"I felt unsafe around my baby": We need to talk about the reality of birth trauma.

The following deals with birth trauma and suicidal ideation, which may be triggering for some.

Kristy Keefe was laying splayed on the floor of her hallway when she started to deliver her second child.

In excruciating pain, the Tasmanian woman tried to focus on the voice of the Triple Zero call centre operator on the other end of the phone. 

It was late one afternoon in 2019. She'd just picked her four-year-old son up from kindergarten. Her husband was still rushing home from work. Her waters had broken. There was pressure in her pelvis. She felt the urge to push. 

Her mind raced back to her previous delivery of the little boy now sitting metres away in the lounge room. He had arrived not breathing and needed intervention from doctors. But there, in her hallway, there was nobody to help.

Mercifully, just as her baby's head and one of its shoulders made their way into the world, Kristy's husband came bursting through the door with paramedics in tow.

Little Riley was delivered safely, and both mother and baby were taken to the hospital. The same place Kristy had been dismissed from just four hours and 45 minutes prior.

Watch: The facts on postnatal depression.

Kristy had presented there earlier that day experiencing contractions, but was sent home by a doctor who insisted that despite Kristy being 3.5cm dilated, despite the fast delivery of her first child (five hours), and despite her wishes, she didn't need to stay. 

"He really just overlooked my judgment and made me feel like I didn't know what I was talking about," Kristy told Mamamia. "He treated me like I didn't know my own body."

Kristy's experience that day rendered her among the estimated one in three Australian women who sustain physical and/or psychological injuries from childbirth — an experience known as birth trauma.

As well as a fourth-degree tear, hemorrhaging and the need for more than a year of pelvic floor physiotherapy, Kristy's unplanned home birth left her battling symptoms of anxiety, depression, post-traumatic stress disorder and obsessive-compulsive disorder in the form of intrusive thoughts.

"I felt unsafe around my baby. I was scared to hold him by myself. I didn't want to be like that. It was like every time I looked at him, he was like a trigger to what happened," she said through tears. "I didn't feel a connection with him at all. But at the same time, I didn't want other people to touch him or be with him."

In the depths of her illnesses, Kristy thought about taking her own life.

"I don't remember the first six months of my son's life because my head was full of trauma, anxiety, deep depression," she said.

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Dr Rosanna Pajak is a clinical psychologist who specialises in perinatal mental health.

Speaking to Mamamia, she explained that psychological birth trauma can occur with or without physical birth complications; it's about the individual's experience of that birth.

"A [psychologically] traumatic birth is one where a woman feels high levels of fear, helplessness or horror, during or immediately after the birth," she said.

The impacts of that are wide ranging.

"A traumatic birth can leave a woman with intense feelings of guilt, grief, failure or anger and significantly impact their adjustment to motherhood. Women can go on to develop postnatal depression and/or anxiety (PNDA), post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD)," Dr Pajak said.

Sadly, both practical and social barriers exist to seeking support. 

With a newborn to care for, parents often have little opportunity to reflect on how their birthing experience might be affecting their mental health, Dr Pajak noted. And when they do, narratives about motherhood and childbirth can lead women to question their own distress.

"Medically, there is a strong focus on the physical health of mother and baby," she said, "so women can come to believe that they should just be grateful for their healthy baby and somehow 'move on' from their traumatic experience."

Stacey's story.

Stacey Parkin was 35 weeks into her first pregnancy in 2019 when she noticed her baby wasn't moving as much as usual. Her instinct kicked in; she knew something wasn't right.

The Perth woman, who'd recently completed her studies to be a nurse, presented at hospital where doctors performed a scan, assured her everything was fine and sent her home.

"I felt sick," Stacey told Mamamia. "But I kind of just went with it. I was like, 'Oh, well, they've done the scan. He's the health professional. He must be right.' But it was still in the back of my mind the whole time."

Two weeks later, Stacey underwent an emergency delivery in hospital. She'd been experiencing a slow leak of amniotic fluid that left her at risk of sepsis and her baby in distress.

There was talk of a c-section, but that was abandoned. An epidural failed. An episiotomy was performed without consent or even warning ("she just grabbed the scissors"). And ultimately, Stacey was told she had an hour to delivery her baby safely.

Stacey and her newborn daughter, Skylah. Image: Supplied. 

Baby Skylah was born into a room filled with doctors and whipped straight onto a resuscitation trolley. Stacey's mother, who'd been present for the birth along with Stacey's partner, persuaded them to allow her daughter to have a brief hold before the newborn was rushed to the neonatal intensive care unit. 

The focus was, rightly, on baby Skylah. But Stacey, shellshocked, in pain, unsure what was going on, felt she was abandoned.

"There was nothing; no support at all until maybe a day or two before Skylah actually left the NICU, which was 10 days later. And they had the social worker come and have a chat to me," she said.

In the meantime, Stacey was told her daughter, who was suffering dangerously low blood sugar, needed to be transferred to another hospital in order to, in the doctor's words, "save her brain". There were communication failures about feeding, which meant Stacey didn't get the chance to supply milk. And she spent five days recovering in a shared room full of women lovingly tending to their new babies. 

She couldn't stem the tears. 

She felt the industry she was entering into had dismissed her needs at almost every turn.

Dr Rosanna Pajak notes that research has connected birth trauma to experiencing a lack of control and poor communication from caregivers. 

"We know that a higher level of medical intervention is associated with birth trauma, but women often speak about not feeling listened to, respected or safe as decisions were made," she said.

"Birth can become medically complicated and injuries can occur, but we know that if women feel well-cared for, listened to, respected and fully involved in decision making about their care, it can go a long way to mitigate the associated psychological distress."

The path to healing.

Back at home in the weeks that followed, the psychological trauma of Stacey's birth took its toll. Her existing depression and anxiety reached new extremes.

"I'd lay awake at night, just watching the baby monitor. In the end my partner put the monitor on his side of the bed so that I couldn't see it. During her day naps, I'd go in and I'd wake her up to see that she was breathing," Stacey said.

"I thought she was going to die. I had these thoughts, racing thoughts, that someone was going to hurt her or something was going to happen to her. It was just a never-ending cycle."

Like Kristy, she had little connection with her child beyond that fear. 

Stacey was ultimately admitted to a local hospital's Mother and Baby Unit for four weeks where she was diagnosed with PTSD.

Kristy Keefe applied for a place in hers three times but was denied. 

These specialist neonatal psychiatric units are only available at some hospitals, and places are limited. Due to significant demand, waitlists can be extensive.

Stacey with her partner, Jake, and daughter, Skylah, now aged two. Image: Supplied. 

While Dr Pajak stressed that effective treatment for birth trauma depends on the needs of the individual, she noted that women benefit from the opportunity to safely process a difficult birth experience.

"Some women find it incredibly helpful to connect with others who have had similar experiences, whilst others benefit from professional support," she said. "Psychological therapy with a trained clinician can enable traumatic memories to be effectively processed, and support women — and their partners — to understand and work through feelings of sadness, grief, loss, anger, guilt or failure."

Kristy and Stacey have taken both approaches.

After leaving the Mother and Baby Unit, Stacey found a counsellor who specialises in PTSD, who she still sees regularly. And close to a year after birth, Kristy found a psychiatrist who took her through therapy to process what happened as well as establishing a medication regime that works for her. 

But they've also leant on the Australasian Birth Trauma Association support group on Facebook; an online space where parents can engage with each other about their experience, struggles and healing process.

Kristy with her husband and her sons, Riley (2) and Connor (7). Image: supplied. 

For Kristy, it's a way of using the voice she feels she was denied in her birth process. She's sharing her experience here as a means of advocating for better care for other mothers.

She would like to see women's physiotherapy included in postnatal care, as well as improved access to psychological services.

Stacey, too, wishes women who endure traumatic births weren't made to feel so alone. She urges others to speak up; to advocate for themselves throughout pregnancy, delivery and beyond.

"You know your body. If you feel something's wrong, just go and get checked, regardless of if you feel like you're overreacting," she said. "It's better to have an answer than just sit in the dark and have something happen."

Dr Pajak's message to parents who've experienced birth trauma is a simple one: "a traumatic birth deserves attention."

"It is a huge moment, the birth of your child, and it is okay to grieve if it was traumatic for you. If a difficult birth has gone on to affect your experience of motherhood, that is also really significant," she said. "You don't just have to 'move on'. In fact, it is really important to take some time to process what has happened. Support is available, from other women and professionals to help you heal."

Birth Trauma Awareness Week 2021 runs from July 19 — 25. For more information and resources, visit the Australasian Birth Trauma Association website. You can also donate to help the organisation continue offering its free  Peer2Peer support program for parents affected by birth trauma.

If you are feeling overwhelmed or having difficulty coping or staying safe, call Lifeline on 13 11 14. Support is available 24 hours a day.

If you are a new or expecting parent and are experiencing anxiety or depression, support is available. Call the PANDA National Helpline on 1300 187 263 (Mon to Fri, 9 a.m.—7:30 p.m. AEST/AEDT).

Feature image: Supplied/Mamamia.

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