Helping moms process traumatic birth experiences

[candiland]

Hey, everyone. On Saturday, I helped a client give birth at our local hospital. I did two prenatals in advance, discussing pro's and con's of interventions, why epidurals should be used cautiously (if at all), etc. etc. Her whole stance was, "Yes, I agree natural is best, but I may end up wanting the epidural..." so she wasn't very convinced of a drug-free birth.
Well, she screamed for the epi at five cm. After she got it, she laid on her side 'til it was time to push. They turned the epi off, and babe was posterior. I had her on all fours, knee-chest, squatting, you name it. After two hours, she was calling it quits. The doctor said he could "help her out". The baby's head was on the perenium; the doc got the anesthiologist and they tried getting her numb again, at which point babe passed thick thick meconium. They gave her a big episiotomy - which she felt, 100% - and yanked and pulled that baby so hard with forceps I felt like vomiting. Babe came out, pink and yelling. Totally fine. However, mom was so shocky and traumatized she did not even want to hold her baby or talk to her. I helped the babe nuzzle at her chest after they stitched mom up, and she took a couple quick suckles. Then the nurse took the babe and said, "You really need to rest... blah blah blah..." and took the little girl to the nursery.
Well, mom called today. She's home from the hospital, nursing is going well, and I'm visiting her on Friday for a postpartum visit. How can I help her process this freightening, traumatic experience? What sorts of questions do you ask, and how much do you tell them? That if it wasn't for the epi, the baby probably could have turned, avoiding all the trauma in the first place? What sort of things should I say, how should I comfort her and enhance the bonding between her and her new baby?:

[Chi-Chi Mama]

if I were that woman, I wouldn't want to hear the "could have been"s so soon after the birth. YKWIM?

it's important for her to understand how things could have been different.. but maybe it's too soon now?

maybe just make sure she is ok, tell her she did a good job, and concentrate on the baby? and wait for her to ask you questions?

i don't know; it's a tough situation.. i'm just thinking of how I would feel in that situation.

oh those damn drs!!!

and hey, at least it sounds like she's bonding iwth the baby!

[mamallama]

I agree with Chi-Chi Mama. Nobody likes to hear the "could have been"s, especially so soon.

I would start by saying "Even though I was there, I'd like to hear what your birth was like from your point of view."

I know I would be traumatized by the episiotomy and forceps delivery, but that's just me. Your client is coming from a different perspective, and maybe she doesn't view her child's delivery as frightening or traumatic at all. Maybe she views the time spent waiting for her epidural as the most traumatic and frightening part. To me, the most difficult part of doula work is truly understanding the more medically oriented clients.

The link between the epidural and the forceps is painfully clear to all of us on this forum, but it might not be so clear to your client. I would tread very carefully here. I think it would be too easy to come across as blaming or shaming--something no new mama needs. I'm sure your client will put the picture together on her own, and when she does she'll probably want to talk about it with someone who was there. Keep the communication channels open.

Good luck. It sounds like a tough situation. I'm interested in hearing what other doulas have to say.

[EarthWind]

Hi,

I just want to second what the other posters have said. I had a homebirth turned hospital birth - 62 hour labor, pit, epidural, almost c-section. My son's birth was a far from what I thought his birth was going to be as it could possibly be - short of c-section! I was in mommy bliss for 10 months postpartum. It was only as his 1st birthday neared that I began to question what happened to my ideal birth. Then I felt all kinds of things - anger, grief, inadequacy, guilt - but it took a while for me to get there - and then I had the long healing ahead.

I think that it is very important to follow the woman's lead on this one. If she has questions, if she needs to walk further down the healing path, listen to her, answer her questions, refer her to people who can help her heal. But if she is completely happy, let her have that. She may experience a sense of loss in the future - but wait until the future is the present to deal with that.

I would also add that you may want to keep in contact with this woman - check in with her at 6 months postpartum and a year postpartum, or more if you feel it may be valuable.. Be available to her and be open to any anger, regret and grief she may feel WHEN IT COMES UP.

Basically, be receptive to her and her needs - and don't confuse them for your own. Erring on the side of forcing her to look at her birth when she is not ready could really backfire for you. On the other hand, avoiding any questions or anger she may experience could also backfire. Walk that fine line.

Also, you may want to think about finding a way for you to process your own feelings about her birth. You may be more affected by it right now than she is - so take care of yourself and allow yourself to grieve the birth you hoped for for her.

That's just my .02 worth!

Peace,

Michelle

[candiland]

That if it wasn't for the epi, the baby probably could have turned, avoiding all the trauma in the first place?

The reason I mentioned this, is because she knows I homebirth my babes. She asked me what they would have done at a homebirth, which is why I brought this up. That's what I mean by "How much do I tell her".... I don't feel it is right for me to lie and say, oh, geez, I probably would have been rushed off for a forceps delivery, too! KWIM?
And she is a bit traumatized, from what I have gathered. I know that I did the best that I could, and like I said in my previous post, she was quite shocky and traumatized following the baby's birth. So much so that she didn't even want to speak or look at her baby.
So I guess I'll just have to use my judgement in asking her questions and answering them. I was just wondering if you guys had specific things you asked a woman to get the ball rolling, so to speak. I mean, on the phone, she wasn't really processing it yet. I definitely agree that it's nothing to be forced; she'll open up when she's ready.
Thanks, everyone, for your helpful replies! It's awesome to have such a great support forum here on MDC!

[mamallama]

How did the pp visit go?