The Afterbirth

It’s a sad fact but, after the chaos and commotion of birth and the first few days with a newborn, many women are left with regret and grief about the way their baby arrived in the world. It doesn’t matter how you gave birth, there are many and varied factors that might leave you feeling traumatised. What matters is how you felt about it, and what it meant to you.

A quick birth for one person might be a blessing, but for another could be a massive shock to the system. A planned natural birth that needed intervention could be just as dramatic as a planned C section that ended in a home birth. A rude midwife who left you feeling uncared for – anything could leave you feeling scarred. Even with the most uncomplicated birth, there will always be a recovery process that might not just be physical.

For us women, used to feeling in control of our lives, the lack of control involved in birth can in itself be hard to accept afterwards. And, for many, that lack of control might extend to unexpected or unwanted medical interventions. With less than half of births in the UK in 2011/12 being ‘unassisted’ (potentially with pain relief including epidural but no induction, instruments, C section and so on), and the C section rate at a quarter of all births (nearly 15% of those emergency C sections), the drama and urgency of modern birth can stay with us for days, months, or years afterwards.

And what does ‘stay with us’ mean? It might be a sense of regret that something didn’t happen the way you’d hoped. It could be a sudden, heart panging memory while you’re falling asleep. Or it could be flashbacks that leave you feeling that you’re back there going through it all over again. The Birth Trauma Association estimates that, while 10,000 women a year in the UK experience Post Traumatic Stress Disorder after birth, as many as 200,000 more women feel traumatised (but may not meet the criteria for PTSD).

The way we deal with our feelings after birth can also have an impact on how much it affects us later. Although many women compare birth stories, and even ‘compete’ over how difficult birth was, these experiences can be presented as a badge of honour – so the real, stomach churning feelings underneath get swept aside. For birth partners too, who have seen you at your most vulnerable, feelings of helplessness and guilt can remain. But in the weeks after birth, when your new baby is taking up all your attention and there are far too many new things to get used to, it is easier to push down the upsetting memories. Particularly when everyone around you is telling you how lucky you are to have your healthy baby, feeling anything less than overjoyed simply doesn’t seem allowed. Sleep deprivation, a lack of time to yourself, certainly a lack of time as a couple – all mean the already hazy memories get hazier and you both just soldier on.

The trouble is, traumatic memories have a habit of jumping up and biting us on the bum just when we’re least expecting them. Even when any physical damage has healed, the psychological wounds remain as raw as ever. They could be as obvious as nightmares, or as subtle as a feeling of guilt when you look at your child. They could reappear as feeling sick when you catch a certain smell, or bursting into floods of tears at hearing about someone else’s birth.  But, because they are so raw and mixed up, it can feel easier to push them away again and try and forget about them. Until the next time One Born Every Minute is on, or you have to pass a hospital.

So why is it that difficult memories are so bloody persistent? Well, here’s one theory. When we process normal memories, we use a little seahorse shaped part of our brain called the hippocampus. This takes into account our new experiences, what we’re thinking at the time, their context, who, what, where, when, all of it. It takes that new experience and files it away in the appropriate place. So that after work drink with your mates which turned into an epic all-nighter gets filed under ‘great nights out’, and that crinkly nosed toothless smile from your 4 month old gets filed under ‘amazing baby smiles’. And the filing system is constantly getting updated and memories re-filed, so ‘great nights out’ turns into ‘madness in my youth’ and ‘amazing baby smiles’ turns into ‘amazing moments with my daughter’. So we can think of the hippocampus as a wise old administrator, efficiently keeping our memories tidy.

The trouble is, when something really rather bad happens, that wise old administrator decides to hightail it outta there. Plus, in order to cope with what’s happening, we might simply stop paying attention – let our mind go on holiday while our body is going through it. That leaves the amygdala to jump in. And if the hippocampus is a wise old administrator, the amygdala is a screaming toddler hyped up on too much fizzy pop, hairing around in a blind panic. And that’s where your memories remain, locked in the amygdala. So, when you watch One Born Every Minute, rather than a nice neatly filed memory getting taken out and examined, a great, big siren goes off, along with all the feelings and worries you had when it was stored. And because that feels so painful, it gets shoved away again – back to the panicky amygdala, un-updated and un-filed, waiting for the next reminder.

You know what I’m going to say, don’t you. Painful as it sounds, at some point, you might want to dig it up again. Of course the feelings might fade over time, and talking about your experience in itself will mean it can be updated with new information and begin to get filed a bit more neatly. But it can be worthwhile to make sure the amygdala isn’t hanging on to anything – particularly if you find it is affecting you in any way. You’ve got to be honest with yourself here. Is that a factor in your wish to avoid having any more kids? Or the reason you take a route home that doesn’t go past the hospital? Or maybe it’s more that you go over and over it in your mind when you’re doing the washing up, even months later. Or still feel furious/sad/guilty/ashamed when you think of it. It could be anything that you know might be stopping you from really filing it away.

For those who feel that the birth is affecting them on a daily basis, it might be a good idea to do this process with a professional. If you do feel that thinking, talking or writing about your birth raises your anxiety to levels you find hard to cope with, or begin to feel you’re back there – it can be helpful to use your five senses to remind yourself of where you are, and that you are safe. Paying attention to your feet on the floor for example, or looking in the mirror can pull you back into the present if necessary.

So how do you dig it up again, without just going over the same old crappy experience and potentially feeling worse? The key is thinking about what it meant to you (not to your husband who is just pleased you got out of it ok, or to your mother who tells you it was worse for her, or to your friend whose baby ended up in NICU but seems to be fine). What you’ve attributed to your experience might surprise you it might not be anger that you needed surgical intervention, but shame that you felt violated by a particular internal exam. Then have a think about what that means to you (‘I missed out on precious bonding experiences with my baby’), or about you (‘I failed as a woman’), or about your baby (‘He put me through all that’). You’ll know you’ve hit the nail on the head when you find a big lump in your throat, or the tears start flowing.

It can be difficult to just sit and think something through, especially when birth can be a long and surreal experience. So you might want to write out your birth story, when you feel ready to, and with someone else if you are worried about how it will feel. Again, pay attention to the bits that make you feel emotional. What are you attributing here – are you making any value judgements (I should have done this, they should have done that)? Then have a think about how you felt at the time that might be leaving you feeling so emotional now – a loss of control, feeling scared, feeling afraid for your life or your baby’s life, feeling disappointed – it all counts.

You might also want to encourage your birth partner to write down their memories too. Not only could it be cathartic for them, reading their experience could be a first step in creating a new narrative for you too.

Then, when you’ve had a good cry/hug/glass of wine/bar of chocolate, have a read through it all again. Having someone kind to hand can help too. And, with all the knowledge you have now about how you are now, how your baby is now, why you made the decisions you made (if you felt that you made them) – tell your story again. Pick up those bits that made your heart hurt and think about new ways of interpreting them. Maybe ‘I failed’ turns into ‘I didn’t have the support I needed’. Or ‘They violated me’ becomes ‘They needed to act quickly and couldn’t consider my feelings’. Or ‘I didn’t try hard enough’ starts to look like ‘I did the best I could’.  Or ‘I could have lost my baby’ is replaced with ‘I now know my baby is healthy and safe’. Do this as many times as you need to, and rewrite it if you want with the new appraisals that you’ve made. What you’re doing is pulling that information away from the hyper toddler and, with the help of the wise old administrator, filing it neatly away. So it can join all the other times you had contact with medics, the times you coped well in times of stress, and the history of your life as a mum so far. And all the other examples of actually being pretty damn strong when all is said and done.

(This approach is based on Trauma Focused Cognitive Behavioural Therapy, which you can read about here. If you want to take it a step further, have a look at the Compassionate Mind approach, which has been put into a programme on Netmums )

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One comment

  1. […] middle. Many women experience difficult or even traumatic births, which I’ve written about previously. And many women have pleasant, pain free and even ecstatic births. And we now know that there are […]

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