More than seven months after the arrival of her first child, Mireilly Smith still gets emotional about her birth experience. “I didn’t think I was going to get teared up talking about this,” she told Healthline, sniffling.

After more than 12 hours of labor that included teeth-gritting, 2-minute-long contractions, uncontrollable body convulsions, and an unstable heart rate at times for both her and her son, the 33 year old was rushed to the operating room for an emergency cesarean section (C-section). Smith had to be strapped down at her arms, legs, and chest because of her convulsing body.

“I didn’t feel pain, I just felt the pressure,” she recalls. Her doctor had trouble removing the baby after cutting Smith’s abdomen, and had to call for two nurses to push on her body while standing on step-stools to help extract the baby. “You know how when something’s stuck, you shake it and wiggle it and stuff like that? That’s what I felt my body was doing,” she describes.

The baby ended up coming out fine: Maverick entered the world nearly 16 hours after Smith first arrived at the hospital in Georgia. Smith, however, had to have X-rays to make sure no ribs had been broken during the procedure.

Unsurprisingly, the whole experience left the new mother traumatized and unwilling to have any more children, even though she and her husband had previously discussed having more.

“I joke around that I went through two labors for one child,” she said. “That experience left a pretty deep impression on me. For the next month, I had recurring nightmares of that whole process. Obviously, I woke up and Maverick was there, and that was reassuring, but in some of my dreams it didn’t work out.”

Smith’s decision to go “one and done” after a harrowing labor and delivery experience isn’t uncommon among women who endure a psychologically traumatic childbirth.

In fact, research has shown that women who’ve had a negative birth experience are less likely to have future kids, or, if they do have more, wait longer to have another. Considering about one-third of women experience birth trauma, the question is: Why is something as natural as giving birth so devastating for some women?

Why is birth so traumatic for 1 out of 3 women?

  • Lack or loss of control: 55%
  • Fear for their baby’s life or health: 50%
  • Severe physical pain: 47%
  • Not enough communication from provider: 39%

Source: 2017 study

Researchers define trauma “as a perception of ‘actual or threatened injury or death to the mother or her baby,’” though others argue that it should actually be defined by the women experiencing it.

Last year, a study in the Netherlands attempted to quantify these experiences. The authors asked more than 2,000 women who reported having birth trauma to share what they thought caused or contributed to it.

The answers that received the greatest responses were lack or loss of control, fear for their baby’s life or health, severe physical pain, and the absence of communication or support.

When asked what could have been done to prevent the traumatic event, the most frequently chosen answers included providers offering better explanations and actually listening to their patients.

“Trauma is the way our system metabolizes an event or a situation,” explained Kimberly Ann Johnson, a postpartum care advocate. “It’s not really the event itself. So in many ways we can never tell from the outside if something’s traumatic or not. Just because a woman had an ideal version of childbirth — 10 hours of labor at home, no tearing, whatever — doesn’t mean that in her system, that didn’t register as traumatic.”

Too often, women dealing with the aftermath of a birth that went — at least in their eyes — horribly wrong are at risk for poor physical and mental health, including post-traumatic stress, fear, and the desire to avoid pregnancy and childbirth again.

Avoiding another childbirth is certainly what Kseniya M. intends to do. In 2015, while she was a four-hour drive away from her North Carolina home on a low-key family beach vacation, her water broke. She was only 33 weeks.

Although doctors at the nearby hospital worried the baby girl still needed more time for her lungs to develop, they ordered an emergency C-section when she went into distress.

It turned out that Kseniya had a placental abruption — an uncommon but serious complication in which the placenta separates from the inner wall of the uterus. “We’re talking to the nurse after and she’s like, ‘You’re really lucky… Both of you could have died,’” she told Healthline.

“That was the first moment it hit me. I kind of thought this was bad, but I didn’t realize how bad it could have been.” Later, after she was released from the hospital and made plans to check into a hospitality house — the baby ended up staying in the NICU for about a month — Kseniya said she was devastated by the realization, “I just had a baby. I just left her in the hospital.”

In addition to going through postpartum anxiety, “There were days,” she said, “where I felt like a giant elephant was sitting on my chest. I [didn’t] want to leave the house because I [was] afraid someone’s going to steal my kid.”

Kseniya expressed frustration at the way her regular doctors handled her care. When she went searching for answers for why she suffered this complication and if her ability to have future children was impacted, she said she felt ignored. As a result, she’s no longer a patient at that practice.

The feeling of being let down by a doctor appears to be all too common.

In a 2017 study conducted by a team of researchers in Australia, a majority of the women surveyed (about 66 percent) traced their birth trauma to actions and interactions involving their care providers. They felt that their doctors prioritized their own agendas — such as wanting to get home — over their needs, coerced or lied to them, and dismissed or ignored them altogether.

“There are still moments where I’m like, oh my god, we got lucky,” Kseniya said, describing her birth experience as “definitely dramatic, definitely taxing, and definitely not something I want to go through again. I know we got lucky with it this time, but I don’t think we’ll get that lucky again.”

Researchers have spent a lot of time investigating how women fare both physically and mentally after birth trauma.

One study actually determined that “all aspects of women’s health are endangered due to traumatic childbirth.” In some cases, that trauma could lead to death.

The United States has the worst maternal mortality rates compared to other developed countries, and it’s still rising. Moreover, black women are three to four times more likely than their white counterparts to die during pregnancy or within one year of the end of pregnancy.

Possibly more telling, a recent NPR and ProPublica investigation found that for every 1 woman that dies during childbirth, 70 women almost die.

The need to address these statistics is why the American College of Obstetricians and Gynecologists (ACOG) recently released a much-needed update to its recommendations for postpartum care. Instead of a single visit, the organization has determined that “ongoing care … with services and support tailored to each woman’s individual needs” is the best way to champion the health of women and their babies.

One young mother who might have benefited from a heightened attention to postpartum care is Allison Davila, a former social worker living in North Carolina. It took the 31 year old and her husband two years to conceive their first child.

While the pregnancy itself was easy, she told Healthline, she found her birth experience to be so horrifying that she decided not to have any more children.

After almost 48 hours of active labor, which included the fearful realization that her baby’s heartbeat was unstable, and significant vaginal tearing due to the strain of trying not to push as the nurses located her doctor, her son was born with his umbilical cord wrapped around his neck.

“He was a disturbing shade of blue,” Davila said. “I was terrified into silence, barely breathing while I waited to hear my baby cry. When he did and they brought him over to me, all I could say was, ‘Hi, you’re here. We did it.’ All I could feel was relief that it was over.”

Davila soon discovered, however, that the physical and mental anguish of becoming a mother wasn’t over. About two months later, she developed symptoms related to postpartum depression (PPD) — though she didn’t recognize what it was until much later.

“I was sleep deprived and my coping skills were nonexistent,” she said. “I felt extremely overwhelmed almost all the time. My son had colic and reflux and was constantly disgruntled. I felt so guilty that I was struggling so hard to be his mom after trying to have him for almost two years.”

Her son is now 3 and a half, and many of her PPD symptoms have faded away. “My husband and I have talked a couple times about the possibility of trying again for another child,” Davila said, “but I ultimately decided my body and mind aren’t prepared for another experience like my first.”

Kimberly Lawson is a former altweekly newspaper editor turned freelance writer based in Georgia. Her writing, which covers topics ranging from women’s health to social justice, has been featured in O magazine, Broadly, Rewire.News, The Week, and more. When she’s not taking her toddler on new adventures, she’s writing poetry, practicing yoga, and experimenting in the kitchen. Follow her on Twitter.