Women are often dealing with birth trauma alone due to a lack of support services. Image / Paul Slater
The last way any new mum expects to spend their first night after giving birth is childless in the maternity ward, listening to other mothers comfort their crying babies.
For Danielle Holmes, this lonely experience was worsened by the whirlwind of activity surrounding what she had thought was a “super normal” birth - up until her daughter was born with a brain injury and had to be resuscitated for half an hour.
The messy and frightening way Willow entered the world, which has left her with a lifelong disability, has also left her mother traumatised. But it is only now, more than three years later, that Holmes is receiving proper care for the birth trauma she suffers.
Holmes is just one of an estimated 50 New Zealand women per day who suffer psychological birth trauma - a statistic labelled “shocking” by a charitable trust set up to support people who have come away from birth with either physical or psychological injuries.
Birth Trauma Aotearoa is calling for every woman to receive at least one physical and psychological checkup after every birth or loss, and more training to prevent birth trauma from happening in the first place.
Holmes said she wasn’t prepared for just how wrong the birth could go.
“I think the toll that took on me was huge,” the Tauranga mum said.
There were multiple issues with her birth, including that she was given the wrong antibiotics during labour, meaning her baby ended up contracting meningitis and group B strep disease.
She was also inadequately monitored during labour, and was bewildered to discover later that doctors chose not to suggest a c-section to her because they believed she was against it.
“If you told me my baby was going to have brain damage, we’re going to cut you open, I would have said ‘yes, cut me open.’”
But Holmes was not informed of how dangerous the labour was becoming and “thought everything was super normal”.
Doctors lost track of Willow’s heart rate about 50 minutes before birth, and had been picking up on Holmes’ elevated heart rate, thinking it was the baby’s. In the end, Willow had become too stressed and not received enough oxygen.
Holmes continued with a vaginal birth and Willow was born with a brain injury and no heart rate, and needed to be resuscitated for 30 minutes before being airlifted to another city for specialist care.
Holmes said she was eventually placed in “sub-par” accommodation where she could hear domestic violence happening in the room next to her, and where she had to get up to pump milk through the night for a baby she wasn’t even with.
Holmes felt nobody was telling her what was happening with her baby, and she was dealing with everything alone.
Willow now has cerebral palsy affecting all of her limbs, and faces multiple developmental delays. At 3 and a half years old, she has only started learning to crawl in the past six months, and she struggles with speech.
“Her age on paper is like an 11-month-old.”
The whole experience has left Holmes traumatised, but she has only recently been granted ACC funding for psychologist sessions to help her work through her birth trauma.
“I think in the early days, there was no support after. I kept saying ‘who can I talk to to try to, like, work through this?’”
She paid privately for mental health support, and a woman came to her home and “just made me talk about my birth for three hours”. Holmes felt the session was unhelpful.
She believes she struggled to bond with Willow in the early days and she was “going through the motions” in her daily life.
Now she mourns what could have been.
“My child has a lifelong disability and I now grieve a life we never got to have,” she said.
“There’s so many moments I was robbed of because of a traumatic birth. Yes, it gets better over time, but that will always stay with me.”
She felt there was little support in place postpartum for mothers.
“Who makes sure the mums okay? What about the mum that has to try raise a newborn baby and try deal with the fact that something traumatic has happened to her?
“Three and a half years later I’m finally able to, like, unpack everything and learn about ways to move through it, so that when I want to have another baby I’m not dragging that into a new experience.”
For Auckland woman Catie McDonald, the birth of her second child was scary and fast-paced after a midwife discovered the umbilical cord was compressed and prolapsing.
“It was between my cervix and the baby’s head. Every time I had a contraction I was cutting off blood flow to the baby,” McDonald said.
“Someone pressed an emergency button on the wall, there was loud beeping, lots of people rushed into the room, they took my earrings out, had me and my partner sign forms, told me I was having an emergency cesarean. They started to push the bed out of the room, my gown was open and the midwife was still on the bed with her hand monitoring the compression - the bed hit a wall, I had to say goodbye to my partner, they put a mask over my face and I went to sleep.
“I woke up a mother but I was so confused and upset and in so much pain as they hadn’t been able to administer a spinal or an epidural before the general anaesthesia and C-section.
“I was on a lot of morphine and totally out of it. I cried and cried and was told by the doctors that I should be so happy that I had a healthy baby. I really tried my best to be, but it took months.”
McDonald wondered if a more senior midwife had been present, they might have performed a vaginal examination sooner and discovered the cord problem before it became so serious, meaning she might have been able to be awake for the birth.
“Who knows? Maybe not, but maybe it wouldn’t have all been so fast and scary and stressful had the birth been managed differently.”
Being told she should be happy to have a healthy baby left her feeling as if her first instincts as a mother were wrong.
“It made me doubt and question myself,” she said.
It took years to recover emotionally from the birth, and even now she is still upset when she thinks about it.
“I just recovered slowly. I feel like that trauma ran alongside me, parallel to everything else in my life and was heightened in the quiet alone moments, which are fleeting as a young mother.
“Birth trauma stays with you for a long time, it has taken me years to be able to talk to people about Eve’s birth without feeling really upset. Even now ... I get tears in my eyes thinking about her birth and the weeks that followed, because I know that the trauma affected my ability to bond and enjoy that newborn time with her.”
Taranaki mum-of-three Anna Pease said she went into her first birth not knowing how to stand up for herself.
In the hospital she told her midwife her body had started pushing, and was told that it wouldn’t be time to push and the baby would still be “ages” away.
Her daughter, Kiana, was born about 10 minutes later in just two pushes, “which involved some interesting tearing”.
She said about five different medical professionals came to check her tear over the next 12 hours, each check causing “excruciating” pain.
“It just felt like they were poking and prodding for no reason.”
While Pease said something did not feel right, she was sent home without stitches or any education on how to care for herself and make sure she healed properly.
Four months on from the birth, Pease was still in pain and couldn’t have sex, but was told there was nothing wrong.
About a year after the birth, she finally paid to visit a pelvic floor physiotherapist who told her she had not healed properly. For the next six months, Pease worked closely with the physio and a gynaecologist “to try to get me to a place where I could live life normally”.
She ended up needing surgery to fix her injury.
One of her enduring memories was that “no one listened” to her.
“I was just shrugged off as a new mum ... I definitely struggled from there with the fact that no one listened to me.”
She wanted people to know that birth trauma was “a real thing that happens”.
“If no one listens to you, you just get shut down and you don’t actually get to deal with it,” she said.
Pease thought everyone should be able to see a physiotherapist who would advocate for them.
Renee Norman is the co-founder of She Moves, an online women’s fitness collective which also specialises in safe pregnancy exercise and post-partum rehabilitation.
She recently shared some of her own experience with birth trauma with her online followers, and was shocked at the flood of responses she had from women who were also left traumatised by their children’s births.
During Norman’s experience, health professionals performed birth interventions on her without her consent and she was not given “desperately” needed pain relief as her baby was born in the posterior position, despite advocating for herself “extremely hard”.
“The lack of emotional support and empathy during such a vulnerable time is something I will never forget.
“Only now, and nine months postpartum, am I ready to put in a formal complaint.”
She said many other mums told her they wished they had put in a complaint about how they were treated during labour and birth.
“As hard as it is, we’ve all got to speak up. If we don’t, how is this meant to change?”
Norman said the trauma caused by “poor treatment of birthing women” was preventable.
“They feel like they are not met with the care they deserve ... women should be walking away feeling supported in that vulnerable time, and empowered.”
New Zealand College of Midwives midwifery adviser Claire MacDonald said community-based midwives were experts at primary care, including “holistic assessments of māmā and pēpi wellbeing throughout the postnatal period”.
Midwives could recognise when additional support was needed and offer referrals, but sometimes there were no support services available locally, or there were long waitlists.
“A gap in service availability for mild to moderate mental health has been identified across the whole health service, including maternity.”
When the country’s community-based midwife service was adequately resourced and supported, this led to improved experiences of care and outcomes for mothers, babies and whānau, she said.
“Recruitment, retention and support of midwives is needed to ensure midwifery continuity of care is available to all whānau expecting a baby.”
ACC strategic clinical advice and governance manager Dr Dilky Rasiah said mental injuries from birth might be covered by ACC if it has accepted a claim for a physical injury first.
“Because every client’s situation is different, cover and entitlements for claims are decided on a case-by-case basis. We encourage people to speak to their health provider about their situation, who can lodge a claim on their behalf.
“ACC can also provide clients with psychological support in order to help them recover from their physical injury, including maternal birth injuries. In other words, psychological support may be offered where the client does not have a covered mental injury, but where it is clear that psychological support is needed to help them recover from the effects of their covered injury.”
Birth Trauma Aotearoa founder and chief executive Kate Hicks said there was stigma and shame around birth trauma, which meant it was likely under-reported.
The unfunded, volunteer-driven charitable trust works to fill a gap as “current support services in the birth trauma space are so lacking”, Hicks said.
While there is little local research into birth trauma, statistics showed a third of mothers considered their birth psychologically traumatic, which Hicks said equated to 50 mothers per day in New Zealand.
“These statistics are shocking and tell us just how much work needs to be done in the space, to prevent avoidable birth trauma and certainly to support trauma when it occurs.”
There are few birth trauma-informed supports when it comes to psychological trauma, Hicks said.
“If a mum is experiencing significant distress then the Maternal Mental Health service can support them. This service, however, can be difficult to access for those with mild to moderate distress and this is due to resourcing restrictions. Mum may be able to access support via her GP but many parents don’t know these services exist.”
Hicks said many health professionals, such as GPs, weren’t asking birth experience-related questions if someone presented with distress.
“Postnatal depression is often considered, but not trauma related to the birth experience. We’re working to improve this education.
“There are many private practitioners who do specialise in birth trauma; however, this is often not funded so presents a barrier for many families. There’s a long list of support services on the My Birth Story website.
“What we would like to see is a nationwide policy of at least one physical checkup and one psychological checkup available to every birthing parent following every birth, or loss, as standard practice in Aotearoa, including access to further care if needed.”
Hicks also wanted there to be more training opportunities for healthcare workers regarding informed consent, trauma-informed care, and especially birth trauma prevention.
“People aren’t ‘making it up’ or ‘being dramatic’ - significant physical injuries can occur during birth as well as significant psychological distress.”
Psychological trauma from birth caused the same body and brain response as those who experienced natural disasters, war or assault.
“The birth trauma community need, and certainly deserve, the same care, empathy and support.”
Melissa Nightingale is a Wellington-based reporter who covers crime, justice and news in the capital. She joined the Herald in 2016 and has worked as a journalist for 10 years.
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