When you look at the probability of trauma in the course of a woman’s life, the statistics are high. One in three will experience sexual abuse in her lifetime, one in four will perceive her birth as traumatic. So, if you’re a childbirth or postpartum professional, you are regularly working with women who have experienced trauma. And keep in mind: a woman who has previous trauma or a history of abuse has a much higher chance of being triggered in birth and experiencing trauma again.
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What is birth trauma? It’s all about perception. When a woman perceives her birth as traumatic, she has felt one or more of the following in an intense and damaging way:

Birth trauma will have immediate effects on a woman and change her experience of birth, postpartum and motherhood. As birth professionals, our goals are to prevent birth trauma by providing support, information and guidance for laboring Mamas. Some of the things you can do during your time together are build trust, tune in to Mom’s behaviors to establish safety in the labor room, and speak to her in a calm, affirming voice. But unfortunately, we can’t always prevent birth trauma.
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Women who have experienced a traumatic birth can develop PTSD (posttraumatic stress disorder). It can be misdiagnosed as postpartum depression or anxiety but the symptoms are actually different. Some signs of PTSD in a new mother are:

There are some important things to keep in mind when dealing with a Mom who has birth trauma. Your support will be critical to establishing safety, support and eventually healing from this difficult time.

​Here are some things you can do to support a Mom with trauma

​The exciting and encouraging thing to hope for is what’s called post traumatic growth. With proper self-care, nutrition, sleep, and exercise she will begin to feel better. Suggest to her that some women find healing through yoga, body work, trauma therapy and groups. Post traumatic growth provides women the opportunity to heal from trauma and become stronger, wiser and more compassionate because of it. With adequate support, education and care, new Moms can fall in love with their babies and leave the shame and pain of trauma behind.

It is okay, stay with me. I know you are saying, what? Why would we talk about Doctors during doula month?!!? Doctors are the reason women need doulas in the first place! I would agree, wholeheartedly, that women need doulas, in part, to help navigate the maternal health care system. But I would also agree that part of the reason that women need doulas is that doctors desperately, desperately need doulas too.

I became a doula nearly 14 years ago in my twenties, and I’m not going to lie, I didn’t last long. I had some births that resulted in healthy babies and the mom was…not disabled at the end of it. Even with a doula, these moms did not receive mother-centered care. For a long time I thought I was just unlucky to get some bad birth situations, but now I know, they were all pretty routine. A male doctor telling me in the middle of a baby crowning that most women urologists would much prefer to have Cesarean births because it preserves the pelvic floor (is this really the time? While this patient is purple pushing her baby out in a lithotomy position that only benefits you?). That time the doctor was in tears because she had agreed to induce at 37 weeks because winter holidays were coming up, and no, to keep it short, it didn’t go flawlessly. I don’t doubt she was crying because she was tired, and maybe a bit raw, and dismayed that the baby needed resuscitation and extended procedures to make the transition to independent breathing.  And yeah, her medical malpractice insurance was about to get tested. I certainly had views on the doctors in these births!

So in my thirties I went to school for a Masters of Public Health with the goal of changing birth outcomes through public health, and if that meant throwing the doctor out with the bathwater, so be it. It was no more than they deserved for being such out of date, out of touch jerks.

But now I’m in medical school in my forties.  I see classrooms nearly half full of 21 year old women being called “Guys” by every lecturer and attending, being erased by every lecturer and attending. I see course curriculum that includes nothing on breastfeeding, and when asked a question about normal breastfeeding, an obstetrician says she knows that answer because she has breastfed for three months! Not because as an OB she has extensive and comprehensive training on breastfeeding (they don’t get any), but because she has beaten the odds as a breastfeeding physician (66% of physician mothers do not meet their breastfeeding goals, most don’t make it to three months).  She is also the one that told the class vaginal delivery was a procedure done by a surgeon.

Physician mothers have nearly a two-times increased relative risk of birth complications, because they are doctors, and if anecdata is anything to go by, can anticipate having every medical intervention in the book --  evidence based or not -- thrown at them (perhaps accounting for that increased risk?).

After birth? For the 30% of women residents that are pregnant, they have minimal leave; it may be paid -- or not; they may get to finish the program on time -- or not. There is no required minimum maternity policy for residencies. Even if leave is allowed, many won’t take the whole of it because pregnant physicians are considered a burden on the residency program by attendings and male residents. Most are expected to return within six weeks, if not sooner. Maternity leave for practicing doctors isn’t much better.  On paper they may have 6 weeks of paid leave, but in reality? Maybe their partners have made it clear that the business will not tolerate that much time away.  Don’t even think about taking time to pump! Their employees and staff have better maternity leave.

So get to the point already, you say, why am I advocating doulaing the doctor? Because if ever there was a group that was high-risk for all the bad outcomes of birth and postpartum, while simultaneously seeming to have all of the protective factors, it is women doctors. They set out to become doctors when they are 18, start medical school at 21, and spend the next 4 years being erased as women and indoctrinated into the medical system's way of maternity care. They often have minimal exposure to safe alternatives to standard medical maternity care because of their training, and even if they want something else, the systemic pressure on them is nearly crushing. They are shift workers as residents, they have no protection under the law for breastfeeding because they are salaried, and sure, they have lots education but also lots of debt and not much income. If they are part of a private practice, they struggle to balance breastfeeding and bonding time with the need to go back to work immediately in order to become a partner and thus-financially secure.

​And yet they do not utilize doulas, because they KNOW about birth, they’ve been TRAINED, their OB is the BEST, the nursing staff will help. The research is pretty clear on this too -- doulas improve birth outcomes, increase breastfeeding rates and reduce postpartum depression. Also, research tells us that doctors are frankly the worst patients in the world, because they are doctors. They literally refuse to ask for help because they shouldn’t need it, they have the training, THEY know what to do.  So a high-risk group that would clearly benefit from doulas isn’t using them, doesn’t realize they need them, and I’d like to see that change.

Great, so I want to see that change. What is the big deal if they don’t use a doula? Most women don’t.  True, although that is changing as doulas become more available and the research on their benefit expands. But the big deal is this: Women physicians have the highest suicide rate of any profession, 250% higher than the rest of the population (men physicians are 100% higher than the population rate), and 400% higher than women in other professions. We are doing something so profoundly wrong in our profession that women who should be healers and leaders and colleagues and parents are killing themselves.

​Suicide has many causes, but here is one I think we haven’t talked about enough: physician mothers are providing care and getting none. Maybe if we nurture our physician mothers through their intense times of change and challenge, support them during their births, help them bond with their babies, meet their breastfeeding goals, maybe we could change that suicide rate. Birth can be transformative, or traumatizing. Doulas can help shift the balance for women, and women physicians need this as much as any other high risk group. Time to doula some doctors and change the world. 

I was 14 when my little brother was born. One day he fell down, like kids do 800 times a day, and he began to cry. I said, "You're fine, stop crying." My mother replied to me, "You don't know how he feels." And you know something? She was right. Ever since that situation it has stick with me: I don't know how others are feeling, why do I feel the need to tell them? I believe this also applies to birth trauma. When we tell women they should just be happy with their babies, no matter what she experienced during birth, we are telling her how to feel. And guess what? We don't really know how she feels. But something we need to realize: her feelings are appropriate and authentic, and they are not wrong. Allison's insight into this world of loss and grief might be difficult to read, yet I am hopeful we can begin to change this. 

​So here it is, my first blog. I’m writing it from my gut, my heart and my mind last. It comes from the words “Well at least you have a healthy baby,” and the response from women, “I guess I just have to get over it (birth that is)”. Writing those words, let alone hearing or speaking them is like the thunderbolt out of nowhere. There is no silver lining to that thunderstorm. Those words have trauma and loss written all over them as well as an absolute lack of empathy. Where has this notion come from? How on earth has society become so warped in its beliefs about birth and the well-being of women who birth our next generation? Words may be transient but their impact is not, the impact hits hard and over time, women believe such words to be true. Such words could not be further from the truth, yet the truth lies in their devastation. 

Birth is a forgotten rite of passage. Women come face to face with their raw vulnerability, strength and power as they walk through the gate of maiden to mother, yet somehow the significance of this experience has become lost and is dismissed within our society. Since having my babies I birthed a new life motto that completely throws this notion out with the bathwater – “Birth has the power to make, break and save our soul”. This I know to be true as I have lived all three. The words of women I have walked with through my birth work also resonate with this belief, yet they are silenced. They have a healthy baby. For some, behind their smile they hide a turmoil of feelings, thoughts and emotions screaming to be let out – their baby may be healthy, but their mind, heart and soul are not. The way in which a woman FEELS about her baby’s birth is as significant, if not more so, than the way in which her baby was born. The latter of course is important too, but that’s a whole other blog. 

Birth trauma and loss, the Pandora’s Box of the birth world. A box that I feel ready to open, pull apart and challenge. So, what is birth trauma and loss anyway? It is way more than the devastating obvious physical pain, the flashbacks, anxiety, depression or the birth that required emergency or medical intervention. Look deeper inside the box. Birth trauma and loss lies in the eye of the beholder.  It has many faces, often subtle and hidden in places too often overlooked, with even the birth that appears “perfect” hiding a life changing unspoken secret. It is the insidious nature of the maternity care system (for those that work within it and those who receive its services), the complex politics, the “one size fits all”, the outdated policies, the power imbalance, the conformity, choices that are not informed, the loss of control, the maternal request that provokes anxiety, the bullying, the care provider or mother who is silenced, the scaremongering, the withholding of information, the coercion, the words that are said or are never said, the disapproving glance, the tut or the sigh, the tick-tock of the birthing clock, technology that replaces instinct and interaction, the medicalisation of birth that interferes with mother nature’s birth dance, the thinking brain, the fear, the adrenaline and the “cascade of intervention”. The list is endless, the contents of the box different for every woman, creating a picture that is etched within their soul, changing over time through varying shades of darkness and light. 

​Birth trauma and loss is a journey of self-discovery, grief and ultimately I hope, strength and transformation.  So for all women, “getting over it” is not an option. Living, exploring and releasing themselves from their birth experience with forgiveness is a very real and necessary option. So instead of “Well at least you have a healthy baby”, next time you are in the presence of a new mother, listen instead of speaking.  Show compassion not sympathy. By listening and watching we hear a thousand words. I end with another motto –“Birth is all encompassing, physical, emotional and spiritual.  It imprints on a woman’s soul and from the moment it occurs, a woman is forever changed”.

​So who looks after the maternity system that looks after the care providers who look after the women who birth our next generation? The answer is ALL OF US.  It is time to challenge society, to choose our words wisely and to bring birth back to women.

Dig deeper into the box.

Allison Tate is the mum of three boys, a birth and bereavement doula, and a childbirth educator serving families in the Edinburgh, Scotland area. She co-facilitates the Positive Birth Movement Group in Edinburgh and the Lothians, and is a member of the Lothian NHS Maternity Services Liaison Committee. She is a volunteer buddy with Bliss Scotland, and works closely to support bereaved families with SANDS Lothians. Allison celebrates and recognises birth as a physical, emotional and spiritual experience and by empowering women through access to information, nurturing their innate wisdom and inner strength to make their own informed choices about their pregnancy, birth and early parenting (without fear of judgement, bias or misinformation) birth is rightly owned by each mother. Back to Birth is her website -- also look for her blog.