Moments before her emergency C-section, with the anesthesia flowing, Julie French realized she couldn’t breathe. She tried to communicate what was happening, but medical staff brushed off her panic. She was sure she would die. “I just remember closing my eyes, thinking I was going to code on the table,” she recalled. “And then I woke up being wheeled into the room where my baby was.”
Although the surgery had gone fine, French awoke to a prolonged nightmare. A wet tap — an epidural complication in which spinal fluid leaks out — left her with debilitating headaches unless she was flat on her back. French had always feared that hardware in her spine from an earlier surgery would cause problems with an epidural or anesthesia, but doctors had looked at her X-rays and told her not to worry. Her Boston-area hospital discharged her while she was still in too much pain to get out of bed. At home, she listened to her daughter’s cries, unable to help and overwhelmed by guilt.
A week after delivery, her husband’s online research turned up a procedure that could help. They went to a different hospital, and she walked out feeling physically like herself again. But mentally, she hasn’t been able to shake off what happened four months ago at the hospital she’d trusted. “It’s still really hard to talk about,” she said. “It felt like they let me down.”
That feeling isn’t rare. A 2019 study of more than 2,100 U.S. mothers found that 1 in 6 reported “mistreatment” during childbirth, including being ignored, threatened or berated, or losing their autonomy. Women of color were even more likely to report such experiences.
It can be hard for parents to speak up after a difficult childbirth. But a small number of health care providers and others are beginning to encourage them to speak up — and to provide feedback about their experiences. In some cases, the process is helping give parents closure, and may even bring about change. In other cases, looking forward may prove better than looking back.
An especially difficult childbirth can lead to post-traumatic stress disorder. A 2011 study of U.S. mothers found that 9% met the diagnostic criteria for PTSD after childbirth. Dr. Daniela Carusi, director of the surgical obstetrics and abnormal placentation program at Brigham and Women’s Hospital in Boston, began a program to screen mothers and connect them with psychiatrists if needed after she realized many of her patients were developing PTSD symptoms.
PTSD symptoms often don’t show up until six months after birth, said Carusi. “So the fact that prenatal care usually stops at six weeks is not really serving the needs for these patients.” Carusi, who specializes in placental complications that can cause severe bleeding, has seen fathers and partners traumatized after a birth too, even in cases where the mother isn’t.
A traumatic childbirth can happen even when medical providers do everything right. But if parents have questions or concerns about their delivery, Carusi encourages them to write down their thoughts — a step that she says can help them sort through their feelings. And for the hospital, a patient’s feedback is most useful if it’s written.
Next, parents can make an appointment to talk with the doctor or midwife who delivered their baby. Hearing a detailed explanation of what happened at the birth can be helpful to patients, Carusi said.
Ananda Lowe, a Boston-area doula and author, never spoke to her own midwife after having her daughter nine years ago. During that delivery, her midwife gave Lowe an episiotomy she didn’t consent to. Lowe spent years wishing she could talk to the midwife about it, but never did. “I did not know how to give feedback or share my perspective with my own provider, even as a professional of 15 years,” Lowe said. Then she shared her story publicly last year at an event focused on ways to improve the childbirth experience. “It felt like a tremendous unburdening for me,” Lowe said.
Lowe, along with another member of her doula group, Dena Carmosino, held a workshop over the phone last month in which they led a small group of mothers in a writing exercise and group discussion about their own experiences.
Among the participants was Vanessa Prohodski, also a doula. Prohodski said her delivery got off to a chaotic start when she and her husband arrived at a hospital emergency room to find it unstaffed. Later, when Prohodski learned she would need a C-section, she asked the doctor for a clear surgical drape so she could see the baby being born, and to hold the baby right away if it didn’t need medical attention. (The World Health Organization recommends that newborns spend their first hour of life in skin-to-skin contact with their mothers.)
“She said, ‘Absolutely!’” Prohodski recalled with a wry laugh. “Then when it was time, nothing like that happened.” An opaque drape stayed up. Staff whisked away the baby, saying she was in shock. The doctor simply walked off after she finished stitching up Prohodski, who never saw her face again.
Prohodski estimates it was half an hour before she got to hold her daughter to her chest. When she requested her medical records later, she saw that the baby was born with a near-perfect Apgar score of 9 — no mention of shock. “I shouldn’t have been separated from her,” Prohodski said. “We needed to be together.”
Although she’s been in touch with a patient advocate at the hospital, Prohodski hasn’t gotten answers about why her baby was taken away, or why the ER was empty when she arrived. Now 10 months out from delivery, she’s working on writing a letter to the people who were present at her birth. The writing exercise in the workshop was helpful, she said. “English is not my first language, so it’s also a little challenging for me to put what my feelings are onto paper.”
There are some tools to help. An organization called Improving Birth, for instance, offers an “accountability toolkit” for filing complaints, and Postpartum Support International, provides mental health resources.
Carusi said that when providers screw up, patients shouldn’t hesitate to let them know. “I would love more feedback!” She said that many years ago, feedback from patients led to a “major culture change” in how her hospital handled postpartum care; the changes included acknowledging that healthy new mothers might not want to be treated like sick hospital patients. If parents get a defensive response to their feedback, Carusi encourages them to take it to someone else. “I think that’s the best way we can make changes.”
Dr. Brownsyne Tucker Edmonds, an OB-GYN at Indiana University School of Medicine who researches decision-making in childbirth, doesn’t think all patients who have had negative childbirth experiences should seek meetings with their providers. “If they really experienced it as a trauma, then it could potentially be re-traumatizing,” she said. She does recommend that patients talk to their new doctors and midwives about traumas they’ve experienced in the past, so patients and providers can work together to avoid any more harm.
Tucker Edmonds was one of the authors of a 2016 statement by the American College of Obstetricians and Gynecologists about consent in pregnancy and childbirth. The statement says that a mother has the right to refuse treatment, even if medical providers feel ethically conflicted because of their concern for a mother’s or baby’s health. “We have to respect that, and recognize that ultimately these are their decisions to make,” Tucker Edmonds said.
She encourages mothers to work with doulas — but recommends they introduce the doula to their doctor or midwife sometime before they’re actually in labor. That can help ensure the relationship between the doula and the rest of the health care team isn’t antagonistic. “We’re all on the same team,” Tucker Edmonds said, and open lines of communication in all directions are important.
Julie French did talk on the phone with someone in her hospital’s patient relations department, but didn’t get any satisfying answers. “I don’t know if I expected it to be a more healing process. But it didn’t feel that way,” she said. “It was, oh, well, these things happen, but I’ll forward your concerns on.” She’s not sure if she’ll keep trying to make her voice heard.
Regardless of whether Prohodski ever gets satisfying answers from her hospital, she said her experience has changed how she works with pregnant mothers. She’s not ready to attend any births at the hospital where she delivered, but she has a few clients who will give birth at other sites in the coming months. She’s trying to listen to them more, and to consider how people’s past traumas might still be affecting them, she said. “I came out of that birth like a hundred times better doula than I was before.”