yIsica Cornwell was silent during labour. She bled while giving birth to her twins with forceps and suction cups, and her life was saved by a doctor who inserted her hand into her uterus to remove the placenta. One of her sons was transferred to the neonatal intensive care unit. She wrote in Birth Notes, I Couldn’t Speak, her memories of recovering from the PTSD she developed. I couldn’t say anything at all.
Cornwell now knows she went into schizophrenia during childbirth. “It started pretty much the moment I went into labor and several midwives commented on how calm I was. She told me how well she handled the pain. Her book, a deeply poetic account of her journey to diagnosis and treatment and a scathing indictment of the lack of knowledge and research into childbirth trauma, was meant to Originally titled “Where There Are No Words”.
Since I was born I have thought a lot about words and language, how good communication can save a person from trauma. Psychiatrists tell me that PTSD symptoms often appear when patients (and their birth partners) feel that communication has been poor when they have no idea what is happening to them or their bodies. High anxiety is usually one of the main causes of PTSD, and when she feels like everything is out of control, no one is telling her what is going on, and no one is listening, all of these things can combine to cause PTSD. “A lot of women will say, ‘I thought my baby was going to die,’ or think they were about to die, but none of the hospital staff seemed to know it,” says Dr. Kim Thomas of the Birth Trauma Society.
According to one study, one in three women describe their experience of childbirth as traumatic, but until relatively recently, childbirth was not considered an event that could cause PTSD. It was normal of course. According to the Diagnostic and Statistical Manual of Mental Disorders3, PTSD was the result of events “generally outside the scope of normal human experience.” This was only removed in 2013, and childbirth is still not explicitly listed as a potential stress, although experts ultimately agree that it may be.
Despite this, birth trauma is often misdiagnosed as postpartum depression. It was two years before Cornwell received her diagnosis after she was told she had postpartum depression, and again, where language should have been, she was absent. Birth trauma and pregnancy were not included in the life events checklist she was given. She wondered if “the lack of distressing categories associated with motherhood was an accident, an oversight, or a deliberate omission—or if the research hadn’t caught up yet.”
It was watching Cornwell, a close friend, try to put these experiences into strong words. She is not alone in this. Sometimes there are several wines, roughly told in the style of a stand-up routine. Other times it is mentioned almost casually, such as the incident when a woman in the café handed me a cup and nodded to the child in the playground across the street. “I only have one,” she said, “because they came out of the womb after that.”
Finding the words, building the narration, helps with processing. I have received an overwhelming number of emails from women with childbirth trauma, often long and detailed reports using medical jargon. These are the women who asked to see their notes so they could find out what happened to them or who attended the debriefing sessions. The questions are always the same: “Why didn’t I hear?” ; “Why didn’t anyone tell me what happened?” ; “Why have my requests for pain relief been ignored?” (Ask for pain relief and not get it is a recurring topic); “Why was this done to me without my consent?”
Sometimes there is a serious deficit of care, but more often the traumatic birth appears to be characterized by communication gaps. Cornwell emphasizes that raising awareness about birth trauma is not about demonizing stressful medical professionals, it’s about figuring out how to improve the birth experience for future patients so that we don’t have to hear these stories over and over again. Entering a dissociative state, as she did, is a guideline for future PTSD, as are past traumas such as sexual violence. She believes that training to help doctors and midwives identify women who are unusually calm during labor so that they can be helped to cope with separation could be a positive development. Thomas points to a study in which women, who were particularly vulnerable, had great success placing a “psychological alert” label on their birth certificates to alert medical staff to mental health problems. Employees can be trained in listening skills and more and more professionals come to them to demand training.
I am still working through the birth stories that have been sent to me. Each is unique, but there are a few phrases that may apply to all women writers, like this one from a mother of three who almost died in labor and now has lifelong health problems: “The main thing that bothers me the most was that I didn’t have a voice. I am being listened to and no one heard me.”
What is working
I am forever grateful to the creators of Ewan the Dream Sheep, a cuddly cartoon sheep that glows red and makes (yes, really) sounds to help my son sleep. Millions have been sold and I can understand why it seems to have a miraculous anesthetic effect. I have already recommended it to many friends.
I would like to apologize to anyone who was forced to watch one of my son’s last year “Bonami”. Unfortunately, we were a bit slow in realizing that we needed a larger size diaper.
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