The fourth from her series introducing us to maternal mental health, Anne Marie McKinley (a Midwife and Birth Trauma Specialist at Afterthoughts NI) focuses her next 3 parts on various aspects of trauma response in birthing.
Birth trauma is still represented as though it is a surprise in some parts of the world. Even with pain relief, and the intention towards active management of normality, women still develop PTSD in the postnatal period. These next three (4-6) contributions will focus on various aspects of the trauma response in birthing and suggest some very practical interventions which may assist in prevention or amelioration of symptoms.
DSM V and Postpartum PTSD
The following statistics are based on a study done in the USA.
‘Postpartum post-traumatic stress disorder (P-PTSD) is a variant of post-traumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centred maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD?’ (Vesel, Nickasch, 2015). 1
Postpartum PTSD appears in DSM-V as a subset of PTSD itself. Previous trauma, which may leave women vulnerable to developing PTSD, can also contribute to the diagnosis of postpartum PTSD. To fulfil the criteria for a Diagnosis of Postpartum PTSD there needs to be 4 categories of symptoms present. 2
Examples of some presentations of individual trauma responses might include any of the following:
- Persistent Re-experiencing of the Trauma – This may happen in a variety of ways but may present in dreams or nightmares, persistent thoughts and re-living various parts of the birth story. Flashbacks may occur spontaneously and uninvited.
- Avoidance – May present as not being able to watch a TV programme or attending mother and baby groups as they may be asked about the baby’s birth. Women have told me, in session, that they will take any road rather than pass the hospital their baby was born in because of the severe symptoms of fear and anxiety which happen when they come near.
- Negative Mood or Cognitions – Low mood, feeling sad or bad about the birth. Feelings of being detached or apart from others, or even themselves. Poor memory of events mean that the story of their baby’s birth does not always have a complete narrative.
- Poor Concentration – Being angry or irritable. Sleep changes; difficulty getting to sleep or staying asleep.
Many women will experience some or all of the trauma symptoms above for years. Some will experience them intensely for weeks or months and they may reduce spontaneously. For others, these manifestations appear to be gone until there is a reminder. This could be an episode of ‘Holby City’ or ‘Call the Midwife’ or a woman who begins to tell her birth story in their company. Thinking about planning another baby might cause emotional distress and awakening of old symptoms.
Again, there may be a reduction in the number and level of symptoms experienced, a reduction in nightmares or re-living for example. Instead the woman begins to experience other single symptoms such as high levels of anxiety or low-mood. In this way women may be treated for these things rather than receive the trauma therapy which would address the original cause.Trauma responses vary depending on the story. Women may have had a number of fearful or psychologically disturbing incidences throughout their birthing experience. #birthtrauma Click To Tweet
Bonding can be disrupted. A somatic (physical) remembering of an instrumental delivery may cause a woman to refrain from intercourse. Women feel unable to attend for smear test (cervical screening), or may develop Vaginismus postnatally. Decisions about another pregnancy may be delayed for years or permanently postponed.
Complex trauma and previous life experiences may also play their part in the development of postpartum PTSD. In my experience, the deepest emotional wounds are when the essential sense of self is shaken. This may predispose women to postnatal depression; there may be a disruption in natural confidence, a waking to a part of the self, unknown before with no immediately visible road to lead them back to their core.
Most women, thankfully, may experience some symptoms for a short while, which then disappear spontaneously with full recovery.
If you are currently experiencing trauma symptoms due to your birth, please enquire with a health professional regarding an appropriate pathway.
I will discuss a variety of ways in which the trauma response may be reduced in part three in this series on birth trauma.
This series is designed to open discussion with therapists and raise the possibility of interest in birth trauma counselling. It may be that you are intimately aware of the burden of postpartum PTSD. Some tools and resources are available on previous pages for anxiety and depression (see parts two and three). Please take care and share how you are feeling with your partner, family or a friend. Please judge if you need to see a GP to discuss your symptoms.
If you are in immediate danger of suicide or you think you might harm yourself you should:
- call 999 or present at your local emergency department
- reach out to Lifeline (NI) on 0808 808 8000 (24-hour crisis helpline, 7 days a week)
- speak to Samaritans (UK) on 116 123
- Vesel J., Nickasch B. An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder. Nursing for Women’s Health. 2015 Dec-2016 Jan;19(6):504-25. doi: 10.1111/1751-486X.12234.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC
A growing list of other support, weekly:
Supporting parents with birth trauma – The Birth Trauma Association
Peer Support Network – Action on Postpartum Psychosis
Part 5 → Birth Trauma: Part 2 of 3