Breastfeeding after a Traumatic Birth

First Feeds

The quiet, early hours of a new day envelop me. I am exhausted from two days of hard labouring and groggy as I struggle upwards to full consciousness after the arrival of my son via an emergency caesarean under general anaesthetic. I am in a dark maternity ward, a midwife and my husband looking over me, as I hold my baby. I am trembling and woozy.

The midwife encourages me to try the first breastfeed. He undoes my gown for me, and moves the various wires and monitors strapped to my body so my little boy can snuggle in close to my breast. I whisper to my little one: “It’s time to have some nourishment now. We’ll do our best, but it may take a while to get used to.”
Holding the baby, and my breast (I am still too drugged to manage this), he brings them together. Bodhi- my son- opens his mouth wide and the midwife helps him to attach himself. Almost immediately I feel a delicious tugging and sucking. How amazing my two hour old baby knows inherently what to do!

“There you go, you’re doing so well!” I coo. After a little while, though, he falls off, and we have trouble attaching again. I am nearly falling asleep and so is he. “We’ll try again first thing in the morning,” the midwife reassures me as I fall asleep to the sound of my husband trying to get comfortable in the chair in the corner, the little cot by his side.

True to the midwife’s word, he is back as the sun begins to creep into the window. My husband leaves to get some things from home and after helping me sit comfortably and attach Bodhi to my breast, the midwife leaves us in peace. I sit there for half an hour, as my baby sucks away vigorously, regaining faith in the body that I felt had failed me.

Birth Trauma is more common than you may realise

Birth Trauma is a general term for a range of undesirable psychological consequences following childbirth- this may include Post Traumatic Stress Disorder or the symptoms thereof. The birth process, whilst natural, can often be traumatic, through the unpredictability of the event, deviations from what is considered to be a ‘normal’ birth are common, and some births may be life threatening to mother and/or baby .

Post traumatic stress disorder (PTSD) is one condition linked with birth trauma. PTSD is an anxiety disorder which is developed after exposure to a traumatic event where horror, fear and/or helplessness are experienced. Symptoms and effects can include nightmares and flashbacks, intrusive thoughts, emotional numbing and character restriction, psychological distress in response to internal or external cues that symbolise the event, physiological reactivity to these cues, avoidance of stimuli associated with the trauma, detachment, sense of a shortened future, hyper vigilance and other symptoms . Obviously, this creates many problems for the new mother.

In one study (Alcorn, 2006), 45.5% of women had traumatic birth events as classified by the DSM-IV (a diagnostic tool for psychological conditions)-that is, partial PTSD, and 53.8% reported their birth as traumatic when asked “Was your birth traumatic?” This study also found that 6.3% of women had full PTSD at 3 months post partum .

Another study (White, Matthey, Boyd and Barnett, 2006), found that co morbidity of PTSD and post natal depression is high .

Maternal distress following childbirth can affect the effectiveness of the functioning of the maternal role, depression and anxiety, adaptation to motherhood, self perceptions, lifestyle, and quality of personal relationships, among other things.

Birth Trauma and Breastfeeding

There is, sadly a lack of information and research into the effect of birth trauma on establishing and maintaining a breastfeeding relationship. However, it is evident that the two are related, but given an appropriate amount of attention and support, this can be effectively addressed and dealt with.

In the most prominent article in this area, Cheryl Tatano Beck, Board of Trustees Distinguished Professor of Nursing, has found that birth trauma can lead women down to very different paths: it may propel them to persevere with a breastfeeding relationship and regain a sense of “motherliness”, or it may impede breastfeeding through trauma symptoms such as detachment from the child and intrusive flashbacks .

Beck suggests that intensive one-on-one support is needed to assist the mother breastfeed successfully. A woman experiencing and/or recovering needs to look at her support network to find such support- perhaps the local ABA group, a lactation consultant, a doula, a counsellor or a well informed GP or child health nurse, or more likely, a combination of the above, can assist.

Francesca Naish and Janette Roberts, in their book The Natural Way to Better Breastfeeding state “a natural, unmedicated birth, unlimited skin to skin contact, the freedom to explore your baby’s body, and for your baby to come to the breast in his own time and for the bonding between you to take place without interruption will all ensure a wonderful start for a trouble free and continuing breastfeeding relationship.” They go on to point out that many of the medical procedures that can accompany delivery of a baby can impede bonding and make establishing breastfeeding more difficult.

These practices, such as immediate skin on skin contact, as well as other practices such as rooming in and breastfeeding on demand are all part of the requirements hospitals need to adhere to when accredited under the Baby Friendly Hospital Initiative, designed to maximise the ability of women to successfully breastfeed their infants .

Physical pain may be a factor in breastfeeding after a difficult birth. For example, the Australian Breastfeeding Association suggests that after a caesarean birth, breastfeeding may be more comfortable by putting a pillow on your lap for extra support, feeding whilst laying down, or feeding the baby in the underarm (or “twin”) position, with the feet pointing towards your back. These kinds of positions are not limited to helping those who have had a caesarean delivery; they may be more comfortable for women who have sustained injury and/or tearing after a vaginal delivery .

If the baby and mother are separated for whatever reason, colostrum may be expressed to ensure the baby still receives amazing nutritive benefits. Avoid artificial teats, as this can cause nipple confusion in the baby .
To strengthen mother-baby bonding, the Australian Bush Flower Essence Bottlebrush may be used. Boronia is useful for flashbacks, and Waratah can assist in alleviating depression. Similarly, Bach Rescue Remedy may assist in dealing with anxiety that the combination of PTSD and breastfeeding may elicit .

Activities that facilitate for close contact and bonding, such as massaging and bathing with your baby, wearing your baby in a sling, and sleeping with your baby may also facilitate breastfeeding.

To deal with flashbacks and other symptoms of Post Traumatic Stress Disorder, both consultation with a empathic GP and counselling- which can offer cognitive tools to overcome such symptoms- is highly recommended.

The path to successful breastfeeding may have extra obstacles to the woman recovering from birth trauma. However, breastfeeding is so important in healthy development in the child, and the woman may need support in finding the resources to assist her breastfeed successfully. Encouragement and practical help from a partner, mother, friend or health care provider, such as getting details of local ABA meetings, providing complementary therapies such as Bush Flower Essences, or simply holding the mother’s hand whilst she breastfeeds (if indeed, she isn’t “touched out”) can play an important role in the health of the child.

Breastfeeding- A Year On

Bodhi is now a year old. Breastfeeding Bodhi, whilst it has had its challenges, has been a delight. It has also been integral to both forming a strong bond which was jeopardised by a traumatic birth, and to feeling trust in my body and my ability to mother again.

Birth trauma made me feel guilty, resentful and sad. It made me think that my body was faulty, that I wasn’t a “real woman” and that I had given my son a terrible start to life (thankfully, after much proactive work, I have resolved these issues).

Breastfeeding, on the other hand, made me feel wonderful. I felt womanly, maternal and natural. I felt a commonality with all mothers worldwide and knew I had made the best decision I could for his health and wellbeing (not to mention my own!).

Staring into his eyes that first morning was only the first of thousands of like stares. And every time I am feeling overwhelmed by life and its dramas, I can sit down and gaze into his eyes whilst I feed him. It doesn’t take long for me to get my priorities right again.

Samantha Cambray is the owner of Birth Healing, a forum  community for support, healing, growth and action after birth trauma