Solace for Mothers
by Sharon Storton

[Editor's note: This article first appeared in Midwifery Today Issue 90, Summer 2009.]
Artwork by Kiki Metzler

She should be grateful. She knew that. She heard it from everyone: her husband, her mother and friends. Even her baby seemed to look at her reproachfully, right before screaming for hours on end. Tanya wanted to be a good mother. She tried. No matter what she did, she still felt numb, inadequate and so much less than the person her family was expecting her to be. The guilt was crushing.

This whole experience had been doomed from the start. The pregnancy had come as a surprise, at one of the worst times in their lives. Her husband had just been laid off, as Tanya was finishing up a graduate program in business. She worked all day and attended school at night, while Toby took whatever temporary work he could find. They seemed to be fighting all the time, as the stress grew. How had they let this happen right now? Then, during the pregnancy, Tanya’s blood pressure rose to the point that her midwife said, “Induction.”

artwork by Kiki MetzlerAt first the decision to induce came as a relief. It had been such a long pregnancy! After they had begun to dip into their savings, the couple replaced their experienced doula with a volunteer doula-in-training. Even with the doula’s moral support, Tanya’s determination to have a “natural childbirth” without medication was quickly tested as the labor-inducing drugs took hold. The labor was much harder than even her worst fears.

She had intended to keep the interventions to a minimum, and here she was with an artificial rupture of her membranes, an epidural, an IV, a catheter, an internal monitoring device, antibiotics for a positive GBS screen, and even the nurse-from-hell in attendance. It seemed that the more Tanya resisted the interventions, the more the nurse intervened. Vaginal exams felt more frequent and more forceful. Tanya slid into her age-old technique of stepping outside of her body. She shut down emotionally, retreating further into her own cocoon and away from the pain and fear. Suddenly the doctor’s voice broke through the barriers, with the news that her “baby was stressed—not handling the contractions well.” The medical staff would have to intervene.

The rest of the delivery is a fog. The murmur of the anesthesiologist in her left ear, the fear in her husband’s eyes, the pulling and tugging and tearing, the cry of the baby, then the awful silence as the staff and Toby went off to the NICU with the baby. The doula looked scared. Would the baby live? Whose baby was it? Tanya’s? It didn’t seem so. She felt small, empty and unnecessary. A used vessel, no longer needed.

Breastfeeding was beyond frustrating, with all the stitches hurting enough to hold back her milk. Before she knew it, the baby’s bilirubin level was elevated, and lights and formula were prescribed. Tanya’s body seemed to be “failing” once again. Why was she even here, she wondered. For all this, she should be grateful. They had saved her baby but Tanya had lost her soul in the process.

Eventually, the symptoms of Tanya’s trauma will probably be diagnosed as “postpartum depression.” If not, she may suffer alone her isolated cocoon, separated from her world by slashing self-criticism, judgment and the effort it takes to avoid the anguish of flashbacks.

It was for mothers like Tanya that Solace for Mothers was formed. Solace for Mothers is an organization designed for the sole purpose of creating and providing support for women who have experienced childbirth as traumatic. Solace for Mothers provides support for mothers, as well as education and support for their family, friends and care team.

For example, if Tanya defines her birth as traumatic, regardless of the birth route and outcome, the online Healing Birth Trauma forum for mothers is here for her (http://solaceformothers.org/mothers-forum.html). If Tanya wants to have a conversation by telephone, she can call 1-866-Solace4 to speak with a trained peer call receiver on the Solace Warm Line. Tanya’s husband can clear some of his confusion about the birth on the Family, Friends, and Advocates online forum (http://solaceformothers.org/advocates-forum.html). Their doula also has a space to connect with other birth professionals on the Family, Friends and Advocates forum.

Solace for Mothers staff regularly provide in-service trainings at a variety of locations, including online webinars for mental health and birth professionals who wish to learn more about supporting women after challenging childbearing experiences. Since there is so much conflicting information on supporting women in the postpartum period, we take care to include the highest quality research and validated practices in our presentations. In an effort to help new families understand their options, Solace for Mothers also has been hosting public education events designed to spotlight the importance of normal birth. To this end, Solace has recently hosted screenings of the movie Orgasmic Birth, with panel discussions following. We have initiated regular “Red Tent” gatherings in various locations to encourage women of many generations to share stories of birth and growth. In so many ways, Solace for Mothers is here for Tanya’s family.

The number of women touched to date by Solace has been astounding. For example, in its few months online, Solace for Mothers has welcomed more than 400 women to the mothers’ Healing Birth Trauma forum. This forum was designed and is moderated by Jenne Alderks and Jennifer Zimmerman. Both women are survivors of traumatic childbearing experiences.

According to Alderks, “After the birth of my son, I felt like I was going crazy. It seemed that no one around me understood why I felt violated by the people present at his birth and the policies of the facility. I felt that an online community would broaden my ability to find peers who understood my experience and would provide a resource for others who felt similarly.”

The discussion board is moderated, supportive and confidential, with topics often updated and revised. The format of the mothers’ forum enables women to intentionally enter discussions segregated by topic and content, so women can control their exposure to distressing stories that may exacerbate their symptoms. In some cases, former members have offered to be a resource for struggling mothers.

The Family, Friends and Advocates Forum, which is just getting started, is designed for midwives, doctors and other advocates who want to advocate for gentler, more mother-friendly birth practices and who support mothers affected by birth trauma.

The Solace for Mothers trainings and seminars introduce professionals to the research, techniques and resources important in their support of childbearing women. In the right environment with appropriate care, healing after birth trauma can be rapid. Mental health providers can be trained to use validated trauma-recovery techniques such as psychotherapy, eye movement desensitization and reprocessing (EMDR) and hypnosis to help mothers stabilize their balance, identity and attachment following childbirth (Dennis and Hodnett 2007). Complementary care methods such as acupuncture and group support have been studied in the perinatal period and found to be effective. Perhaps most important, providers will learn what is not helpful. Professionals suggesting that a mother “should be grateful” has become alarmingly common and disrespectful to mothers who are struggling with the memories of their experiences.

Interestingly, in professional seminars, we have had to “untrain” as much as we train. For example, minimizing and misdiagnosing trauma after birth is a significant temptation on the part of providers. A diagnosis of postpartum depression provides something of a relief to care givers whose legal, personal or financial well-being could be threatened by an acknowledgment of trauma as a result of childbirth. Further, an unintended effect of the recent public awareness campaigns around postpartum depression is that the diagnosis is even more tempting. Cardinal trauma and anxiety symptoms such as worry, panic and self-criticism can easily be considered markers for postpartum depression (Kabir, Sheeder and Kelly 2008).

Complicating matters, trauma and depression are often intermingled in the postpartum period (Söderquist et al. 2009). These challenges to a mother’s wellness must be considered separately for treatment purposes. The work of performing this differential diagnosis can be subtle. Even when a birth was considered to be “normal” by medical standards, as was Tanya’s, up to 33% of women described it as traumatic and experienced symptoms of trauma-induced stress in the weeks following (Creedy, Sochet and Horsfall 2000). Sometimes the trauma is rooted in childhood experiences, particularly childhood sexual abuse (Simkin and Klaus 2004). In other women, symptoms of trauma following childbirth arise from a loss of control over interventions, feeling unsupported or even mistreated by significant others or by medical staff, or from complications that cause mothers to be fearful for their own or their babies’ lives (Beck 2004). Women can experience symptoms for a considerable period of time without understanding the true source of the distress. If trauma-affected mothers avoid another pregnancy in order to sidestep a similar experience, the root events often fade to invisible. When women do become pregnant after a previous traumatic birth, research indicates that the risk of resurrecting traumatic symptoms increases as the next pregnancy progresses, and mood upheavals following that birth are even more common (Söderquist, Wijma and Wijma 2004; Söderquist et al. 2009). Providers must be able to be gentle and respectful, but thorough in their assessment process. That takes training and practice.

We frequently receive feedback that Solace for Mothers fills a critical need in a mother’s recovery process. At times, this support can be life-saving. According to the British “Why Mothers Die Survey,” “…Psychiatric illness leading to suicide is a significant factor in at least 10% of maternal deaths [in the first year postpartum].”(UK Department of Health 1998) Correct diagnosis and supportive treatment of trauma, particularly trauma that leads to depression, may well save lives in the childbearing year.

Solace for Mothers is working hard toward a more just and caring environment for Tanya and others like her. We are here to listen, learn and provide a voice to women after traumatic childbirth.

Sharon Storton, MA, LMFT, CCHT, CLE, is a licensed psychotherapist specializing in perinatal mental health and trauma recovery. Sharon founded Solace for Mothers in 2007.

References:

  1. Beck, C. 2004. Birth trauma: in the eye of the beholder. Nurs Res 53(1): 28–35.
  2. Creedy, D., I. Sochet and J. Horsfall. 2000. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 27(2): 104–11.
  3. Dennis, C., and E. Hodnett. 2007. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev 17(4): CD006116.
  4. Kabir, K., J. Sheeder and L. Kelly. 2008. Identifying postpartum depression: are 3 questions as good as 10? Pediatrics 122(3): e696–702.
  5. Simkin, P., and P. Klaus. 2004. When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Seattle: Classic Day Publishing.
  6. Söderquist, J., J. Wijma and B. Wijma. 2004. Traumatic stress in late pregnancy. J Anxiety Disord 18(2): 127–42.
  7. Söderquist, J., et al. 2009. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG 116(5):672–680.
  8. UK Department of Health. 1998. Why mothers die: report on confidential enquires into maternal deaths in the United Kingdom 1994–1996. Published online at www.archive.official-documents.co.uk/document/doh/wmd/wmd-00.htm.

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