Post Birth Traumatic Stress Disorder

Every day in my job, I hear from women who have experienced birth trauma. They want a different experience this time around, and they are willing to try almost anything. In most cases I can help them. But first we need to overcome the biggest obstacle of all: the fear

Sarah* phoned me yesterday to discuss the option of us working together to maximize her chance of a VBAC (Vaginal Birth After Caesarean). She was softly spoken, and I could sense that she was entrusting me with something that was difficult for her to relive. Sarah spoke of her previous birth, with both terror and fascination. It was obviously very painful for her to talk about what happened, but she also seemed relieved to be uncorking the bottled up fear. Once she had started to tell her story, the words and the tears flowed.

We talked for nearly two hours about her expectations, and the dreams that she’d had prior to her first baby’s birth. Sarah explained that she had not been dilating at the recommended 1cm per hour, and after many interventions she had succumbed to an emergency caesarean. She told me about the terror that she’d felt, lying helplessly on the operating table while her baby was whisked into another room.

She expressed her guilt at depriving her husband of the chance to meet their daughter under the circumstances which they had planned carefully down to the tiniest detail. Sarah felt like a failure for not having the natural birth that she’d spent months dreaming about, and planning for. In the days after her caesarean birth, Sarah started to remember the events that led to it. All of the people in the room. The internal examinations which left her feeling exposed and uncomfortable. The pressure to dilate within the “allowed” timeframe, before her threatened caesarean.

Sarah was offered sleeping pills in hospital for her “baby blues” insomnia. By the time she had left the hospital, she just wanted to forget that she’d had a baby. She gave up breastfeeding on day 8 because the stress she was under was so severe that she spent whole days crying in her bed. She had nightmares for two years, and saw a counselor who diagnosed her with Postnatal Depression.

3 years later Sarah fell pregnant again. It was unplanned, as she had refused to have another child. But Sarah made a decision to make this pregnancy and birth a positive experience. She educated herself on VBAC and is working hard to overcome her fear around birth. Despite this, Sarah is still haunted by the memory of her traumatic first birth. Physically the scars have healed, but the fearful association with birth remain.

Several things can help you to overcome fear around birth prior to your next pregnancy or birth. Talking to a counselor. Choosing to have a Doula, or trained support person attend your birth. Accepting what has happened and educating yourself on your body’s natural birthing instinct.

Post traumatic Stress Disorder following birth is a very real disorder which affects many women. It strips you of your trust in your body to birth. It can last a life time. And the medical profession needs to take action in helping women to get help before they leave the safety net of the hospital.

If you have experienced any of the following, you may be at risk of PTSD following the birth of your baby.

·         Managed labour

·         Induction

·         Poor pain relief

·         Feelings of loss of control

Post Traumatic Stress Disorder - PTSD

There are certain events, situations or even characteristics which may contribute to your chance of experiencing a higher risk of PTSD. These can occur at any time during the pregnancy, the labour, birth or shortly after. Each risk factor can increase the chances of PTSD occurring. Most can be avoided or lessened considerably by those looking after the woman, by simple measures such as giving the woman respect, treating her with dignity, acknowledging her needs and communicating effectively at all times.

These symptoms should alert you to possible PTSD:

• Experienced an event perceived by the person experiencing it as traumatic
• Flashbacks of the event, vivid & sudden memories
• Nightmares of the event
• Inability to recall an important aspect of the event - psychogenic amnesia
• Exaggerated startle response, constantly living on edge
• Hyper-arousal, always on guard
• Hyper-vigilant, constantly looking around for trouble or stressors
• Avoidance of all reminders of the traumatic event
• Intense psychological stress at exposure to events that resemble the traumatic event
• Physiological reactivity on exposure to events resembling the traumatic event- panic attacks, sweating, palpitations
• Fantasies of retaliation
• Cynicism and distrust of authority figures and public institutions
• Hypersensitivity to injustice

COVER-UP SYMPTOMS

The longer the person has suffered from untreated PTSD, and the more severe the trauma, the more likely the PTSD will be hidden by one or more of these or other cover-up symptoms:

• Alcohol and drug abuse
• Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
• Compulsive gambling or compulsive spending
• Psychosomatic problems
• Homicidal, suicidal or self-mutilating behaviour
• Phobias
• Panic disorders
• Depression or depressive symptoms
• Dissociation symptoms
• Fainting spells

If you have experienced any of the symptoms, or cover up symptoms of PTSD, please seek advice from your GP or local Community Health Centre. These symptoms may start very soon after the birth, or even years later. If left untreated PTSD does not go away.

For more information go to:

Trauma and Birth Stress www.tabs.org.nz