Friday, 6 December 2013

Childbirth - when it doesn't follow the plan.

Any woman who has been pregnant will have dreamt of an effortless, calm birth... perhaps involving water, music, maybe even a homebirth... a few swear words and squeezes of your partner’s hand and then out would pop your beautiful baby followed by the feeling of elation, the congratulations and admiration of all around. And so you should as childbirth is not to be feared. Sadly though this is sometimes not the case and women can unexpectedly be faced with an event to make even the toughest wonder what the hell could possibly be worse in the whole world??!!!

Traumatic birth events, a serious threat to the health of you or your baby, disappointment in that the whole event did not go the way you expected, feeling powerless in the process and feeling a lack of support or poor care can all leave you with a confusion of emotions to say the least.

Recently, there have been reports on a government plan to have a mental health midwife in all maternity units by 2017. This is an encouraging move but the fact that it will take so long goes to demonstrate the shortage of trained staff available and the unfortunate neglect of maternal mental health. Post-natal depression (PND) is reported to affect as many as 1 in 7 women, but I suspect it may be even more due to under-reporting. Women may not want to admit their struggles and may feel unsupported due to a lack of continuity of care throughout the whole of pregnancy and after the birth.

While researching PND I discovered another area I was much less aware of: Childbirth-related Post-traumatic Stress Disorder. This certainly sounds quite severe and I’m sure in most cases it is, however on reading more about it I wondered how many women could actually relate to the issues surrounding its development. The condition may arise following greatly traumatic events but can also be linked to the expectations of the mother following birth. There is a general approach that the mother should ‘get over’ the ‘natural’ experience once (hopefully) all is well with the baby and you have physically recovered. A widespread lack in understanding of the psychology of birth and feelings of isolation can leave the new mother without a voice in society. If the birth has been very difficult they can feel detached and vastly dissimilar to other mothers, furthering feelings of isolation. In future months, women may avoid sex for fear of pregnancy and associations of the birth with their body. Worryingly, they may also avoid future smear tests. You may worry about the desire for future children being under threat by your new fears, with guilt and pressure building as the condition goes unrecognised. Avoiding triggers that remind you of the whole event, such as watching hospital TV programmes, talking about the birth or having to go to hospital or to see any healthcare professional may also result.

Personally I can relate to some of the above following a traumatic birth experience. Fortunately, although I experienced some anxiety and sleep problems I did not feel I was experiencing anything that I could not manage. (Although my feelings towards future pregnancies and childbirth are completed unbeknownst to me at this stage!). When the condition really warrants help the mother will be suffering from panic and fear that is interfering greatly with her life. What concerns me the most is that in seeking treatment in those that are brave enough to put themselves forward, women suffering PTSD are frequently wrongly diagnosed as suffering PND. They may then be prescribed anti-depressants to help them ‘move on’ but these will be completely ineffective in this case. Women can also suffer both PND and PTSD at the same time and so the PTSD in itself may go unrecognised.

If you feel that you are experiencing PTSD the good news is that cognitive behavioural therapy can really help. Not only can CBT introduce coping mechanisms in understanding and altering thought processes surrounding the birth, but a new study has shown that it can reverse structural changes in the brain that result from trauma (Levy-Gigi et al 2013). It is also possible to call up the maternity unit and make an appointment to discuss the medical side of your birth experience. This can help to get your head around what happened and can happen years later, perhaps if you are thinking about having another baby.  

To minimise distress to the parents and possible implications on their parenting it is important to recognise PTSD and turn to CBT as early as possible. I hope that improvements are seen in recognising this as distinct from PND and that the focus on maternal mental health will develop and increase significantly.

For more information on PTSD:

#childbirth #birth #PTSD #PND 

by Rachel Brophy