“I Am Not OK” – a mother’s reflection on identifying birth trauma

 

At past 40 weeks pregnant, we were anxiously and excitedly awaiting the birth of our fifth child. When my water broke, we hurried to the hospital feeling excited and ready to meet our girl. We were laughing and cracking jokes when we arrived and got to the room. This was our 5th rodeo, after all. After changing into my gown and climbing onto the bed, my sweet friend and nurse checked my progression. She was quiet and thoughtful for a few seconds while she felt for my baby.

“That’s a shoulder,” she said.

Immediately, our plans for a peaceful and empowering natural delivery changed to prepping for a c-section for the health and safety of both of us.

As I signed forms too quickly for me to read, knowing I had no control over what I was agreeing to or putting my name on, nurses came to the room to prep me for surgery. My husband stood silently by my side, panicked and unprepared, feeling shocked at the quick turn of events. One nurse explained what to expect during the procedure, and my thoughts shifted to what I’d read about c-section deliveries— feelings of tugging and the smells of the O.R., trying to mentally ready myself and stay calm.

“It’s alright. I’m ok,” I thought, “this is her story. This is how we get her here safely,” and I focused on getting to see her sweet face sooner.

Going into the operating room was a shock of bright lights and a cold, sterile environment from the warm, soothing lights of the labor and delivery room. For whatever reason, the size of the table was what stood out to me the most. I thought I was prepared, but I didn’t remember reading anything about that tiny table. It took super human effort to try and slow my heart rate and fight the sudden threat of tears as I sat on the edge of it and bent forward for the anesthesiologist to administer the spinal.

These amazing professionals knew their role and what to do. They were ready. Two nurses stood to my left by the warming table ready to care for my baby girl and chatted about the Super Bowl. This was every day for them. It was a shock to me. My doctor and nurses continued to prep behind the curtain, and the anesthesiologist’s assistant stood to the right of my head watching my vitals.

Laying on the table, surrounded by people, I felt alone.

My husband was finally able to come in, took his seat to my left, and held my hand. He was quiet. He later told me that one of the worst parts was standing in the hallway alone while they wheeled me back, and he just felt helpless. When I look back at photos, I see the worry and concern etched on his face, and it breaks my heart.

After checking to be sure the spinal was effective, it was time to begin. I avoided looking at the lights above me so I wouldn’t see the reflection of what what happening and was vaguely aware of the activity behind the drape. I felt the sensations others described, and smelled the burning skin from my incision. “It’s ok. I’m ok. I read about this. This is normal. I’m ok.”

Then, it got quiet. This is not normal.

“She’s really stuck,” my doctor said, and I could see the concentration on his face and just began to pray for her to be out and to hear her cry. It was like the entire room was holding its breath.

More tugging and pulling, and she was out. We heard her. Catherine Elizabeth. She was ok.

Instead of feeling her warm, slippery body on my chest, I watched her being taken to the warmer covered in my blood. I tried to focus on her, only her, while I was put back together and the silent tears I couldn’t stop from falling slid down my cheeks. She was bundled in blankets and brought over to the table for me to meet her. She was beautiful.

“Smile! You just had a baby!”

And I did my best to smile and be ok because she was ok.

“This was in my top 3 most difficult deliveries,” my doctor said behind his mask.

“I’m an over-achiever,” I joked.

“You can have more children, but they will need to be c-sections because of the incision I had to use. She was really stuck.”

Little Katie Beth enjoyed her time with mommy so much and had so much room that she preferred to lay sideways to relax. She was in that position when my water broke, with her shoulder and hand in the birth canal. Thank God for that, because she stopped her cord from slipping through and cutting off her blood supply. Thank God my water broke before labor began, or I wouldn’t have gone to the hospital. Thank God her position was found early so we could act quickly. Thank God.

Because she was so firmly wedged, my doctor couldn’t deliver her with the standard horizontal incision and had to quickly modify to add a vertical cut, resulting in an inverted T on my uterus. It was a hard-earned scar, and necessary for us both, but I was told it would mean future deliveries would need to be planned c-sections at 37 weeks to completely avoid labor and the risk of uterine rupture. Along with the emotional shock of the emergency c-section, I added thoughts of future babies and births to feelings to be processed.

During this time, he continued to work on stitching me back up, and I struggled to keep from shaking as a result of the anesthesia, all while feeling burning on the upper right side of my abdomen and lower chest- like Indian sunburns kids used to give each other at recess. The anesthesiologist’s assistant was an angel and held my hand while I hissed through my teeth. “She has a hot spot right there,” she said.

My husband sat next to me holding our daughter, watching my face, and refusing to move when nurses tried to direct him out as they finished. He was allowed to stay, and I alternated between looking at my daughter in his arms and wishing I could just hold her to looking at the clock with gritted teeth held together to try and stop the shaking.

When I was finally transitioned to my room and continued to be monitored, I held my baby and did my best to nurse her while laying down and trying not to shake. I refused any meds to help because I didn’t want them to be passed to her. She latched on like a champ, and my heart rate slowed as I was able to relax a bit more. Eventually, the shaking stopped.

Exhausted, I just wanted to sleep, but every time I began to doze off, I would jerk myself awake, subconsciously afraid that if I went to sleep, I wouldn’t wake up.

In the early hours of the morning, my husband had to leave to check on our other children and make sure they were alright. For the next three days, this would be the routine as he coordinated family and friends in rotating shifts at the house to care for our older children while I remained at the hospital with Katie, breaking down and crying more times than I care to admit.

A day later, I was able to focus enough to post a birth announcement for her with a brief note about our unexpected c-section.

“I’m so glad you’re both ok!” I read it over and over in the comments, and it rang hollow, but I couldn’t figure out why.

Recovering enough to leave the hospital was a struggle as I developed horrible headaches and kept fighting nausea any time I sat up, vomiting and feeling like my abdomen would split. I wanted so badly to just be better and be able to care for myself and my baby as well as my family at home. When we were finally able to leave, it wasn’t with big smiles, it was with a pale face and grimacing as I fought the headache and nausea on the drive home, literally crawling up the stairs to my room once we arrived, and immediately vomiting in the bathroom when I made it there.

Our first night home, our youngest son fell needing stitches, and my husband had to take him to the emergency room while I cared for our oldest three and got them ready for bed as best as I could, which wasn’t very well. Even walking down the hall was a painful challenge, and I had to hold on to the wall to even stand. I definitely couldn’t do more than simply be present.

I don’t know how long I stayed in my room, only able to care for my newborn and listen to everything going on in the rest of the house. I still felt sick, had no appetite and only ate to take care of myself and Katie. I went through every pain pill on a religious schedule and slept as much as I could, but I still had trouble falling asleep and would continue to jerk myself awake. I could do nothing to care for anyone else besides us. I fought the depression of being inactive and unable to give attention to my other children, having to rely on others while I struggled with a much more difficult and lengthy physical recovery than my previous deliveries. Eventually, I didn’t want to leave my room, and when I finally did, I couldn’t be without my baby. Being separated from her left me fighting anxiety and panic attacks.

A few weeks into my recovery, just as I was starting to think I had a handle on my new normal, I was holding my hand over my scar while I coughed and felt sudden sticky wetness. When I looked, I found oozing that sent me into a panic, and I lay in bed shaking and crying at the thought that something was wrong and I might need to go in for surgery again. Thankfully, after getting it checked, it was found to be normal discharge, but the anxiety was difficult to shake. This type of anxiety flare-up became the norm any time an unexpected, stressful situation arose.

At my 6wk follow-up, although I was still uncomfortable, everything seemed to be physically healing normally, and I was asked about how I was feeling. I didn’t know what to say. I knew something wasn’t right, but it didn’t feel like what I’d always heard PPD to be described as. I didn’t feel disconnected or unattached to my baby. I felt almost hyper-connected and constantly self-assessing my physical healing while simultaneously avoiding how I was doing emotionally. I kept replaying her delivery in my head, and looking through photos was a struggle. I would look at photos of my “before” self and get angry at the smiling woman in the picture because she didn’t know this was going to be different. Holding my baby, I felt comfort and peace in the outcome, but I found it impossible to find joy in the process. I remained open about my struggles with her delivery, and have found many sympathetic responses, usually followed by, “thank goodness you’re both ok.”

“At least you have a healthy baby.”

“It will get better.”

“It’s all worth it.”

“You’re ok.”

OK.

I’ve spent a lot of time reflecting on that word. Reading it and hearing that response left me feeling unsettled, and I tried to brush it off and move on without dwelling on why I didn’t like hearing it, but I realized something. When people say, “thank goodness you’re ok,” what they really mean is, “thank goodness you’re alive.”

I kept waiting to feel ok. Was I even allowed to not be ok? My baby was here. She was healthy. As far as emergency situations go, this one turned out well. She didn’t need any time in the NICU or have any major issues. I have her. I am alive without any known long-term complications. So, was it ok for me to not be ok?

Because I was not ok.

I cried buckets over the last year. I have struggled with severe mood swings, anxiety, and feelings of depression. While I am functioning pretty normally on the outside, I’m still processing and working through a lot of emotions surrounding my daughter’s birth and the impact it will have on future pregnancies, deliveries, and recoveries.

I began to scour medical journals for studies and articles specifically relating to factors affecting uterine rupture. I read blog and journal entries from women who experienced horrible situations and losses as a result of uterine rupture. I read heartwrenching stories of c-sections gone wrong and long term impacts on maternal recovery. I also read many stories of women who went on to have successful VBACS and gentle c-sections with “special scars.”

Sorting through and gathering information helped me feel more grounded in what I was experiencing, and I realized that it was normal. I began to confront and analyze my emotions to get to the root of what makes me so anxious. Reflecting on and journaling my own thoughts and feelings has been an enlightening journey and has given me some clarity on how to manage my anxiety and depression. It is still an ongoing process.

These reflections have made me question what it means to be “ok” and how heavily emotional and psychological health should be weighted as part of informed birth decisions, caring for the mother during the birthing process, and care for her beyond her physical recovery period. In speaking with other mothers who have been through a delivery they found traumatic, this pain often becomes private as others around them dismiss their feelings because “it could have been worse” or they “should be over it by now.”

What can be done to help these women?

For me, the moment I stopped being OK was when I entered the operating room. The change in environments was truly a shock. Though there were at least half a dozen people in the room, I felt as if I didn’t belong, in spite of being the “guest of honor” at this surprise party. I was terrified. It’s possible there were introductions, and I don’t remember them- it was a bit of a blur- but if it is not part of standard procedure, I do think that is something that should be done by every person in the room, making eye contact, and telling the mother what their role is and a word or two of encouragement.

I needed that. I needed to hear, “you’re brave, you’re doing what you need to do, you’re doing great, we’re excited to be here with you to help you get your baby here safely.”

Consider giving her something to do, even if it’s only a simple distraction. Give her something she can control. Coach her. “Breathe, push, relax your forehead,” a laboring mother is coached and encouraged. She knows she has a job to do. Having that suddenly change added to my feelings of helplessness and being out of control. It became much harder to relax. Instead of working with my body in labor and concentrating on delivering my baby, I now had people working on my body, and I no longer felt that I had a role in her arrival. It felt more like a procedure and less like a birth.

For most of the room, focus was understandably on what was happening on the other side of the curtain, but I felt detached on the other side. I will never forget the anesthesiologist’s assistant who was monitoring my vitals. She held my hand even when I was squeezing it in panic when the tone of the room changed. She continually made subtle reassurances during an already intense situation. I felt that while watching the numbers for my health and safety, she also recognized their reflection of my stress and tried to help calm me. It might not have seemed big to her, but it was huge to me.

Once my child was delivered, all I wanted was her. I do not know what hospital policy and procedures are to allow for a family-centered cesarean (or what, if anything, can be done to allow for this during an unplanned c-section), but I feel it would have helped me if I had been able to bond with her sooner. In cases where this isn’t possible, communicating about the baby and reassurances that she was alright would have eased my mind.

Being with her in the recovery room was better. Helping me get her to latch and do skin to skin as soon as possible was a big benefit, but when I wasn’t holding her, I struggled. I didn’t want to take my eyes off her- not just in awe of this new little person, but in fear that something would happen if I wasn’t watching her. Although I was exhausted, I couldn’t sleep and would jerk my eyes back open because I subconsciously felt like I wasn’t supposed to and was afraid I wouldn’t wake up. It was something I felt foolish admitting, but looking back, it was definitely a sign that I was having a hard time.

My nurses throughout my stay at the hospital were amazing! They were kind and caring, attentive to my pain, and didn’t rush my recovery. My doctors and the medical staff were all respectful and answered my questions. I never felt like my physical health wasn’t a priority.

I also didn’t know how to bring up or verbalize all of the confusing emotions that I was feeling about the delivery and how difficult the recovery was going for me. Those weren’t things anyone asked about, and I didn’t know how to bring up questions that weren’t about my physical health. “How did I do in the operating room? Is it normal to be so scared? Is it ok for me to be struggling right now?” I thought it was something I was supposed to just power through and put a good face on. I smiled and stayed positive when people were in the room, but I would start crying as soon as I was alone.

I don’t know if there’s a special list of questions that might unlock the door to identifying those problems in the hospital and at follow-up appointments. Maybe it’s as simple as including, “how are you feeling about your delivery? How are you feeling about your recovery?” I didn’t feel like my symptoms aligned with what I’d read about PPD or the questions I was asked. I felt like something wasn’t right, but it didn’t quite fit. Though PPD self-evaluations were readily accessible, it wasn’t until a friend mentioned ptsd that I skeptically looked into it and was surprised to find that it aligned so much more with what I was experiencing.

Reviewing questions to evaluate for emotional birth trauma, anxiety, or depression that differentiates from PPD may be of benefit for doctors and patients. I feel that if I’d been asked to evaluate my emotional state in other ways, it may have been pinpointed sooner.

Working through these feelings is a work in progress for me. I know that I can reach out at any time and get more help, but just knowing that what I’m feeling is normal has helped me grant myself grace and allowed me the courage to admit to and face my struggles rather than trying to ignore them. Giving myself permission to feel this way has been a relief.

I have not been ok.

But I am going to be ok