“I did not feel seen as a whole person.”
On pain dismissal, birth trauma, and other avoidable psychological scars with author, Rachel Somerstein
“The wrongs done to my body had shown up in my head”
– Rachel Somerstein, Invisible Labor: The Untold Story of the Cesarean Section
Nearly one fifth of birthing humans experience childbirth as traumatic.
Whenever a percentage this high is attributed to any aspect of the parenting journey, I often talk about it in the context of normalization. Rates of miscarriage – up to 20% – let’s normalize miscarriage. Rates of perinatal anxiety/depression – 1 in 5 – let’s normalize maternal mental health disorders. In these contexts, normalization reflects open discussion and calls for increasing access to support these normal1, difficult and health impacting, parts of life.2
But, in the case of birth trauma – 19% – we cannot and SHOULD NOT normalize it. And yet, in our society, this is exactly what we do.
Well, maybe “normalize” isn’t the right word for what happens in cases of traumatic birth experiences. How about “dismiss”? Or “ignore”? Or “minimize”?
Major risk factors for those who might experience birth as traumatic include expected factors, like mental health history and birth complications. But risk factors also include internal sense of control and poor Quality of Provider Interactions (a metric capturing how people feel about the medical care they received during labor and birth). Given how those feelings are two MAJOR RISK FACTORS, it is not a stretch to expect that a good chunk of the birth trauma percentage may be completely avoidable. Unnecessary stress. A systemic issue. This projection is further validated by research demonstrating that continuous support during labor+birth significantly improves perceived control AND significantly decreases fear of birth and birth trauma. Compassionate, supportive care as a valuable intervention.
In her book, Invisible Labor: The Untold Story of the Cesarean Section, author, journalist, and social scientist, Dr. Rachel Somerstein, wrote a beautiful, haunting, poignant, brilliant evaluation of cesarean birth in this country and the way we (mis)handle birth trauma. Viewed through the lens of her own experience and the psychological scars it left behind, alongside the historical, medical, and societal context for the surgery.
Conversations with Rachel, digging further into women’s pain dismissal and identifying the ways maternal stressors during birth interconnect and follow far beyond the first year postpartum, have further fueled my fury around the risk:risk analysis that over-prioritizes babies at the expense of mothers’ health.
Below is our (edited) conversation. May it fuel your fury too…
MOLLY:
Your book does such a beautiful job of running a thread that seems to speak directly to the ways medicine and society prioritizes baby over mother.
I’m not sure if you ever named all these big and small incidences as “stress exposure” but when I was reading I just kept thinking: “here it is again, and here it is again, and here it is again, and here it is again.” I saw (unnecessary) stress exposure everywhere!
I would love to get your thoughts on how you've seen this play out in your reporting, from other stories and your own experience. Especially as it relates to the potential long-term health effects.
RACHEL:
To start, one thing that I've been thinking about recently is how we don't consider the impacts of postpartum stress or birth trauma beyond one year postpartum.
Most of the studies tend to end at one year postpartum. But think about the ways that a traumatic birth shapes people's lives, even a high stress experience that wasn't a traumatic birth or a highly stressed postpartum period. It shapes their reproductive lives, their health, their professions, their marriages. And yet that effect is completely hidden. There's no variable for that. There's no long term study (that I know of anyway) in the postpartum literature, in terms of the long-term implications.
MOLLY:
That's a really important point. That’s another level of invisibility – how the memory embeds in the brain and becomes another neural touch point for everything else along the parenting journey and life, in general.
“Think about the ways that a traumatic birth shapes people's lives... It shapes their reproductive lives, their health, their professions, their marriages. And yet that effect is completely hidden. There's no variable for that. There's no long term study.” — Rachel Somerstein
Makes me think I need to revisit this on the stressor map and consider even more touch points!
RACHEL:
People will get on with their lives. They do. Or they may seem to, according to the data that's collected: they're back in the workforce, they're not having more ER visits, or whatever metric might help assess.
MOLLY:
And research is not going to catch long-term health consequences unless you're doing extreme longitudinal studies, which, of course, takes an immense amount of money. No one's gonna do it. (And, well, our current funding environment is certainly not helping advance this.)
The other thing that came to mind as you were talking about all the ways traumatic birth could show up later in life was how birth trauma, and the long-term psychological effects of birth trauma, has started popping up as a theme in fiction. Take Fleishman is in Trouble (spoiler!) and how the novel weaves in the story of birth trauma following a main character and contributing to her mental health over a decade later (along with the “good mother” narrative!) As a reader, you are invited to attribute her breakdown back to her birth trauma.
I love seeing this in fiction, but I have not seen it discussed that way in the medical space, which tends toward a baby's out, baby's good! version of the birth experience.
Does this come back to over-prioritization of baby?
You have talked about how taking a zero-risk to baby approach in medicine may relate to fear of the litigious society we live in: “if something happens to the baby, I (the doctor/the hospital) might get sued”.
For the mother with that same doctor/hospital, if you have a mental breakdown 15 years later because of something done to you during your birth in an effort to “save the baby”3, you're not going to sue, you can't connect the two things.
RACHEL:
And also, that provider probably wouldn't even know about it, right?
Think about that disconnection. They wouldn’t pick it up. To use the term, sequela, who picks that up? If you develop cardiovascular problems related to the PTSD of your birth, that's not going to get picked up by your OB. In fact, you're probably not even seeing the same person because you had a traumatic birth. You might not be seeing the same person because you moved or because your insurance changed. Maybe the person who caused your trauma wasn't even your regular OB or midwife. There's no way for them to even track this if they wanted to.
“I don't think there is a widespread recognition of the value of psychological safety for the mother.” — Rachel Somerstein
After I had my baby, I was avoidant of medical care4, and I was really avoidant of going to the dentist. It took me years to figure this out but I now understand that it's actually super common for people who have a birth trauma to avoid the dentist. You're laying down, it's like an operating room, it’s tapping into what the body remembers. There's a light, there's people in masks, your body position is very similar. When I started going again, I had one hygienist say, “you're shaking. Are you ok?” And I told her, “I actually, I had a little bit of medical trauma”.
My body was reacting to this space, but I didn't understand what was happening to me. Nobody said to me, “Oh, Rachel, that makes a lot of sense that you're having that response. Maybe take propranolol before you go so you don’t spike your heart rate or maybe to calm you can take a Xanax or whatever.” None of that was part of my practice. So here you have a dental hygienist dealing with the outcome of a traumatic birth that happened two and a half years prior. What could she possibly do other than what she did do? She was really gentle and perceptive and said “I might cause you pain” and then continued to check in.
But did I go call up the OB and say “hey, this is still following me around…” ?
MOLLY:
“You're paying for my next cavity!”
RACHEL:
Exactly!
So how does that even happen? The focus is on the baby's well being, as opposed to on the mother. And another part is what you pointed out – you're more likely to lose a lawsuit if the baby's been harmed, because it is a whole lifetime of harm.
I don't think there is a widespread recognition of the value of psychological safety for the mother. The focus is: we're gonna get you out of here alive. We need to make sure you're physically safe.” And, yes, absolutely. But psychological safety is part of that. And that goes back to how we don't credit the ways that the mind is part of the body. Right?
MOLLY:
YES! There's a quote from your book that is so perfect for this: “the wrongs done to my body had shown up in my head”. I think about that quote All. The. Time.
“It's actually super common for people who have a birth trauma to avoid the dentist. You're laying down, it's like an operating room, it’s tapping into what the body remembers. There's a light, there's people in masks, your body position is very similar.
When I started going again, I had one hygienist say, “you're shaking. Are you ok?”
My body was reacting to this space, but I didn't understand what was happening to me.” — Rachel Somerstein
And speaking of your book – somehow we managed to get this far without going into your story!
Can you give a quick overview of your experience going into birth, in the moment and during your c-section, and then the treatment afterwards? I think that it opens up an important view on psychological safety and what could have been done along the way to preserve that.
I do want to make a quick note to say that c-sections are absolutely medically necessary and life-saving for about 10% of cases. Let’s give it some wiggle room and say, 15% is a reasonable average rate for c-sections. We are not there. C-section rates in this country can be as high as 30%. You have reported on this as well. Which means there are a lot of unnecessary c-sections done in this country.
But speaking in the context of life-saving 10-15% and the context of the unnecessary surgeries, we can still look at your medical journey and consider what it might even look like if a mother’s psychological safety had been prioritized.
RACHEL:
I think it needs to start in pregnancy. Even though I had midwifery care, I did not feel seen as a whole person. As an example, when I got my medical records, I saw that one of the clinicians had written down that I had anxiety, they had diagnosed me with anxiety. I only found this out years later when I got my records. And I was like, “Well, why didn't anybody tell me this?”
For context, when I was pregnant, I was negotiating for leave, we had very little money, my husband was freelancing, my salary was low, I was afraid I was gonna lose my job which I had worked really hard to get, and if that happened then we’d lose our house. Of course I was anxious!
And if a clinician had said to me while I was pregnant, “I'm noting that you're experiencing a lot of anxiety, you might want to talk to a therapist. Here are some resources,” I can't absolutely say that I would have done it, but it was never even suggested to me.
We know that how you are doing mental health-wise while pregnant is a really important factor for how you're going to do with your mental health afterwards. The biggest risk factor for developing a postpartum mental health disorder is having a disorder when you're pregnant.
Then the birth was a fucking nightmare, and if I already had a relationship with a therapist, I don't think it would have taken me two and a half years to go talk to one.
“The pain that I said I felt when I was in labor, the sense that I got, was that they thought I was exaggerating.” — Rachel Somerstein
Appreciating the whole person, communicating that diagnosis to me and not just my chart, that would have been ultimately protective. It would have helped me to deal with the trauma of the birth (which nobody knew was coming) much sooner.
When I look back at it, and think about the time when I was suffering – my relationship with my daughter suffered, my relationship with my husband suffered – that could have been avoided if I’d already had a therapist. Instead, I had this unresolved trauma that I didn't even fully appreciate.
MOLLY:
How did this play out during the birth?
RACHEL:
During the birth, during the labor, I just wasn't taken seriously. This is super common, in terms of expressing pain. The pain that I said I felt when I was in labor, the sense that I got, was that they thought I was exaggerating.
What we need to do in medicine, and I say this with the humility of not being a clinician, is to recognize that if a person says it's pain, it's pain. Period. Some people have a very high pain tolerance. Some people don't. You're not in my body. If I'm telling you I'm in pain, I’m in pain.
From a clinician's perspective, they may be focusing on certain cues: “ you look calm…” or “you're only one centimeter dilated…” or “you got an epidural and it should be working”. What I would imagine is the hard thing, for a clinician, is to have the confidence to use their skills, see what's going right, assess and think “well, there's a mismatch”. As in: “she's only one centimeter dilated BUT she says she's in a lot of pain…” or “She has an epidural BUT she says she's in a lot of pain…” or “She looks totally calm BUT she says she's in a lot of pain…” Just to step back and be skeptical. As a clinician, assessing what's being presented, not in the sense of not believing the patient, but in the sense of maybe there is something else going on.
Crediting her experience as opposed to what they are meant to expect, medically. It is super hard.
“You're not in my body.
If I'm telling you I'm in pain, I’m in pain.” — Rachel Somerstein
I gave a talk for Grand Rounds at UMass Medical School. And I was thinking how am I going to do this in a way that will be respectful, as an outsider. I decided to use journalism as my way in, showing how for journalism and medicine, we're in the same situation. We're in an economic crisis. Private equity is fucking over both institutions. There's a crisis of trust. When the biggest screw-ups happen in journalism, it’s when veteran, seasoned reporters fail to ask questions and be skeptical. It's the same thing you could say with clinicians.
MOLLY:
It's almost like the inconvenience of accepting a variable? This avoidance of asking the questions and being skeptical is just more convenient?
RACHEL:
Exactly.
MOLLY:
It makes me think of the reporting in the Serial/NYT podcast series, The Retrievals, about the Yale fertility clinic where the patients were going through egg retrieval procedures without pain medication because a nurse was stealing the fentanyl and refilling the vials with saline.
When the OB started cutting, and I said “I felt that,” he should have said, “felt what?”
Instead he said, “you'll feel pressure”. — Rachel Somerstein
Hearing the women’s stories, it seems so obvious that whatever pain medication the medical staff thought was being used, was not working. As an outsider you can make this very logical conclusion when you listen to the women talk about their experience as, “I can feel everything.” “I was shaking” or “I was kicking my legs from the pain”. And then how the doctors and medical staff would say to them: “stay still, you’re fine, you're on fentanyl. It’s normal to feel pressure. It’s not pain.” The clearest answer is that the fentanyl is not fentanyl. But that is not the variable that they wanted to accept.
RACHEL:
Absolutely. Because “it's all set up. I did everything right.”
We do this to our children, right? “How can you be hungry? You just ate.”
MOLLY:
Oh, wow, absolutely. When my younger daughter was a toddler, she got stung by a bee, and I was like, “Oh, come on, it's not that bad.” And then, like, a week later, I got stung by a bee, and I was like, “fuck, that hurts!”
RACHEL:
Totally! Part of treating pain is calming the person. That's real. You don’t want to blow it up and add to the anxiety of pain.
But the stakes are just so high in medicine. You have to be totally solid in your skills and your confidence to step back and ask “how could that not be working?”
MOLLY:
Considering pain dismissal in medicine, it does disproportionately affect women and those in marginalized communities, especially Black patients. That really ties into that psychological safety and trust later on.
“I think a big aspect of what was traumatizing for me about the birth, is that I *did* speak up… I did advocate for myself and the doctor didn't listen to me.” — Rachel Somerstein
From your experience, when you were on the table… your epidural was not fully working, right? So you could feel everything? And then to also be in the hands of medical professionals, who were literally moving your guts around, and you feel like they aren't listening to you when you expressed your level of pain. How do you think that affected your feelings of psychological safety in that moment and afterwards?
RACHEL:
When the OB started cutting, and I said “I felt that,” he should have said, “felt what?”
Instead he said, “you'll feel pressure”.
I said again, “I felt that”.
As I explain in the book, this is all happening in the middle of the night. I have been in labor for more than 24 hours. The fact that I can even talk is incredible. Then I'm in labor, laying on the table, I had just been pushing and my body was still trying to get her out. The fact that I wasn't able to specifically say, “I feel PAIN” is not surprising.
I think a big aspect of what was traumatizing for me about the birth, is that I did speak up. This is similar to what I have heard from other moms who I've spoken to.
I don’t think there should be an expectation that somebody who's having a baby needs to advocate for themselves. It’s just too much. If you can advocate for yourself, that’s great, but you shouldn't have to.
In my case, I did advocate for myself and the doctor didn't listen to me.
That doctor is not a sociopath. He did not go through all of medical school just to torture women. But the idea that you could tell somebody what's happening, that you're feeling intense pain, and then they override you? What that means in the long term is: I am not safe – I can't trust other people, whose responsibility it is to keep me safe, to actually keep me safe.
That's not logical. But your brain has planted this connection back to safety. And if that's happened in your life before, which, if you're a woman or from a marginalized community, it probably has, then your brain is thinking, “uh, there's a pattern here”.
“the idea that you could tell somebody what's happening, that you're feeling intense pain, and then they override you?
What that means in the long term is: ‘I am not safe’; ‘I can't trust other people, whose responsibility it is to keep me safe, to actually keep me safe’.” — Rachel Somerstein
For my second birth, when I had my son, I had a really great birth, but a couple months later, I developed mastitis, and it was chronic. I went to the ER because my heart wouldn't stop racing. They did these tests but then they were like, “we think you're having a panic attack”.
But really, I was developing an antibiotic-resistant infection.
I was shaking. It was during COVID so I was alone. And they sent me home.
A few days later, I went back to the doctor because I couldn't get warm. I was admitted to the hospital to get IV antibiotics and I had to go through the ER again because of COVID. I saw the same physician who was like, “have you been drinking alcohol?” Again, I was alone. I'm white. I have private insurance. I wear a wedding ring. I'm sure I looked terrible.
MOLLY:
Yeah, you were basically SEPTIC.
RACHEL:
Yes, and I was treated as a social case (and if I was treated as a social case, despite all of those marks of 'privilege,' how are other people treated?)
For me, that experience reaffirmed the message “you are not safe with these people who are supposed to care for you.” Even though I have many examples to the contrary, once your brain learns that – and your body does too – it's very hard to overcome or divert that. It’s hard to access the logic part of your brain to say “you are safe.”
MOLLY:
And then the way our brain perceives and responds to feelings of safety is this ancient, conserved part of our brain. Of course, there's no logic. We've adapted to respond immediately to things that aren't “safe” for survival. It’s built into our bodies and our brain. I hate to say something so cliche as “it’s primal” but, it kind of is!
RACHEL:
And to answer your question, in terms of what could have been done, it’s about the acknowledgement. The doula I was working with really minimized what had happened to me. People in the hospital didn’t acknowledge it. I think that contributes to the lack of psychological safety. Your whole body is telling you that it was a very dangerous situation, yet you’re being told “your baby's healthy, move on”.
You still don't feel safe because you haven't been affirmed or helped to process. That denial of birth trauma means that the lack of psychological safety lasts longer. It becomes unresolved.
MOLLY:
Thinking about what can be wrapped around this experience to soften/reduce the way that we embed and respond and carry this memory and how it follows us as a source of stress…
The one thing that you mention in your book, that I'm so curious about, is the concept of apology law and creating legal safety around medical professionals saying, “hey, I fucked up. I am so sorry”. That could really help with acknowledgement – acknowledge that I'm not crazy in thinking this was a big thing for me; acknowledge that my body has internalized it and it is affecting me.
Don’t say that it was nothing!
“Your whole body is telling you that it was a very dangerous situation, yet you’re being told, ‘your baby is healthy. Move on’.” — Rachel Somerstein
How do we make that stress buffer of acknowledgment more available to people who have experienced a birth trauma?
RACHEL:
Why is there no psychological first aid, in general?
I think the apology could be really important for the providers too. They're also carrying it. It's worse for the patient, but the providers carry it and it can be traumatizing for them too.
In other countries, there's a midwife who comes to visit you at your house. It would be incredible if we had somebody who could pair both midwifery care and social work or perinatal mental health to do this kind of evaluation or first aid attendance, especially for somebody who is marked as having had a traumatic birth, or has the likelihood of developing PTSD, which can be predicted based on different variables during pregnancy and birth. To see the person in their home, one week out, two weeks out, three weeks out, and then get them the help they need, the additional treatment, whether that's medication or talk therapy or EMDR or some combination.
Right now, if you even go in for your postpartum visit, six weeks out, there's very little time to talk about what's really going on with you. The screener that's used doesn't actually pick up PTSD. I think that psychological first aid would be transformative for people.
MOLLY:
When I was working in the maternal health space, the general feeling I got from clinicians was that they hesitated to diagnose or even suggest the possibility of a mental health disorder because a lot of times there is no best care pathway to fix or treat it. The number of providers that specialize in maternal mental health is not where it needs to be. It's so common, it's so normal for someone to have a perinatal mood disorder. It should be accepted as just a normal part of pregnancy and birth. It should just be part of the system and we should have a person per person, but the infrastructure is not there. It's not part of the system so clinicians avoid diagnosis.
RACHEL:
The other thing that makes me think about is the role of insurance. Insurance only covers that postpartum visit, and what if insurance more broadly covered things like mental health visits, lactation support, pelvic floor physical therapy?
Those providers are the ones who are hearing about birth trauma. When you see a physical therapist or pelvic floor physical therapist in person, it doesn't feel so medical, it’s more holistic. That could be another way to get people into the system (in a good way!).
Someone is catching it.
MOLLY:
Yes, someone is catching it!
And then, from your own experience, even having someone to acknowledge the gravity of the experience so it’s not stuck inside your brain, bouncing around. It sticks different when you have someone say, “I see you and this is what we're gonna do / this is what you can do / this is what I've seen done” Just to have that one other person.
“Also, the person helping to process is not on the partner. Partners might also be traumatized… You want your partner to be with you and what you're going through, but they probably have their own need for support.” - Rachel Somerstein
Having access to providers who have that more of a hands-on-body role could be so key here. Even if the care has nothing to do with physical recovery from a c-section. It might be the person touching your boobs or working with your pelvic health. Because they are present with you, helping your body at a time when your brain is still processing the birth, it could help work through happened to your body in a different context?
RACHEL:
Totally.
Also, the person helping to process is not on the partner. Partners might also be traumatized. If you’ve never been at a birth before, it can be overwhelming. If it was a traumatic birth, they may also have feelings of guilt. My husband, for years (and probably still does to some degree), felt really guilty that he wasn't able to protect me and stop the operation. Everybody has their own psychology but he dealt with it by just deflecting whenever I would bring up the birth. It was too uncomfortable for him. He had feelings of guilt, and the feeling of who is he to feel traumatized by this when obviously it was worse for me.
You want your partner to be with you and what you're going through, but they probably have their own need for support. You also might need to talk to somebody who's not them if you blame them or if you’re angry at them. You need someone who's not in that closed system of the family.
MOLLY:
That’s so interesting. When I think about stress buffers, I think of the social support and the available support network. It’s an important call out that the person who is closest to you, and who is in that moment with you, may not be a healthy support to rely on. Thinking about my own birth. I didn't experience it as birth trauma, but my husband definitely did. It definitely affected him, psychologically, more than me. If I had been traumatized, if I had blamed him at all, he would not have been an accessible stress buffer for me.
RACHEL:
What's super interesting, when you look at somebody in your situation or somebody in my situation, on the surface, you have access to all the things that classically buffer stress. Right? You have all these protective elements: being married, a certain SES, private insurance, all the stuff might predict stress associated with being postpartum. But you still need more support.
In a strained system where there are so many people who are underserved, if you have an “ok” birth, you can fly under the radar. You’re not at risk in the same way as somebody who is un-partnered or is in a financial situation or has a chronic health condition. And yet, you still might need more support to deal with the stress of the birth.
There is no such thing as too much support. No matter what your demographic is.
MOLLY:
I'd love to just, like, dream a bit about what care flow could look like if we started from a mom-centric approach to pregnancy, birth and postpartum. How do we reset the risk:risk analysis in a way that highlights the high general risk of stress to mom compared to the low (but often dramatic) risk for baby?
RACHEL:
Great question.
Prenatal education has to be deepened to include psychological safety, to include stress and to look holistically at the person's life. Stop treating it like you drop into pregnancy without everything else coming along with you, psychological and physical health wise. That would be essential.
“If you have an ‘ok’ birth, you can fly under the radar… And yet, you still might need more support to deal with the stress of the birth.” — Rachel Somerstein
C-section is my area of focus, so I think expanding the conversation about c-sections – how they can shape the trajectory of your reproductive life, even if you need to have one. It's not about stigmatizing c-section, it's about respecting them more. That would mean counseling the pregnant person differently – here are the physical implications, here's what can happen – and discussing the risks of the operation. If you start to talk about pain during c-section as a possibility, it opens up the conversation as opposed to the language of: “let's just get this scheduled”/ “It's nothing.” / “Don't worry about it.” It’s not about convincing someone not to have one, talk about the risks as a way of saying “here's what you might be dealing with.” Then providers, and moms, would respect the operation more.
That type of conversation also puts the focus on mom. As opposed to saying “here is what we might have to do to save your baby.”
MOLLY:
That right there! That plays into the weight of narrative and language. Even having that conversation as you framed it. Moving away from “this is what we need to do to save the baby” or “this is what we need to do to get the baby out of your body”
Instead, having the conversation of “this is the experience, all signs are pointing to how this is the best course of action for you both, and this is what you're going to experience”.
The baby-centric approach (and you tell me from your experience) seems like it could lock in your brain that, “in order to be a good mom, I have to let them cut me open, do what they need to do, and get the baby out. Nothing else matters.”
RACHEL:
Yes, it’s the “I’m the wrapper, my baby is the candy” feeling. It sets that expectation when you're pregnant and extends into postpartum. You keep hearing “as long as you have a healthy baby, that's all that matters,” from people who are well meaning or maybe they don't even know what to say. They've also been conditioned into thinking that the mom's value is subordinate to her babies.
Instead, it could be “how are you?” / “how was your recovery? / “how was your birth?” / “How is your baby?”
I think this is the thing that we have a problem with society writ large right now – acknowledging that two things can be true. You can be completely in love with your new baby and grateful for her health AND you can also be grieving and angry about the birth. One doesn't cancel the other out. They can both be there. That's the nuance. That's also the reality of most people's births. It's not a fairy tale, even if it goes beautifully.
Then it gets to what we said earlier. You want to be seen for who you are and how you evolve as a mother or what you've gone through during birth.
MOLLY:
I’ve started trying, for anyone who has a baby now, to not even ask about the baby. I'm just gonna ask you about you. Balance it out a bit.
RACHEL:
Me too. I do the same thing.
And I sometimes think “am I going too far in that direction?” But I don't think so. Most people are like, “nobody asked me that!”
“You can be completely in love with your new baby and grateful for her health AND you can also be grieving and angry about the birth. One doesn't cancel the other out. They can both be there.” — Rachel Somerstein
I was talking with a mom who just had her first baby, and she was telling me how she wanted to breastfeed but it just wasn't happening. She was pretty devastated and we talked a bunch over the phone. And finally she said “I really appreciate that you are giving space for me to feel grateful that I can keep my baby alive with formula AND I can grieve that breastfeeding is never going to happen for me as I always dreamed that it would”
They're both true, they’re both real and deeply felt.
MOLLY:
Acknowledging that has so much power and I don't think enough people get to experience that.
RACHEL:
It’s like talk therapy. The power of talk therapy and one reason that it fucking works is the message: “I see you”.
You want someone to see you. The depth of who you are. Not just the easy part.
Read more from Rachel here:
Ok, weird request.
I have no concept of how valuable any of this information is to anyone so… If you’ve made it to the end of this crazy long post, would you consider bumping up to a paid subscription? Since the Maternal Stress Project is an educational and idea-spreading initiative and available to all, I never lock any content and all posts head to your inbox in their full, open form. I know that paying for everything you want to read on Substack kinda sucks (I pick and choose too) so for those open to this small gesture of ‘keep going, Molly, this work is important’, I set up a 75% discount for the annual subscription. That’s $12.50 — it’s basically two (overpriced) coffees or 30 minutes of (overpriced) summer camp.
Your support is always much appreciated. And if you’re still not feeling like going paid, sharing and spreading the word is equally valuable and appreciated!
After sending this out, I had a reader point out an issue with the word “normalize” . She sent me a link to this excellent article in Time and noted: “just because something is common, doesn't always mean that we should accept it as 'normal', because if it is accepted as status-quo then efforts slow to change something that can and should be addressed.”
So many subtleties in language that we have to consider. Another reason to keep digging and acknowledging the nuance. Thank you, Elle!
has a new book coming out NEXT WEEK called Normalize It: Upending the Silence, Stigma, and Shame That Shape Women's Lives. just posted this fantastic interview with her. (Welcome to Substack, Erin!)
Using quotes for “save the baby” given how many of the interventions done to decrease the risk to baby are not actually “saving” the baby but are impacting the birth experience and exposing the birthing person to potential stress and trauma.
Consider the effects of avoiding medical care (common for those who have experienced birth trauma. As Rachel pointed out to me:
“The majority of people have babies before they’re 40. Chronic things, like cancer or other illnesses that could develop over time, – things that could be monitored, halted, slowed, treated – those conditions are more likely to come up in your 40s and later. But what if you no longer trust the health system because you weren't listened to during childbirth or you didn't get the help that you needed postpartum? That is disconnected in the data which makes all of this total conjecture. If someone falls off the medical radar, by the time they get back on (or can no longer ignore the issue), they have a big problem. If they had been getting checked all along for preventative care, this cholesterol issue or even cancer might not be as advanced as it is when they do finally go in.
I think that is a hidden effect of traumatic or stressful birth that may be hidden because of the age gap between when people are having their babies and later health issues.”
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I really appreciate this conversation. I ended up with postpartum PTSD after a “normal” vaginal birth. But didn’t know what was wrong until my kiddo was 2 years old. I spent years sorting through the experience, with professionals and support groups and other moms. My final conclusion after reading “Choosing Cesarean” was I needed a planned C-section if I was ever to have another child. Luckily, I found a fantastic OB and he agreed and I went on to have another baby without the PTSD complication. There are so many different routes to ppPTSD because there are so many different brains being pregnant and having babies!
“When I started going again, I had one hygienist say, “you're shaking. Are you ok?” And I told her, “I actually, I had a little bit of medical trauma”.
Idk why this part made me tear up! This whole convo is just so so good.
Love your work, Molly!