Friday, October 8, 2010

Postpartum PTSD: Birth Trauma in the U.S.

The most troubling aspect of the current state of affairs surrounding birth in the U.S. is one that hits very close to home: postpartum post-traumatic stress disorder (PTSD). This disorder is very personal because I still suffer from PTSD as a result of my first child’s birth more than four years ago. There has been an increase of interest in the disorder from the media as more and more women are starting to come out of the woodwork and describe their birth experiences as extreme trauma or even “rape”. These descriptions might raise eyebrows when people naturally expect women to endure childbirth in order to get a healthy baby. The image of a woman screaming in terror as the heroic doctor delivers the baby is an all-to-common scene in movies and TV shows. But is birth supposed to be traumatizing? Does the birth experience really matter or are women who describe being birth-raped overreacting?

Most people are familiar with postpartum depression, and that is not surprising considering the troubling statistics that one in ten women will be diagnosed with this debilitating disorder. However, the diagnosis of postpartum PTSD is a relatively new one. PTSD is usually associated with soldiers returning from war or survivors of rape or natural disasters. Symptoms of PTSD include recurrent distressing memories of the event, nightmares, flashbacks, panic and anxiety. People who suffer from PTSD usually go out of their way to avoid places or objects that remind them of the traumatic event, such as driving on the other side of town to avoid the hospital where the traumatic birth took place.

A recent U.S. survey showed that, of more than 900 mothers, 9% had a positive screening for postpartum PTSD. Also, 18% of the women surveyed had some symptoms of the disorder. Earlier studies which had been done outside of the U.S. had put the rates of postpartum PTSD somewhere in the range of 1.5% and 5.9%. These studies would suggest that the rates of postpartum PTSD in the U.S. are disturbingly high. It has been suggested that the rise in these rates can be attributed to the increase in interventions in birth as well as cesarean sections and feelings of helplessness in threatening situations.

Many of the women who suffer from postpartum PTSD have horror stories for birth stories. They describe feeling betrayed by the same attendants that they trusted would provide them with the birth experience that they had planned for. These women had procedures done against their will or without their consent. They felt threatened or coerced by their attendants into having inductions, c-sections, or instrumental deliveries which were not medically indicated. They had fingers, hands, scissors, and scalpels in them after they had protested against such actions. A chilling example is the case of Catherine Skol whose horrific birth experience included her husband holding her down while her doctor repaired a laceration without anesthetic.

So are these women exaggerating their experiences? Are these women who feel violated, birth-raped, or whose care providers put them or their babies lives in jeopardy overreacting? Is birth trauma a relative term and a matter of how the birth is processed? As someone who has experienced these feelings, I would say absolutely not. Birth is a very raw, primal, intimate process. When the people you entrust to share in this process with you breech this trust, trauma occurs.

Postpartum PTSD changes your life and how you view your birth and baby forever. How can it be enough to have a healthy baby when the mother is in a state of trauma from the same experience which should have been the most empowering experience of her life? These mothers feel shattered and shaken. They have less confidence in their abilities as mothers because their birth experiences were stolen from them. It can affect their ability to breastfeed and bond with their baby as well as their relationships with their partners, family, and fiends.

Is it just a pie-in-the-sky fantasy to believe that birth can be beautiful and not traumatizing in the least? We are born trusting birth and accepting that it is normal. If you show a video to a young child of a smiling woman giving birth their response will be something nonchalant like, “Oh! Cute baby!” Children don't expect birth to be traumatic, and neither should we. If over 90% of women can give birth safely without interventions, then we must not accept the current rise of inductions, cesareans, and other interventions in this country. If we want to raise a generation of healthy children, we must protect and empower their mothers. We have to stop accepting birth trauma as the norm and expect birth ecstasy instead. There is no excuse for the rising rates of postpartum mood disorders in this country. These rates are a disgrace and should make people outraged and demand a change.

So what can be done to avoid PTSD and other tragic postpartum disorders? It would seem that the common denominator among women who suffer from PTSD would describe feelings of helplessness during their birth experiences. People who provide care to birthing women need to understand that the birth belongs to the mother, not them and they must never take that power from the mother. Birthing women should have the final say in what happens to them in labor and postpartum. Women need to birth in ways that minimize interventions and surround themselves with positive people who trust birth and believe in their abilities. Women need to be re-taught to trust in birth and in their bodies and that to believe that birth is inherently dangerous is to believe a lie. Informed, empowered women who are supported in their choices have the safest and healthiest births, physically, emotionally, and mentally. They enter motherhood feeling on top of the world and ready to take on the challenges of raising a new life. I don't think that's too much to ask.


Sources:


Salon

http://letters.salon.com/mwt/broadsheet/feature/2008/08/06/postpartum_ptsd/view/?show=all


Postpartum Progress

http://postpartumprogress.typepad.com/weblog/postpartum_ptsd/


Psych Central

http://psychcentral.com/news/2008/08/08/ptsd-after-childbirth/2716.html


The Wall Street Journal

http://online.wsj.com/article/SB121789883018612223.html


The Midwife Next Door

http://www.themidwifenextdoor.com/?p=1182


ICAN

http://www.ican-online.org/recovery/postpartum-depression-and-post-traumatic-stress-disorder


The Unnecesarean

http://www.theunnecesarean.com/blog/2008/12/17/more-than-just-rude-behavior-the-rest-of-catherine-skols-all.html

Tuesday, July 13, 2010

Why it is So Hard to Counter Birth Fright

Being able to counter birth fright is such a challenge because it is everywhere. Movies and TV shows often associate disastrous outcomes with pregnancy and birth. The media is constantly running stories that show home births or any births outside of the “norm” in a bad light. Interviews of pregnant celebrities always focus on the “horrible pain” of childbirth. Even most people you talk to about pregnancy and birth have opinions that slant toward those events being among the most dangerous and painful one could ever encounter in life. But, in reality, birth is inherently safe and can be the most empowering experience of the mother's life. So, how can someone push back the wave of birth fright with the truth?
In the world of TV and movies, pregnant characters are almost always shown giving birth while screaming and dripping with sweat. Although there might not be complications, per se, the emphasis is that birth is hideously painful. Even a seemingly normal birth will sometimes take a turn for the worse in an instant with only seconds between life and death for the mother and baby until the hero doctor swoops in and saves the helpless pair. Almost worse than their portrayal of birth is their portrayal of doctors being able to perform god-like feats of life-saving proportions. The message is sent, “Thank God that woman was in the hospital so that the doctors could use their life saving machines and save them both...”
The media is not any better. They don't hesitate to run every story about home births gone “bad” or to make a huge emphasis on the danger of a woman giving birth in a car, in a shopping mall, or accidentally on her kitchen floor. And there always has to be someone to save the day, be it a policeman, plumber, or the person on the dispatch who talked the frantic husband through the “delivery”. If a home birth should end in tragedy, the story is run on the slant that it was because of the home birth that the baby or mother died. However, if the story is about a laboring mother who developed life-threatening complications from procedures at a hospital, the doctors are still seen as the heroes and the near-tragedy is shown as a “Christmas Miracle”.
People that you talk to about birth all have their opinions, most based on what they have seen, read, or heard, and not necessarily from what they've personally experienced. They will tell you about their sister's cousin's ex-girlfriend who would have died if she hadn't have had that cesarean or about their brother-in-law's mother-in-law who lost a baby because she had a home birth with one of those “midwives”. People believe what they understand and it doesn't make sense to them that doctors, the media, or their favorite character on TV would lie to them. They buy into the lies that the hospital is the safest place for every woman to have a baby, even though they are more likely to die in a wreck on the way there than in childbirth.
Birth fright is so rampant, the thought of trying to counter it can be overwhelming. But when people are armed with the truth, it can be amazing to see fear and lies melt away. The truth is that birth doesn't have to be horrendously painful. Women have been giving birth since humanity began and I haven't heard a story of a woman dying from the pain. I have, on the other hand, heard stories of women having orgasms during childbirth! And I have also heard stories of women dying from what they received for pain relief. It is also the truth that birth is safe and births have better outcomes when they are left alone, as nature intended. People are born trusting birth and those of us who still believe in its inherent safety and stand in awe of its ability to transform a woman into a mother must never stop speaking these truths.

Monday, July 12, 2010

Dispelling Birth Fear

People in our culture have been programmed to fear birth. They are taught to believe that birth is inherently dangerous and must be left in the hands of the “experts”. In order to dispel these myths, they must be shown how safe birth is when it is left alone. They must hear, read, and see the truth so that they can learn to trust birth again. Providing reliable information about normal birth is a good way to take down the curtains of lies and expose the truth.

It is imperative for people to hear positive stories about birth. It seems as if, as soon as a woman becomes pregnant, everyone, including strangers, feels the need to share birth horror stories with her. Women don't need to hear those; they need to hear good stories. They need to hear the story about their neighbor who had the home water birth in her jacuzzi tub. Or about the woman at the deli counter who gave birth, with the presence of a midwife, next to the tree on Christmas morning. People who know these empowering, uplifting stories need to speak up and tell them. No one can tell a positive birth story too many times and hearing these stories can be so encouraging. They should also be warned away from childbirth education classes that teach women how to “deal” with birth in a hospital. Instead, they need to hear that they instinctively know how to birth their baby with or without whomever they choose to attend them. Attending local birth story circles at free standing birth centers or midwifery offices is a good way to hear these positive stories.

Women also need to read good material. They shouldn't read books about how to “survive” pregnancy and birth, but rather, how to embrace and be transformed by these events. Books, stories, articles, and websites about normal birth need to be recommended and shared. We've all heard that information is power and it's the truth. Women need to be fully and completely informed about their ability to give birth without any interventions. They need to read material that reminds them of what their bodies were made for and that they and their baby form a very successful team. Sharing websites, blogging, publishing articles in the local paper, or making brochures with reliable information are good ways to share the truth about birth with people.

Being able to visualize what normal birth looks like is also a key factor in dispelling birth fear. Watching positive birth videos and documentaries that depict birth in its unaltered, untainted glory can be very affirming. Women have so many visuals from movies, television shows, and other media that show birth as being a horrifying, dangerous experience. Very few women have seen what a birth looks like when it is left alone. Thanks to video-sharing websites, there are a lot of beautiful births too be seen if someone takes the time to search them out. Making a play-list or posting them on social networking sites or blogs is a great way remind people of birth truth. Someone could also host a birth video movie night (complete with popcorn) and share some inspiration.

Getting information about birth truth is crucial to dispelling the fears surrounding our society's view of birth. Making positive birth stories the norm and sharing videos of normal birth will help restore confidence in birth. Inundating the public with important, reliable information will ensure that pregnant mothers will make decisions about their births based on facts and not fiction. Social networking sites and blogs are making it easier than ever to share birth truth with people from all over the globe. Lies cannot stand up to the truths about birth and when a birthing woman is armed with birth truth, she is unstoppable.

Friday, July 9, 2010

Remembering...

There were light feet
Curious uncertainty
Cautious what if
Maybe, maybe not
What if I am?
There's your answer
Crimson Messenger
Sickening pain
Cold sheets, lights
You were, but you're not
We're sorry
Crackers, pills
On your way
Long drive home
Tears fall in silence
Guess we wanted
after all
Rocks hit water
Screaming, anger
Never the same again
Doesn't make sense.

More expectation
Just know this time
A welcome sickness
Full feeling
As soon as it was
it's gone
Familiar pain
Curled on couch
Not much said
What's to say?
Still doesn't make sense.

Total surprise
Jumping for joy
Skipping on the beach
More light feet
Time passes
Full, round belly
Hopes are high
Dressing toy lambs
in ribbons
It's a Sunday
Crimson Messenger
Hit the floor
Can't get up
No one to catch me
He's here and
he just knows
Cold sheets
No heartbeat
We're sorry
We don't know why
Just bad luck
Pain pills
On your way
Long drive home
Feeling lost
Wake me up
from this nightmare
Perfect devastation
Waves of pain
Labor with no reward
Emptiness

They are loved
and remembered
Always
But it will never
make sense.

In memory of my lost little ones
October 22, 2005
April 19, 2007
July 8, 2007

Sunday, June 13, 2010

What I Believe About Unassisted Birth

For some birthing women, having an attendant at their birth is a comfort to them and helps them feel empowered. While others may feel that having an attendant makes them nervous and uneasy. For these women, having an unassisted birth would be a safer choice.
In order to let natural birth unfold on it's own, the mother must be completely surrendered to the process. Some women feel that having a birth attendant helps take away the distraction of being aware of potential anomalies during the birth process so that they can be more focused and centered on the task at hand. For them, an attendant that they trust is an asset to normal birth and not a liability.
Other birthing women believe that having anyone attend them would interfere with their birth process. They might feel nervous about the attendant making suggestions which they might not agree with but wouldn't have the presence of mind to ignore in the moment. Or they might feel that they are being judged on their performance and not able to fully let go and do what feels comfortable for them. There are many other reasons why some birthing women are not comfortable having a birth attendant other than their family or friends and some would even feel safest birthing alone.
The process of normal birth is depended on the mother feeling safe and empowered. Therefore, she must do what she feels most comfortable with. Having an attendant is not a requirement of having an normal birth.
Birth belongs to the mother and her baby. No one should ever take the power away from the mother and tell her where or how to birth her baby. The process of birth is a very sacred event and the decisions of where, how, and with whom to share that event are the mother's to make.

What I Believe About Home Birth

Sunday, June 6, 2010

AFP (Alphafetoprotein) Test

This is another brochure I made for my doula course. Again, if you would like copies, let me know!

Q. What is an Alphafetoprotein Test?

A. An Alphafetoprotein Test (AFP) is a blood test taken to screen for Neural Tube Defects such as spina bifida, anenecephaly etc. as well as, more recently, to predict the risk of Downs Syndrome.

Q. How is the test preformed?

A. A sample of blood is drawn from the mother for testing. This can be done in the caregiver’s office or at a separate laboratory.

Q. When is the test done?

A. The test has the greatest accuracy between 15 and 17 weeks of gestation. Accurate dating of the pregnancy as well as knowing the number of babies in utero is very important to the accuracy of the test results.

Q. What at the risks of the AFP Test?

A. Other than mild discomfort at the sight of the blood draw, there is no risk from the test itself. However, depending on the results of the test, the AFP test may lead to further tests which do carry risks. Further tests that may be recommended are an Amniocentesis and/or Level II Ultrasound.

Q. Who is the test recommended for?

A. All pregnant women are offered the test, however, most practitioners especially recommend it for women who have a family history of birth defects, are 35 years or older, have used possible harmful drugs during pregnancy, or who have diabetes.


Q. What do the AFP results mean?

A. It is very important to note that the AFP test is a screening test and not a diagnostic test in any way. This means that it is used to note if a woman is at risk of carrying a baby with a potential disorder. It is not used to diagnose any disorder. If the test produces abnormal results, further testing must be done in order to reach a diagnosis.

Q. How accurate is the AFP Test?

A. The benefit of preforming the AFP screening is that 70% to 90% of babies with neural tube defects are discovered. However, about 10% of women who receive the AFP test will show abnormal results. Of these women, 1 in 50 will actually have an affected baby. This means that 49 women will receive false positive results. The downside of receiving false positive results is undue emotional distress.

Q. How can I decide if I should have the AFP test preformed?

A. In order to decide whether or not to have the test preformed, you should ask yourself what you would do if the test showed abnormal results. Choosing to have further testing could help you research potential medical interventions, start planning for a special needs child, start anticipating lifestyle changes, and find support groups and resources. You might also choose to not have further tests preformed because you would be comfortable with the results no matter the outcome, making a decision about
carrying the baby to term is not an option, or you want to avoid any testing that poses any risk of harming the developing baby. Because making a decision about having an AFP test preformed can be a very difficult one, it is important to have all your questions and concerns addressed by your caregiver.