Women like Daniela go home from the hospital with a baby, a surgical wound, and the memory of a birth experience that did not go as planned. At best, the unexpected C-section is a disappointment and a significant physical setback for a new mother. She may feel upset that she could not give birth vaginally like she imagined, and she now has to recover from major surgery while also taking care of her new baby, but she feels blameless and trusts that the right decision was made by her doctor or midwife. At worst, and all too often, the C-section is linked in a woman’s mind with the terrain of self-worth and agency. She may feel her body failed her, or that she let herself and others down, or that her wishes were not respected. She may reconstruct in her mind the hours of labor and wonder if she shouldn’t have chosen to have the epidural, thinking maybe that choice is what ultimately led to the C-section because it may have slowed labor. She may feel angry or sad that she couldn’t clutch her baby to her chest immediately. She may be reeling from the terrible fright of being rushed into surgery, if it was an emergency and the baby’s well-being was in question. All that was true for Daniela.
Settling in back home with her new baby girl, Daniela struggled to make peace with her birth experience. As she sifted through her fear, anger, disappointment, and self-blame, she looked to her husband to bear witness to her feelings. He couldn’t. It hurt him too much, I suspect; he just wanted her to feel better, so he encouraged her to “let go” and focus on their beautiful daughter and the fact that everyone was healthy and alive. His inability to be with her in her feelings about the birth became just one of many divides between them in their new lives as parents.
Talking to an acquaintance and mother of three recently, I was forced to pinpoint what, exactly, I believe about the lasting impact of childbirth. This woman has had three uncomplicated vaginal births. She is the picture of the “earth mama,” a natural beauty with long blond hair and a baby at her breast, a toddler in an Ergo on her back, and a school-age child holding her hand. She was talking about a friend of hers who had just had a terrible birth experience, and she said, “I just wish she could fast-forward to the time when she won’t care about how her baby came into the world. We focus so much on preparing for childbirth, and we don’t realize, while we are pregnant, how the birth experience is just one small blip on the screen of motherhood.”
On one hand, her words rang true and wise. There was a part of me that stood in wholehearted agreement with the idea that birth itself is nothing compared with the endless stream of challenges that motherhood brings.* And I have seen women with even the roughest birth stories put those stories well behind them, with humor and a sort of “what was I upset about?” attitude now that they are immersed in the un-glorious, unrelenting business of parenting. Whatever is hard and less than ideal about birth, it eventually pales in comparison to what is hard and less than ideal about motherhood.
On the other hand, a part of me resisted my acquaintance’s conceptualization. Although, in time, the conscious memory of birth usually becomes just a small blip on the screen, the birth experience is anything but insignificant. It is a lived, felt experience that is remembered forever in the body and the psyche. It has real implications for how a woman copes physically and psychologically in the postpartum period, and even how she sees herself long into the future. All these years later, I still draw on my experience of healthy, natural, not-scary deliveries of my sons when I need a reminder of my own strength and competence. The experience of childbirth has stayed with me, and in my case, that’s a good thing. But what about when troubling, disappointing, even traumatic birth experiences stay with the women who had them? What about the psychological impact of perceiving yourself as a failure at motherhood—because you “failed” at childbirth—right out of the gate? And beyond the repercussions that are consciously apparent to these women—for instance, a blow to self-efficacy or a mistrust of medical professionals—what about the unconscious repercussions? What about what the body remembers?
In his tremendously important book The Body Keeps the Score, trauma expert Dr. Bessel van der Kolk shows us that our bodies are living archives of everything we have ever experienced. Even in the absence of conscious mental memories of certain events, the body “remembers” and reacts to new situations based on what it recalls about the past. This is especially so in the realm of trauma. When we have faced horror or prolonged neglect or the threat of death or great harm (to ourselves or someone we love), our bodies never forget. These traumatic experiences leave an indelible mark on our physiology, altering our way of moving through the world as embodied beings.
When I was sixteen years old, I underwent reconstructive jaw surgery to correct a problem with my bite. In the recovery room moments after the surgery was complete and my jaw had been wired shut, my blood oxygen level began to plummet. Due to unexpected swelling in my nasal passages from the removal of my adenoids during the surgery, I could not breathe through my nose, and I could not open my mouth to gasp for desperately needed air. In a panic, the doctors snipped the wires that were supposed to be there for six weeks and manually opened my mouth so I could breathe.
I remember none of this. I was still under anesthesia, and the whole experience was just a story told to me once I was alert enough to listen to the medical team and my parents tell me how things had gone with the surgery. From my conscious first-person perspective, I might as well have been hearing the story of something that had happened to someone else; my reaction was something along the lines of “Wow, that sounds really scary.” It took me over twenty years to realize that my body was there the whole time, even if my consciousness was not. My body knows very well that this happened to me, not someone else. Until reading van der Kolk’s The Body Keeps the Score, I never stopped to wonder why I feel a pronounced ache and tension in my jaw every time I feel anxiety or fear. I don’t hold tension in my jaw in general; stress doesn’t cause me to clench my jaw, I am not a teeth grinder at night, and I’m not prone to headaches. But in moments of acute anxiety or fear, suddenly my jaw clamps shut so tightly, it might as well be wired shut. That’s my body remembering. That’s my body associating profound fear and panic—from being unable to breathe—with immobility in my jaw.
Each of us has a story like this, if not several. The most dramatic moments of our lives are encapsulated in our bodies. Our bodies remember long after our minds forget. Our bodies remember even when we want to forget. Our bodies remember even—perhaps especially—if we never formed a conscious verbal memory of the experience in the first place. In other words, when those dramatic moments are also traumatic, dissociation is a common reaction. We cope with the unbearable by removing ourselves psychologically, and the results are fuzzy, distorted, or even nonexistent memories of what happened. But it turns out that sometimes the faintest, fuzziest of memories can have the most impact. In her bestselling memoir The Liars’ Club, Mary Karr writes about her dissociation from her own childhood trauma:
When the truth would be unbearable the mind often just blanks it out. But some ghost of an event may stay in your head. Then, like the smudge of a bad word quickly wiped off a school blackboard, this ghost can call undue attention to itself by its very vagueness. You keep studying the dim shape of it, as if the original form will magically emerge. This blank spot in my past, then, spoke most loudly to me by being blank. It was a hole in my life that I both feared and kept coming back to because I couldn’t quite fill it in.3
These words bring to mind the relationship many women have with their traumatic birth stories. The worst moments—like when they feared their baby might not survive—are often removed from conscious memory. That is an adaptive coping mechanism; it’s too painful to bear, so we just don’t bear it. But it is through that removal, that disavowal, that the moments retain such power. We cannot fully forget, and we cannot fully remember.
A similar process unfolds even when the birth experience is not traumatic per se, but just difficult, unexpected, or deeply disappointing. Wishing away th
e negative emotion, as women so often attempt to do (either of their own accord or at the urging of their loved ones), prevents its resolution. We cannot metabolize the difficult experience and integrate the memory of it into our life narrative if we do not give it room to breathe and be felt in the first place. And without the chance to voice and work through perceptions of failure and inadequacy in childbirth, those feelings might follow women into the rest of motherhood, where there are already countless opportunities to doubt and question ourselves.
This is all the reason we need to give women both the permission and the resources required to attend to their bodies, their minds, and their hearts in order to recover from difficult births. “Permission” means allowing women to be distressed about their distressing birth experiences. It means we stop telling ourselves and one another that the outcome—a healthy baby—somehow negates or justifies the scary, disempowering, or otherwise upsetting birth experience that culminated in that healthy baby. It means we stop assuming that a woman who is fixated on her upsetting birth story must have postpartum depression and should probably take medication. It means partners, husbands, parents, in-laws, nurses, midwives, lactation consultants, coworkers, and friends stop encouraging new mothers to move on from whatever disappointments they have about their birth story, and start encouraging them instead to tell that story as many times as they need to, to as many pairs of supportive ears as they can find.
The stories of Daniela and Natalie highlight what happens when women aren’t given time and permission to feel their feelings about bad birth experiences. And difficult, or downright terrible, birth experiences are alarmingly common. Roughly one-third of births in the United States are caesareans.4 Yet research conducted by the World Health Organization indicates that maternal and child health benefits do not increase as the C-section rate increases beyond the 10 to 15 percent mark. This means that a large proportion of C-sections performed in our country are medically unnecessary. They result from the practice of defensive medicine, and from our “fee for service” health care model in which the more interventions and procedures medical providers use, the more they get paid. Premiums for malpractice insurance are especially high in obstetrics, and the pressures imposed on obstetric providers to practice “legally defensible medicine” often result in medically unnecessary interventions, including C-sections. Among the 1.2 million American women undergoing C-sections every year, there will likely be a range of big, bad feelings about how the birth went, whether the surgery was medically necessary or not.
There Is No Such Thing as “Bouncing Back” After Birth
Regardless of whether the birth itself went well, every woman needs a great deal of practical and emotional support in the early weeks and months of motherhood. Unfortunately, she is unlikely to receive the care she needs. Babies safely ensconced in their arms, new mothers in the United States enter into a postpartum culture of caring and support that can only be described as woefully inadequate.
Elsewhere in the popular and scholarly literature, the sociological, political, and economic aspects of this issue have been explored in depth. My hope is to illuminate the psychological repercussions of this inadequate culture of caring for new mothers in the United States. It’s bad enough for women’s short-term welfare that the childbirth experience itself is so fraught, and that the postpartum window during which rest, recovery, and support are sanctioned is so outrageously brief. But there is also the very real, and poorly understood, longer-term impact. There is a ripple effect in which our uniquely restrictive, high-pressure, low-support culture of birth and postpartum recovery sets women up to struggle in so many ways, both internally and within their relationships.
Seven weeks into my new role as a mother, I wrote:
Today Noah is seven weeks old. Supposedly the official postpartum period ended one week ago, meaning that now my life and my body are supposed to be back to normal. I’d like to know who decided that a woman is only “postpartum” for six weeks. An arbitrary cutoff like this carries with it all sorts of implicit messages like that the hard part is over, that one shouldn’t still be on the verge of a nervous breakdown, that one’s adjustment to life as a mother should be well under way with only a few minor kinks to work out. So, if a new mom is still struggling on a daily basis and feeling significantly out of sorts, she gets to add to the mix a sense of inadequacy and shame for not being “all better” yet.
I am certainly not “all better” yet. Today has been an extremely challenging, exhausting, nerve-racking day like so many others I’ve had in the last seven weeks. Noah won’t stop crying unless I feed him, and when I feed him, he fusses and then spits up, suggesting he really wasn’t hungry and he’s just getting overly full. My nipples are sore again from this increase in the frequency of his feedings. The house is a mess and I have had the usual experience of adding more tasks to my to-do list instead of crossing any off. I feel fat. Nothing in my regular wardrobe fits me, and my maternity clothes make me look dumpy—not to mention it just feels miserable to still be wearing them when I’m not pregnant anymore. My back aches and I’m carrying so much tension in my body that I’d kill for a massage, but where will I find the time or the money for that?
It was so easy to rattle off this long list of complaints at the seven-week mark, and that’s a good indication of just how much I was still struggling at that point. But the real problem was my sense that I should no longer be struggling so much. When you are six weeks postpartum, you visit your midwife or OB-GYN, and assuming all looks well in the parts that were involved in giving birth, you are given the green light to have sex again. Do what? It is the rare woman who actually feels like having sex when she is caring for a weeks-old infant,* but I digress. Attached to the six-week mark are so many milestones that imply the adjustment period is over. For most working women, paid maternity leave ends at this point. Day care centers usually accept babies six weeks old but not younger, another suggestion that at this point a mother can begin to “move on” and return to the facets of her life that have been put on hold.
Author Hillary Brenhouse writes,
In the [United] States, a woman is looked after, by herself and by others, only so long as her body is a receptacle for the baby. Attention then transfers to the needs of the infant. To ask for respite is to betray not only weakness and helplessness, but selfishness. You should be prepared for the emotional and physical demands of your new motherly role and you should like them, too.5
The message being sent to new mothers within this unforgiving postpartum culture is, essentially, “You should be able to handle this yourself and bounce back quickly.” When women struggle on either or both fronts—when they find themselves in need of support and/or they find it’s taking them quite a long time to “bounce back”—they figure something must be wrong with them. Brenhouse writes, “For the expectant, we issue reams of proscriptions—more than can reasonably be followed. We tell them what to eat and what not to eat. We ask that they visit the doctor regularly and that they not do any strenuous activity. We give them our seats on the bus. Finally, once they’ve actually undergone the physical trauma of it, their bodies thoroughly depleted, we beckon them most immediately to rejoin the rest of us.”
Most immediately, indeed. Three weeks after giving birth to my first child, I was in the classroom, teaching. Why? Because it was the first day of the semester, of course! At least I had three weeks to recover before I had to show up to work! My timing was even more fabulous with my second son, whose birth was wedged right smack in the middle of a semester. That meant I was grading papers and exchanging emails with students while I held a days-old infant in my arms. I had taken great pains to leave my students in good hands for the couple of weeks I wouldn’t be able to physically be in the classroom; I mapped out assignments and activities and exams in advance, and I lined up several of my gracious colleagues to substitute for me as best they could. But when classes are under way and you are the professor for those classes, no amount of adv
ance planning for an absence leaves you truly “off duty.” I was still responsible, and I was orchestrating the classes and tracking the details of them from my computer at home, instead of devoting my attention exclusively to my new baby, my recovering body, and my family.
I want to be sure to convey that I was granted generous maternity leave, and that nobody forced me into the precarious work/newborn juggling acts I just described. With both of my sons’ births, I got the equivalent of a semester off from teaching. But both times, the leave time was a complicated, pieced-together arrangement involving teaching at least one class while transitioning to having a new baby. I would say to people, “I’m only teaching one class this semester instead of three because I have a brand-new baby” (when Noah was born), or “I’m teaching two classes this semester instead of three because I’m going to have a baby halfway through” (when I was pregnant with Quinn). These are accommodations, to be sure, and I was grateful for them, but they are a far cry from the ideal picture of a new mother nestled in at home with her infant, free of work responsibilities until many months later. I thought I was lucky compared to a lot of other new moms, and in terms of being able to keep my salary intact, I truly was. Viewed from a different angle, though, this arrangement stands in direct opposition to the concept of “leave.” I did not leave my work responsibilities behind at all. It was practically guaranteed that I would fail to take adequate care of myself in that early postpartum period. And this, I’m afraid, is the norm in our society.
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