes and expectations of a romantic nature.  A study conducted in Taiwan4, found that expectations were related to the following categories: the environment of caregiving, labor pain, support by partner and medical staff, and the ability to participate and have control.  Other studies conducted in the United States and in the United Kingdom, had similar findings with an emphasis on control as a common expectation for may women2,5.  Having control means being informed and having an active role in decision making throughout the pregnancy and birth5.  The Taiwanese study also showed that those who attended childbirth education classes appeared to have higher expectations of the birth experience4.  Another study, conducted in the United States by Dr. Susan Lynn Highsmith6, based on the finding of a large study by Green, Coupland and Kitzinger (1998) that “pregnant women tend to get what they expect”6, examined the subconscious expectations of childbirth along with the conscious ones. She found that the study participants’ actual birth experiences were different from their conscious expectations, and concluded, “that these women [may have] actually experienced what they unconsciously expected”6.

Unfortunately, there is a gap between women’s expectations of childbirth and the actual birth experience2,5.  Many women enter the birth room expecting to be treated with individual attention, but instead they find an “uncaring [and] cold” medical staff.  Some even describe their experience as “drive-thru medicine”5, and as “being processed through labor and delivery like factory food on a conveyer belt”2.  These women often times feel humiliated and undignified by the attitudes of the attending staff2,7: “They kindly left me in stirrups with swabs hanging out of me while they scrubbed up and someone let the cleaners into the room, who complained bitterly about the ‘bloodbath’ they had to sort out.  Stupid, but that memory is for me just so humiliating… I felt… that any dignity I had was gone”7.  Childbirth is a time when others, usually complete strangers, are allowed to enter a woman’s sacred intimacy, which puts her in a very vulnerable place; her private areas are open for all to see and touch.  When this is treated with an ‘as usual’ attitude, the woman may feel violated and disrespected by her caregivers3.  Birth attendants, whether doctors, nurses or midwives, should feel honored to attend such intimacy as childbirth, and shift practices, or attitudes, from “taken for granted”3, to a sacred service.

Post-natal anger appears to be the most prevalent emotion for many women.  A study conducted in 2002 by professors at the College of Nursing of the University of Tennessee, investigated women’s childbirth-associated anger. Study participants expressed anger over unmet expectations of trust, control and being informed.  Many participants felt anger over uncaring hospital staff and the feeling of being “disregarded”5.  Women who participated in other surveys expressed anger over the “aggressive management”7 of their birth, which left them feeling “butchered, assaulted [and] raped”2.

Being unable to be an active participant in decision-making due to lack of complete or accurate information, leads to having no control over their own birth experience and is a great source of anger for many women.  Some women express anger over the “emotional blackmail”2, which is the birth attendant’s way of getting the woman to agree to certain medical procedures. Telling a woman she may have a VBAC, but that she may not live to meet her baby, is a classic form of ‘emotional blackmail’2.

For some women the lack of control makes them feel ashamed, disempowered2,5,7  and even “inadequate”5.  Once doctors and technology take over, a woman may feel inept, unable to do even the smallest things for herself: “My legs were held by a nurse and my husband.  I felt so embarrassed, humiliated and useless that I couldn’t even do this for myself…”2.

Many women have expressed anger over the loss of their dream birth.  They felt “deprived… of the memorable experience they had hoped childbirth would be”5, and “disempowered in a very important event in their lives”2.

Women’s dreams may be broken, too, unrelated to the birth itself.  Many women have the notion that motherhood is gentle and cuddly; that people would care for them and surround them with the love2.  While this may be true for women in many countries around the world, for most women in developed countries, such as the United States, it is quite the opposite.  Their reality is far lonelier and the sudden drop in maternal attention, and support, can prove to be shocking and overwhelming2,8.

Poor relationship with the attending staff, is an important factor of “birth trauma”7, since it may influence the woman’s perception of the birth.  A very instrumental delivery, which is potentially traumatic, may not be perceived as such by the birthing mother if she had a positive and trusting relationship with the attending staff.  On the other hand, a completely natural delivery, with minimal or no medical interventions may be perceived as traumatic if there was animosity or mistrust between the mother and the staff7,9.  After all, it is the woman’s perception of the experience that counts, and not so much the experience itself2,5,7,9.

The first step toward healing is acknowledging and accepting the woman’s loss and powerful emotions10,11.  Allowing her to talk about her experience and express feelings about it is an important part of her healing2,12.  A woman may first need to work through her emotions regarding the birth and those who attended it, before she can begin to articulate them12.  At first she may be numb to the experience and unaware of her emotions, but once the numbness fades away, the “floodgates open”2 and she may begin to relive the traumatic birth experience and become more aware of her feelings about the birth.  Once people’s comments, such as “at least you have a healthy baby,” provoke her, she may be ready to acknowledge her loss; “If something jars or thunks inside while hearing those words, a woman is at the beginning of the journey”10.

Feelings of anger, sadness and guilt, common emotions experienced after a traumatic birth, are all part of healthy grieving.  Acknowledging them and not avoiding them, is of utmost importance in the healing process13,14.  It is also important to diagnose the woman’s symptoms as PTSD or grief, and not as depression, as misdiagnosis may lead to the woman’s medication with anti-depressants, which would not eliminate her trauma.  What she needs is attentive listening and an open heart2.

Birth attendants could help minimize the trauma by allowing the mother to discuss her birth experience closely after the birth.  This is an opportunity to clarify any misunderstandings and acknowledge the mother’s feelings.  Doing so may help prevent negative emotions from staying bottled up5.  If nothing else, this may simply initiate the grieving process and lead to quicker healing15.

Childbirth is a natural part of life and may be the most powerful experience a woman may ever have.  When the woman is treated with compassion and respect, her experience would most likely be a positive one.  However, there is also a great potential for emotional trauma to ensue.  This trauma may be due to “aggressive”7 or insensitive management of the birth, or simply perceived as such by the mother.  The source of the trauma does not make it more or less real, since the woman’s perception of the experience is the important factor.

Preventing birth trauma requires birth attendants to consider changing current practices and make birth a more personal experience1.  Creating a relationship of trust is necessary for a more positive birth experience.  Keeping communication lines open and including the birthing woman in all decision making, would allow her feel in control of her birth, which is an important component of a positive birth experience.

The experience of birth is an intricate issue that involves the actual experience, as well as subjective perception of it.  Due to this complexity, further research is needed to understand all aspects of it, so birthing women may be better served and cared for7.

Women in birth must be protected and surrounded with love.  Their vulnerability must never be taken advantage of.  We should strive to ensure that more women experience birth as the empowering event it can and should be.

And finally, women must receive realistic preparation for birth so they may develop more realistic expectations.  Childbirth preparation must be objective and help prepare the mother for all possible outcomes1,5.

1. Swalm, D., PhD.  Childbirth and emotional trauma: why it’s important to talk talk talk. Retrieved December 8, 2006, from http://www.tabs.org.nz/pdfdocs/important2talk.pdf

2. Kitzinger, S. (2000). When a bad birth haunts you. Prima Baby. Retrieved December 4, 2006, from http://www.sheilakitzinger.com/ArticlesBySheila/BadBirthHaunts.htm

3. Kitzinger, S. (2004). One reason why a woman may dread birth. Retrieved December 4, 2006 from http://www.birthtraumaassociation.org.uk/publications/kitzinger.pdf

4. Kao, B. C., Gau, M. L., Wu, S. F., Kuo, B. J., & Lee, T. Y. (2004). A comparative study of expectant parents’ expectations. Journal of Nursing Research, 12(3), 191-202. Abstract retrieved November 26, 2006, from PubMed database.

5. Mozingo, J. N., PhD, RN, Davis, M. W., PhD, RN, Thomas, S. P., PhD, RN, FAAN, & Droppleman, P. G., PhD, RN. (2002). “I felt violated”: Women’s experiences of childbirth associated anger. The American Journal of Maternal/Child Nursing, 27(6), 342-348. Retrieved December 4, 2006, from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=285754.

6. Highsmith, S. L., PhD. (2006). Primiparas’ expectations of childbirth: The impact of consciousness. Dissertation abstracts, Santa Barbara Graduate Institution.  Retrieved December 8, 2006, from http://www.sbgi.edu/html/rea3.html

7. Post-natal post traumatic stress disorder. A Birth Trauma Association paper/brochure. Retrieved December 4, 2006, from http://www.birthtraumaassociation.org.uk/publications/Post_Natal_PTSD.pdf

8. Panuthos, C. & Romeo, C. (1984). Ended Beginnings: Healing Childbearing Losses. South Hadley, MA: Bergin & Garvey (p. 33).

9. White, G. Childbirth and the development of post-traumatic stress disorder (PTSD). Retrieved December 8, 2006, from http://www.tabs.org.nz/pdfdocs/childbirthdevptsd.pdf

10. Madsen, L. (1994). Rebounding from childbirth. Westport, CT: Bergin & Garvey (p. 1).

11. Panuthos, C. & Romeo, C. (1984). Ended Beginnings: Healing Childbearing Losses.  South Hadley, MA: Bergin & Garvey (p. 35-36).

12. Madsen, L. (1994). Rebounding from childbirth. Westport, CT: Bergin & Garvey (p. 2).

13. Panuthos, C. & Romeo, C. (1984). Ended Beginnings: Healing Childbearing Losses.  South Hadley, MA: Bergin & Garvey (p. 140-149).

14. Woods, J. R., Jr., MD & Esposito Woods, J. L., MBA (Eds.). Loss During Pregnancy or in the Newborn Period. Pitman, NJ: Jannetti Publications (p. 9).

15. Woods, J. R., Jr., MD & Esposito Woods, J. L., MBA (Eds.). Loss During Pregnancy or in the Newborn Period. Pitman, NJ: Jannetti Publications (p. 24).