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Photo: Jacky Lam / Getty Images
Photo: Jacky Lam / Getty Images

ParentsOctober 27, 2016

Birth trauma is real – and we need to start talking about it

Photo: Jacky Lam / Getty Images
Photo: Jacky Lam / Getty Images

Giving birth can be a traumatic experience for some women and when that happens recovery can take a long time. Dana Chandler-Brown writes about her personal experience of birth trauma, and why we should be doing more to support mothers going through it.

This post talks about birth trauma, a very real issue in New Zealand. I hope that this post will give voice to women who have suffered from this or are currently working through their journey and will raise awareness of the topic. Please be aware that this article may be triggering for mothers who have survived traumatic births.

When I decided I wanted to write this post I did not want it to just be my story. I wanted it to be the collective voices of other mothers who had lived through birth trauma – Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. If a mama reading this is going through something similar, please know this:

You are not alone.

Your experience is valid.

You are so entitled to feel what you’re feeling.

Before I had my son, I had never been frightened of birth. In fact, I was in awe of it. Being a student midwife, I had been lucky enough to watch the power of mothers in their birth zone: deep within themselves, swaying rhythmically with their contractions. I’d had the privilege of watching elective caesareans. I’d seen the joy on the faces of parents as their baby was lifted above a surgical curtain and they met for the very first time.

I lived and breathed birth and I could not wait to experience it for myself. I held my birth plan lightly; I knew from my studies that birth rarely goes as planned and I was happy to ride the waves of the journey. I was ready for change and adaptation.

I was not ready for the loss of power and autonomy, or the physical disconnection from my baby.

Photo: Jacky Lam / Getty Images
Photo: Jacky Lam / Getty Images

I chose a midwife who I had met while on midwifery placement. I saw her in practice – fierce and passionate about protecting her women – and I knew she was the person I wanted to deliver my baby. I often wonder how different my birth story would have been if it had only been her.

I want to be clear, that this is not another article attacking midwives. I still admire and hold deep respect for our midwifery system in New Zealand. As an autonomous feminist profession founded in partnership with women, I feel that midwives, like the women they care for, still suffer under a misogynistic system.

It seems there is a deeply ingrained fear of women’s knowledge, whether it be the knowledge of a birthing woman, or a midwife who has completed a gruelling four-year degree and gone on to provide world-class, women-centered midwifery care.

Due to complications, I ended up with a registrar obstetrician in the room whose fear was palpable. Her distrust of my body and disregard for my rights and consent left me damaged and confused. She performed a vaginal examination without consent and told me to wait when I asked her to stop.

I lost autonomy, undergoing further invasive procedures done against my will. I was angry for a long time: at the obstetrician for her actions, at myself for allowing it to happen, and at my husband for not stopping it.

My son was born prematurely and was taken to the Special Care Baby Unit, known as SCBU. I would walk across to SCBU every three hours to have skin-to-skin contact with him and to attempt a breast feed. I would give a top-up and then go back to my room to pump. My body would ache with after pains and I wasn’t even allowed to hold my son for comfort.

My birth trauma stole away the empowering birth I had longed for. As I struggled to come to terms with what had happened to me, I felt isolated and lost.

I had my healthy, beautiful baby yet I carried so much anger. I would stand in the shower for months after, going over and over the events in my head.

I felt violated and stripped of my rights. I felt alone and isolated. I felt guilty for the way I felt.

It wasn’t until months down the track, when I began researching why I might feel this way, that I stumbled across the term ‘birth trauma’. Birth trauma is a very real issue. It is not spoken about enough, let alone given the validation that it needs and deserves.

Along with a dawning realisation that my experiences were real and identifiable as birth trauma, I found an online community where my feelings of disempowerment and lack of consent were echoed. When I asked mothers on a private birth trauma Facebook group to share with me their experiences, I got dozens of private messages:

It’s the loss of control that’s hard aye, all those things that are done to us even when we, or our advocates, are saying no.

It’s like we suddenly cease to become human beings while we are giving birth.

I was in a lot of pain, had to be given lots of morphine. I kept asking if my baby was ok, and no one could tell me anything…

…next minute a male specialist comes into the room… then he asks me to open my legs, which I duly did. The midwife said “oh he’s the obstetrician, he does this part” when I looked a bit confused. I was thinking “gee thanks for letting me know beforehand that a man was doing this part…

Caring for your baby ‘under the microscope’ of staff and the suffocating NICU ‘rules’ and being aware you’re not making the decisions for your baby as you normally would – when to feed, when to bath etc really undermines your parenting confidence.

The trauma was not being able to trust the one person you’re meant to.

New mums are quite literally told that we should “leave our dignity at the hospital door.” We are taught as mothers that at the end of the day all that matters is the result: a healthy baby. But what about the mental health of us as mothers?

There seems to be a major disregard for the mental safety of new mothers. Perinatal suicide is one of the leading causes of death for pregnant women, yet despite numerous experts and professionals urging the Ministry of Health to launch a government review of the mental health services in New Zealand it’s just not happening. That leaves us with mothers who are struggling to access free, supportive counselling with medical professionals who understand birth trauma and its effects.

Women have spoken to me about how their GPs have brushed off their request for counselling referrals because they weren’t “depressed enough”. One mother recounted how her counsellor “had never heard of birth trauma”.

There needs to be a shift in our health system, but we also have a responsibility as a community to surround each other with love and support.

Some wonderful women have already stepped into this void, like Carla and Jenni Sargent, two New Zealand sisters with backgrounds in midwifery and new mother support groups who founded Voice for Parents in 2015. Carla and Jenni’s experiences had shown the need for an organisation focused on the emotional needs of parents who were struggling to come to terms with a traumatic birth experience.

Last year Voice for Parents published a survey which shared the stories of parents who had been traumatised by birth. The survey outlined what those mothers believed would have been most helpful to them in aiding their recovery: the informal support of talking and writing about their experiences. Voice for Parents went on to provide a range of services, including a safe online forum for women to share their stories. This online community was so healing for me; it was there that I was able to share my experience and be validated by a community that lifted other women up.

Dana Chandler-Brown with her children.
Dana Chandler-Brown with her children.

I went on to have another birth that was cathartic and healing. Although it wasn’t the home birth I had hoped for, I felt in control the entire time. It does not seem right to me that I considered myself so incredibly lucky to receive a basic human right.

To help women move past their trauma we need to provide them with a safe community willing to listen without judgement. We need to get back to our village mentality. Our mothers need to be treated as people first and foremost, whose thoughts and feelings matter.

To mothers who have survived traumatic births I would like to say this: Please know that it often will get better. The start is hard, so hard. But there is light at the end of the tunnel. Accept every single piece of physical help people give you.

It’s so important to remember that it’s not your fault. You did your best. And if you find yourself not coping, or unable to come to terms with your traumatic birth, for the love of God don’t hide it. You’re not alone.

Dana Chandler-Brown is a veterinary nurse, writer, and adoring, often exhausted mother to two. She uses writing to help her make sense of the world she’s raising them in.


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Photo: Image Source / Getty
Photo: Image Source / Getty

ParentsOctober 26, 2016

Amber beads are bullshit, and other parenting quackery debunked

Photo: Image Source / Getty
Photo: Image Source / Getty

‘Have you tried…?’ It’s the call of unsolicited advice-givers everywhere. Dr Jess Berentson-Shaw tackles the science (or the lack thereof) behind the latest fad treatments for babies – including those damn amber beads.

The Krakatoa eruption had nothing on this. I watched in horror as a voluminous fountain of precious breast milk blasted high into the air straight above our heads like a pyroclastic blast and then crashed back down over us in a tsunami of liquid gold. I looked down and a huge grin was visible on the chubby face that was otherwise masked in regurgitated milk.

This was my first daughter. A spewer of the most extraordinary talent. She would feed and feed and feed, then cry and cry and cry and cry and cry and cry, then vomit.

I remember my brother-in-law, watching amazed at one of these spectacles, rushing off to the kitchen where I caught the end of what he said to my sister: “….and it was like, like, like a lahar of vomit!”

It was overwhelming and she cried a lot. The midwife and GP did not have a lot to offer in the way of concrete advice except to say it was probably colic or maybe an immature valve in her tummy (this is code for your baby screams heaps and sometimes vomits and isn’t that a bit shit?). We spent a fortune at the pharmacy and health shops on various potions. Nothing really worked and she seemed to grow out of it.

Every parent has one or more of these stories – some childhood ailment that causes a lot of crying (that drives you to the point of insanity and maybe drink) and has no clear fix. So you spend a ton of money on a myriad of treatments, most of which don’t work. There is so much exploitation of the desperation of parents.

Often it would simply be better for everyone if the honest approach were taken for persistent but relatively minor concerns like teething pain. This, would go something like: “Yes this really sucks for you and them, and feels like it will never end, but babies do weird shit and (sometimes literally) have weird shit. Just be confident that you are doing everything you can and it will pass. There is, so far, no good science for anything else. I am sorry. Can I perhaps fold that huge pile of washing for you that looks like it may smother the baby if it falls?”

The ideal would be an empathetic pep talk telling you not to waste your cash. After all, you need it for when they are still at home at 27 because you are “such an awesome parent’ and they cannot bear to leave you.

Having said all that, science really needs to up its game on some of this stuff that affects parents, especially the most common and distressing aspects (like nausea in pregnancy).

So let’s talk about the quackery and where it lurks, and also what might actually work for some of those minor (but nonetheless insanity-inducing) ailments.

Amber beads for teething

So OK, I have to admit I had no idea what on earth it is that amber beads were supposed to do for a teething child, but since I know a bit about this researching lark, I went ahead and did a bit. Turns out they are supposed to relieve teething pain. Not by chewing on them, but apparently by releasing analgesic oil into the skin when worn as a necklace. The active agent is something called succinic acid and this is only found in true Baltic amber. However, a study of Baltic amber teething necklaces in Australia found that while there were trace amounts of the acid, the only way it was released was when the beads were smashed, and even then it did not have sufficient anti-inflammatory properties to make a difference to teething pain.

There is not a single published randomised control trial to test the claim that amber beads work (always a red flag for bullshit, as usually there will be at least one study on any intervention making such claims). Even if Baltic amber beads worked (and let’s be clear, they don’t) many of the beads commonly sold are not even Baltic amber. The worst part about amber beads is they pose a risk of either strangulation or choking on the beads if the necklace breaks. While this risk may be small, the impact is pretty severe. So really, amber beads: total bullshit.

Evidence it works: 0/10
Risks: Death (rare, but you know …)
Cost: around $32

Here is some reliable, evidence-based information on what might help with teething pain.

Photo: ICHIRO / Getty Images
Photo: ICHIRO / Getty Images

Oestopathy or chiropractic techniques for colic specifically

Argh the crying! It is so distressing! Anything, anything to stop it! Gentle manipulative techniques used by osteopaths and chiropractors have been tried by many parents to help with colic. This is one of those areas where current low quality studies suggest it is not really effective, but we need higher quality studies to be clear. In some studies it did reduce crying but that was only if the parents knew the child had had the treatment. Whereas if a parent did not know (we call it being blind to the treatment) there was no reduction in crying. While no risks were found, many studies did not actual measure the risks. Hmmm… not an overwhelming body of evidence to suggest it should be tried.

Evidence it works: 2/10
Risks: Unclear (but not likely to be severe or we would have heard). Note that this is only for gentle manipulation; run like the wind if someone wants to crack anything on your baby.
Cost: around $80-$125 per session

Herbs for colic (chamomile, fennel, lemon balm)

The idea here is that the baby screams because they are in pain due to tummy cramps (as opposed to just trying to break your spirit), and these herbs will relieve the pains/gas/etc. Some herbs are given directly to the baby (herb oils or water-based solution) and some are teas that breastfeeding women drink. There is a little bit of evidence that these may work to reduce the amount of crying, but the evidence is a little dodgy (what we call low quality trials with a risk of bias). It should be noted that herbs are not like homeopathy (which is basically water). They can have powerful biological effects, so adverse effects need to be considered. In the studies of these herbs only minor side effects like vomiting, sleepiness and constipation were reported. So overall it may be something that is worth trying.

Evidence it works: 3/10
Risks: Some side effects but not severe
Cost: Gripe tea $18

Laxatives for constipated babies

You know, I sometimes think if babies and kids are not pooing all over you and your home (“How the fuck did it get there?” you ask yourself, while staring in horror at some random part of the house), they are not pooing at all. Either way their poo stresses you out. It is a gift they bring at birth.

When they stop going for 5, 10 – I heard 20 days once – the terror sets in. If you have a child in nappies you stop leaving the house at all: the fear is too great, and you hunker down waiting and hoping for the inevitable. While you do, you start to spoon in the various quack remedies that appear to be ‘natural’. They are all laxatives though.

Laxatives come in two types: osmotic and stimulant. Osmotic include lactulose, milk of magnesia and polyethylene glycol or PEG (it is sold as Movicol here in NZ) – these work by drawing water into the poo. Stimulants make the intestinal muscles contract, and include caster oil, aloe, senna, fibre and other such things.

A systematic review of all the good quality published studies concluded that Movicol (PEG) at a higher dose (0.7 g/kg) may work best and the side effects were minor compared to other treatments like castor oil and aloe. As a side note I have to say reading studies that use “rate of defecation” as a measure is not my favorite part of being a researcher.

Evidence it works: 6/10
Risks: Some side effects but none are severe
Cost: Can get it on prescription so $5, or free for children under six.

Photo: Santiago Urquiljo / Getty Images
Photo: Santiago Urquiljo / Getty Images

Ginger, mint oil, vitamin B6, acupressure, acupuncture and lizards’ tongues for pregnancy nausea

Actually that bit about the lizards’ tongues I made up, but frankly the health community has let down women badly in the area of researching treatments for nausea in pregnancy. So badly that we are willing to try anything some old hag in black hat sells us. For those lucky women who don’t experience nausea, well, I can’t think of anything polite to say so… moving on. For those who experience the hell of hyperemesis gravidarum and for those in between, there is still very little evidence regarding what works, despite the acknowledgement that is a serious and debilitating condition.

Just looking at the ‘natural’ treatments and whether they work, the first thing I notice is a pretty poor quality of trials – just people not doing good science and yet still claiming a remedy works. Frankly women deserve better than that. However, some treatments do show some reductions in scores on the delightfully named ‘Rhodes Index of Nausea, Vomiting and Retching’. Overall, according to a systematic review of all the evidence (the best science you can get), ginger and P6 acupressure (think of the seasickness bands) “may be helpful to women, with some evidence of benefit but the evidence overall was not consistent”. Everything else is unclear still and the lizards’ tongues I would not suggest.

Note that although ginger may be effective it is actually still a powerful pharmacological agent (for example it can act as a blood thinner), so if you are going to try it talk to your GP or midwife about taking it safely. Feel free to direct them to this study on its risks and benefits. Also pharmacological intervention is an option. The evidence for this is not extensive, so again talk to your GP about risks and benefits.

Evidence it works: 4/10
Risks: Some risks for ginger, none for acupressure
Cost: Ginger syrup $18, seasickness bands $30 or self-administered acupressure on the wrist (just search for P6 acupressure point): FREE.

A plea to funders, scientists, researchers and health practitioners here: we need more quality research on this! Nausea, vomiting and retching in pregnancy is common and hideous; it can impact seriously on women and their family’s mental wellbeing, as well as on productivity. People get pregnant; we need them to in fact – it is pretty hard to support ageing populations without new members of society. What we need is science to better assist in overcoming the shitty aspects of it.

Cabbage leaves for breastfeeding

Sometimes when a baby is having problems breastfeeding (or for other reasons) women get breasts that overfill – and if you did not already feel slightly like a dairy cow, this will pretty much do it for you. The result: swollen painful breasts. While this might raise a snigger, it is actually pretty distressing and can lead to women ending breastfeeding because of the knock-on effects like infection. There is very little out there to help women with the engorgement issue hence many remedies are ones that have been used for years, including that old midwife standard, cabbage leaves. Also used are acupuncture, acupressure, cold packs, massage, ultrasound and medication.

The bad news is, basically none of this stuff has been studied enough for there to be really good evidence regarding what works. On the other hand, cabbage leaves (they don’t need to be cold) and hot/cold packs, for some women in some small studies, do relieve distress and pain, and are cheap. So as an individual they are worth giving a go. Just keep your expectations low.

Evidence it works: 4/10
Risks: None
Cost: Not going to bother calculating the cost of a cabbage leaf or two due to seasonal and demand fluctuations.

Lanolin, peppermint oil, drugs, nipple shields versus nothing or breast milk for cracked nipples while breastfeeding

Researching this I have to say peppermint oil sounds pretty uncomfortable on cracked nipples – I am kind of grimacing as I write. The good news is that it is bullshit so don’t bother.

A systematic review into what works for cracked nipples concluded the following:

“Currently, there is not enough evidence to recommend any specific type of treatment for painful nipples among breastfeeding women. These results suggest that applying nothing or expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.”

Great! The free treatment is likely to be just as good as ones that cost. Also the authors point out that most women find the pain reduced to ‘mild’ by 7-10 days after birth. Still I think let’s all agree it sucks and it the source of a lot of new parent distress. Frankly, way more structural support for breastfeeding is needed generally if we want to provide the optimal environment for exclusive breastfeeding. Stop making it a woman’s responsibility to overcome the many obstacles in the way of breastfeeding (and hence making it her fault when she can’t) and put in place appropriate environments and support systems (like freely available lactation consultants to visit at home and unconditional paid leave for parents) that makes it more likely she can.

Evidence it works: 5/10 (breastmilk)
Risks: 0
Cost: FREE!

Next time I am going to take a dive into what works for infant sleep – because far and away the most quackery exists in that area. But equally, there are some effective behavioural techniques that can help, and that you do not need to spend thousands on.