The nine participants’ characteristics were as follows: aged between 31–43 years; all were college graduates; six had jobs; all were married; five had a child; four had two children; and there were 13 births in total (vaginal, 8; caesarean, 5). The range of IES-R-K was 25–61 points. The ranges for the age of the first and second childbirth were 29–31 and 31–34 years, respectively; all participants were satisfied with their child’s gender (Table 1).
Table 1
Participants’ demographic and obstetric characteristics
Id | Age | Education | Employment | Marital status | Score of IES-R-K | Age at time of childbirth | Child’s gender | Mode of birth | Complications | Satisfaction with child’s gender |
1 | 31 | College | Yes | Married | 52 | 29 | Male | Caesarean birth after induced labour | - | Satisfactory |
2 | 34 | College | Yes | Married | 57 | 30 | Male | Vaginal birth | - | Satisfactory |
34 | Female | Vaginal birth after induced labour | - | Satisfactory |
3 | 35 | Graduate | Yes | Married | 46 | 31 | Male | Caesarean birth after induced labour | - | Satisfactory |
4 | 38 | Graduate | Yes | Married | 27 | 28 | Female | Caesarean birth after induced labour | - | Satisfactory |
5 | 42 | College | Yes | Married | 38 | 31 | Female | Vaginal birth after induced labour | - | Satisfactory |
32 | Male | Vaginal birth | Gestational diabetics | Satisfactory |
6 | 34 | College | No | Married | 61 | 29 | Male | Vaginal birth after induced labour | Mild perineal injury | Satisfactory |
31 | Female | Vaginal birth after induced labour | - | Satisfactory |
7 | 29 | College | Yes | Married | 37 | 27 | Female | Vaginal birth | Mild perineal injury | Satisfactory |
8 | 43 | College | No | Married | 25 | 28 | Female | Caesarean birth after induced labour | - | Satisfactory |
32 | Female | Vaginal birth | - | Satisfactory |
9 | 39 | College | No | Married | 39 | 31 | Female | Caesarean birth after induced labour | - | Satisfactory |
IES-R-K: Korean version of Impact of Event Scale-Revised |
[Insert Table 1 here]
Thematic analysis of interview transcripts generated two themes: 1) person-centred and 2) society-centred factors. The person-centred factor themes consisted of three subthemes of pain, guilt, and threatened dignity. The society-centred factor themes consisted of three subthemes of damaged femininity, confusion in social relationships, and maternal identity conflict. Representative quotes for each subtheme are presented below.
1. Person-centred factors
The participants focused on their own experiences of traumatic childbirth. In other words, they expressed psychological damage related to unpleasant sensations (i.e. pain, vaginal examination, etc.), excessive motherhood, and inhuman birth process.
1.1 Pain
The participants anticipated childbirth pain, but it exceeded their expectations. They attempted pain relief measures such as alternative painless childbirth methods, analgesics, and non-pharmacological methods. However, they expressed that the pain intensified progressively, eventually reaching a point where it felt uncontrollable:
‘After delivery, the pain suddenly became excruciating, as if my spine was being ripped apart. I was in so much pain that I couldn't even make a sound. It felt like a car running over my abdomen. Painkillers were ineffective, and although I tried my best to endure it, it was unbearable.’ (Participant 4).
‘I screamed for someone to save me because the pain was unbearable. It felt like my flesh was tearing apart, and I felt terrible. I attempted to be strong to have a painless childbirth, but the pain persisted. At that moment, I thought that I might die and all I wanted was to escape from that situation.’ (Participant 5).
1.2 Guilt
The participants described really attempting to have a vaginal birth despite clear medical reasons to have a caesarean section. They blamed themselves and experienced guilt towards their child, while seeking reasons for caesarean sections themselves:
‘At the beginning of my pregnancy, I searched for a hospital that would allow vaginal birth for my baby. Although I was afraid of vaginal birth, I mustered up the courage to try it. However, my perineum was torn apart by the baby's large head. I cried out for surgery, but it was already too late. Even now, I experience symptoms of urinary incontinence.’ (Participant 6).
‘If the doctor suggests surgery, just go for it. I didn't know during childbirth, but the recovery process felt too animalistic. After being discharged and coming home, the perineal area was painful. Going to the bathroom was painful, and I couldn't even take a shower (omitted). I subjected myself to severe suffering by forcefully opting for a natural childbirth.’ (Participant 7).
‘The third attempt at in vitro fertilization was successful, leading me to quit my job and seek out a hospital that offered Leboyer birth practices. So, I waited in expectation even with prenatal education, but the birth did not go well, so I eventually had surgery. Ah! I regretted that I did not have a vaginal birth, if only I had endured a little more at that time, and wondered whether I had been a good mother to my child.’ (Participant 9)
‘I wanted to experience natural childbirth because my first child was delivered through surgery, without pain. So I had the thought of wanting to try it at least once [natural childbirth]. I was asking myself, wondering if I was being a coward or if I had too easily decided on the easier method for fear of pain. Did I do my best for the sake of my child?’ (Participant 1).
1.3 Threatened dignity
The participants anticipated giving birth in a pleasant birthing environment and receiving special treatment from healthcare professionals and their partners. However, they described the actual childbirth experience as being devoid of any psychological support in an environment that was no different from animals giving birth:
‘The healthcare professionals didn't empathise with my pain, as they considered childbirth to be something familiar and routine for themselves. They treated all labouring women the same and disregarded them. It was disheartening when they coldly said, “If you can't give birth with this level of pain, you'll have to suffer more.” (omitted) I had multiple vaginal examinations during labour, and I didn't want them. I wondered, “Why should I feel like there is a fist coming in during the vaginal examination? Why do they use such unhygienic and inhuman methods [for childbirth]? With the advancements in medicine, isn't there any other way?”’ (Participant 5).
‘My husband was behind the curtain. He was there briefly during the early stages of labour, but not during the later stages. It would have been nice to hold his hand during the contractions, but I had to endure them alone, feeling like I was in a lonely battle.’ (Participant 6).
‘I felt like I wasn't human. When the doctor was inserting their hand inside me and tearing me, it felt like I was being treated like an animal by a veterinarian. I was treated like a dog in labour. Childbirth is supposed to be noble and sacred, but I couldn't find any trace of that in the delivery room.’ (Participant 8).
2. Society-centred factors
The participants expanded their experiences of traumatic childbirth from a personal perspective to their relationships with society. In other words, they reported social damage in relation to their partners' lack of support, the lack of respect in the birthing environment, and their shabby appearance and primary focus on childrearing responsibilities after childbirth.
2.1 Damaged femininity
The participants felt embarrassed by their birthing posture and exposed appearance during the birthing process. After childbirth, they were disappointed by their shabby appearance, ultimately describing the disappearance of a women's beauty and mystique:
‘I didn’t have a long dating period, so I didn’t want to show my naked body to my husband after giving birth, such as when I changed my pad or underwear….’ (Participant 3), and ‘After childbirth, I wasn’t treated like a human. I had to wear a dress without my underpants; I had to open my shirt for breastfeeding, and my stool was on the pad; the birthing posture was also weird…’ (Participant 7).
‘My face was swollen, my hair fell out, my pelvis is now larger, and my body shape has changed. I hated my reflection in the mirror.’ (Participant 2).
‘After childbirth, my body was ruined. I'm still overweight, with sagging skin, and I still have urinary incontinence. My appearance after childbirth has been stressful so far. Every time I have a chance, I still exercise like I’m obsessed. I liked to do make-up; I liked to wear heels, and I liked to dress up. But now, I don’t look like I did when doing these things as I did before, no matter how I do my make-up or dress up.’ (Participant 7).
2.2 Confusion in social relationships
The participants felt resentment towards their indifferent partners during the birthing process; even after childbirth, their negative feelings towards their partners did not disappear, leading to ambiguity in their relationships. In addition, participants were afraid to return to work; some contemplated whether to quit or keep their jobs because of reduced efficiency and confidence in their work:
‘When I look at other new mothers, I want to do everything for them. At first, my husband was somewhat responsive, but when I kept talking, he just thought it was painful. I want to empathise with everything the new mother says, I want to listen to her. The baby is really beautiful, but I didn't want to see my husband at all. My husband did nothing during childbirth. I even thought about getting a divorce when I was recovering.’ (Participant 7).
‘Since my husband didn’t do anything during pregnancy and childbirth, and it’s all women’s work, he was just a stranger in that sense. We are becoming parenting comrades; we are not in love, and that makes me so sad.’ (Participant 6).
‘I thought, “Did my previous ability remain the same? What if I’m not good at my job after returning? Won’t the juniors ignore me?”’ (Participant 3).
‘I quit my job of my own free will. I used to be a perfectionist who lived a social life without mistakes, but I kept making mistakes [after returning to work]. I had to do many things related to parenting, so I kept forgetting what I had to do at work.’ (Participant 7).
2.3 Maternal identity conflict
The participants endured excruciating pain while focusing solely on the baby's well-being during childbirth, but they described losing their freedom as individuals due to childbirth, leaving only their role as a mother:
‘Though everybody celebrated after childbirth, I was feeling empty. Ah! What is worse is I am not the person I used to be. I’m done. I’m completely done. I don’t know who I am now. I have to take responsibility for this child and live bound by the child.’ (Participant 6).
‘Having a beautiful baby is one thing, but after childbirth, I can't control my own time. [I used to] live happily before giving birth to a child. Childbirth is an experience that you don’t have to have. Do we have to do this hard work? I just want to make my dreams come true without any restrictions. After the child was born, I started to live someone else’s life, not my own.’ (Participant 4).