September 11, 2020

The hidden part of the birth trauma journey – the psychological impact

Our client, Sharna, had a very traumatic birth experience with her second daughter, who suffered Erb’s Palsy as a result of shoulder dystocia during the birth. Sharna was anxious about her child being a big baby throughout her pregnancy so when, during labour, her child got stuck there was lots of panic in the room:

“When my baby was finally born she was taken away, she was not even put onto my belly for a few seconds like my other daughter was. The thought of this is very upsetting and brings me to tears even now. She was taken to the corner of the room and I did not even get to see her. My partner went with her to the corner of the room and stayed with her whilst she was being resuscitated. She had a little oxygen mask put over her face. I did not even know what my baby looked like at this point. I can remember seeing the midwives try to rub her body to make her respond however she was non-responsive. I was incredibly upset but the midwives reassured me that would be okay and was just in shock. It was a good 10 minutes before I was able to see and hold my child.

After my baby was born, during the time she was being resuscitated, the Dr told me that she had been stuck inside of me and that her left shoulder had to be dislodged. During my baby’s birth they did not say how or why my baby got stuck. When the Dr told me this she said it in a matter of fact way and did not express how serious it was.”

Discovering a birth injury

Sharna did not know her child had Erb’s Palsy, or even what Erb’s Palsy was, when they left hospital. She was told she simply had a dead arm and that it would recover. The first she heard of Erb’s Palsy was when a community physiotherapist gave her a leaflet on the condition:

“As soon as I saw the leaflet it felt like a huge smack in the face. I just cannot understand why things were not explained to me at the hospital, especially after my child had a full body examination, which obviously showed some issues with her arm. There was a diagram of a baby being stuck inside of the leaflet. When I looked at it I just broke down in tears.

What had happened to my child during labour and delivery and the extent of everything suddenly became clear to me. I was shocked and very upset when I learned more about the condition.”

After she found out about Erb’s palsy, Sharna made a complaint to the hospital about what had happened. However it did not result in the open and honest conversation about her experience that she had perhaps expected:

“We attended a debrief meeting at the hospital. In my opinion this meeting was a complete waste of time. It was very closed and we did not really get the answers to the questions that we posed.

I felt as though they were just going through the motions and giving nothing away. I do not feel that the hospital appreciated the impact that all of this has had on our lives.”

The psychological impact of the birth

Following the birth, Sharna suffered anxiety and low mood. She was scared of seeking help due to a fear that she would be labelled an unfit mother, but eventually saw her GP:

“After my child was born and discovering that she had Erb’s palsy I constantly started rethinking her birth. I did not feel my usual self; I put off talking about it to others or seeing my doctor because I thought maybe the feeling would pass. However I just felt worse the more I learnt about Erb’s Palsy. I felt upset, drained, and angry. All of the changes that happened to my life since my child’s birth were a lot to adjust to and a lot to take in.

At this time I had thoughts that life was not worth living, but I did not do anything to harm myself. Eventually I went to my doctor, I can’t remember when exactly but I broke down about everything that had happened since my child’s birth. My doctor said I had depression and that it sounded like it stemmed from the traumatic birth and the discovery of my child’s Erb's Palsy. I felt embarrassed and weak to pour myself out like that. I felt that maybe admitting I had a problem made me look like a bad and unfit mum”

Later on Sharna became pregnant with her third child, one she had been planning for and wanted. She was therefore happy when she found out, but this soon turned into fear about the delivery because of her past experiences. To make things worse, for logistical reasons, Sharna didn’t have a choice but to go back to the same hospital where she had given birth to her daughter.

To help with her anxiety, Sharna attended appointments with the Perinatal Mental Health team. Sharna also thought it was important to her to make sure that the clinicians involved in her other child’s birth were not involved in this next one. She therefore went to great lengths to explain her history and her concerns to every clinician that she saw, to ensure that the same thing did not happen again. She describes how repeatedly reliving everything was emotionally exhausting and had a real impact on her mental health.

Fortunately, her third child’s birth was relatively straightforward, however Sharna’s mood continued to deteriorate afterwards. She felt anxious, her appetite was disturbed and her sleep was poor. She did not want to leave the house as she would panic that something bad might happen. She felt exhausted by these thoughts even though she knew them to be irrational.

It was at this point that Sharna discussed medication, but she was worried about the effects on her breast milk; she wanted to be the best mum that she could be.

Sharna saw a Psychiatrist who said that she appeared to be suffering from post-natal depression with an underlying anxiety and a significant element of PTSD, secondary to her traumatic birth experiences with her child. The plan was therefore for her to start anti-depressant medication, which would be gradually increased over the coming months, during which she had continued input from the Perinatal Psychology and Psychiatry team.

Since her second child’s birth Sharna has had recurring nightmares, including one where that she is pregnant and in hospital about to give birth. In her dream she is very frightened and anxious about what is going to happen. She always wakes up before the point that her baby is born. This continued throughout her pregnancy with her son.

Sharna states that life has changed since her second child was born. She is lot more irritable than she was before her child was born, her concentration has reduced and she struggles to maintain focus. She finds it hard to complete a task and flits from one job to another. It is not very often that she actually finishes something.

Perhaps worst of all, she used to go out more and laugh more but now finds it harder to be happy. Instead, she often wants to be alone and be quiet, very rarely seeing friends and feeling nervous if visitors come to the house. She tries to push herself to build her confidence and fight her anxiety, and feels very trapped at home. However, as a result of her experience she is also very anxious to go out, as she worries about being there to ensure the safety of her children.

Psychological birth trauma has a significant impact on mothers’, and fathers’, lives. However, it is just one of many ways in which people can be impacted by a difficult birth.

We hope that this helps to shed light on this area of trauma, as we recognise Birth Trauma Awareness Week this week, and that it demonstrates how the journey through birth trauma can go on for many years after the event.

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