When birth doesn't go as hoped

Many people go into labour with a picture of how it will be, and many births turn out differently. Sometimes the difference is small and easily set aside. Sometimes it leaves a weight that is hard to put down: a caesarean you did not want, an induction, a long labour, a frightening emergency, a baby taken to the neonatal unit, or feeling unheard. This chapter is about those feelings and how to heal from them.

Disappointment and grief

It is possible to be deeply grateful for a healthy baby and still be sad, angry or disappointed about the birth. Both can be true at once. You may hear "All that matters is a healthy baby," and while your baby's health matters enormously, so do you and your experience. Grieving the birth you hoped for is not ungrateful or selfish.

These feelings often come in waves: when you tell the story, when you see a scar, when friends share their birth stories. For many people they ease over weeks as the experience is talked through and understood.

Birth trauma

Birth trauma is the lasting distress some people feel after a birth that was frightening or overwhelming. What makes a birth traumatic is not only what happened, but how it felt: fearing for your life or your baby's, feeling out of control, being in severe pain, or feeling ignored, rushed or disrespected. A birth that looked straightforward from the outside can still be traumatic for the person who lived it.

It is common. Studies suggest that roughly a quarter to a third of people describe their birth as traumatic in some way, and about 4 to 6 in 100 develop post-traumatic stress disorder (PTSD) after birth. The risk is higher after an emergency, a previous trauma, or a lack of support during labour.

Signs of post-traumatic stress after birth

Watch for these, in yourself or your partner, especially if they last more than about a month or are getting worse:

Reliving the birth: flashbacks, nightmares, or intrusive memories that feel as if it is happening again.

Avoidance: avoiding the hospital, your baby's checkups, talking or thinking about the birth, or sex, or feeling numb or detached.

Being on edge: feeling jumpy, irritable, unable to relax or sleep even when your baby sleeps, or constantly alert for danger.

Negative thoughts: blaming yourself, feeling a failure, or finding it hard to feel close to your baby.

Post-traumatic stress can occur alongside postpartum depression or anxiety, which the daily entries in weeks 3 to 5 cover in full.

Call your midwife, doctor or public health nurse if these feelings are still strong after a few weeks, are getting worse, or make it hard to care for yourself or your baby. Effective help exists, including talking therapies focused on trauma.

Get help right away if you have thoughts of harming yourself or your baby. Call your local emergency number or go to the nearest emergency department.

Understanding what happened

Gaps in the story are hard to live with. Many people find it helps to understand exactly what happened and why.

Ask for a birth debrief. Many hospitals offer a meeting with a midwife or doctor to go through your birth, often weeks or months later. You can ask your care provider to arrange one. Bring your partner and a list of questions.

Review your notes. You usually have the right to see or get a copy of your medical records. Ask a midwife or doctor to go through them with you, since the language can be hard to read.

Write it down. Writing your birth story, in as much detail as you remember, can help you make sense of it. You can include what you felt, not only what happened.

Talking it through

Talk with your partner, a friend, a support group or someone who listens without hurrying to make it better. Some people find peer groups for birth trauma, caesarean recovery or neonatal unit families especially helpful, because others there understand without explanation. If you were treated poorly, you may also choose to give feedback or make a formal complaint. Some people find that this helps them feel heard; others do not want to. Either choice is fine.

Partners can be traumatized too

Partners watch the person they love in pain, sometimes in danger, often feeling helpless and pushed to the edge of the room. Many partners are deeply shaken by an emergency birth and say nothing, because the focus is rightly on the birthing parent and baby. The same signs of post-traumatic stress can appear in partners. If you are a partner, your experience matters too: talk about it and ask for help if it stays with you.

Healing with time and support

For most people, difficult feelings about birth soften with time, sleep, support and understanding. Healing does not mean forgetting or pretending it was fine. It means being able to remember without being overwhelmed. Be patient with yourself, and with each other. Your relationship with your baby is not decided by how they arrived: bonding grows day by day, through feeding, holding and care.

Planning a future birth

If you have another baby, tell your care provider early about your previous birth and how you feel. You may be able to meet a senior midwife or doctor to plan together, see the birth unit beforehand, discuss a planned caesarean or a vaginal birth after caesarean (see "Special situations"), and write a plan that names what you need to feel safe. Many people find a later birth healing in its own way.

In short

You can be grateful for your baby and still grieve the birth you hoped for. Birth trauma is common, and it depends on how the birth felt, not only on what happened.

Flashbacks, avoidance and feeling constantly on edge beyond about a month are reasons to ask for help.

A birth debrief, your notes and writing your story can fill in the gaps. Partners can be traumatized too, and deserve support.

With time and support, most people heal, and a future birth can be planned with care.