Monday, June 14, 2010

Coping with Birth Disappointment

    I have birth disappointment.  I've had two cesareans, and I am not thankful for them.  I do not believe they saved my life.  Sometimes I am angry.  At times I am frustrated or sad.    Sometimes I lie awake for hours wondering where things went wrong.  None of these things make me a bad mother.

    As a mother coping with birth disappointment, I can tell you that depression in mothers is terribly misunderstood.  Birth is broken in America.  As women we are asked to accept interventions without question and pressured to make decisions when at our most vulnerable.  We have 5 minute prenatals with an obstetrician that might be present during our births.  Electronic monitors tell nurses when we are worthy of their attention and pitocin is now as essential to birth as the baby itself.  So it's no wonder that even the most prepared mothers often come out of birth having experienced interventions.  For a mother that enters birth with certain expectations, unplanned interventions, use of pain relief, or cesarean birth can be devastating.

   Dealing with feelings of anger, shame, sadness, or disappointment regarding your birth can be difficult.  Well-meaning family and friends remind new mothers that they have a healthy baby despite the experience, and while the sentiment is meant to make the mother feel better - after all, what better prize is there? - it generally only makes her feel worse.  Often the mother feels judged, as though others see her as ungrateful or selfish.  However, the feelings associated with birth disappointment are valid.

   Birth is a momentous experience in a woman's life.  It is transformative for the woman regardless of whether it is her first child or her fifth.  It is her first experience mothering that child, and it is important to her.  It is not simply a means to an end.

   It is key that women are allowed to cope with birth disappointment rather than try to ignore it.  Birth disappointment can affect a woman's desire to have children.  Some are too scared to want more, others become obsessed with trying again in an effort to heal the previous trauma.  Ignoring it could certainly put mom at higher risk of PPD and PTSD.
    The first step in healing birth disappointment is to acknowledge it and accept it as valid.  So here is what having birth disappointment means and what it doesn't mean.
Having birth disappointment means:
- A mother experienced unplanned, and often undesired, interventions.
- A mother may have experienced an undesired outcome, such as a cesarean section or episiotomy.
- A mother's birth memories elicit undesirable emotions such as anger, fear, or sadness.

It does not mean:
- The mother does not love her child.
- The mother was uneducated or poorly informed.
- Interventions were not necessary.

Women who are experiencing birth disappointment should take some comfort in that they are not alone.  Realizing what you are experiencing is normal and valid allows you to take healing steps.  Below are some strategies for coping with birth disappointment.

Ways to cope with birth disappointment:

- Join a support network. Not only will you benefit from having others who understand your feelings, but it can help you feel more empowered about future births. The International Cesarean Awareness Network (ICAN) has chapters that meet monthly in most areas. Birth Network National has chapters in many states that offer monthly meetings on a variety of birth topics.

- Talk with your care provider. If you are lucky enough to have a really supportive care provider, discussing your birth experience with them might provide better insight into why things didn't go as you wanted. Even if you don't have a strong relationship with your care provider, think of this as an opportunity to understand what happened during your birth. It may also give you an indication of whether or not you want to use this provider for future births.

- Seek medical help, if necessary. PPD and PTSD following birth is more common than most women realize. At a time when you are supposed to be happy, often mothers feel that they can't speak up about being depressed. However, PPD is most likely caused by a hormonal imbalance out of the woman's control. SSRIs might be necessary, or talk with your provider about hormone therapy (My doctor put me on natural progesterone pills. By the next day I was laughing, and I no longer needed them at 2 months!)

- Write out your birth story. While time supposedly heals all wounds, it can also just make things fuzzy. Sometimes the further you get from an experience, the more likely you are to forget minor, but important details. Three years from now all you might remember is getting an epidural not the reason you had for getting one. Ask your partner or labor support person to help.

- Be gentle with yourself. I have to give credit to my midwife for this one. It's something I remind myself of daily. Whether or not you could have changed your experience with different decisions is a moot point. We all did the best we could with the information we had at the time. Reminding yourself of this can help when you experience moments of self-doubt or self-recrimination.

Coping Mantras

My feelings are valid. I will not be ashamed of them.
I will allow this experience to be part of me, but not dictate who I am.
My birth experience does not determine who I am as a mother.
I will be gentle with myself.

   If you have a friend or loved one who is experiencing birth disappointment, be patient, listen to them and express genuine sympathy.  Avoid lectures on gratitude.  Do not try to remind her of her blessings.  Your gentle reminder can send her into a shame spiral.  Instead respect her experience and offer support.  Often the love and support of others can do more to help heal her wounds than any other strategy.

Readers:  If you have dealt with birth disappointment, what helped you?


Dionna said... [Reply to comment]

What a wonderful resource!
I think what may be most empowering for me is researching and educating. I didn't know then what I know now, and I am healing by sharing information with others.

shae said... [Reply to comment]

Thanks fr posting this. Birth trauma is very real and too often dismissed.

Lisa C said... [Reply to comment]

I had terrible birth disappointment. I really feel I was traumatized by my son's birth, so much in shock the first few days that I couldn't even bond with him. I literally got nothing I wanted from my birth plan (except a midwife, although the doctors hovered in the background). When I finally wrote a poem about my experience and shared it on my blog, my brother said I seemed "anti-medical" and his wife told me the important thing was that I got a healthy baby. It was really hurtful, like they completely ignored all the painful feelings I had just shared. My sharing was definitely healing, and it's been almost two years, and I think I finally reached a level of acceptance about it, but I'm still sad about it.

Colleen said... [Reply to comment]

My first three children were born with an epidural, even though I went in thinking I would do it naturally. I was so dissapointed after each one, and never had that "amazing" birth experience to talk about. For my fourth baby, I decided to use a midwife who didn't allow any medication. Simply by taking out the option to have it made me feel stronger going into the birth, and I had a completely natural birth. Now I finally have a birth story I love to tell. I think to get over birth have to do anything within your power to change the circumstances you didn't like. For me it was the epidural, for others, it might be having a midwife instead of a doctor, giving birth at home, using a different birth method, whatever makes you feel more powerful. No matter what, we mothers are a STRONG and wonderful group :)

Anonymous said... [Reply to comment]

Journaling my dreamed of birth & my pregnancies thru the birth helped me understand that it was all a process. It more clearly showed the turning points & what made me feel disappointed. Talking over the birth story with my providers and partner helped so much. Not immediately buteo that I could eventually piecethe whole experience together.

After my first son's cesarean I had nightmares for 18 months right after and they resumed when I became pregnant with my daughter. To deal with those emotions again I read Birthing within and about every book I could from ICAN on VBAC. I also did lots of artwork. My scribbles & water colors (would do playing w my toddler) surprised me. It revealed emotions and deep rooted fears I had forgotten (from prior abuse) & neverdealt with full out (disappointment & abandonment feelings towardmy spouse). Art, twitter friends & ICAN really helped me deal quicker with the mourning of a hospital birth and episiotomy that made me feel mutated again. Now I'm in the process of re-loving every scar , stretched out body parts, & a little bit of that disappointment.

On another note. I really like the layout of this post. It made it so easy to read and useful. The way you compared what birth disappointment is or isn't also helped me remember the stigmas that surround womensfeeli ga concerning parenting issues. Sarah

Anonymous said... [Reply to comment]

What a fantastic post! If I hear "you should look at that baby and be grateful he's healthy and so are you" when I talk about how sad and disappointed I am because of my c-section, I just want to scream. People really don't get it, even other mothers (but mostly this comment comes from those who didn't go through similar situations).

I planned and researched a natural birth for my first baby (at age 40). I had a fantastic doctor who supported me and was even available to deliver my son when the time came (thankfully!). I refused all interventions and had a wonderful, also supportive L&D nurse who honored our birth plan to a T. I labored at home for almost 13 hours before going to the hospital and we had a great doula with us, too. Everything was going so beautifully until I was ready at 10cm and it was push time. I pushed for almost 10 hours with no progress--contractions were getting farther and farther apart. My doc was baffled and not sure why, baby's heartrate was perfect, I was also doing fine, he just wasn't coming down. After careful deliberation, our doc recommended surgery, though he hated to do it and was genuinely sorry. He kept telling us there had to be a reason, one that he couldn't see until he did the section. We finally agreed because I was too exhausted to keep going.

The surgery revealed a significant tear on my bladder, one that would have definitely caused my bladder to rupture if I had pushed Luke out naturally. Even though in my case the surgery was life-saving for my son and myself, I still grieve and cry about it one year later. My doc continues to reassure me that had I delivered naturally, my bladder would have ruptured and gone septic and I could have died before they determined the source of the infection. I appreciate that, but it does nothing to change the horrible delivery and slow, painful recovery. We had been in a dark, peaceful room with music we selected and then were whisked into that bright, harsh, cold, clinical OR. I couldn't hold my son, wasn't able to wait for his cord to stop pulsing so my husband could cut it... nothing we wanted. It still stings. Thank you for honoring and validating my pain!

Anonymous said... [Reply to comment]

Thank you! So many people do discount the feelings we have when we don't get the birth that we dreamed of. I got blasted once for feeling bad and angry about my birth, and jealous of others great stories, by a mother who lost her child - while I understand where she was coming from, her loss does not make my feelings any less significant, valid, or meaningful.

I dreamed of an all natural birth, but after 9 hours of pushing and no progress I decided on a c-section. I wasn't pressured at all by doctors or loved ones, I had great support in my decision to "go natural" from both family and caregivers, my hubby was a fantastic advocate for my care the entire time, I was pushing effectively, the contractions were effective, my son's heart rate stayed strong - my baby got stuck and no one knows why. For me that is one of the most painful things - there is no known reason. The same thing happened the second time, 7 months ago, and I am still dealing with depression from it.

I am so thankful to have a supportive family who really gets why it has been so hard on me. They listen to me when I "breakdown." I really can not imagine how hard it would be if I did not have the wonderful caring support that I do have.

I do take some sense of empowerment from going drug free during my first birth and from pushing for so long - but it is a small thread to hang onto.

Thank you for such a wonderful post - I will be sharing this one.

A. said... [Reply to comment]

Thank you! So much of what you wrote (and what others have shared in the comments) has been validating, comforting and healing. Thank you. I see similarities in so much of what you and others have written. I feel that I continue to heal and I've tried to reach a place where I can lovingly let it go - I think perhaps I haven't quite reached the place where I need to be gentle with myself, forgive myself (so I don't feel guilty) and embrace my feelings.

Thank you - from deep inside of me.

Anonymous said... [Reply to comment]

Thank you! Much appreciate people like you talk about this kind of thing. Birth is highly emotional and so not respected... !

Stephanie said... [Reply to comment]

I can't even begin to describe my birth dissapointment. I am not grateful for it because I got sliced open for no other reason than I had been in labor "too long" UGH. I am however grateful for the insight and power it has given me to become a HUGE birth activist. I speak out about it on a daily basis, and I will never stop. Because of my experience I became a birth doula and a breastfeeding counselor and a childbirth educator. Because of my experience I am in nursing school and I plan to become a midwife attending ONLY homebirth and birth center births. I cannot do it in a hospital.

Stephanie said... [Reply to comment]

I also just wrote a research paper on post partum post traumatic stress disorder, which I had. :(

Jenn @ Connected Mom said... [Reply to comment]

I agree that one positive of my experience is becoming an activist and working with ICAN. It's a somber thing to have so many brought together by this though.

Big hugs to all of you.

Cheryl said... [Reply to comment]

Thank you so much for this article! I too did not have the natural birth I had hoped for. I was induced due to high blood pressure and did not progress well because I think my body and my daughter just weren't ready.

I ended up on pitocin, and eventually had an epidural because the contractions on piton are so much harder to handle (though I did go several hours before I "gave in"). Two and a half days after first being admitted to the hospital I finally gave birth vaginally to my baby girl.

Though I was grateful she was healthy, it took a long time to recover from the whole experience. I was released too early and back at the ER hours later to have a coley catheter inserted, and then sent home with a NEWBORN for three days before my GP removed it for me. It was a nightmare and it upset me so much each time someone said that I should just be thankful that I did not end up having a c-section and that my daughter was healthy. Luckily my doula, and a post-partum doula we later connected with helped me to start coping with this. I battled through PPD for several months, but am happy to say that at 6 months we are both doing well.

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