Amy Dawes, Co-founder of ABTA, Australian Birth Trauma Association
This week is Birth Trauma Awareness Week and a couple of years ago one of my lovely patients who had suffered birth trauma wrote a blog for me. I loaded it into the blog site and then ‘life’ took over and I didn’t get to post it. As Birth Trauma Awareness Week started on 19th July 2021, I thought it appropriate to post this patient’s story for all to read. I encouraged her to write it as it is often cathartic to put pen to paper, write down the words that flow out to help verbalise how an experience is traumatic for her and this may help with her healing process. And hopefully someone will learn from what she has revealed.
Birth trauma is described as a wound, serious injury or damage – it can be physical or psychological (deeply upsetting and distressing) or a combination of both. Both mother and the father/partner can be affected by birth trauma.
Birth stories can be a very mixed bag. Some are glorious and fulfill every dream that the mother / parents may have had. Many times though they leave the woman disappointed, anxious, devastated and in this case – this mum felt diminished by her experience. Part 1 of this birth story relates to the things that happened in labour ward rather than the actual birth injury that KM suffered. That part will come later. But the Australasian Birth Trauma Association support is available for anyone who suffers any perceived trauma and provides support and a space for women who are affected by their experience.
But people often say: ‘Isn’t it enough that you have got a healthy baby and you (look) healthy. What are you complaining about?’
What happens in labour ward does matter. To every individual mum and her partner or support person if she has one. Individually, women are most likely only going to get 1,2 or 3 goes at having a baby in their lifetime. The average size of a family in Australia is dropping as women are having fewer children. The 2017 total fertility rate of 1.74 was also the lowest rate on record, declining from a peak of 3.55 in 1961. That was 2017, 4 years ago. It may well be lower now.
Wouldn’t it be incredible if every woman was able to have a birth experience that was not traumatising, not diminishing of her wants and needs, but respected that the experience that is happening for each woman is very special and unique to her. Now there are always going to be medical emergencies in birthing and these are stressful times when doctors and midwives are moving quickly to save the baby and the mother from suffering injuries.
But what we are about to read in this mum’s story, is a lot about process. And it is important that we understand that each individual interaction with a labouring mum can make or break their birth experience. Every word that health professionals and other staff members say to labouring mums (like this mum) is going to have an impact on how her special day is remembered by her…… forever.
‘Control the controllables’
This is one of my favourite sayings I have learnt from an Irish pelvic health physio colleague and friend, Michelle Lyons. It is something we can all apply to life’s journey. We can’t control many things in life. The weather, how others drive, house prices (good luck to the next generation <insert sad emoji>).
But there are small, important things we can control.
Like how kind we are to patients. Are we empathising with what they are going through? Have we really attempted to make the best of a busy session where there are no beds and decreased staffing? Can we stop and explain things so she’s not panicking about this new, incredibly different experience she is enduring? Have we said sorry? Did we smile enough and make her feel reassured?
In this first part of the blog you will read that much of what went wrong for this mum may have been turned around with simple kindness, good explanations and a big dose of empathy.
Read KM’s blog Part 1:
I’d like to share my birth story. Like many women, it’s not quite the story I hoped I would be telling, but it’s my story and so here goes…
I was so excited by my pregnancy that I told everybody at 5 weeks! I went to every appointment, and my husband and I attended every Parenting Class offered by the hospital. We learnt all the risks of medication during labour, the risks of having a C-section, that breast is best. We even got to tour the new birthing suites, which have deep baths in them, so you can relax during labour. We went through what to pack for hospital, including some magazines and scented massage oil so hubby can give me a rub down between contractions. As a first time mum, I was told time & time again that my labour would be a minimum of 24 hours and to stay at home as long as possible.
When my waters broke at 2.30am, I stayed calm. I knew I had at least 24 hours up my sleeve. I had a nice warm shower and I woke my husband. He mumbled ‘congratulations’ and rolled back over to sleep. (Yes, we are still married.) I called the hospital, and was surprised that I should head in for an assessment; I thought I should wait out early labour at home? The nurse said they would just check if it was really my waters and then I would be sent home to labour as I was a first time mum and it was going to take 1-2 days for this baby to arrive.
In my naivety, I didn’t even take my hospital bag out of the car. I didn’t want the nurses to think I hadn’t been listening. I was a little surprised that there was no room for us when we arrived at 4am. We had called ahead, and been told to come in. Instead, we were greeted with ‘Sorry, we’re so full – it must be a full moon or something.’ We were told to go sit in the review clinic waiting room until an assessment room became available. What a warm, welcoming space that was – a row of uncomfortable hospital chairs and… nope, that was it. We waited there so long, I thought they had forgotten about us. By now my contractions were a regular 10 minutes apart.
5.30am Hooray – a bed. Ok, a narrow, hard, clinic assessment bed, but still good. The nurse was great, she checked baby’s movements, the frequency of contractions, and explained it was too early for an internal check.
We felt informed and calm.
I sent hubby to get my bag out of the car, and told him ‘don’t let them send me home, it’s not going to take all day’. I got changed into a loose, comfortable dress and took my knickers off. I was ready for this baby to come.
At 7am, the shifts changed, and that’s when things started to go a little pear-shaped for us. The new nurse was crabby and dismissive. She did my first internal and said : ‘You’re only 2 cm, you’re going to be here all day love. So did you come to hospital to lie down, or can you get up and go for a walk in the corridor?’
I tried my best, I walked up and down a main hallway. The cleaners passed me as I crouched in pain, hanging on to the plastic side rail. I stared with envy at the women presenting for planned procedures.
I felt raw, exposed and defeated.
I couldn’t do this, it was too hard. So I went back to my room, with it’s curtain for a door. I was so thirsty. I didn’t want hubby to leave me, but I needed a drink, so I sent him off to purchase one from a vending machine. While he was gone, I sobbed my heart out. I asked to see a nurse but nobody came. My contractions were getting closer, but nobody came.
I was scared and uncertain, but nobody came.
Finally, at 9am I had enough of being ignored. With every contraction, I bellowed and moaned and screamed to my hearts content and the nurse came. And do you know what she told us when I was feeling so desperate for help and guidance? ‘Guys, this is a review clinic, it’s like Emergency but for pregnant people. So that means it’s priority based – and right now you are not at the top of that list. Maternity is full, so right now we have women giving birth in here and they need to be our priority. Here is the gas, use it just before your contraction starts.’
Then she was gone. Now, I’m not the kind of person who plans that much – I didn’t have a set birth plan, or a list of expectations. Just the general idea that being in labour and being in a hospital meant I would be cared for, looked after.
Not left alone, feeling like a burden, with no idea of what comes next.
So I checked out too – mentally. I breathed that gas in like it was oxygen and I was drowning. I became separated from my reality and that’s what I wanted. I didn’t care what anyone thought anymore. I got down on all fours on the hospital lino, and backed up so I was pressed against the wall to try and relieve some of the sacral pressure I was feeling. I didn’t care about germs or the fact that my husband just saw me pee myself. Hubby and I struggled along, alone for just shy of 2 hours. And I mean alone. Nobody came to check on us, nobody offered us food or even water.
I have never felt so worthless in my entire life.
My contractions were a minute apart, it wasn’t enough time to recover. I promise you I didn’t feel like massage oils or reading a magazine. I wanted to be reviewed, but nobody came. I sent hubby out to find help, but he was told they were busy, and nobody came. He went again, and said my contractions were a minute apart and we didn’t know what to do – but that’s right, nobody came. I pulled him close to me and said ‘Go, stand there at the nurses desk, make a scene, do what you gotta do, but do not come back in here on your own!’
So in came the same nurse who was so crabby earlier. She found me huddled in a pool of my own bodily fluids, desperate and gassed to the eyeballs. She looked down upon me with disdain and said ‘What are you doing down there? You’re making a mess, you’ve got mucus on the walls. Here’s a clean pad, put your knickers back on and get into bed.’ I refused. I wanted to know what was happening.
I wanted somebody to listen, to assess me.
I dug my heels in and demanded an internal, and you know what? I was 6-7cm dilated and ready for birth suite. BUT, the story of my visit, there were no beds available. At 11.30am there was finally a room for us and I was asked to walk across. I refused. I was taking back control. I didn’t care if it was just down the hall, I wanted a wheelchair.
Arriving in birth suite was like a fairy tale. I had space, privacy and a midwife who cared. I eased back on the gas. I felt safe, I felt positive. I laboured on my hands and knees so gravity could help me. I felt like a warrior as my baby’s head crowned. And then…..in came the tea lady. She popped her head in the door and said: ‘Would you mind if I duck around you and grab your dirty lunch tray?’ Lucky I was still in warrior mode so I said ‘No, go away’. Which wasn’t clear enough as she said ‘Come on love, it won’t take long’. Me ‘Aaaaarrrggghhhhh would one of you nurses tell her to kindly leave.’
Bub was also getting distressed by now and I was told I only had one more push left before ‘Plan B’.I still had no idea what that was. Anyway, with an almighty roar of :’Come out now!’- my baby was born. I heard her rush out of me and land on the bed in an explosion of meconium. I’m not sure who was more shocked – me, the baby or the nurses. Hubby and I stared down at our baby girl. She was perfect.
I needed stitches, that was OK, I expected that. I didn’t expect to wait in stirrups for over an hour as the ObGyn got called away urgently. I didn’t expect the junior to stitch me, then say ‘Oopsies’ as she peered up guiltily from between my legs. She had snipped off the knot that was to hold the stitches in place and now I had to wait for the Senior ObGyn to see if they could fix it.
The senior doctor came in to review me. The overhead lights weren’t working and the lamp wouldn’t stay up, so a student midwife shone her iPhone torch at my vagina. Stitches fixed, we were moved out of birth suite, into a small side consulting room with a desk and a computer because…. again there were no beds available. Eventually we made our way to the maternity ward where the understaffing was obvious. All in all, my labour was 10 hours and 20 mins from the time my waters broke to the time my little girl arrived.
I never imagined spending so much of it terrified and alone
I never imagined a nurse could make me feel so worthless, so degraded
I never imagined having to fight for my privacy in my most vulnerable of moments
I never imagined the depth of silence that surrounds birth trauma & birth injury
I never imagined that nearly 2 years later writing this can still make me cry
Part 2 will be about my prolapse journey – a result of the physical part of the birth trauma.
Quick Facts about physical trauma
Research suggests that 10-20% of first-time mothers, between 15000 and 30000 women in Australia per year, may suffer major irreversible physical birth trauma in the form of pelvic floor muscle and/or anal sphincter tears.
Statistically we know that up to 20% of all women who deliver a baby vaginally will end up with surgery for pelvic organ prolapse, anal or urinary incontinence, and yet few talk about such health problems to friends and family or to health professionals.
You are not alone mumma’s. Birth trauma is real. Birth injuries are far more common than anyone lets on. It’s time to end the silence.
Thank you KM for this blog. There is much to be learned from this mum’s account of her birth experience.
Me about to pop a baby circa 1991
It’s funny when she talked about moaning and bellowing and screaming, I was suddenly transported back to my third birth experience. I hadn’t thought about it for many years. It was over 30 years ago. In those days we were in the old labour wards at the Mater and the room I was in had an internal window in that room – I knew that on the other side of that window was the tea room for special care nursery staff.
I had morning tea there many a time and suddenly with that awareness, I remember moaning and bellowing and screaming …and thinking why is this labour room so inappropriately situated next to the tea room? How embarrassing that I can’t be quieter, but I couldn’t – I was in pain because my doctor was doing a manual removal of the placenta without any pain relief. The cord had broken when he tried to remove the placenta (because he was in a hurry to get to an antenatal clinic) and all I could think of was what I used to say in the antenatal classes I used to run at the hospital. ‘
If the cord breaks you will be taken to theatre for a light GA to remove it.
Where the hell was my light GA?? ‘
To all the mums who have suffered birth trauma, I hope you are not being too triggered by the many birth stories that will pop up during this week. The goal of this year’s Birth Trauma Awareness Week is to lobby the government to fund routine physiotherapy treatments at 6 weeks post-partum. I have created this movie (link below) with the help of many mums who gave their precious photos for me to use; with the help of Tilly Lawson who is an amazing singer and with thanks to John Lennon for his iconic song Imagine. I have created the lyrics to help promote this message. Feel free to share.