Forty years ago this year, my first pregnancy ended in a very unexpected miscarriage at 19 weeks. I ended up delivering the baby in the doctor’s office after not knowing I’d been in labor all night. In a shocked daze, I watched as the doctor used a pencil eraser to poke around at my dead baby who was now in a metal basin, out of my body and away from my view.
Although the experience of welcoming a new human into the world is often well-planned for, much desired, fondly dreamed of & happily anticipated, the process itself is fraught with unexpected twists and turns that can affect generations to come.
While watching the 8-episode series “Fleishman is in Trouble” on Hulu-FX recently, I was struck by the idea that the all too common experience of physical, mental, and emotional trauma sustained while going through the process of birthing can have long term, seemingly unrelated effects on the entire family. I have been pregnant five times, and experienced some type of trauma in each one of them. It was during my third that I decided I wanted to go to medical school and become a physician so that I could help others. Reflecting on the path my life has taken over these 40 years, I now understand that had I recognized and dealt with the traumatic effects of my birth experiences, I may have avoided the divorce and other devastating disruptions to the family I worked so hard to get.
Spoiler Alert! This article contains descriptions of what happens in the series. You may want to watch it before proceeding.
Actors Jesse Eisenberg, Claire Danes, Meara Mahoney-Gross, & Maxim Swinton eloquently portray the nuclear family affected by what happened to “Rachel” (Claire Danes) while she was in the hospital at the end of her pregnancy with her first child, “Hannah” (Meara Mahoney-Gross). Despite the fact that her husband “Toby” (Jesse Eisenberg) is a highly esteemed physician at the same hospital, Rachel is treated in a most disrespectful way which leads to a traumatizing and dehumanizing experience for her.
Recently divorced 41-year-old Toby Fleishman dives into the brave new world of app-based dating with the kind of success he never had dating in his youth, before he got married at the tail end of medical school. But just at the start of his first summer of sexual freedom, his ex-wife Rachel disappears leaving him with 11-year-old Hannah and 9-year-old Solly and no hint of where she is or whether she plans to return. As he balances parenting, the return of old friends Libby and Seth, a potential promotion at the hospital that is a long time coming, and all the eligible women that Manhattan has to offer, he realizes that he’ll never be able to figure out what happened to Rachel until he can finally face what happened to their marriage in the first place.
https://www.fxnetworks.com/shows/fleishman-is-in-trouble
Also, for sensitive viewers:
What Parents Need to Know
Parents need to know that Fleishman Is in Trouble is a dramedy about a divorced New York City couple going through a difficult time. Sexual content is frequent. We see couples having sex in many scenes, with nude breasts and buttocks, suggestive movements, and moans. A character has frequent consequence-free casual sex with women he doesn’t care about emotionally; we don’t hear much about how those women feel about it. Talk can be graphic, with dialogue about group sex, orgasms, body parts, masturbation, sexual acts, and more. Characters drink at bars and gatherings, sometimes to the point of sloppiness, and in a few scenes ostentatiously smoke cigars. Language includes “f–k,” “f–king,” “s–t,” “bitch,” and “assh–e.” Characters say cruel things to each other, such as when a husband implies his ex-wife relegates child care to sitters. The trappings of wealth (designer clothing, fancy cars, big houses) are evident, and a middle school-age character complains frequently that her family isn’t as wealthy as her peers’.
Although this is a fictional account of a New York family, Taffy Brodesser-Akner, who wrote both the screenplay and the original novel on which the show is based, captures the essence of a typical traumatic birthing experience. What was done to Rachel by the covering physician happens in real-life situations more than one can imagine. Rachel is admitted for a labor induction because of increased blood pressure; when she does not go into labor, she presents a viable and very reasonable plan to the doctor, which includes stopping the induction and staying in the hospital for continued monitoring. The doctor (not her regular physician) replies that he needs to check her cervix first, and while Toby is out of the room, the doctor does the exam, says, “There is some leakage here”, asks the nurse for an “amni-hook”, and without a word to anyone, artificially ruptures the membranes.
Any Obstetrician, midwife, or delivery attendant knows that rupturing the membranes can put a woman into labor, and no doubt, this was the doctor’s intention. As a physician on call covering someone else’s patients, it is often the mindset to get things going so that deliveries happen during the covering shift. Also, it is not easy to determine if “there is some leakage” on an exam. During my training I myself witnessed (more than a few times) providers lying about circumstances like leakage of fluid in order to have more control over when and how a delivery might happen. As a medical student I had not understood these dynamics; it seemed that sometimes doctors needed to do things before having a long discussion with the patient, and most the time everything turns out OK. In Rachel’s case however, this seemingly harmless act led to a Cesarean Section and untold grief for Rachel and her entire circle of family & friends. It was also an act of “battery against her person”, having been done without her consent. Even though she and the baby were physically ok, Rachel had been the victim of an assault.
Rachel Fleishman did not find help in a Pregnancy & Postpartum Support Group, but rather one being held for “Assault Survivors”.
While researching material for this post, I came across the term “Postnatal PTSD”, and found this article stating that 33% of women feel that giving birth is a traumatic experience:
Although neither DSM-IV nor DSM-5 explicitly list childbirth as a potential traumatic event…the notion that childbirth can represent a traumatic stressor is supported by the fact that every third woman describes giving birth as a traumatic experience (Creedy, Shochet, & Horsfall, 2000). In some cases, this leads to the development of PTSD symptoms, with some women meeting full diagnostic criteria for PTSD.
https://www.sciencedirect.com/science/article/abs/pii/S0272735822000423
Furthermore, it is not just the mothers who are traumatized. The UK Birth Trauma Association offers information and resources for partners and other family members who might be affected. From their home page:
What is birth trauma?
Birth can be traumatic for all sorts of reasons. It could be that you were left in pain for hours, or your baby’s heartrate dropped and you needed an emergency caesarean section. Perhaps you had a difficult forceps birth leaving you with severe tears. Perhaps you had a postpartum haemorrhage, or your baby was born ill, needing to spend time in special care.
There may have been times during labour when you felt that staff didn’t look after you properly, or didn’t listen to you, and you felt alone and frightened.
And afterwards, even your baby is well, those feelings don’t always go away. Research shows that about 4-5% of women who give birth develop post-traumatic stress disorder (PTSD), with symptoms such as flashbacks, nightmares and extreme anxiety that makes daily life immensely challenging. That’s about 30,000 women a year in the UK. Many more have some trauma symptoms, but not enough for a PTSD diagnosis. We use the term “birth trauma” to cover everyone who feels that their traumatic birth is continuing to affect them.
Fathers and partners can develop PTSD as a result of witnessing a traumatic birth. They need help too.
https://www.birthtraumaassociation.org.uk/
I was in my early/mid-twenties when I lost my first baby and had no reference point for how to deal with such an occurrence. Thankfully, PTSD therapies have come a long way since then. I have taken advantage of these and have found great help; I’d even go so far as to say that I have recovered. The work now involves reconnecting and rebuilding relationships with those in my life who were also affected.
Moving Forward
A new program is now available to help heal the effects of Perinatal PTSD. It employs the use of well-researched and studied therapeutic modalities such as CBT (Cognitive Behavioral Therapy) and EMDR (Eye Movement Desensitization & Reprocessing) and is provided by certified practitioners. This is designed to include anyone involved in the birthing process, whether it be the mother, child, spouse, doctor, nurse, or anyone who has sustained trauma related to a birth. Please Click below for more information:
Karen Janowski MD 