A striking feature of women’s stories about birth trauma is how often they mention guilt. One woman I talked to for my book on birth trauma, Alice, realised that she was in second stage labour and ready to push, but the two midwives attending her kept telling her that she was in early labour. When they finally realised she was right, they had to rush her to the delivery room, and she gave birth a few minutes later. The baby had the cord around its neck. Alice told me:
“I felt very guilty that I maybe should have complained more at the time because if anything had gone wrong with the baby it would have been my fault. I remember about eight weeks after feeling really guilty that he could have been disabled, or brain-damaged.”
Alice, in fact, did everything she could – the problem lay with the two midwives who misread her labour. So why did she blame herself?
Guilt is a common feature of PTSD. It doesn’t matter whether the sufferer has PTSD as a result of being a victim of sexual assault, or seeing their colleagues killed in battle, or giving birth: there’s frequently a belief that the event could have been avoided if they had done something different.
Some time ago, I interviewed David Blore, a psychotherapist who specialises in treating PTSD sufferers with eye movement desensitisation and reprocessing therapy (EMDR).
David treats people whose PTSD has arisen as a result of something that has happened in the course of their work. These are people who have had to make a spur-of-the-moment decision, such as doctors, nurses, police officers and paramedics, on matters of life or death. They often blame themselves when that decision ends badly, usually with the patient or crime victim dying, reliving the moment when they made the wrong decision.
I was particularly struck by what David said about his work with train drivers who had unwittingly been party to a suicide. Train drivers are taught that they have to be in control of their train at all times. And then, says David, someone stands in front of the train:
“I’ve had plenty of train drivers over the years who have denied the laws of physics in order to preserve their belief that they should be in control. Take an East Coast mainline express, weighing 700 tonnes, travelling at 125 miles an hour – to get the momentum, you have to multiply those two figures together. Well, it isn’t going to stop in 20 yards. It might stop in three-quarters of a mile, but if the person in front of the train is hell bent on committing suicide, they’re going to make certain that they’re least likely to be spotted until the last minute.”
Part of the therapeutic process is to help the driver understand (not just rationally, but emotionally) that they couldn’t have stopped in time: that the death wasn’t, in fact, their fault.
And this is where Alice’s experience comes in. The idea of being “in control” emerges frequently in women’s labour stories. Forty years ago, women were generally not “in control” during labour: birth was something that was done to them, rather than something in which they were active agents. Campaigners for women’s rights in labour, as well as for patients’ rights in general, have changed that. Now women expect to be consulted on what happens to them: whether they are induced, for example, whether they are given drugs, whether they have an episiotomy. This has allowed many women to have a much happier experience of birth, in which they labour under their own terms – remaining upright, for example, or labouring in warm water rather than lying down on a bed.
But control brings an added dimension of anxiety. If a woman doesn’t have a wonderful birth in warm water, but instead has a long, difficult labour involving drugs and forceps or an emergency caesarean, is that her fault because she made the wrong decisions? If the midwife says that she needs to lie down and be strapped to a monitor for the good of the baby, what should she do? If she says “no” so that she can carrying on moving around, will it be her fault if the baby’s health is compromised? Or if she says “yes”, and she then has a difficult birth with multiple interventions as the result of being unable to move, will that be her fault?
The truth is that, most of us, faced with a recommendation by a midwife or doctor to have a monitor attached or have an epidural or an episiotomy or a forceps delivery, don’t know what risk is involved in either going along with, or not going along with, that recommendation. Whatever we decide, we are likely to feel it is our fault if things go wrong: and yet, as with the train drivers treated by David, the reality is that the situation is out of our hands. And this raises the question: how do you enable women to feel they have the freedom to give birth in the way they want without burdening them with guilt if things turn out differently?