Birth Trauma is Real

Birth trauma is real. For twenty-five years it sat like a tumor in my chest; I couldn’t cough up that last bit of fluid. It was trapped there, and I didn’t even know it, because it was my normal; in some ways it still is.  Still, one day it moved to the side just a little bit.

I was sitting with a group of sisters, watching an innocuous birth film full of kiddie pools, empowered women, and beautiful stories. My heart felt full as I watched what we hardly ever get to see - babies moving, unencumbered by drugs or fear, making their way out of their mamas, welcomed with the energy of peace.

Voices slowed around me as I watched one woman give birth with the “assistance” of a reformed obstetrician who had reportedly progressed beyond the confines of the medical model of childbirth. Only he hadn’t. Because as this beautiful woman gathered all of the power of the universe in the moment of restitution, when her baby’s head was on the perineum, her “caregiver” reached toward him, seemingly to begin head traction. He was pulling on the infant’s head. Mama suddenly yelled “DON’T” or “NO” – I can’t remember which – and my heart started thumping quickly as I watched that disembodied glove continue its manipulation. So close to her sex, opened boldly and magnificently; so close to little ears and lips painted pink in the dim light.

And at that moment the little stone in my chest that had obstructed my breathing for so many years moved just a little to the left, caused an avalanche, and I could feel those dull latex hands on my own tender scalp. Suddenly all of the times that I had said no, and had it fall on deaf ears -all of the times that I had said “No” or “Don’t” rose from my chest to my throat and I choked on the words. My heart turned over with sickening thump.

Tears dripped onto the blanket that I clutched tightly around me as I waited for some sort of justice; surely it would be brought up in the recollection of this woman’s birth. This “birth assistant” would be spoken to, embarrassed; it would be acknowledged that both woman and infant had been violated – this would be part of the film.

But it wasn’t. And Mama felt good about her birth. There she was, a few weeks later, cheeks rosy and smile wide and honest. Her baby was bundled in her arms, perhaps breastfeeding, or simply being rocked and comforted.  She told her birth story, but that word – “NO” – was left out somehow.

In my mind I was transported back to the birth of a beautiful baby named Dallas – a baby born to a mama who fought as hard as she could to keep him safe against hospital protocols. At home, before she panicked and decided to go to the hospital, we hung out and folded what little baby clothes had been passed down from her sister. We listened to rap music, and her dark eyes shone with pride as she talked about how she was going to have her baby “naturally” – they had told her there was a birth tub even. I hung cedar in the doorway and brushed her shiny black hair as she ate tater tots and rubbed her belly.

Once the hospital doors whooshed open and enveloped us, there was no turning back.  She closed her eyes against the onslaught of fluorescent noise.  I wanted to take her by the hand, back to her little townhouse where the lights were weak and her heart was strong. She let go of my hand, and that was it.

After negotiating with nurses to let her walk, keep her “off the monitor”, to let her have something to drink (only ice chips of course), to let her wear her pants under her gown because she was sixteen and embarrassed by stretch-marks, I sat down in the corner, numb. Through blurry eyes I watched her sleep; I wrung my hands and watched the monitor as her contractions wandered in and out like the bustling nurses and interns. The first time one of them slipped a glove on and parted her legs she woke with alarm, and I heard familiar words – “It’s okay.” “Just relax.” I also heard her say no. What right did she have to say no?

None. Not there. The monitors beeped and swooshed and she went back to sleep.  By the third time she didn’t even wake up when the nurse apologized for cold fingers, and I winced as I watched a gloved hand reach under the blanket, probably feeling for baby’s head. When we were alone again I pulled her hair back from her face, warmed her tiny hands in mine, and covered her legs back up.

Later on they shook her awake and told her to push – her baby was ready to be born.  For a second I saw her dark eyes flicker and when they told me to hold her legs back I could not leave her side; I didn’t want to let go of her hand.  The nurse rolled her eyes at me and, after twenty minutes and an episiotomy, Dallas was born.  I watched, anesthetized, as they wrapped him up quickly and put him in the warmer, where he was suctioned endlessly. His black eyes caught mine and I spoke to him with my mind. “I’m sorry,” I told him. “There is love here – it’s just a few feet away.” And it was. His mama lay there, watching and waiting.

A few hours later I stumbled past the grass in front of the hospital and into my friend’s car. I cried myself to sleep.

I had, even at that point, seen many births like this one. I have heard many women say “NO,” or “DON’T” – words meant to stop, to remind the other person that attached to this body is, indeed, a human, but these words are meaningless so much of the time.

So many of us said no when we were children too, and no one listened then either. We learned to go to sleep, to leave our bodies, because we couldn’t make it stop.  For some of us this began the moment we struggled to take our first breath.  Rough hands pulled on our heads, objects were shoved down our throats as we gagged and choked until we stopped even believing in the power of our own voices. We entered this world believing that our mothers were too weak to push us out, that we were too weak to breathe on our own, that not even our fathers or our months of practice breathing could protect us from hands that do not recognize us as human. We did not learn what it means to be alive. Compassionate. Gentle. Loving.

That doctor – all of the doctors – They didn’t learn it either.  Maybe they were pulled out of their mamas too, just like I was. And maybe, like me, they carry that around in their own chests, and it obstructs their breathing like it does mine, especially in moments of fear. Maybe no one listened to their “No’s” or “Don’ts” either and they would surrender just as easily.

Birth trauma is real, for everyone involved. The soul of a human being is not meant to engage in an order that systematically destroys confidence in the most fundamental, instinctive process there is. The denial of women’s power to give birth, strapping her down, rendering her helpless and unable to assist in the journey of her own baby, is the most basic and absolute expression of misogyny and gynophobia. This is not fixed by hospitals fixing up their rooms to look more “cozy”, or with the purchase of birthing balls or pools or bars that can be affixed to hospital beds. These are objects made to exacerbate her failure – if she has access to props and she still cannot give birth properly, what kind of woman is she? There is no possibility of success.

Even when there is felt success (a healthy family), it is illusory, because the process of birth is orchestrated so perfectly, so beautifully, that it is not meant to be tampered with in any manner at all. No hands. No instruments. No monitors. Women, with no intervention, can give birth easily and safely.

After all, how could possibly cause more harm than we already have?  We live in a world where women and infants are, at the best of medical-model births undermined over-managed, and at the worst - brutalized and sexually assaulted. Hospital hallways (even in Canada) are lined with portable carts filled with bottles of formula ready to shove in a baby’s mouth at the first sign of their mother’s failure to feed them.

Failure. No. Don’t. We need to stop closing our mouths and ears against these words and take back our births, for the sake of the memory of our bodies and those of our children and of their children and theirs.

There is no ending

My eleven year old son and I are sitting a couch eroded by time and evenings of wrestling and cuddling; it is eroded by the spilling over of sickness and pet hair and declarations of endless love.

His bare legs are over mine; he has no sense of where his space ends and mine begins. In my peripheral vision I see eyes made up of every colour conceivable, eyes carefully sketched by the hands of a magnificent god.  They are gazing out the window at people shuffling by with shopping carts filled with soon-to-be-cashed-in televisions and empties that promise five dollar bills and tins of moist tobacco.  Children toddle far behind, clutching coins sticky with sweat and anticipation, black hair gleaming like the most beautiful fire. In front of the house next door, a man walks in endless circles, like a restless dog on a chain.  Noah can’t see him and I am glad.  Instead he blinks and I watch his irises contract against an aggressive sun; in my mind I picture this sun hunting my child, lifting up chairs, searching in all shades of darkness.

I pull him against me and he is warm, and all is well again until I hear my name. He speaks hesitantly, absently rubbing his feet on his sister’s hair. She is seated on the floor, colouring a picture, and I wait for him to finish.

“What will the world be like in a hundred years?”

Sasha looks to me, waiting for my answer, turning over her picture so that I won’t see it, but I do anyway. It’s a unicorn.  Be careful, Damien, I think to myself, and I try to be but inside my heart the world speeds by in fast forward, and it is nothing that I can speak aloud to my children.  Noah pulls me back again with a giggle. “It’s okay, Bob,” he says, idly stroking my arm. “In a hundred years everyone we know will be dead.” Sasha laughs too, and I hold my breath in waiting.

She glides on her knees on the worn wooden floors, to where we are sitting, and smiles up at me, but I can see her eyes, coal black, turn to liquid. Those eyes that I have studied like the most precious jewel; eyes that, when she was born, I held up to the window,  to see the colours held within, shaken but not surprised by the iridescence of all that is hidden inside black – like a raven’s wing in the sunlight.  I speak to her with my mind as my heart climbs into my throat. Come.

Noah moves and she crawls into my lap, wrapping her tiny brown arms around me and squeezing as hard as she can.  Her sobs fill my ears and I talk to her softly about how there is never an ending – that she will never end.  Noah reminds me – Bob, not everyone believes that- but I keep rocking and whispering because I cannot bring myself, in this moment, to take away what she is desperately clinging to; this hope that at the end of all of this – there is something else.  I cannot tell her about my own sleepless nights and bargains with God – that will come later, when her heart is mended and standing all on its own.

Later, after everyone is sleeping and I am washing my face before bed, I stare at my reflection in the mirror. My own eyes are shining, despite knowing loss and fear for so many years. Theirs will too, I think, and I am relieved – there is no ending.

“Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere [do no harm]” (Kloosterman, 1982)

Toward a More Humane Paradigm of Birth

Over the last fifty years, neonatal mortality rates in Western countries have drastically decreased, largely due to changes in technology that have allowed for more accurate fetal assessment, and earlier, more proactive obstetrical intervention (Harper, 1994). Dr. David Chamberlain describes a typical hospital birth in the developed world:

In hospitals, natural birth seldom survives the cascade of well-intentioned interference. Deliberate rupture of membranes will eliminate the hydraulic covering which protects the (infant) head; birth in the lithotomy position will nullify the effect of gravity and make progress difficult…complications may be assessed with electrodes implanted in the scalp, and blood samples taken by making a scalp wound. If chemicals have upset the normal processes of labour, the baby may have to be turned forcefully and removed by forceps (Chamberlain, 1989, p. 8).

While opportunity for physical survival may be less fragile for the human neonate, more progressive research suggests that the medicalization of childbirth undermines human life in other, more profound ways. Prominent obstetrician and natural childbirth advocate Michel Odent states, “Humanity is at a turning point, when all our deep rooted perinatal beliefs and rituals are losing their evolutionary advantages” (Odent, 1999, p. 24). While medical-model childbirth proponents approach birth as a process that must be “managed”, by excessive monitoring, pharmaceuticals, and violent interventions, there is evidence that sheds light on the need for a gentler paradigm of birth. This gentler paradigm is necessary to accommodate an expanding body of research that supports our growing understanding of neonatal consciousness and response to pain.

The Medicalization of Childbirth

Prior to colonial times, birth was viewed as a social event, and babies were born into the hands of their mothers or other women, gently and without fear (Feldhusen, 2000). In the mid-18th century, before midwifery was driven underground by male obstetricians who were operating with a primitive understanding of the infant brain, minimal damage was done to neonates in the process of childbirth, which was, for the most part, non-invasive (Feldhusen, 2000). After this point, though women actively surrendered their bodies, the event remained a spiritual rite of passage until the association between midwifery and witchcraft forced many women into complete resignation to the medical model (Feldhusen, 2000). Currently, though some work has been done to reclaim childbirth as a rite of passage, obstetrical interventions are rapidly increasing (Buckley, 2005). In most urban centers in Canada, more than one third of infants are born by cesarean section, most labours involve some synthetic hormonal intervention, and the vast majority of neonates are born under the influence of narcotics (Buckley, 2005). In this culture of technocratic birth, a question lingers that must be asked: How much does the manner in which we are born affect who we ultimately become? It is obvious, states Dr. Sarah Buckley (2005) that “such deviations from the natural order, whose lore is genetically encoded in our bodies, must have enormous repercussions” (p.32).

Why, in the 21st century, has this model of technocratic birth become normalized, when research indicates that most medical interventions in childbirth are not only unnecessary, but destructive? There are many answers to this question, not the least of which is monetary greed. Czechoslovakian psychiatrist, Stanislov Grof, has studied the phenomenon of this self-perpetuating cycle of greed and violence for over fifty years. According to Dr. Grof: “It is not hard to imagine that the perinatal level of our unconscious which ‘knows’ so intimately the history of human violence is actually partially responsible for… (human) atrocities. If this is true, it should be possible to reduce the amount of malignant aggression by a change in birth practices (Grof, 1995, p. 16). Why, then, has this cycle been allowed to continue? A partial answer to this question can be found in current obstetrical understanding of neonatal psychology, and the fact that we may be operating from an outdated perception of the consciousness level of the human neonate (Randolph, 2011).

The Conscious Neonate

Though the study of neonatal consciousness dates back to the emergence of modern psychology, it was not until 1929, when Otto Rank published his work entitled Das Trauma der Geburt (The Trauma of Birth), that most research on this subject began (Sheets-Johnstone, 2008). Rank, a student of Freud’s, who disagreed with Freud’s analysis of the origins of trauma, began to study the experience of the neonate (Sheets-Johnstone, 2008), especially as these experiences relate to neurosis. Rank believed that “birth was the individual’s original encounter with anxiety and that it would inevitably plague him throughout his life”(Randolph, 2011, p.1). Rank also traced many physical ailments back to an individual’s experience of birth trauma, contending that “all neurotic disturbances in breathing (asthma), which repeat the feeling of suffocation, relate directly to the physical reproductions of the birth trauma… the migraine goes back to the specifically painful part allotted to the head in parturition…(Rank, 1952, p. 23). Following Rank’s contribution to our current understanding of the experience of the neonatal experience of childbirth, other researchers have since corroborated his findings (Buckley, 2005).

But just how conscious is the neonate? There is mounting evidence to suggest that the perception of neonates as “primitive” beings with immature, underdeveloped brain structures without the capability of complex activity, is incorrect at best (Prechtl, 1984). According to Dr. David Chamberlain (1989), neonates, and even prenates are conscious and able to respond to pain:

… American physician, George Ryder, heard the sound of a baby crying after he had applied traction with forceps. Listening via stethoscope his assistant and nurses said the sounds were “high and squealing, much like the mew of a kitten.” This moving event led to a world literature search… in many languages, reported by 114 different authors. Analysis of these records showed that crying (in utero) was almost always associated with obstetrical procedures. About 20% of the crying prenates died – indicating the urgent nature of the cries (p.4).

Further research found this report to be irrefutable. Babies were witnessed crying in utero when experiencing “a hand entering the uterus to bring down a leg, application of forceps, injections of analgesia, inserting a catheter, or rupturing the amniotic sac” (Chamberlain, 1989, p. 4). Dr. Chamberlain describes an account of a group of doctors, midwives, and a mother, who heard a baby “cry five different times over a twelve hour period before labour began, describing it as a startling and awesome event” (p. 4). Though some scientists have judged pain to be healthy for the neonate because it “activates endorphins and prepares the baby for real life” (Chamberlain, 1989, p. 2), research points to the fact that they could not be more wrong. Dr. Sarah Buckley (2005) questions the impact of modern birth practices on more than just neurosis:

We live in a society where depression and anxiety are among the largest burdens of disease worldwide, according to the World Health Organization, and children as young as four are being diagnosed with these conditions; and where young people, at the prime of their lives, are choosing in large numbers to opt out of reality, with mind-altering drugs, or to opt out permanently through suicide (Buckley, 2005, p. 32).

The Impact of Childbirth Interventions on Psychological Functioning

A handful of researchers in Sweden questioned these social issues, and, interested in the correlation between addiction, suicide and birth interventions, studied the birth records of opiate addicts born in a twenty year span, comparing them with the records of their non-addicted siblings (Jacobson, 1990). Individuals whose mothers has been administered pain medications in labour, such as nitrous oxide, opiates, or barbiturates, were predisposed to amphetamine and opiate addiction later in life, especially if the administration of these drugs was ongoing throughout a woman’s labour (Jacobson, 1990). Grof (1995) sums up another research study by Jacobson (1987) which examined the link between suicide and birth interventions. This study found that there was an alarming correlation between the type of intervention, and chosen suicide method. Grof points out: “Suicides involving asphyxiation were associated with suffocation at birth, violent suicides with mechanical birth trauma, and drug addiction leading to suicide with opiate and/or barbiturate administration during labour” (Jacobson, 1987, Grof, 1995, p.16). These studies have since been repeated in America with strikingly similar results (Buckley, 2005).

This research points to a process called ‘imprinting’, which is described as “an unconscious need to repeat a traumatic experience at birth as an adult” (Jacobson, B., 1987, p.370). Randolph (2011) describes the infant perception of pain in terms of “concept of time” (p.5), stating that every experience, to the neonate, feels like “forever” (p.5). This complicates the therapeutic process for individuals attempting to heal issues related to birth trauma, due to the fact that “when they are reliving birth feelings, the pain feels as if it is unending” (Randolph, 2011, p.5). The same author relates her own experience as a professional in the field of primal therapy, the process of reliving one’s birth in a controlled, therapeutic setting:

This perception of unending pain may cause a patient to become hopeless and suicidal. We… have found that all suicidal feelings arise from the individual’s first confrontation with severe pain and near death from morbid conditions in the womb. It’s not just the pain that plunges one into suicidal gestures, but these infantile feelings that go with it; the sense of timelessness, that the pain will never end (Randolph, 2011, p.5).

Randolph (2011) continues by stating that neonates have a built-in reflexive response that can filter “some of the sensory process” (p.5). She states: “As the infant’s total consciousness is reduced, he loses some of his ability to fight for survival, and, to varying degrees, relinquishes his participation in the birth process” (Randolph, 2011, p.5). The result of necessitation of this specific defense mechanism can be devastating. Randolph (2011) concludes by stating that “Some infants may have blunted consciousness so extensively, owing to the unrelenting pain, that they are delivered half dead” (p. 5).

Conclusion

Though the medical community is currently operating on the principle that most self-destructive behavior has its roots in early childhood and infant frustration (Grof, 1995), “modern consciousness research has revealed additional significant roots of violence in deep recesses of the psyche that lie beyond postnatal biography and are related to the trauma of biological birth” (Grof, 1995, p. 7).

What can be done to reduce the amount of suffering attributed to neonatal birth trauma? Recognition that neonatal pain is inevitable in childbirth due to the physiology of the birth process itself is not enough to justify the normalization of obstetrical interventions that have been proven detrimental to the human psyche (Chamberlain, 1989). We must change our perception of beings smaller and seemingly “less intellectually sophisticated” than ourselves to include the possibility of inflicted harm. Medical professionals can no longer plead ignorance, and continue to ignore a body of research that indicates that the experiences of the infant, neonate, and even the prenate, are an important aspect of how we live, and who we ultimately become. In the words of Dr. David Chamberlain (1989), a “cultural lag” exists between “what we know and what we do” (p. 9). We must confront this cultural lag, and insist on gentler, less invasive management of labour and birth. We must consider not only the experience of the mother, midwife, or doctor, but also the tiny human being who is not only sentient, but wise, and conscious. Let his first experience with touch be gentle, his eyes given opportunity to adjust to a world with light, and his future be spared painful body-memory of an event under which he had no control. Let us follow the research toward a more humane paradigm of birth.

References

Buckley, D. (2005). Gentle Birth, Gentle Mothering. Brisbane: One Moon Press.

Chamberlain, D. (1989, Summer). Babies Remember Pain. Pre- And Post-Natal Psychology, pp. 297-210.

Feldhusen, A. (2000). The history of childbirth and midwifery in America. Midwifery Today.

Grof, S. (1995). Consciousness evolution and planetary survival: Psychological roots of human violence and greed. Spirituality, Ecology, and Native Wisdom (pp. 1-23). Killarney, Ireland: Thirteenth International Transpersonal Conference.

Harper, B. (1994). Gentle Birth Choices. Rochester: Healing Arts Press.

Jacobson, B. E. (1987, March 15). Perinatal origin of adult self-destructive behaviour. Acta Psychiatr. Scand., pp. 364-371.

Jacobson, B. N. (1990). Opiate addiction in adult offspring through possible imprinting after obstetric treatment. BMJ, 1067-1070.

Kitzinger, S. (2000). Rediscovering Birth. New York: Little, Brown & Company.

Kloosterman, G. (1982). The universal aspects of childbirth: Human birth as a socio-psychosomatic paradigm. Journal of Psychosomatic Obstetrics and Gynaecology, 35-41.

Kresser, C. (2011). Natural childbirth III: Why undisturb birth? Fertility, Pregnancy & Childbirth, 1-15.

Nyberg, K. A. (1992). Socio-economic versus obstetric risk factors for drug addiction in offspring. British Journal of Addiction, 1669-1676.

Odent, M. (1999). The Scientification of Love. London: Free Association Books.

Prechtl, H. (1984). Continuity of neural functions from prenatal to postnatal life. Oxford: Blackwell Scientific Publications.

Randolph, B. (2011). Birth and its effect on human behaviour. The Denver Primal Journal, 1-8.

Rank, O. (1952). The Trauma of Birth. New York: Robert Brunner.

Sheets-Johnstone, M. (2008). The Roots of Morality. University Park: Pennsylvania State University Press.

my real mother

tonight i walked straight into the arms of my mother.

she held me tight against her

"i heard you crying," she said, and i nodded, my face pressed into her neck

"i waited for you to come to me."

on the way there

the harvest moon waited and i watched out the car window

listened to stories of grief

humbled by these women who have seen many more days and nights

especially nights

i saw the ghost of "jenny", heard a mother's sorrow

thought about my own

i bit my nails, knowing what was coming

i made my way through a labyrinth to find her

i made my way through a garden to find her

i made my way through my mind to find her

tonight i walked straight into the arms of my mother.

she held me tight against her

"i heard you crying," she said, and i nodded, my face pressed into her neck

"i waited for you to come to me."

voices from the carnival

In the beginning

**

A man on stilts walks by, laughing maniacally.  An obviously drunken clown follows,  playing some sort of musical instrument.

"That about sums it up," my friend says, and I nod.

**

In the end

**

A woman walks by, dressed in crappy stuffed animals and almost nothing else, face askew.  Her navel glints like a diamond in the middle of the Void

I am falling

Leather Face:

(His eyes are changing, he has forgotten what he was taught to say so many years ago)

In this climate of absolute despair

Despair is absolute

Hold onto this

She: Walks on by

They: Walk on by

Everyone walks on by

Me and Leatherface look at each other and smile

THIS IS IT

Two kids are pushing an old lady in a wheelchair.  Their black hair shines in the sun and they stop and watch the game.

"Wanna play?" I ask, and they shake their heads in unison.

"Got no money."

And I want to pull it all down

pull it all down

walk away

the sun