When Shauna Buggy found out she was pregnant, she was nervous and excited, scared and happy; the usual mixed bag of emotions that all stages of motherhood bring. But not too far along, complications arose, leading to a difficult and anxious pregnancy, and a traumatic birth which had a lasting impact.
“Birth trauma is a real condition, but it is often not talked about or recognised,” says Dr Krysia Lynch, chair and spokesperson of the Association for Improvement in Maternity Services (AIMS Ireland). It is estimated that approximately 17-19 per cent of people will suffer from post-natal depression (PND), which is around 12,000 - 13,000 people a year in Ireland, and 6-18 per cent will suffer from birth trauma (which may or may not include a formal diagnosis of post-traumatic stress disorder, or PTSD). This is the equivalent of up to 4,500 - 12,500 people a year in Ireland.
Such trauma can leave a lasting imprint. Because of this, when we talk about our experiences, even over coffee with friends, our birth stories often come with a trigger warning, and as such, so does this article. If you’re finding the content challenging, please give yourself permission to step away.
“The excited and happy feelings would all but disappear,” says Buggy of her pregnancy, “as I spent nine months terrified, anxious and a shell of the person I once was.” Her early pregnancy was spent fearing a suspected miscarriage, to what was considered a chemical pregnancy, and finally an assurance of pregnancy but a risk to the baby. She felt her anxiety was dismissed. “I told a doctor when I was four months pregnant that I didn’t think it was normal to feel as anxious as I did, and they assured me no one can relax until their baby is in their arms. I wanted to scream. This was supposed to be a magical time and I spent it terrified, constantly holding my breath.”
They brought me to theatre, and I never felt more scared in my life
At 39 weeks and two days, her worries became a reality. Concerned that her baby was not moving, she was admitted to hospital for observation and eventually induced. What followed was a difficult labour with an at-risk baby.
“All of a sudden there were ten extra people in the room, muttering to one another, smiling at me like kind strangers in the street, sticking their hands in me to feel the baby, handing me forms to sign. I didn’t read them, just scanned for keywords. Death was one, infertility was another. I signed. They brought me to theatre, and I never felt more scared in my life.”
Unable to perform a C-section due to the baby’s positioning, her child’s heart rate continued to drop and an episiotomy and forceps were needed to deliver her baby. Buggy says she felt alone without answers or autonomy.
The difficult and painful birth was to be followed by further trauma post-partum. Discharged with a broken sternum and dislocated hip, her wounds from the mediolateral episiotomy and tearing required so many stitches they said it was better if she didn’t know.
“As the weeks and months passed it became clear that I was struggling in almost every way. The anxiety I’d felt in pregnancy remained and strengthened. I lived in a state of flight or fight. I was also left incontinent of both bladder and bowel from the interventions during birth. There I was, in supposedly the happiest time of my life, wearing nappies, crying most of the time, depressed, anxious, and traumatised by everything.”
As her daughter turned one, Buggy felt the ability to mentally breathe. She started cognitive behavioural therapy (CBT) on the phone with her local community mental health service, and after a few months began to improve. She utilised the tools she learned in therapy and applied them in day-to-day life and practised mindfulness every day.
“But what really made me feel better,” she says, “was telling my whole story from start to finish to my therapist, who was the first person to truly acknowledge all I’d gone through. You get so used to hearing people tell you to be grateful, you had a healthy baby, isn’t that the main thing, but she fully heard me.”
You get so used to hearing people tell you to be grateful, you had a healthy baby, isn’t that the main thing, but she fully heard me
“In Ireland we do not have enough education, information or understanding surrounding birth trauma,” says Dr Lynch. “Many women do not have their difficult experiences validated. Women are not treated or viewed holistically, and yet giving birth is probably the most holistic act we perform in that it involves body mind and soul; all of which can be traumatised or injured.”
“In birth, how you are made feel is as important as how the baby is born,” says Bairbre Brooke, a qualified Doula and birth trauma specialist based in Galway. “The language used around birth is often coercive and controlling. Phrases like ‘we won’t allow you’, ‘we will bring you in’, are commonplace in antenatal appointments. ‘Failure to progress’, ‘incompetent cervix’, ‘poor maternal effort’, ‘foetal distress’ are some examples of poor language that potentially cause harm to women, and can add to an already traumatic situation. Care providers need to guide women in their choices around pregnancy and birth with respect, in language that is clear and easily understood, and which promotes discussion around care rather than expecting obedience.”
I feel so lucky. Ridiculously lucky. Maybe that’s just being optimistic. And maybe it’s a bit of a coping strategy
Birth trauma encompasses much more than the unilateral idea we have of physical trauma. It can affect mothers, fathers, life partners, and birth partners also. It is not restricted to the physical nature of how a child is born, but the complications that can occur during pregnancy, the difficulties in conceiving, fertility struggles, loss, a stay in the neonatal intensive care unit (NICU), or the diagnosis of health conditions.
Caoimhe Quigley says she feels “lucky.” She repeats this word consistently throughout our conversation, as though her experience of pregnancy and birth, and the trauma she experienced, is not as valid as that of others.
“I feel so lucky. Ridiculously lucky. Maybe that’s just being optimistic. And maybe it’s a bit of a coping strategy,” she says. Quigley endured weeks in hospital with pre-eclampsia, a serious blood pressure condition that develops during pregnancy, followed by the unexpected trauma of caring for her newborn in NICU.
“Other people have it worse,” she says, “but I didn’t get the normal pregnancy, and I didn’t get to bring my baby home straight away or breastfeed and bond. It was a really hard time.”
Those three weeks were like a strange purgatory. It was so emotional
Due to swollen ankles, Quigley’s GP queried her health and sent her to hospital for tests. What started out as routine follow ups turned into an overnight observation, ending with a diagnosis of pre-eclampsia and a further three weeks of active monitoring in hospital until her baby was born. “This was a hell of a lot to process,and I hadn’t even hit the third trimester. Those three weeks were like a strange purgatory. It was so emotional.”
Consistent scans, traces, and further monitoring were stressful despite the doctors and midwives keeping calm professional tones. “I could sense the urgency,” she says. This took its toll on the first-time mother.
“I never got to enjoy that stage in pregnancy where I could feel the kicks, or put my husband’s hand on my belly for him to feel the kicks sitting on the couch in the evening. There is a definite grief there for what should have been. I wasn’t under any illusions that pregnancy would be perfect but when I think of my last memories of being pregnant, they’re thoughts of, we’ve made it to 28 weeks, that’s good. Okay, we need to hold on for as long as we can. We need to try to get to 30 weeks.”
There was a sort of high alert phase as well afterwards. Added to that, I didn’t feel human and was conscious we were living in a pandemic with a fragile baby
But they didn’t make it to 30 weeks. Her baby daughter was born at 29 weeks and three days. “The doctors were saying, don’t stress yourself over things you can’t change. But you’re hanging in there or lying there in a hospital bed for however many hours a day breaking up the day with scans and traces, questioning the statistics that she might suffer brain bleeds or have difficulty with her lungs or immune system. I didn’t wake up that morning thinking I might get to meet my baby today. It was sort of like, oh shit. I’m pretty sure I was dissociating as they prepared for surgery. I was falling, sinking into what was happening.”
Her baby was less than a kilo at birth. “I didn’t get to hold her. She was born around late morning, but I didn’t get to see her in NICU until after midnight. You’re not facing the normal experience of having a child and welcoming them and being able to bond with them. They moved me into a room with a mother whose baby was with her, and I remember sobbing. I was in floods of tears because she got to have her baby with her, and I didn’t.”
When Quigley was discharged, she went home with her husband by her side, her baby still in NICU. She was still recovering from birth and pre-eclampsia while battling a trauma of conflicting experiences and emotions in new motherhood. “At the time I was so swollen and so unwell,” she says. “There was a sort of high alert phase as well afterwards. Added to that, I didn’t feel human and was conscious we were living in a pandemic with a fragile baby.”
Quigley sought out talk therapy to sort through the complicated emotions over her pregnancy, birth, and early motherhood. She came out of it conscious of the fact that she does not want to experience this again.
“I don’t think I can do this again,” she says, “When people say to me, oh you’ll change your mind, I try to remind them that that’s not the important part here. What I’ve realised is that when someone says, I don’t think I can do this again, they’re saying, I’m struggling with this right now. I’m finding this hard.”
For many women the very act of returning to the hospital can feel impossible and very triggering
“Classic trauma symptoms include intrusive thoughts or memories, nightmares, flashbacks, panic attacks, hypervigilance, and avoidance,” says Niamh Healy, a Cuidiú Antenatal Ireland antenatal educator, GentleBirth instructor, and birth trauma resolution therapist who can be found at My Bump My Birth My Baby. “Parents have told us the lengths they go to avoid passing the hospital where they gave birth, or needing to change the channel if something about birth comes on the TV. However, there is an overlap with some of the milder PTSD symptoms and PND symptoms, which often means people with PTSD may not be identified effectively as GPs are usually on the lookout for PND. For example, feeling anxious, or panicky is a symptom of both. Another symptom that overlaps is not looking forward to things or feeling no hope for future events. Difficulty sleeping can be experienced with both PND and PTSD. Inability to see the funny side of things and loss of interest in things or feeling disconnected can often confuse diagnosis. Being misdiagnosed as having PND can be problematic, as treatment for PND will not resolve the trauma and in some cases will make it worse.”
While many hospitals now have a birth reflection service and for some this might offer some help in understanding the way labour unfolded, Brooke advises that “for many women the very act of returning to the hospital can feel impossible and very triggering. Going through birth notes can often throw up more questions than answers, and is rarely enough to help a woman overcome her trauma. Frequently the official version of events will not match up with the woman’s recollection of the birth. Women can feel even less validated and more traumatised if the debriefing is not handled carefully.”
Along with a professional debrief of the birth with someone qualified outside of the hospital setting, Brooke says there are other avenues women can explore if they feel traumatised. “There is a Facebook group Birth Trauma Support Ireland run by Birth Trauma Resolution therapist, Maria Saunders,” says Brooke.
“It’s a safe platform for women to share their stories and support each other. The rewind technique is a recognised treatment for all types of PTSD. It is a non-intrusive, safe, and highly effective psychological method of de-traumatising a person, especially effective around birth, and is performed once that person is in a state of deep relaxation.
“There are several birth trauma resolution practitioners around the country who are trained to help specifically in this area, and do rewinding as part of a treatment programme for birth trauma. If there is no one near you the sessions can be done online. Agencies like Nurture Health and Aims Ireland can arrange counselling, and there are counsellors around the country that specialise in trauma, however seeing someone who works specifically with birth will usually be more successful. Carving out some time for yourself every day away from commitments to relax, read, walk, meditate can be valuable for recovery.”