Recalibrating Our Expectations of Childbirth

Most births don't have complications but some do, and it is unfortunate when women feel they or their births are failures for failing to meet their preconceived notions of success. Women should strive for a birth that is manageable and meaningful, but without a sense of entitlement that it must be fast, painless, and stoic.
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I have noticed an uptick recently in mothers discussing their traumatic birth experiences, and I think that the growing awareness is positive. However, bringing this topic out into the open has stirred up some strong emotions from other women, especially those who have had adverse outcomes during conception, pregnancy, or childbirth. And, amidst the backlash and the backlash against the backlash, I feel that there are some important issues getting lost in all the noise.

PATTCh (Prevention and Treatment of Traumatic Childbirth) is one of the leading organizations spreading awareness of traumatic birth experiences and birth-induced PTSD (Post-Traumatic Stress Syndrome). According to them, a mother can have a traumatic birth experience when she believes that she or her baby were physically or emotionally threatened during birth, or that their lives were in danger. There are two things that strike me about this definition: one, that a traumatic birth experience is based on someone's belief; and two, that emotional threats are included as a possible cause. Both of these factors are very subjective since they are founded upon each individual's perception, emotional state, and beliefs.

If we want to reduce the prevalence of traumatic birth experiences, we're going to have to confront some common expectations, narratives, and perceptions around childbirth to help shape women's beliefs and emotionally prepare them for the realities of childbirth. Childbirth is often glamorized as a spiritual journey, but physically, it is called labor for a reason. Sure, it can be a transcendent experience for many women, but it can also be a challenging ordeal involving blood, sweat, and tears, among other bodily fluids. Without adding any other stressful or complicating circumstances, childbirth already has all the necessary ingredients to be bewildering, frightening, and emotionally exhausting. And yet, because of the subjective nature of experience, two mothers can have the same events happen during birth, and one can emerge merely rattled while the other emerges with PTSD.

A good place to start with recalibrating beliefs and expectations of childbirth is with the image of an ideal birth with little pain, no complications or medical interventions, dim lights, and soft music. It's a lovely and inspiring conception of birth, but we should also acknowledge that absolute perfection is rarely a reality. Most births don't have complications but some do, and it is unfortunate when women feel they or their births are failures for failing to meet their preconceived notions of success. Women should strive for a birth that is manageable and meaningful, but without a sense of entitlement that it must be fast, painless, and stoic. Holding unrealistic expectations of childbirth can set women up for disappointment.

While we're at it, we should acknowledge that a birth plan is an oxymoron. It should be called a birth idea, vision, or hope. It should anticipate the unexpected and contemplate contingencies. Women should be educated that birth doesn't always go according to plan, but that only increases the value of preparation. If women's birth visions help them approach childbirth with confidence and reverence and humility, then they will be more likely to handle the challenges that get thrown their way. What birth preparations most definitely should not do is set us up for failure, giving us the illusion of complete control and admonishing us when things turn out differently than what we imagined. I am saddened every time I hear another women say she feels guilty and ashamed for having an epidural or that she feels like a failure for having a C-section.

I had a birth that went nothing like the birth plan I placed in my medical file, taped to the door to my room at the hospital, and plastered on every wall. I wanted no medical interventions at all, and I ended up with every intervention in the book, as well as the director's cut extended edition. So how was I able to come out of the experience without feeling violated and traumatized? It had quite a bit to do with the guidance our birth instructor gave us. She wisely told us that when in labor, making a clearheaded decision is very difficult. She coached us to discuss the many contingencies beforehand so we went into labor with some decisions already made. She also gave us three more pieces of advice that proved to be the key to feeling empowered in my birth experience:

1)Keep three trusted people on speed dial to call for advice (we rang a doctor friend, our birth instructor, and another friend who was a birth advocate).

2)Any time a decision needs to be made, pause for a moment and ask everyone to leave the room. That left my husband, my doula, and my advisors on speed dial with the time and space to discuss each intervention and consider other options (clearly, this is not possible in certain emergency situations).

3)Have someone with you (partner, friend, family, or doula) who knows your wishes and can speak on your behalf if you cannot speak for yourself at the time.

Our birth instructor gave us the education and confidence we needed to assert our rights and make informed decisions, and I know this made all the difference in how I experienced my birth. Of course I was a bit disappointed that I didn't have the birth I had envisioned, but after hearing far too many birth stories that veered from trauma to tragedy, I just wanted us to come out of the experience alive and well. Which we did, with an abundance of gratitude and no regrets about our birth experience.

Although I did not experience a traumatic birth either time I gave birth by unscheduled C-section, between a fourth and a third of women experience a traumatic birth, and almost a quarter of them can develop PTSD. Some of these women emerge from the birth process with a healthy mother and baby, while others are emotionally traumatized not only from the experience itself, but by a negative health outcome. It is from these women that I hear disbelief when they encounter stories of a traumatic birth where the mother and child are physically healthy. Their comments in response to birth trauma articles can be heart-wrenching. Their pain is manifest and their emotions are raw with grief and envy. This also holds true for many women who have suffered miscarriages or have not been able to get pregnant in the first place. It is hard for them to understand how a woman who had a healthy baby could be filled with sadness, guilt, and remorse. After suffering miscarriages and secondary infertility myself, while also experiencing two births that did not go as planned, I can understand and sympathize with the emotions felt by both sides.

The heart of the argument against mothers with traumatic birth experiences is the notion that they are ungrateful. According to their detractors, women who have had traumatic birth experiences yet emerged healthy and alive along with their babies are supposed to see the glass as half full rather than half empty. They ought to feel fortunate that they were able to get pregnant, that they had a healthy child, and that their body has healed. Their experience, no matter how traumatic it felt, had an outcome that many other women feel envious of and would not take for granted if they could only switch places.

The fact is that suffering -- the perception of emotional trauma -- defies logic. It therefore ought to defy judgment. Who am I to judge whether someone's experience is "worthy" of suffering? What do we possibly have to gain by comparing our experiences and feeling offended or outraged at others who dare suffer as much as ourselves? I suppose it must be human nature because I catch myself doing it, too. But being aware of this pitfall, can we find it in our hearts to show compassion for both the women who've been affected by traumatic birth experiences, as well as all the women who would be willing to trade places with them just so they could have a healthy baby?

Nevertheless, the backlashers do bring up an important set of questions for women with traumatic birth experiences: How long do you want to dwell on the past before putting it behind you and enjoying the present? At what point do you celebrate the birth that gave your child life instead of mourning the way you experienced it in the moment? And if you have diagnosed yourself with PTSD or post-partum depression, then what are you doing to seek treatment?

Most women recover from traumatic birth experiences within a month of giving birth. But for the women who don't, there is no merit badge for living with birth-induced PTSD, just as there is no merit badge for an all-natural vaginal birth. PATTCh provides a list of treatment options to help women recover from their traumatic birth experiences, and I think that a comprehensive conversation of traumatic birth experiences cannot be complete without discussing the responsibility mothers should accept in seeking a way to recover.

I understand firsthand that it can be difficult to process, accept, and move on from traumatic experiences. Life is not fair, and I too have had my unfair share of undeserved happenstances. But personal tragedies have also taught me that life is much too short to dwell on sadness and pain. Mothers who experience a traumatic birth and don't heal emotionally may cause unintended emotional harm on their children if it affects their ability to bond and attach with them. With all due respect to mothers who have had traumatic birth experiences, I sincerely believe that children deserve for their birthday to be one of the best days of their mother's life, not the worst. Therefore, I think it is worth exploring a different way to process, accept, and move on from traumatic birth experiences -- if not for the mother's own sake, then for her children.

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