By Tracy G. Cassels

Ever tell someone you were dissatisfied with your birth experience?  That it left you feeling lost, unhappy, frustrated, or something worse?  And then been told that you were selfish because you had a healthy child and all that should ever matter is that your child is healthy and happy, no matter how he or she came into the world?  It’s such a common turn of phrase that I imagine many people can empathize.  In our society, to care about your birth experience has become selfish and uncaring.  We who care are evil and cruel for putting anything even in the same realm as the well-being of our child.  But the thing is, it’s because I want my child to be healthy and happy that I care so much about my birth experience.  And for those of you who call us selfish, please listen.

At the very core of it, we all want our child to come into this world healthy.  But just because a child is born healthy does mean that’s the end of the road.  A newborn requires a nurturing, caring mother (and father) to help develop into a happy, healthy infant then toddler then adolescent then adult, and a mother’s birth experience will affect, at the very least, those first steps in this path.  To examine this point, let’s start with one of the central acts of a mother – breastfeeding.  Sadly it is one of the areas that is consistently affected by the birth experience.  Though it has been on the decline in Western society (perhaps because of these birth experiences?), it provides the nourishment a newborn biologically expects to receive and is one of the fastest and easiest ways to promote bonding between mother and infant[1].  However, certain birth experiences seem to have a negative effect on breastfeeding, for example, having a caesarean-section[2] or labour medications (including epidurals, pitocin, and the various medication used to induce labour)[2][3] (though it is important to note that hospitals who show a commitment to breastfeeding show no difference in breastfeeding success with respect to the use of epidurals[4]).  Furthermore, the possible negative effects on breastfeeding can have further reaching effects as failure to successfully breastfeed (when intended) has been linked with higher risk for postpartum depression[5].  In a more general sense, maternal and infant stress during labour and delivery have also been associated with delayed lactation[6].

While breastfeeding provides a very specific example of the effects of the birth experience, the more general problem associated with a negative birth experience is to do with postpartum depression.  In research on the factors that predict postpartum depression, a negative birth experience and separation from the infant (typically associated with a negative birth experience, such as in an emergency c-section) continue to be major predictors of PPD[7][8][9][10].  In one study, women who experienced high levels of obstetric interventions and who were unhappy with their care during labour were most likely to develop trauma symptoms in line with postpartum depression and trauma[8].  What is the effect of postpartum depression on an infant?  Well, infants with mothers who suffer PPD have worse attachment relationships with their infants[11], their children show worse cognitive outcomes later in life[11][12][13], greater behavioural problems [12], and worse emotional development[13].  Not to mention that these children also show greater cortisol reactivity to stressful situations[14] and other neurological abnormalities[15] which can lead to long-term neurological effects.  Oh, and while I already mentioned that a negative birth experience can affect breastfeeding directly, it can also do so indirectly via postpartum depression[16].

Negative birth experiences have other effects as well.  In one study out of Sweden, it was found that negative birth experiences affected future reproduction[17].  Specifically, the authors found that women who reported traumatic birth experiences 2 months post-partum were significantly less likely to have a second child over the next 8-10 years.  In fact, only half of these women had a second child relative to the greater than 80% of women who had a second child who reported a better birth experience.  This is most likely explained by research showing that while physical pain during birth recedes in memory as time passes, an overall negative birth experience does not seem to attenuate with time, resulting in a long-term negative memory for birth[18].  In preterm children, it has been found that negative birth experiences are related to mother-child interactions post-birth and child behavioural and emotional problems at ages 5-6 years[19].  In other words, the effects of a negative birth experience don’t end with the birth, they can continue for years and affect the very health and happiness of our children we’re supposed to prioritize over everything else.

Given the problems that can stem from a negative birth experience, it should hardly be considered “selfish” to care about how one’s child comes into this world.  Thus taking the time to try and ensure a positive birth experience (whether that means a home birth, a water birth in a hospital, a drug-free birth, a necessary c-section, etc.) for oneself is not only not selfish, but is more considerate of one’s child than feeling bad for feeling bad when one does have a negative birth experience.  Caregivers need to be highly cognizant of the factors associated with a negative birth experience and work to minimize them on a case-by-case basis.  Not all women will have a poor labour because of labour medication, but some will and they are most likely the women who would like to avoid it in the first place.  Being respectful of that is key.  It is also why it is so important to remember that sometimes things will happen that will lead to a negative birth experience, and as such, when a woman does have a negative birth experience, we should not call her “selfish” for being upset by it, even if her child is born healthy, but rather work to help her handle those feelings so that her child can remain healthy and grow to be a healthy and happy child.

 

Did you have a negative birth experience?  How did you handle it?  Did you receive criticism for voicing your discontent?

 


[1] Else-Quest NM, Hyde JS, Clark R. Breastfeeding, bonding, and the mother-infant relationship. Merrill-Palmer Quarterly 2003; 249: 495-517.

[2] Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ.  Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss.  Pediatrics 2003; 112: 607-619.

[3] Waldenstrom U.  Experience of labor and birth in 1111 women.  Journal of Psychosomatic Research 1999; 47: 471-482.

[4] Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris SE, Leighton BL.  Effect of labor analgesia on breastfeeding success.  Birth 1999; 26: 83-88.

[5] Fergerson SS, Jamieson DJ, Lindsay M.  Diagnosing postpartum depression: can we do better?  American Journal of Obstetrics and Gynecology 2002; 186: 899-902.

[6] Dewey KG.  Maternal and fetal stress are associated with impaired lactogenesis in humans.  The Journal of Nutrition 2001; 131: 3012s-3015s.

[7] Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J.  Risk factors and predictive signs of postpartum depression.  Journal of Affective Disorders 1998; 49: 167-180.

[8] Reynolds JL.  Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth.  Canadian Medical Association Journal 1997; 156: 831-835.

[9] Creedy DK, Shochet IM, Horsfall J.  Childbirth and the development of acute trauma symptoms: incidence and contributing factors.  Birth 2000; 27: 104-111.

[10] Waldenstrom U, Hildingsson I, Rubertsson C, Radestad I.  A negative birth experience: prevalence and risk factors in a national sample.  Birth 2004; 31: 17-27.

[11] Murray L, Fiori-Cowley A, Hooper R, Cooper P.  The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome.  Child Development 1996; 67: 2512-2526.

[12] Grace SL, Evindar A, Steward DE.  The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature.  Archives of Women’s Mental Health 2003: 6: 263-274.

[13] Murray L, Cooper PJ.  Effects of postnatal depression on infant development.  Archives of Disease in Childhood 1997; 77: 99-101.

[14] Halligan SL, Herbert J, Goodyer I, Murray L.  Disturbances in early morning cortisol secretion in association with maternal postnatal depression predict subsequent depressive symptomology in adolescents.  Biological Psychiatry 2007; 62: 40-46.

[15] Jones NA, Field T, Davalos M.  Right frontal EEG asymmetry and lack of empathy in preschool children of depressed mothers.  Child Psychiatry Hum Dev 2000; 30: 189-204.

[16] Dennis C-L, McQueen K.  The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review.  Pediatrics 2009; 123: e736-e751.

[17] Gottvall K, Waldenstrom U.  Does a traumatic birth experience have an impact on future reproduction?  BJOG: An International Journal of Obstetrics & Gynecology 2002; 109: 254-260.

[18] Stadlmayr MW, Amsler F, Lemola S, Stein S, Alt M, Burgin D, Surbek D, Bitzer J.  Memory of childbirth in the second year: the long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers.  Journal of Psychosomatic Obstetrics & Gynecology 2006; 27: 211-224.

[19] Latva R, Korja R, Salmelin RK, Lehtonen L, Tamminen T.  How is maternal recollection of the birth experience related to the behavioral and emotional outcome of preterm infants?  Early Human Development 2008; 84: 587-594.