Part One: Should PTSD be treated differently just because it is childbirth onset?

birthtouch perinatal mental illness guide book front1How many times must we ask for sensitive care?

Note:

The following is a composite of many women I’ve seen over eighteen years as a licensed psychotherapist, childbirth educator and doula.  With variation, this same brutal story has been repeated over and over again in my office, as it’s repeated in therapists’ offices across the country. Any resemblance to one particular person is coincidental.

And every time, I feel rage as I ask myself….How many times must we ask for sensitive care? Why do women get treated like this during their precious time of childbirth? WHY are women treated less than humanely? Why do hospitals turn childbirth into a brutal experience?

WHEN will maternity units be havens of holistic care? When I worked in the a major Cancer Center, I ran a grant-funded, free MindBody program that served hundreds of people from the surrounding community. 

She came into my office. Sat down on the couch with skepticism in her eyes. I could tell she didn’t think I could help her. She had a haunted look, and dark circles under her eyes.  She told me the story of the past months with her young baby. She’d never been to a therapist before. Was always fine, managed her life well.  But now, there was no frame of reference for her intense feelings. Crying every day, for long periods of time, mostly alone at night, trying not to worry her husband. Breastfeeding was going well and was important. She stated it was one of the things holding her together. She felt very much bonded to her baby. But her moods were all over the place: with much joy in her baby, co-existing with a dark, endless despair.

“Will I ever be well again?  Why was I treated so poorly in the hospital? Why did the nurses joke to each other over me? It feels rude enough when hairdressers talk over you to each other across the room…but, geez, this happens even during birth? I felt dehumanized.  I was ignored. They yelled at me, they ganged up on me …  things were done to my body without informed consent. Informed consent was a joke. My rights as a citizen were violated;  my body was violated. I felt raped.  There were several people whom I think were medical students in the room…I didn’t give permission for that! I became a spectacle during my birthing time, my special time…it was humiliating.What I wanted was irrelevant. All that mattered was what the hospital and staff wanted.

I can’t stop thinking about it…that time comes back to me over and over again. I was treated as less than human. I feel ashamed and anxious, but separated from the ordeal…like I’m looking at another person. I’ve been attending a group….that helps sometimes, but people push their own agendas there, about natural birth, rituals, essential oils….I need to feel well again, not be sold something. I don’t know if you can help me. Are you good enough to help me? Medical people are all incompetent and uncaring…What will help me? Will I ever be well?”

What is birth trauma or traumatic childbirth?

 

Cheryl Beck, Ph.D., a leading researcher on traumatic childbirth, defines traumatic childbirth as an event where a woman experiences “…actual or threatened serious injury or death to the mother or infant…and/or where she feels “…stripped of her dignity…” (Beck, Driscoll & Watson, 2013, Kindle loc. 269 of 6077).

 

Because childbirth is a common and “normal” event, it might be difficult to understand that a mother may find her experience to be “traumatic” in the same way as, for instance, war may traumatize a young soldier.  There appears to be two different categories within birth trauma. The first category being those childbirth experiences that are easily identifiable as potentially traumatic: those where the mother experiences preterm birth, preeclampsia, stroke, hemorrhage or other life-threatening events or where the baby is stillborn, suffers an injury or another life-threatening event.

 

The other category is where the birth is appears to be outwardly normal (in particular to the medical providers), but the mother experiences treatment by the providers as callous, does not feel as if she gave informed consent, or there were many medical interventions that the medical team believes were necessary but the mother does not (Ford and Ayers, 2011).

The emergent themes of this type of birth trauma are: powerlessness, abandonment, being stripped of dignity and worth, loss of control and feelings of actual body and emotional victimization. The birthing woman feels disconnected and ignored from the medical team and experiences isolation and abuse (Beck, Driscoll and Watson, 2013).  This is often referred to as “birth rape” whereas, during a most significant event in her life, childbirth, a woman feels devalued and dehumanized (Elmir et al, 2010).

In the latter category, the hospital and medical staff may view the birth as normal and actually even successful, but the birthing woman feels dehumanized and  traumatized (Beck, Driscoll, and Watson, 2013).


PTS – Is a normal, self-limiting reaction to difficult/traumatic events

 

Some researchers suggest that diagnosing a woman with post-traumatic stress disorder may be over-pathologizing normal emotional responses to difficult events.

 

In fact, after a traumatic event, many people experience what is known as post-traumatic stress (PTS). PTS is a normal human reaction on a biological and emotional level to a traumatic event. In PTS, a person experiences:

  •  Dissociation
  • Numbing
  • Flashbacks
  • Sleep disturbances
  • Nightmares
  • Reliving/rehashing the event
  • Hyperarousal
  • Strong emotions such as
  • Anxiety
  • Depression/sadness
  • Self-doubt
  • Helplessness
  • Shame

 

These PTS symptoms occur because the brain and mind don’t have time to process a difficult/traumatic event at the time of the event. We are only concerned with immediate survival at the time of the event. This adaptive way of managing the event at the time of occurrence, and beyond, in order to survive is referred to both as “coping ugly” or “pragmatic coping” or having “positive illusions” in the research literature.

 

So, the PTS symptoms are an indication that we are processing the event on a mindbody level, slowly, in smaller chunks, in order to assimilate the event into our life experiences. On a biologic level, the brain is recalling fragmented memories of the event in order to create a coherent memory in storage in the neuronal network.  On an emotional and psychological level, we are trying to recall and make sense of our experience, imbue it with personal meaning, so as to integrate this into the definition of the self.  PTS symptoms are self-limiting and self-resolve in about three months. PTS is considered a normal reaction that over 35% of people exposed to trauma experience and should not be labeled and pathologized.

PTSD – Is a normal reaction to difficult/traumatic events that may need treatment to resolve  

 

PTSD has the same symptoms as PTS, but more intense and for a longer duration, maybe even lingering for a lifetime.

 

To put PTSD as a pathology in perspective, the National Institute of Health estimates that 6.8% of the total U.S. population experiences PTSD symptoms for a lifetime, 3.5% for over 12 months and, of that 3.5%, 1.3% experience severe symptoms.

  •  Dissociation
  • Numbing
  • Flashbacks
  • Sleep disturbances
  • Nightmares
  • Reliving/rehashing the event
  • Hyper-arousal
  • Strong emotions such as
  • Anxiety
  • Depression/sadness
  • Self-doubt
  • Helplessness
  • Shame

PTSD, like, PTS, is a result of the brain on biologic level and the mind, on an emotional and psychological level, attempting to assimilate and make sense of the traumatic experience after the event is over. At the time of the event, the brain hijacks the body and puts the entire being into survival mode. So biologic encoding of the memory is fragmented, not integrated. In PTSD, integration of the experience occurs slowly, over many years, but depending on the person and the feelings of personal horror and helplessness, symptoms can linger for a lifetime for some.

 

PTSD – Rates & Risk Factors for PTSD (Childbirth Onset)

 

The rate of PTSD childbirth onset is inconsistent in the literature and the sample sizes for this type of research is small, usually from 14 – 200 women included. However, the studies show that about 34% of women experienced their birth to be traumatic.  However, depending on the research you read, about 1 – 6% of these women actually develop PTSD.

 

One of the major risk factors for the development of PTSD (childbirth onset) is the existence of prenatal PTSD and/or high anxiety due to experiencing a prior trauma, such as a history of sexual abuse prior to the birth experience (Beck, Driscoll & Watson, 2013; Ford & Ayers, 2010).

 

But, of course, a person isn’t only defined by the traumatic events in her life!  The human body, mind and emotions are modifiable!  Professional treatment and lifestyle changes can help your personal growth and be very healing, so stay tuned for Part Two!

 

In Part Two, I’ll discuss Popular and Professional Treatment Options for PTSD (Childbirth Onset)

 

For childbirth educators and doulas, do you need a concise overview of Perinatal Mental Illness for reference materials and solutions to add to your classes?   See my book, Perinatal Mental Illness for Childbirth Professionals on Kindle!

birthtouch perinatal mental illness guide book front1

References

Beck, C., Driscoll, J., & Watson, S. (2013). Traumatic Childbirth. New York: Routledge

Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010). Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. Journal Of Advanced Nursing, 66(10), 2142-2153. doi:10.1111/j.1365-2648.2010.05391.x

Ford, E., & Ayers, S. (2011). Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology & Health, 26(12), 1553-1570

Westphal, M., & Bonanno, G. A. (2007). Posttraumatic Growth and Resilience to Trauma: Different Sides of the Same Coin or Different Coins?. Applied Psychology: An International Review, 56(3), 417-427. doi:10.1111/j.1464-0597.2007.00298.x

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