This week we recognize Maternal Mental Health.
I have worked in the Maternity Field for 20+ years, and I”m pleased that we’re so much farther ahead in recognizing the importance of maternal mental health and the implications it has for the birthing person, the partner, the baby — in fact, the entire extended family and community.
One issue that factors into maternal mental health is the perception of how the birth turned out and whether or not the birthing person experienced any birth trauma.
It’s absolutely true that some women are experiencing birth trauma at the hands of birth workers unaware they’re triggering trauma or directly causing harm to the birthing person when they’re most vulnerable. But there’s another way in which birth trauma is occurring, which I think we might be able to address that could potentially help lessen the risk of birth trauma.
When a person becomes pregnant, the feelings they have about this pregnancy can be varied and complicated. They might feel: excited, ambivalent, scared, negative, thrilled, satisfied, proud, terrified, etc. And throughout the pregnancy they might feel all of these emotions jumbled together, even as one feeling predominates.
But as birth approaches, many pregnant people begin to imagine what they’d like their birth to look like. They start to get an idea about how they want this whole thing to turn out. Their ideas might be fuzzy at first, but as they read more about birth, or listen to other’s birth stories, or take a class to prepare for their upcoming birth, those fuzzy ideas start to solidify into a cohesive picture of what a “good birth” looks like.
Now, this can vary from person to person.
One person’s “good birth” means zero interventions, zero medications, and an at-home water birth. Another person’s “good birth” might mean a very controlled induction with medication available and all the interventions possible (including surgical birth, if necessary) at the ready.
As birth workers, we sometimes have our own ideas about what a “good birth” looks like. Does our idea of a “good birth” match up with the ideas of the families that we’re serving? Are we able to recognize that when we say women should be able to choose the way they wish to give birth, that this means they should be able to choose whatever they feel is right for them? Even (especially) if those choices aren’t included in our own, personal idea about what constitutes a “good birth?”
What happens is that all of us, birth workers and families alike, can get caught up in comparing the ideal birth that’s been put on paper or the one that exists in our imagination, with the real birth as it unfolds. What happens when those expectations are not met?
The birthing person changed their mind and received medication when they were originally dead-set against having them… The birthing person needed to be medically induced and this led to many more interventions than they could have imagined… The birthing person was set to have a scheduled Cesarean, but went into spontaneous labor the day before and ended up feeling lots of contractions before the surgery was started…
The distance between one’s expectations and one’s reality, is always equal to disappointment. And when we’re talking about birth, that disappointment can lead to birth trauma.
So how can we potentially lessen this risk?
Stop trying to define what a “good birth” looks like on paper, and instead focus on how you feel about the birth you actually had.
Birth doesn’t have to match up to your ideal for it to be a positive and empowered experience. It could look nothing like what you’d hoped for, but you could still love that birth experience and look back on it with positivity and a sense of pride.
Stop believing that a “good birth” is supposed to go a certain way. Birth is normal, physiological — and oftentimes, surprising and too big to really plan.
There’s nothing wrong with birth “planning.” But, it’s most effective when that planning is done in early pregnancy to help you can choose the right provider, birth team and place of birth most likely to support the type of birth you’re hoping to have.
But you’ll still need to remain flexible and able to make different choices in case anything comes up during the remainder of your pregnancy that would require you to change your provider, your birth team or the place of birth.
After that initial planning, recognize there are pros and cons associated with every type of birth. Soften the expectation that a “good birth” has to match up perfectly with what you imagined for yourself and instead be ready to adjust and flex your definition of a “good birth” to contain the birth that you’re actually having.
I’ve taught thousands of couples over the years and I’ve yet to hear from any of my families that their birth went “exactly according to plan.”
That doesn’t mean that they had a negative experience at all. In fact, most of my families feel like they had a good birth. Why? Because the focus is on how they feel about the way they were treated during their births, as opposed to how the births actually turned out.
What do I mean by this?
It matters more that you feel cared for, supported, encouraged, loved, listened to — and this next one is very important — that you were a decision maker in your birth… to your own personal comfort level.
There’s a range on the shared-decision making model. On one end, there’s the birthing person who has specifically chosen a provider because they know that they will be making ALL the decisions and this makes the birthing person feel safe, secure and less anxious about having to make the “right” decision themselves while they’re in labor.
This might seem extreme (and it is) but there are people for whom HAVING to be the decision-maker can cause more harm than good. They’re almost paralyzed with fear about what happens next after that make any decision. It could be traumatizing to them if the decision they make ends up being the “wrong” one.
At the other end, there’s the birthing person who doesn’t want anyone to even think about making eye contact unless they have asked for consent first! This might also seem extreme (and it is) but for this person, there’s a huge difference between: “We’re going to check for dilation now.” vs “Would it be alright with you if we checked you for dilation now?” For this person, checking for dilation without asking for consent first can absolutely lead to birth trauma.
But here’s the thing…
Have we let our provider and all of the members of our birth team know where we stand on the range of the shared-decision making model? Have we even figured it out for ourselves?
This piece is critical to our maternal mental health when it comes to preventing birth trauma. We need to be honest with ourselves and figure out where we stand personally on making decisions when it comes to our births because BIRTH HAPPENS. And then, you tell the birth story about it later.
Birth unfolds, as it will, and you’ll be required to change course — sometimes, only slightly, other times you might feel as though your boat has capsized and you’re not quite sure how you’ll get yourself righted again. You’ll need to make decisions in real-time during your birth. So how involved in those decisions do you need to be in order to feel good about your birth experience no matter how it turns out?
Because — and I know I’m repeating myself here…
It matters more that you feel cared for, supported, encouraged, loved, listened to and that you were a decision maker in your birth… to your own personal comfort level.
Unless we know what that comfort level is, and then do the work of making sure that everyone involved with our birth knows what that is (and then respects it!) the potential for birth trauma exists.
I’ve found that women who have experienced birth trauma need to process that experience. But often they’re told, in so many words, to “get over it.”
What is touted as the most important aspect of their birth experience is “Healthy Mom, Healthy Baby.” And while everyone can get behind this idea, something profound has happened to the birthing person. They’re changed by this experience — even when it’s a positive event — and there’s a lot of processing necessary to incorporate the birth experience into who they are now.
If the birth wasn’t a positive event, there’s even more processing needed to make sense of it all.
This is one reason why, on a subconscious level, expectant parents are on the receiving end of negative birth stories. The person who’s been traumatized by their birth is still trying to process the experience, but everyone around them has told them it’s time to move on, “Healthy Mom, Healthy Baby,” after all.
These folks will see a pregnant belly and without thinking twice, proceed to tell the pregnant person all about their negative, traumatic birth — not because they’re intentionally trying to scare the pregnant person, but because they’re still trying to process this event and integrate it into the person they are today… weeks, months, years, even decades following their negative, traumatic experience.
To that end, I’ve created a writing exercise that I hope will help you retell and reclaim your birth experience and integrate it into the person you are today. I offer this to you here, so that if you’re finding yourself either wanting to capture the details of your birth story while they’re fresh in your mind, you can write this out and put it into the baby book or trying to process and heal from a birth where you decidedly were NOT in the center of that experience, you can have something to help you get back there.
Please accept this as my offering to you as you try and process the huge life transforming event that is birth. It’s an enormous undertaking that has forever changed who you are physically, emotionally, mentally and spiritually — and sometimes we need to acknowledge all of this before we can even begin to think about “moving on.”
And I know this is MATERNAL Mental Health Week, but if you know me, I love Dads and Partner Parents so much, that I want to make sure that they’re able to do their own processing from the birth experience. We pay a lot of attention to what happens to the birthing person, but not as much as we need to for the partner.
I look forward to a day when birth processing is something that happens in the hours and days after someone gives birth so that this integration can occur sooner than later. But until that becomes the norm, please share this with anyone whom you think would benefit from reclaiming their birth and bringing themselves back into the center of the experience — no matter how it unfolded.
*I’m NOT a licensed therapist and this birth processing tool could never take the place of working with a skilled provider. If you’ve experienced trauma with your birth, please seek professional support if/when it’s necessary. Consider this an additional resource to your overall maternal mental health plan. Your mental health is so important that it needs to be addressed as central to your postpartum recovery.
Much love to you during this week and always!