I’d like to heartily welcome Stacy Biscardi as a guest on Postpartum Progress today. Stacy has written an illustrative article about postpartum PTSD, her traumatic childbirth experience and how she is being treated for this disorder.
Women forget the pain of labor and delivery. That’s what everyone says. But it’s been more than one year since my traumatic delivery and painful postpartum complications, and I am still trying desperately to forget.
For one hour, every other week, I sit in a therapist’s office, squeezing pulsing electrodes in each hand, reliving my experience vividly, in an effort to release the trauma from my body and mind and get on with my life.
I have postpartum post-traumatic stress disorder (postpartum PTSD) an illness typically associated with combat veterans. The only battles that I fought were in the delivery room and the ER, but the trauma I experienced triggered anxiety, depression, flashbacks and nightmares that left me drenched in a cold sweat night after night.
I know that I am not alone. Up to nine percent of postpartum women meet the criteria for a diagnosis of PTSD, according to a recent study by Harris Interactive for Childbirth Connection.
What is Postpartum PTSD?
“Postpartum PTSD is a postpartum anxiety disorder,” explains Karen Kleiman, MSW, LSW, author, and Founder and Executive Director of The Postpartum Stress Center, which provides treatment for prenatal and postpartum depression and anxiety. “PTSD can emerge when a woman experiences actual or perceived threat of death or severe injury to herself or someone she loves,” says Kleiman. “Events such as these cause intense emotional reactions, such as fear, horror or feelings of helplessness.”
My birth experience fits this description precisely.
As my labor progressed, my baby turned in the wrong direction and his heart rate dropped, along with mine. Without warning, a nurse fastened an oxygen mask over my nose and mouth. Doctors told us that they needed to get the baby out quickly and the only options were an emergency c-section or forceps delivery. Both had their risks and neither was what I had expected for my first delivery, especially after smooth sailing through pregnancy.
My doctor thought forceps would be the preferable option because of the baby’s low position. The forceps looked like a medieval torture device. They were gigantic metal tongs, running the length of my arms. I gagged at the sight of them. “The baby’s heart rate is dropping,” one nurse reported in a panic. “We need to do this quickly,” the doctor instructed the team.
My mind went numb and my body was no longer my own. Four doctors, a few nurses, and residents poked and prodded me as if I was a 4th grade science experiment. I watched them from a place high above my bed. It felt like my life was in limbo and I was terrified that my baby might not survive either. I drifted away while the doctor flipped the baby around with the forceps and everyone chanted, “Push, push, push!” One doctor yelled, “Here comes the baby! It’s a . . . boy!”
I felt nothing. I saw nothing. I heard nothing. I waited for the cry. I squeezed my husband’s hand and waited. The deafening silence overwhelmed the room, pained my heart. I watched the medical team rushing around. I waited for the cry. And waited. And waited. “This must be a nightmare,” I told myself. Finally, at last, I heard a cry.
I did not get to see or hold my baby for a few agonizing minutes. “Is he OKAY?” I screamed, over and over again, hysterically, as tears poured down my cheeks.
Who Is At Risk for Developing Postpartum PTSD?
Women may be at higher risk for developing postpartum PTSD if their delivery included:
– an unplanned C-section
– use of vacuum extractor or forceps
– baby going to Neonatal Intensive Care Unit
– feelings of powerlessness, poor communication and/or lack of support and reassurance
In addition, women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD, according to Postpartum Support International.
How Is Postpartum PTSD Diagnosed?
“There are three clusters of symptoms that must be present in order to be diagnosed with PTSD,” Kleiman explains:
“1) Re-experiencing of the trauma: This refers to the experience of intrusive memories of the trauma, nightmares or flashbacks about the trauma, and/or distress when something triggers memories of the trauma.
2) Emotional numbing and avoidance of reminders of the trauma: At least three of these avoidance and numbing symptoms are required for a PTSD diagnosis, including efforts to avoid reminders of the trauma, difficulty remembering aspects of the trauma, diminished interest in pleasurable activities, detachment from others, a restricted range of emotions, and a sense that the future will somehow be cut short.
3) Increased arousal or anxiety: Symptoms include signs of increased arousal, such as sleep impairment, irritability /anger, difficulty concentrating, hypervigilance, and a sensitive startle response.
Despite reassurances that my baby was perfectly healthy, my spirit was shattered. For days, I could not stop crying hysterically. For weeks, I could not stop horrible images from racing through my mind. I avoided driving past the hospital where I delivered and watching television shows about childbirth.
I swore I’d never have another baby. I lost faith in the doctors whom I had trusted for a decade. Family and friends told me in vain to focus on my beautiful, healthy baby, and to forget the delivery and horrific postpartum complications that landed me in the ER a week later. It was easy for them to say and they did so with the best of intentions. But, they did not understand the depth of my despair.
I knew that I needed help and I got it within weeks of my son’s birth. I visited a therapist who specializes in postpartum stress and began talk therapy and an antidepressant, which provided almost instant relief from my worst symptoms. After a few therapy sessions, I thought I was healed. But, the trauma continued to haunt me.
I replayed the delivery and complications over in my mind day after day, week after week. Although it took a full six months for me to recover physically, emotionally, my scars lasted much longer. Reminders were everywhere: pregnant women at the supermarket, sounds of suffering on television, even newborn babies. Nightmares shook me to my core for more than one year.
I was overcome with anger, sadness, and terror. As my son neared nine months old, I returned to therapy and revealed new details about the intrusive thoughts and nightmares I had been having all along. My therapist believed I was suffering from postpartum PTSD and suggested I see a trauma specialist.
“The primary reason that PTSD is frequently misdiagnosed or undiagnosed is that women are reluctant to disclose the details of their experience or scary thoughts and healthcare providers are equally disinclined to probe for details of this nature,” explains Kleiman. “Sadly, this impasse can lead to prolonged suffering.”
What Kind of Treatment Is Available?
After nine months of suffering from postpartum PTSD, I began a groundbreaking therapy called “EMDR,” (Eye Movement Desensitization and Reprocessing). “EMDR is a treatment which allows traumatic memories that are locked in the brain to be unlocked and reprocessed,” explains Sue Milbourne, MS, LMFT, an EMDR-Certified therapist and senior staff therapist at Council for Relationships. “A person undergoing EMDR will focus on the worst parts of the memories to allow them to unblock, and that may include experiencing them again briefly in order to reprocess them in a positive way,” says Milbourne.
EMDR helped me reprocess my traumatic memories and feel more empowered. Although my memories are still present, they no longer have the devastating impact on me as they once did. This comes as no surprise to Milbourne, who has had much success bringing resolution and relief to clients battling postpartum PTSD since she began EMDR work in 1996.
How Can You Lower Your Risk of Developing Postpartum PTSD?
First, ditch the idea of a “birth plan,” Milbourne suggests. “Birth plans are a bit dangerous because they set women up for disappointment. Often times the ‘plan’ is not a possible choice.” Milbourne recommends that women discuss their “birth hopes” instead, and remember that a birth experience “is not a failure if it does not go as planned or hoped.”
Additionally, “be free to ask your doctor questions” so that you can make informed decisions, Milbourne adds. “Stay in the moment and breathe and, no matter what is happening in the delivery room, say to yourself, ‘This is happening as it should,’” so that you can process even a complicated birth as a positive memory.”
Finally, “whether your birth experience is like a merry-go-round or a rollercoaster ride, keep your eye on the prize,” Milbourne says.
My prize is a healthy baby boy who reminds me of the beauty in life every day. I am hopeful that he will become a big brother in the near future and, whether I’m on a “merry-go-round” or “rollercoaster,” I will be better prepared for the ride.
Thank you so much for sharing your story. I did have a birth experience that was not in "my plan". When my first son was born everything went beautifully so I thought the same for my second. He came out with the cord around his neck. I too was waiting to hear cries and all I heard was silence for what felt like an eternity and hearing nurses asking for respiratory care. Finally he did cry loud and long. I am happy to say he is healthy.
Oh my story is SO similar!! I was back in the ER a week after delivery as well b/c I had so much blood loss from the 3rd degree tear from the forceps! Lucky me also needs repair surgery later on to fix my sphincter muscle that also tore from the forceps.
I'm 17 months post partum, on the decline of antidepressants, and feeling great. I'm even a little bit happy over the idea of another baby!
The thing I'm taking away most from this article is changing my future birth plan to "birth hope!" I've learned to let go of so much I can't control, which I'm hoping will make baby #2's arrival more joyful!
Thanks for sharing! I know I'm not alone in my trauma, and today is another reminder!
EMDR is a fabulous technique to process these types of trauma. I, too, have used EMDR to process past trauma and have found it very successful.
Thank you, Stacey, for writing so bravely about your experience and introducing this technique to the Postpartum Progress readers.
Thank you Stacy for writing about your experience of Postpartum trauma and recovery. As an EMDR trainer, consultant and clinician, I found your article a wonderful introduction and an important reminder that symptoms of PTSD can be caused by a wide range of life experiences, not merely by combat trauma.
I've treated many individuals with different kinds of medical related PTSD and found EMDR to be an essential part of recovery from these experiences. Our EMDR professional association just posted a long list of articles and conference presentations on the use of EMDR with medical conditions to the member's only area, but abstracts for all these can be found on the Francine Shapiro Library at: http://emdr.nku.edu/emdr.php
Those interested in introductory information on EMDR can find links on my training and my practice sites:
Thank you all so much for your kind comments. I thought that if anything good could come out of my experience it would be helping other women to avoid postpartum PTSD, understand it, and heal from it, if necessary. Thanks again for reaching out. Wishing everyone a healthy and happy 2011!
According to Phillip Levine, in An Unspoken Voice, one of the key factors in whether a person develops PTSD is whether he or she can respond to the trauma or is immobilized in some way. That's why it's so important to let people shake after an accident or after anesthesia. Just tossing that out there as info that may be helpful to others.
Wow, does this hit home. Eight years later and I'm still struggling with maternal depression, having not bonded with my daughter from the moment they laid her in my arms. A "precipitous" dilation/labor period and winter weather stalled the night staff's "call" to the anesthesiologist; so, SURPRISE! I had a natural childbirth!
My husband and family are a great support network, but will truly never understand the depth and breadth of my "numbness" towards my child. And, it all started that first night. It was SO shocking and horrible and I felt so alone and the nurses just brought her to me and left her and no one let me sleep and I thought, "This is the beginning of the end of my life…."
Unfortunately, I'm still waiting for the sun to shine.
I am so glad to see this subject explored here! I have to say, though, I think the idea of “ditching the birth plan” is a bit misguided. What research continues to find is that it is not so much the medical trauma in childbirth that leaves an impression as it is the way a woman is treated in birth. It is so important that women are treated with the utmost respect and as the ultimate decision-makers in birth – not mere vehicles for delivery. Note the six themes identified by researchers here after birth trauma: ‘feeling invisible and out of control’, ‘to be treated humanely’, ‘feeling trapped: the reoccurring nightmare of my childbirth experience’, ‘a rollercoaster of emotions’, ‘disrupted relationships’ and ‘strength of purpose: a way to succeed as a mother’ (http://www.ncbi.nlm.nih.gov/pubmed/20636467).
But back to my first thought: birth plans represent preparation and the idea that women are the captains of their own ships. Our needs and wants are extremely important. Believe it or not, births are SAFER for both mom and baby when women are treated well. I Foregoing a birth plan because unexpected things happen sometimes isn’t the solution. And, the frightening alternative of no expectations represents “anything that happens in L&D is okay as long as baby is alive.”
It’s like saying I’m not going to meticulously plan my wedding because I don’t want to be disappointed if things don’t work out just right.
Handing over the birth experience is the exact opposite of what women should do if they wish to avoid birth trauma. Here’s something I wrote that touches on this: http://www.improvingbirth.org/2013/05/selfish-women/
This article is great. My only problem with it is the advice at the end:
no matter what is happening in the delivery room, say to yourself, ‘This is happening as it should,’” so that you can process even a complicated birth as a positive memory.”
This seems almost silly, would you guve the same advice to someone experiencing other types of trauma like say, rape, car accident, acts of war?
I experienced pretty much exactly the same birth except my baby was also injured by the. Forceps and spent 10 days in special care due to oxygen desaturations. I thought I was going to loose her and I’ve never felt so scared and panicked in all my life. I also had a bleed out after the birth and then tried to breast feed for 3 exhausting weeks with no milk. Six months later and I still revisit it almost every night before I go to sleep. I blame my husband for not being there for me like I needed him and I don’t think our relationship will ever be the same again because of it. Yes I am forever grateful for my now healthy (and very beautiful) baby but that day changed me and has changed my life and I can’t ever go back. I wish you and all the other women experiencing the same thing the best of luck.
Wow I was wondering what has been going on with me. I had to be indused and my son was not positioned right. I was almost 2 weeks over due. All of a sudden I went from 4 to 9 from the drugs snd my sons heart stopped. It was a mad panic to “wake him up”. Then they looked to me to deside forsepts or c section. I was tramatized with an o2 mask on. Looking for others in the room for guidence. It was almost midnight and the dr thought foresepts would be faster. They had to rotate him and then pull him out. He had bruises on his temples and would cry in bright light. Then he lost a pound while I was trying to breatfeed and needed the light therapy for jaundice. (Sorry sp). It was awful. I clung on to him. I felt like we only had so much time together and I needed to make the most of every moment. I felt like a zombie the first year. Now he is 3 and he had and still has night terrors. I just cling on. Don’t get me wrong I was ok for others to hold him and he spends time away from me. As you csn tell I am still batteling this. I think part of this is because he was my second pregnancy but first birth. But due to all of this and the night terrors he has I still haven’t slept a full night. I actually have nightmares that an unforseen forse is trying to attack him in his sleep and I am trying to protect him. And i have to cling on to him. Like a ghost horror movie style. Also why can’t they make diapers that can hold pee all night??!! I might have gotten more sleep if I wasn’t so worried about cleaning up a bed full of pee in the middle of the night. Ok if you are still reading this my point is I don’t feel like I have depression and I don’t feel like I have anxiety. It feels like something else and this seems logical. Also I went in with out a birthplan I was ready to go with the flow. There is no prep for “oh we lost your baby’s heartbeat and we have to stop the potosone and this will also stop your active labor and we have to get him out now and my shift for the group dr experience you signed up for is about to end so lets just yank him out with these things. Dont worry we will sow you up and give you painkillers and after sitting on ice for a week or two you will hardly remember what you put your poor defenceless child through.” Ok now I’m just venting.
Ugh, I’m so sorry you went through this. It is most certainly trauma and you most likely are dealing with PTSD. That would be normal for anyone who experienced this kind of terror and trauma. It’s okay to vent, and it would be so good for you to continue to do that in therapy. I hope that’s an option for you. There is such good help for PTSD. You don’t have to keep living in fear and that feeling that creeps up that can’t be described. I’m sending you peace.
I am 62 yrs old now and not a day goes past without my thinking about the horror of the forceps delivery that I had to endure are 26hrs of labour with only one pethidine injection for pain. I have had two major operations to try and fix an internal bowel prolapse and uterus prolapse that I developed in later life. I have still more prolapses that have developed since, and live a life of daily discomfort even now. Labour and childbirth strikes terror in me even now – having read this article and comments I am in no doubt that I may still be traumatised by this event. Thanks for sharing your stories – it makes me feel less alone.