Birth trauma and EMDR

Warning: Trigger Content: this blog contains information about birth trauma (severe perineal tear and levator ani avulsion), PTSD, and the use of obstetric instruments.

As a society, we often shy away from discussing topics like birth trauma, obstetric injuries, and PTSD. But it’s crucial to break the silence.

I’d like to share my story with you. I hope it gives you good insight into the power of EMDR, and encourages you to open up and share more with others. It’s through sharing our stories that we can transform our culture and reduce the weight of stigma and shame.

A Smooth Pregnancy

I had a 'smooth' (and mostly uneventful) first pregnancy and was well-supported by my caring osteopathic husband- he would give me very regular osteopathic treatments (how lucky!) At this stage in my life, I was even more into holistic health and was determined to have a midwifery model of care. My husband and I did substantial prep for a natural birth by doing intensive ‘active birth yoga’ courses and practicing hypnobirthing techniques. I also religiously used a device called the ‘Epi-No’ and visualised the birth going smoothly every single day. I would regularly practice tolerating pain (for example, holding ice in my hands for long periods until it burned whilst practicing pain management techniques). Having had chronic pain from a very young age, I already had a high tolerance and was familiar with how to manage it.

An Unexpected Turn

The first stage of labour went beautifully, filled with raw and primal energy. I embraced it without the need for any pain medication. However, the second stage went south (sound familiar?) After two hours of pushing, my baby’s shoulder became stuck. We later found out he had a very large head, was a large(ish!) 4.2kg baby (at 38 weeks) and I had undiagnosed Ehlers-Danlos Syndrome (EDS).

I was out of options. It was too late for an epidural. The only operating theatre at the hospital was in use already. So my baby was pulled out with forceps, but it resulted in a 3b perineal tear (this means a big tear all the way through to my external anal sphincter muscle).

I was taken to theatre for a repair. I recall being in shock and shaking uncontrollably. It took a long time to come out of recovery - my blood pressure was very low. It wasn’t until the morning that we realised that our baby’s head was terribly misshapen due to the prolonged second stage and use of forceps. He was unable to open one of his eyes for many days due to the damage. It's likely this was the cause of him developing a severe motor speech disorder (that has now resolved due to a lot of therapy).

The Aftermath

I remained in shock for many months, staring into space for periods of time. I later realised that this was dissociation, commonly seen with trauma. I had terrible flashbacks, intrusive thoughts, and panic attacks. I tried to hide this from others, not wanting to worry them. I think it was also due to shame. I was supported by health care providers, but no one was able to recognise that I had PTSD. I wasn’t depressed. I had a good bond with my baby. Ironically, being a psychologist myself delayed getting the right type of help.

When I was pregnant with my second son, I went back to the same hospital. But I had a severe panic attack, and was referred to the hospital social worker. We did extensive exposure therapy, but it didn't help....I can recall that there was one particular spot in the hallway of the postnatal ward that I couldn’t walk past without crying hysterically. It was there that I had stood, almost 2 years ago, rooted to the spot - realizing that it would be a huge struggle to walk to the car to go home with my new baby, but I equally couldn’t be pushed in a wheelchair due to being unable to sit. In fact, due to the physical damage, I was unable to sit up properly for many months and had to learn to breastfeed by lying on my side.

It's a primal need to be able to move our bodies. It goes back to 'cave man days' where we need to be mobile to escape danger. I couldn’t sit down properly for months, nor could I walk. The reality of this physical limitation was very confronting.

More Damage

It was later confirmed via an MRI that I also had a levator ani avulsion on one side (we have two big muscles holding up the pelvic floor- one of mine tore right off the bone- this can't be 'fixed'- some woman have mesh, or repair work, but the rates of success are very low, and this type of surgery is delayed to later years as much as possible). Due to this injury, I was strongly advised that I should never lift more than 10kg ever again, and should never run, skip, hop, and so on. I used to love the gym and latin dancing. Now, I was advised to ‘slide and glide’ (and not ‘jump around’) at dance classes. I was also told that the damage was permanent.

The anal sphincter repair in theatre wasn’t enough, and I had severe pain for five years from a chronic anal fissure. I was told that I couldn’t have this fixed until I had finished having babies and finished breastfeeding. I lived in fear of having to do a bowel movement and lived in constant pain- pain medication wasn't enough.

My body was broken.

How did it all go so wrong?

I felt like I was lied to. We were told that all babies can be born from all-sized pelvises. Much more awareness needs to be made about this. There was no mention of the high-risk factors associated with forceps in women of my age (33), or the risk of long-term physical injury. If I had known that, maybe I would’ve pushed for a caesarean section. Sadly, it wasn’t identified that I had EDS. It wasn’t until a few years later that after many hours of researching, I realised myself that I, in fact, had EDS (later confirmed by a specialist).

I had two rounds of medical-grade botox in the sphincter to try to heal the chronic fissure but had to opt, in the end, for a second cut to the sphincter, but what choice did I have? On a side note, it is very risky to have two cuts into the anal sphincter- it puts you at high risk for faecal incontinence later in life. I'm fine so far, but that can change.

Second Labour - A Healing Experience

My second birth was an emergency c-section - I was 7cm by the time I got to the hospital (a c-section was booked, but he came early). Prior to this birth, I worked very closely with my healthcare providers to try to get the birth I wanted. I was proud of myself that despite the team trying to get me to birth naturally upon arrival, I insisted that they give me a c-section. Despite the fact that they tried to remove my husband from the delivery room, I insisted that he stayed. Despite the fact that they urged against delayed cord-clamping, I insisted that they at least tried it until he had to be taken away to the NICU. I was determined to breastfeed him, so I got out of bed every 2 hours (post c-section!) to shuffle down the hall to feed him when he woke up. So despite all this, this was quite a healing and beautiful birth, all because I felt empowered, and because I was determined.

Discovering EMDR

Eye Movement Desensitisation and Reprocessing (EMDR) is a powerful therapeutic tool to treat trauma and a huge range of psychological presentations. It was originally developed by Francine Shapiro to treat PTSD. The World Health Organisation recognises EMDR as a ‘Level A intervention’ (i.e.- the highest level) for the treatment of trauma in adults, adolescents and children. EMDR has been recognised as having the highest level of research evidence for the treatment of PTSD by the Australian Psychological Society.

The exposure therapy by the hospital social worker wasn't helpful. It propelled me to research other options...I first came across EMDR in 2018.

EMDR has allowed me to share my story without crying hysterically and feeling broken. The memory has faded - it’s still there, but not as vivid. I only saw the labour in black and white. But now, there is colour. I also see the beauty in the birth.

I now am at peace and fully accept what has happened. I don’t play the ‘what if’ game (what if I was diagnosed with EDS prior to the birth? What if I insisted on a c-section? What if I knew about the risk of injuries with forceps?) I live in the present, and focus on being the kind of mum, partner, and friend I want to be.

Both sons and I have an excellent bond, and the experience made my husband and I even closer as a couple. I no longer have PTSD either.

I loved EMDR so much that I had two years of EMDR therapy with a delightful psychologist and processed every single trauma I could recall.

I have since become an 'Accredited EMDR Practitioner' and am planning on applying to be an 'Accredited Consultant' when I have the spoons. I have done EMDR on hundreds of clients, most of them with amazing outcomes that bring tears to my eyes. I've helped to process medical traumas, natural disasters, wars, conflict, refugee traumas, DV situations, sex trafficking, MVAs, developmental traumas (childhood neglect, abuse, and so on), sibling trauma, and so on.

The birth trauma doesn’t trigger me anymore, and I am able to provide EMDR to others with birth trauma.

Any Tips?

My advice is to fight fiercely for your mental health. If it’s not getting better, change practitioners, change strategies, and persist until you find improvement. Not all mental health professionals are 'born equal'- some are better skilled than others, some have a very niche set of skills, and some are more experienced than others. So look for someone with training in perinatal mental health and trauma, and someone with substantial experience in EMDR if you'd like to try it (now is not the time for a new grad!) Have people around you who are loving, non-judgemental and actively supportive- life is too short to spend time with those who aren't kind or loving towards you.

Key advice pre-birth:

• Understand the risk of using obstetric instruments like forceps in labour

• Actively seek out difficult birth stories and not just the labours that are uneventful

• Consider having a birth doula or dedicated midwife (or student midwife) to help you feel empowered and to advocate for you

Key advice post-birth:

• Check out Australasian Birth Trauma Association for support

• Try to see a psychologist who is trained in perinatal mental health, and able to screen for and treat PTSD- look one up here

• Consider EMDR- find a practitioner here

• Consider reading ‘How to Heal a Bad Birth’ by Melissa Bruijn and Debbie Gould (I loved this book)

• Find a highly regarded pelvic floor physio- I see the wonderful Sue Croft 

• Advocate for what you need- don’t give up!

A Call for Change

As a society, we need to share with women the 'good' AND ‘bad’ birth stories to prepare us. We need to ensure that information about the risk of obstetric injuries is more commonly made available. We need more support and tools to follow up women to identify PTSD. Many get misdiagnosed with PND, and a correct diagnosis of PTSD is missed. This is tragic, since the treatment for PTSD is quite different. Check out this recent link here.

We also need to better identify and diagnose pregnant women with EDS. It is hard to diagnose for various reasons. However, it's critical, since the rate of my fellow bendy zebras who sustain serious pelvic floor injuries due to childbirth is staggering. Check out this 2023 research paper here.