DISENFRANCHISED GRIEF AND THE IMPACT OF ISOLATION IN THE POSTPARTUM
By Jennifer Summerfeldt, CCC-Q, MACP, CTRC, CGSC
first published on MaternityCare Consumers of Alberta Network
(MCAN)’s Blog on October 1, 2017
There is a rising dilemma experienced by many mothers during the postpartum period, even years after birth, which is rarely discussed within the childbirth communities, academic journals, or amongst birth professionals. Sure, it may be referenced a few times here and there, and yes, there is public acknowledgement of the terms, “Disempowered childbirth,” or, “Traumatic birth,” but what are the consequences of such occurrences? The predicament I am referring to is the effects of disenfranchised grief and social isolation due to unplanned childbirth interventions which contributed to an unexpected negative or traumatic childbirth experience. This article aims to unpack the concept of both of those terms, the consequences of such, and how we (mothers and community members) can attempt to address this problem.
It is important to note that the event (what happened during the pregnancy, birth, and postpartum) and the individual perception of the event are both contributing factors that influence how well a mother integrates, makes sense of, and resolves what happened during her childbirth experience. Two mothers could experience a similar unfolding of events and each of their perceptions of that experience will be different, which means that the impact of the experience will be stored differently within their nervous system and brain. How we perceive an event is influenced by many factors such as and not limited to: past events, family and childhood experiences, beliefs, current events, cultural and community beliefs, capacity for dual awareness, state of wellbeing, and overall mental health before the event occurred. Thus, the impact of a mother’s childbirth experience is unique with a dynamic interplay of both internal and external influences, all of which influence how she thinks, feels, and responds in the postpartum.
Disenfranchised grief
Research suggests that the quicker a mother can process and integrate what has occurred the less likely she will present with symptoms of postpartum mood disorders (1,2). One of the ways mothers integrate highly charged emotional information is through expressed grief. Thus, it is imperative that a mother can process and integrate what happened during the continuum of her childbirth experience. Grief is a state experience that airs itself in response to a loss or death. It encompasses a multitude of emotions and includes non-linear stages of expression such as denial, anger, shock, guilt, shame, sadness, confusion, and blame. Disenfranchised grief is a type of unacknowledged grief that occurs when culture, family, and community lack understanding and support towards the aired grief (3). In such conditions a mother feels alone and confused by her emotions when those who matter the most to her, and society at large, do not grant permission to grieve. Most likely, it is not that those around her do not support her grief, but rather they lack understanding or do not know how to offer support. Hence, the grief becomes internalized and suppressed, and an internal negative dialogue takes over, intensifying an already challenging situation. One can imagine that if a mother has unexpressed grief along with a negative mind-set about herself and her birth experience, the likelihood of having difficulty in the postpartum increases, followed by a growing probability of being diagnosed with a postpartum mood disorder. What presents is unexpressed grief and internalized emotional and mental pain that was accumulated by the high degree of physiological stress throughout the childbirth continuum, resulting in no outlet to restore ‘self’ back to homeostasis (a balanced state of wellbeing).
What was lost?
Mothers who had unplanned, unwanted, or unexpected medical interventions at any point throughout the continuum of childbirth can experience the following losses: loss of birth dream and vision, loss of physical health, disconnection to self, loss of financial stability, loss of career or vocation, loss of relationships, loss of spiritual connection and loss of mental faculty. One can imagine the energetic outpouring and attachment that occurs when a mother spends nine months or more imagining, dreaming, learning, anticipating, and planning for a certain kind of childbirth experience. To then be met with a completely different and unexpected occurrence than what was planned or envisioned. It is thus normal to experience disappointment and grief when that expected event turns out to be a different reality than initially planned. Attached to a mother’s childbirth experience are all the thoughts, feelings, smells, sensations, and images. The event is encoded with all of this information causing neurons to fire together, and thus wire together, cultivating what neuroscientists call, “A neural network,” of associated information (4,5,6). If this information was processed as stressful, terrifying, disempowering, painful etc., then the memory will be stored as such.
Within the continuum of childbirth, the stress response could be triggered due to the following: feeling out of control, lacking informed consent and choice, aggressive or unwanted physical exams, violating procedures, strangers as caregivers, overwhelming pain, terror of harm for baby and/or self and intrusive sounds, lights and/or people. Distress, disappointment, and sadness are valid responses to such an experience. A mother who experienced something similar needs the space and encouragement to be allowed to cry, share, express anger and guilt, and come to terms with what happened. Yet, I have witnessed mothers quickly attempt to cover up those feelings of distress. Many experience shame in expressing their grief. There is a sense that it is not okay to feel sad because baby is healthy. This sentiment furthers the gap of isolation.
When a mother is negatively impacted by her childbirth experience, has unexpressed grief, and lacks support to process and integrate the event, her risk of being isolated in her emotions, thoughts, and sensations can escalate. Mothers cannot heal in isolation. As social beings, we heal in relationship to one another (7,8,9). This lack of belonging comes as a surprise to many of the mothers I work with. Allow me to elaborate. Let us look at the scenario of a mother who was planning to have a natural childbirth that resulted in an unplanned caesarean birth. Prior to her perceived negative childbirth experience this mother was a part of the natural childbirth community. Perhaps she joined a natural birthing class, attended a yoga or pregnancy movement class, joined online forums and blogs, talked with other mothers who gave birth naturally, and had a prenatal cohort. During pregnancy there was a sense of belonging, belonging to something meaningful and purposeful. However, the secondary loss of no longer belonging to a ‘community’ of mothers who can relate to one another has added another layer of grief to an already complicated situation. In my experience, these mothers are sitting in silence with their grief, unsure how to integrate what has happened, and questioning where and if they belong to any group. To understand more clearly what I mean by different childbirth ‘groups,’ I believe it is essential to distil what I call, “The different camps of childbirth.”
The different camps of childbirth
Natural Physiological Childbirth
Planned Medically Assisted Childbirth
Unplanned Medically Intervened Childbirth
To begin, I would like to preface this conversation about the different childbirth ‘camps’ with a transparent statement that what I am suggesting is an opinion that is formed through my experiential lens which was informed mostly by the midwifery model of care. That said, much of what I am writing about today is informed by my experience with mothers as I listen to their stories and hold their grief. Throughout the past 18years I have witnessed the tension held between two differing models of care: The Midwifery Model of Care and the Medical Model of Care. Generally speaking, the natural vs medical childbirth debate has been in opposition for years now as it pertains to their approach to supporting childbirth.
Within the viewpoint of the natural childbirth camp, at its core birth is seen as a physiologically normal event. Whereas within the point of view of the medically assisted childbirth field, birth is regarded as an event in which a woman needs to be medically managed in order to give birth safely: suggesting that foundationally the medical view does not trust the body to birth instinctively. Robbie Davis-Floyd, a medical and cultural anthropologist, offers lots of insightful discourse on this topic. Essentially, the point to consider is that each model of care has differing points of view about childbirth.
To reiterate, this is not an article about which camp is better, but rather, to acknowledge that they are different. The difference between these childbirth points of view is what is contributing to a growing number of mothers experiencing disenfranchised grief and feeling isolated during their recovery. Thus, what I am observing is a third camp of mothers who perceive that they no longer belong to either camp. These are the silenced voices of mothers who aligned with the natural birthing community and had a childbirth experience that resulted in an unplanned and most often, unwanted, medically assisted birth. These mothers make up the majority of those who are coming forward to process their grief and trauma associated with their childbirth experience. Until recently, these mothers did not have a ‘term’ to describe what they are experiencing. They have been silenced due to internalized shame, confusion, disconnection, and externalized expectations.
The current problem
It is tolerated that camp A and B will have differing opinions, and often, when these mothers get together they choose to not discuss their differing perspectives and choices of childbirth. Many mothers feel supported within a community of mothers with likeminded parenting and birthing world views, and they rarely venture outside of this cohort. Thus, they are not isolated and they belong. However, mothers from camp C experience something different – they belong to neither camp A nor camp B. They are often afraid to speak about the event, especially if they are grateful for the medical support they received. Rarely do they have space to speak authentically about what happened and how they feel about it, nor do they feel safe to process their grief. I have heard mothers say that they refrain from sharing about their birth experience because they do not want to sound like they are complaining, or they are concerned about negatively impacting another mother’s perception of childbirth, and they sometimes internalize their grief as a sign of weakness.
This lack of belonging, which contributes to the psychological and social isolation I spoke about earlier, can hinder the healing process for such a mother. Given that humans are social beings (10,11,12), the psychological impact of social isolation within the postpartum can be far-reaching. As a therapist, I am observing a common theme amongst mothers who have experienced their birth to be both disempowering and traumatic. One is utter loneliness. The following is a list of observed attributes:
Mothers who do not want to be around other mothers who had a positive birthing experiences because they are afraid of being judged for, “Not doing it right”
Mothers who do not want to hear about other positive births because it is too painful
Mothers who do not want to share about their birth for fear of making other pregnant women afraid of childbirth
Mothers who are angry, but do not feel justified in their anger
Mothers who are grieving, but feel confused about their grief
Mothers who feel that their body failed them or that they did something wrong
Mothers who stop going to mothering groups because they feel they can no longer relate
Mothers who rarely tell other mothers that they are in therapy
Mothers who do not feel supported by their primary partner or family members
Mothers who are hiding their deeper truth
Mothers whose viewpoint on childbirth has changed and they no longer relate to their old way of thinking
A proposed new role
Although many mothers feel silenced or isolated in their experience there is an emerging voice that is beginning to surface, and the hope is that these mothers can offer encouragement and support to others. This group of sprouting mothers who are reaching out for support and courageously choosing to heal have an important role and influence within the childbirth community – they are bridging between two world views. Let’s take a closer look at this notion.
What is a bridge person?
Someone who can close the gap between one point of view and another point of view because they can offer insight and perspective based upon experience. This new role cultivates meaning and fosters a new sense of belonging amongst mothers and families. These brave voices will hopefully help to eliminate the, “Us vs them,” mentality that overtly, or subtly, positions mothers against one another. We need more connection as mothers, and less shaming or shunning for childbirth choices.
How to become a bridge person?
To begin, there is a need to own one’s story and begin to share it. Even if the story is unfinished and contains sadness, anger, frustration. This story is as important as every other birth story told. It offers a different perspective on birth – for some birth is hard, surprising, challenging, scary, confusing, disempowering, isolating and unexpected. In all of that, there is still power, understanding, opportunity to heal, insight, transformation and an experience that has brought the mom to her edge. There is no right or wrong way to give birth; there are many ways to experience childbirth. Within that, there are many stories of birth. We need to hear all stories of birth, each unique tale, and engage with curiosity.
Concluding remarks
Although this article was a brief introduction to a larger point of view, and truly only skims the surface of a complicated and intimate journey into motherhood, it is my hope that as mothers and community members we begin to listen, truly listen, to each other with an open heart and mind. Thus, we begin to heal. Sometimes this is enough – to be fully received with open presence by other mothers and family members. To know that your experience is as valid as everyone else’s, and to understand that your process to sort out your childbirth experience is unique and important. When humans are truly received, we feel like we matter and thus, we belong. Belonging is one of our deepest innate drives. Thus, it is critical that we work towards inclusion so that mothers can rise strong. We need each other, bottom line. For some, belonging and being heard can help to shift unprocessed emotions about a negative childbirth experience towards deeper understanding and acceptance. Acceptance that as a mother you did nothing wrong, your body did not fail you and that you did your absolute best at that time. Deeper yet, a shared knowing that you are all mothers on a journey.
Notes:
1. S. R. Edwards, L. Devries and A. R. Hagan, “Risk Factors for Postpartum PTSD: Coercion During Labor and History of Abuse,” (2014): 10-11.
2. Rebecca Grekin and Michael W. O’Hara, “Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis,” Clinical Psychology Review, (2014), retrieved from https://doi.org/10.1016/j.cpr.2014.05.003.
3. Jane Simington, Trauma Recovery Certification Handbook, 6th ed., Edmonton: Taking Flight International.
4. Joe Dispenza, Breaking the Habit of Being Yourself: How to Lose Your Mind and Create a New One (Carlsbad, California: Hay House Inc., 2012).
5. Daniel J. Siegel, “Toward an interpersonal neurobiology of the developing mind: Attachment relationships, ‘mindsight,’ and neural integration,” Infant Mental Health Journal, 22, no. 1–2, (2001): 67–94, retrieved from https://doi.org/10.1002/1097-0355(200101/04)22:13.0.CO;2-G.
6. Daniel J. Siegel, Mindsight: The New Science of Personal Transformation (New York: Random House Publishing Group, 2010).
7. Bonnie Badenoch, Being a Brain Wise Therapist: A Practical Guide to Interpersonal Neurobiology (New York, New York: W.W. Norton & Norton, 2008).
8. Shari M. Geller and Stephen W. Porges, “Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships,” Journal of Psychotherapy Integration (2014), retrieved at https://doi.org/10.1037/a0037511.
9. Stephen W. Porges, “The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system,” Cleveland Clinic Journal of Medicine, 76(SUPPL.2), (2009): 86–90, retrieved from https://doi.org/10.3949/ccjm.76.s2.17.
10. Badenoch, Being a Brain Wise Therapist.
11. Stephen W. Porges, “Love: An emergent property of the mammalian autonomic nervous system,” Psychoneuroendocrinology, 23 no. 8 (1998): 837–861, retrieved from https://doi.org/10.1016/S0306-4530(98)00057-2.
12. Stephen W. Porges, “The polyvagal theory,” 86–90.
Jennifer specializes in maternal mental health and trauma-informed care. She holds the following credentials: Canadian Counselling and Psychotherapy Association (CCPA) member; Masters of Arts in Counselling Psychology (MACP); Certified Trauma Recovery Counsellor (CTRC); Certified Grief Support Counsellor (CGSC); Certified Holistic Doula; Childbirth Educator; and she was a student of traditional direct-entry midwifery for many years.
