I have become especially interested in the phenomenon of Postpartum Post-Traumatic Stress Disorder (PTSD) as of late. I live and work in a community where “natural” choices and Attachment Parenting are both respected and expected by many. Bradley Childbirth Education classes are common. Having a home birth or delivering with a midwife in the hospital are frequently chosen. Breastfeeding is often non-negotiable for new moms just beginning their journey, and non-medicated birth is the preferred option for a large number of women here.
While there is certainly a culture of success (meaning that many women do end up with the births that they had hoped for), there are also the very common realities that take many women off guard: the emergency C-Sections; the “cascade of interventions” during childbirth that may start with induction; the common breast-feeding challenges, the delivery by an OB that was not preferred; the reality of pain in childbirth; the loss of sense of control that can occur for many, many women, especially those who have a prior history of trauma or abuse; the premature baby or baby with medical issues that lands a family in the NICU; and infants lost during childbirth or shortly there after. These things can happen, no matter how “prepared” or with what intentions well-meaning moms and medical providers hold on to.
Often, I see these moms in my office weeks, moths, and sometimes years after experiencing a birth that was in someway “traumatic” for them. I put this word in quotes because we know by now that it is not the specifics of the birth events that can lead a mom to be traumatized, but her perception of these events. On paper, a birth might look “perfect” when, in reality, a mom may be walking away from her experience with some significant post-traumatic stress. Physicians, midwives, doulas, nurses, spouses, partners, and family members may assume that all is fine and dandy for a mom after she delivers a healthy newborn when, in reality, her perception is very, very different.
When looking at the probable “causes” of postpartum post-traumatic stress disorder, this is what we know may contribute to risk:
A perception of lack of caring: Moms feel abandoned by providers or partners during their pregnancy or childbirth experience; moms do not feel reassured or supported during childbirth.
Poor communication: Moms feel unheard during childbirth and feel that their perspectives around choices were not validated. Moms feel uninformed about choices being made to benefit herself and her baby during childbirth.
Feelings of powerlessness: Moms feel unprotected and under-supported by medical/birth staff. Moms feel that they had no control over birth process.
A re-triggering of old trauma histories or fears: Moms went into childbirth with intense fear and uncertainty that was not addressed.
Does a healthy baby justify a traumatic delivery? Moms feel that attention was on health and well-being of her baby while she went “unnoticed.”
The reality is that postpartum PTSD is not that uncommon. Statistics vary, but the one that I have seen the most is a whopping 9% of women who deliver a baby will go on to develop symptoms of post-traumatic stress after birth. A recent study published in Birth: Issues in Perinatal Care (38:3 September 2011) broke these symptoms down into three categories.
- Intrusion symptoms: Repetitive re-experiencing of the birth trauma through flashbacks, nightmares, distressing recollections of the birth experience, and psychological distress following birth.
- Avoidance symptoms: Attempts to avoid reminders of the birth experience such as doctors offices as hospitals, people associated with birth experience (sometimes including the baby), thoughts about the birth experience.
- Increased arousal symptoms: Difficulty sleeping, heightened anxiety, irritability, and concentration challenges.
And there can be significant consequences for moms with postpartum PTSD if support isn’t put into place. Moms who suffer from PTSD are less likely to have subsequent births (and are more likely to have an epidural or a scheduled C-Section if/when they do); they are less likely to receive follow-up medical care; they are less likely to breast feed (due to pain, feelings of violation, low milk supply, self doubt and lack of confidence, and/or painful reminders of childbirth); they are more likely to have challenges bonding and attaching with their newborns (again, often due to triggering reminders of events); and they are more likely to experience conflict in their marriages/relationships and experience sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to also suffer from depression.
We know that risk factors such as antenatal depression, lacking social support, previous trauma histories, breast feeding challenges, and physical challenges following childbirth can heighten a woman’s reaction to trauma. But we also know that preventive measures such as well-established stress management strategies, “health promoting behavior” such as healthy sleep, nutrition, and exercise, and opportunities to debrief birth experiences can reduce a mom’s risk for PTSD. In other words, with effort, some of these postpartum PTSD stories can be lessened.
And, why is it important to know whether a mom has Postpartum PTSD? Because in many cases, women are treated for their depression (remember, most women with PTSD will also be depressed), and their PTSD is not addressed. If a mom isn’t asked the right questions and if she does not tell the whole story, she may be in treatment for a long time without the desired relief. A mom with Postpartum PTSD needs support in re-processing the experiences that led her there; in understanding why she developed the reaction that she did; in understanding the role of old and new beliefs that may have led her to her reaction to her birth or that have been created due to her experience in birth. These women benefit greatly from having an opportunity to re-frame and better understand their birth experience for what it was—to them. For many women, specific work around trauma is necessary.
It is a great honor to be given access to a mom’s story during birth, whether it was one that met her expectations or one that was upsetting and “traumatic.” These stories are a woman’s first experience with being a mom to a baby on the outside, and the ones that will often inform her earliest parts of motherhood. What was your birth story?
For support and information on Postpartum PTSD:
– Kate Kripke, LCSW