A VBAC (vaginal birth after cesaran) I attended a number of years ago ended up in c-section. While there are so many what-ifs in these kinds of scenarios, it is not my place to tell the mother what she should or should not do. The choices made were all hers, and I felt comfortable about that. However, she was struggling to deal with it all, and I’m not sure she would have chosen to attempt a VBAC had she known how it would have ended up. On the other hand, she was mourning her loss of a vaginal birth. So as her doula, I worked on the best way to help her deal with her loss, and I remembered a model to help people understand and work through traumatic experiences.
This particular model was created by Elizabeth Kubler Ross, a doctor that pioneered the work of dealing with grief. She is best known for her Five Stage Model of Grief. She applied this to death and dying , but it can easily be applied to any sort of traumatic or difficult situation we face in life.
Here’s a good description of why this applies to birth trauma.
This makes the model worthy of study and reference far outside of death and bereavement. The ‘grief cycle’ is actually a ‘change model’ for helping to understand and deal with (and counsel) personal reaction to trauma. It’s not just for death and dying.
This is because trauma and emotional shock are relative in terms of effect on people. While death and dying are for many people the ultimate trauma, people can experience similar emotional upsets when dealing with many of life’s challenges, especially if confronting something difficult for the first time, and/or if the challenge happens to threaten an area of psychological weakness, which we all possess in different ways.
One person’s despair (a job-change, or exposure to risk or phobia, etc) is to another person not threatening at all. Some people love snakes and climbing mountains, whereas to others these are intensely scary things. Emotional response, and trauma, must be seen in relative not absolute terms. The model helps remind us that the other person’s perspective is different to our own, whether we are the one in shock, or the one helping another to deal with their upset.
The five stages she talks about are denial, anger, bargaining, depression, and acceptance.
I wanted to start by talking about where we want to arrive at in our grieving process. It is absolutely acceptable to go through all the stages of the process, like anger or depression, but we don’t want to stay there. No one wants to be depressed forever or angry forever. So the challenge is allowing those emotions to work through us and eventually get to what is called the Acceptance stage.
This word can be a little confusing because we tend to think of acceptance as being ok with some of the bad things people might have done. That is not the case, though. Acceptance means you have accepted the reality of the loss and are at peace with yourself. It does not mean that you liked what happened, but that you are ready to move on. By accepting something, you no longer harbor feelings of anger, guilt, or depression, but have moved on to become more productive with your emotions.
I often see this happen as people start to devote a portion of their lives to helping other woman navigate the maze of pregnancy and birth. Woman also move on to show more compassion or caring for others around them, sometimes not even related to birth. I found myself doing this after my own miscarriage. I found a lot of healing in being able to help other women work through their own feelings during a miscarriage. In particular, I remember a woman that I was assigned to take care of who had a miscarriage at 16 weeks, the same time I had mine. I found myself being able to talk to her about the emotions and difficulties that go along with that. While it is hard, I find a lot of satisfaction in this.
Another more minor experience from my own life was the birth of my last son. With all my other babies, I was able to hold them immediately. With my last son, the hospital staff took him away just because it was protocol. I feel like I went through a bit of the grieving process with his birth. Now, I make sure that I know what the mother expects and how she wants things to go at her birth. Again, being there for other woman has helped me reach acceptance. My story also talks about the essential role of forgiveness, which I think is another misunderstood word, but very beneficial.
Key to all of this, is that we allow ourselves the time to reach this stage. It does not happen all at once, and sometimes we come and go. We need to remember to love ourselves enough to allow ourselves the time to grief what was loss, whether it was something big or small. Sometimes we may even need professional help to work through our grieve. Don’t be ashamed to reach out for help.
When Elizabeth Kubler-Ross first started working on the stages of grieving, she lived in a time when it was not deemed acceptable to grieve for the loss of loved ones. I feel like we have the same mindset in regards to birth trauma. This makes it hard because grieving for the loss of your ideal birth seems strange or wrong to some people. But be assured, it’s not. Many, many women grief the loss of what they wanted during the birth, and they grief how they were treated.
As an example, a few years ago, I spoke at a symposium about birth culture. Afterwards there was a question and answer time. An elderly gentlemen, probably around 80, stood up and started crying. He explained how traumatic it was for him to not be present at the births of his children and wondered if that at least had changed. My heart went out for this man that had been holding on to this grief for years and more than likely never felt like he had permission to grieve for something like this.
So, I give you permission to grief the big and the small. But I also hope to help women work through this… to allow the emotions to wash over them and renew them. I hope that we may all work through this grieving process and come to a spot were we can accept where we are at and be at peace with ourselves and others.
Other topics you may be interested in:
blog post: Childbirth Choices: Epidural
webinar: Grief and loss in childbirth
Kubler-Ross, Elizabeth. (2011). On Death and Dying. Simon and Shuster.