But At Least You have a Healthy Baby: Traumatic Birth and Maternal Mental Health

But At Least You have a Healthy Baby: Traumatic Birth and Maternal Mental Health
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By Catharine McDonald

The title line to this article is one I have overheard many a times---always conscious not to use it myself, this phrase is a common response to a woman's complicated, disappointing, or even traumatic birth.

What exactly is a traumatic birth? That is in the eye of the uterus-owner. Traumatic birth cannot be defined by anyone other than the mother; it is very real and can lead to Perinatal Post-Traumatic Stress Disorder (PTSD), similar to war veterans and terror or abuse survivors.

When I was expecting my daughter, I was inundated with traumatic birth stories; it's enough to send a pregnant belly running! Three friends of mine were pushed into questionable inductions that year, resulting in numerous C-sections, procedures and interventions they did not anticipate. One of my friends who we'll call Karen was told she needed a C-section 20 hours into labor, she was prepped for surgery and didn't learn until the surgery started that the epidural had failed- she felt her body being cut open. To further her trauma, Karen was quickly put out with general anesthesia and woke up in recovery, screaming--separated from her baby for hours. Her intention was to breastfeed exclusively and by that time her son had been given formula, the first of many nursing complications they endured. For months she struggled with depression, nightmares and flashbacks of that operating room. She struggled with guilt and disappointment, feeling as though she failed her son. While she planned to have closely spaced children, Karen is now unsure if she wants to conceive again, fearful of another horrendous birth experience.

2013-06-05-TraumaticBirth.jpgMy friend Jill was never asked by her provider if she had a history of trauma. Jill dreaded her late-pregnancy appointments where her doctor did internal exams that were uncomfortable and emotionally painful, she dreaded being in a hospital, feared delivery, and felt depressed in anticipation of her due date. After a long and painful labor, Jill underwent a cesarean because she never dilated. No one providing her care ever considered the important mind-body connection and all the pain her mind was enduring at this vulnerable time. She, like Karen experienced flashbacks both of her sexual abuse history and of her labor, having multiple residents examine her, anxious to be in hospital attire rather than her own clothing, and then feeling exposed in the operating room.

Both of my friends experienced traumatic stress symptoms postpartum, neither of whom knew what to label their experience or where to turn for help. MotherWoman reaches out to providers in Massachusetts and surrounding areas, educating providers on potential traumatic triggers for moms as well as how to screen for trauma history. They also provide important support groups for women living with traumatic stress and Perinatal PTSD, offering education and validation surrounding the trauma, empowering them to work toward recovery from their symptoms.

Mothers with Perinatal PTSD may experience flashbacks, insomnia, nightmares, anxiety, depression, and in some cases feel disconnected with reality. Women may also experience breastfeeding challenges, difficulty bonding with their newborn, and social isolation.

This Perinatal Emotional Complication (PEC) can be triggered by a number of factors or events--having a history of trauma, particularly sexual trauma, can create traumatic stress prior to a birth, making routine prenatal care a stressor or a flashback trigger, like in Jill's case. Stopping mental health medications that are contraindicated for pregnancy can exacerbate existing psychiatric conditions such as depression, bipolar disorder, or anxiety. During labor and delivery, a very long, exhausting delivery, or a quick and overwhelming labor can both be traumatic. Women may experience trauma because of unplanned [or unwanted] interventions, cesarean section, feeling powerless, injury during labor or delivery to mom or baby, having a real or perceived fear of dying in labor, fear of the baby dying in delivery, medical complications or stillbirth of the baby, and the newborn being whisked away to the NICU. Whether or not these experiences were anticipated, any of them can be traumatic.

Letting the mother decide for herself if her birth was traumatic or not cannot be stressed enough. Two women can experience the same circumstances of birth and one shrugs off a negative experience while the other may feel debilitated for weeks and months on end and may need support and treatment to address these feelings.

Many mothers suffering from Perinatal PTSD do not recognize their symptoms as a complication, nor do their providers who may unintentionally minimize or misdiagnose PTSD symptoms as Postpartum Depression. The two conditions share many symptoms and have similar treatments, but a mother suffering after traumatic birth cannot heal without her trauma being validated and processed. Trained mental health clinicians are key and can support obstetricians and midwives in helping mothers in this recovery process. Communication between medical and mental health providers can facilitate prompt referrals and quality treatment early. Treatments are available that are compatible with breastfeeding and many of them are drug-free.

Perinatal PTSD is more common than one would think; it is not frequently discussed and rarely gets media attention. Statistics vary greatly; some researchers estimate the prevalence to be anywhere from 7% -16% of women experience PTSD symptoms postpartum. Compare those numbers to 10% of the general population lives with PTSD to put things in perspective. Additionally, as many as 34% of women describe their children's births as traumatic. If one-third of women have a traumatic birth and nearly one-fifth of women experience post-traumatic stress, we as a country are not meeting new moms' needs!

Social isolation is a risk factor for Perinatal PTSD and that is our current solution -- leave women to fend for themselves. There is a distinct need for open conversation about mental health during prenatal visits, comprehensive informed consent in labor and delivery, and improved post-natal mental healthcare for all women. MotherWoman recognizes how real and distinct Perinatal PTSD is, and advocates for women who survived traumatic births to get the assistance they need to recover.

Catharine McDonald, MS, NCC, LPC works as a Senior Clinical Therapist and Access Specialist in Crisis and Behavioral Health at a community hospital. Her clinical interests include trauma, family therapy, and maternal mental health. Catharine is also active in La Leche League and Holistic Moms Network in supporting pregnant and postpartum mothers in her area. She lives in Connecticut with her husband, daughter, and their two spoiled dogs.

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