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