Treatment Options for Trauma Survivors with PTSD

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Kathleen Kendall-Tackett, PhD, IBCLC, FAPA

Traumatic events can have a long-term impact on both your mental health and the overall quality of your life. Fortunately, you have a wide range of possible treatment options available to you. Comprehensive trauma treatment involves patient education, peer support, trauma-focused psychotherapy, and medications.

Education and Peer Counseling

The role of both patient education and peer counseling is to help you understand your experiences and reactions after trauma. Education and support lets you know that your reactions are both normal and predictable, and your symptoms are not your fault (Friedman, 2001; Kendall-Tackett, 2010).

Trauma-focused Psychotherapy

The two most effective therapies for PTSD and trauma symptoms are cognitive behavioral therapy and EMDR.

  • Cognitive-Behavioral Therapy (CBT) – CBT includes several modalities, including cognitive therapy, exposure therapy, and stress-inoculation therapy. All types of therapy address beliefs caused by trauma (e.g., that you are helpless) and also helps counter conditioned-fear responses. If treatment has been successful, you will be able to confront your traumatic past without triggering PTSD symptoms (Friedman, Cohen, Foa, & Keane, 2009).
  • Eye Movement Desensitization and Reprocessing (EMDR) – EMDR is highly effective and considered a frontline treatment for PTSD. In EMDR, you are instructed to think about your traumatic experience while moving your eyes back and forth following the therapist’s fingers as they briefly move across your field of vision (Friedman, 2001; Friedman, et al., 2009; van der Kolk, 2002). It is based on the hypothesis that saccadic eye movements can reprogram the brain, and therefore can be used to help alleviate the emotional impact of trauma (Friedman, et al., 2009). EMDR reduces symptoms after just a few sessions. Certified practitioners of EMDR can be found at the EMDR Institute or the EMDR International Association .

Medications

There are several classes of medications that can be used to treat PTSD.

  • Antidepressants – Antidepressants are a key part of treatment for PTSD. The Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) are frontline medication choices in that they treat all types of PTSD symptoms, and include medications like Zoloft, Paxil, Lexapro, Prozac, and Effexor (International Society for Traumatic Stress Studies, 2009).
  • Adrenergic Agents and Atypical Antipsychotics – Other medications that may be added if the SSRIs/SNRIs and/or psychotherapy are not bringing you sufficient relief of symptoms. These include adrenergic agents and atypical antipsychotics.  These can be helpful for symptoms such as nightmares and intrusive thoughts (International Society for Traumatic Stress Studies, 2009).
  • Benzodiazepines – In the past, trauma survivors were often been prescribed benzodiazepines, such as Valium, to help them cope their trauma symptoms. These medications are no longer considered appropriate for patients with trauma because they can make depression worse, and are also addictive (International Society for Traumatic Stress Studies, 2009).

For information on all of these types of medications that can be safely used while you are pregnant or breastfeeding, visit the InfantRisk Center Website.

Summary

If you have experienced trauma, you do not need to continue to suffer in silence. You have many treatment options. And in most cases, these treatments can be safely used while you are pregnant or breastfeeding. For more information, visit the National Center for PTSD, or the International Society for Traumatic Stress Studies.

References

Friedman, M. J. (2001). Posttraumatic stress disorder: The latest assessment and treatment strategies. Kansas City, MO: Compact Clinicals.

Friedman, M. J., Cohen, J. A., Foa, E. B., & Keane, T. M. (2009). Integration and summary. In E. B. Foa, T. M. Keane, M. J. Friedman & J. A. Cohen (Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp. 617-642). New York: Guilford.

International Society for Traumatic Stress Studies (Ed.). (2009). Effective Treatments for PTSD: Psychopharmacology for adults (Guideline 6). New York: Guilford.

Kendall-Tackett, K. A. (2010). Depression in new mothers: Causes, consequences and treatment options, 2nd Edition. London: Routledge.

van der Kolk, B. A. (2002). Assessment and treatment of complex PTSD. In R. Yehuda (Ed.), Treating trauma survivors with PTSD (pp. 127-156). Washington, DC: American Psychiatric Association Press.

 

Kathleen Kendall-Tackett, PhD, IBCLC, is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is a Fellow of the American Psychological Association in both health and trauma psychology, and is a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is the owner of Praeclarus Press, a small press focusing on women’s health and is editor-in-chief of the journal Clinical LactationDr. Kendall-Tackett also can be found at Uppity Science ChickBreastfeeding Made Simple, and www.facebook.com/kathleen.kendalltackett. She is a board member of PATTCh.

 

 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.

 

Breastfeeding After Traumatic Birth

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Teri Shilling, MS, LCCE, CD(DONA), IBCLC

The image of a baby’s arrival into the world often shows a calm, romanticized picture of a beautiful baby being gently lifted into the waiting arms of the baby’s mother, followed by the mother putting the baby skin to skin, leaning triumphantly back while releasing a relieved sigh in the spirit of “I did it.” The baby is then supported in doing its dance to bop and wiggle to find the breast and latch on.

What if instead the journey has been fraught with challenges and struggles and separations or surgery? What if fears and trauma and suffering have colored the experience? What if the mother is overwhelmed or not supported or unable to deal with anything other than the basic survival of the experience? What happens then to early breastfeeding?

Cheryl Beck and Sue Watson (2008) in their research on the impact of birth trauma on breastfeeding, cited that over a third of all mothers have reported experiencing a traumatic birth. The breastfeeding research lists challenges to early and successful breastfeeding as unscheduled cesarean birth, psychosocial stress, and pain related to labor and birth. Other influences include loss of control, exceptionally long labors and dissatisfaction with care and support.

By closely looking at the impact of birth trauma on breastfeeding, there seems to be two paths — on one path women persevered and on the other path, breastfeeding is curtailed. What allows a woman to take the path toward a fulfilling breastfeeding experience? Beck and Watson (2008) identified three themes:

  • sheer determination
  • a motivation to make up for a baby’s less than optimal arrival or
  • the time spent breastfeeding was soothing

The path that led to less than the desired length of breastfeeding was influenced by:

  • a fear that breastfeeding was just one more way to fail
  • no emotional or pain-coping reserves were left to cope with possible breastfeeding pain and discomforts after the overwhelming physical pain of birth
  • a feeling that the traumatic birth created an insufficient supply of breast milk
  • flashbacks that intruded on the breastfeeding experience
  • a feeling of detachment from the baby created by the birth trauma

So what guidance is there for the women who have had a traumatic birth who want to follow their own path to a fulfilling breastfeeding experience?

  • Seek intensive one-on-one support to establish breastfeeding. Set short-term goals. Discuss options like pumping or substituting skin-to-skin time for breastfeeding or supplementing early feeding with donor milk.
  • Find respectful support. Often it’s preferable to find help from someone who can provide support and assistance while verbally guiding you and building your confidence vs. someone who grabs your breast and pushes the baby on for the sake of efficiency.
  • Locate non-judgmental help from someone who will support you in your choice to continue or stop breastfeeding without guilt or judgment.  This person should be someone who can listen to your birth experience and knows the symptoms of traumatic stress and knows to whom to refer you to for dealing with these feelings and reactions to a traumatic birth.

Find the support and resources to follow your path to feed your baby!

Reference

Beck, C.T., & Watson, S. (2008). Impact of birth trauma on breast-feeding. Nursing Research 57(4), 228-36.

 

Teri Shilling, MS, LCCE, CD(DONA), IBCLC is the director of Passion for Birth, the largest Lamaze accredited childbirth educator training program, creator of the Idea Box for Creative and Interactive Childbirth Educator, and instructor at the Simkin Center for Allied Birth Vocations at Bastyr University.  A past president of Lamaze International, she now focuses her volunteer work with PATTCh, Skagit Valley Breastfeeding Coalition and W.I.S.E. Birth (a 3 county Doula Collective.) She has a small private practice providing doula support, lactation support and birth education in her Mount Vernon, WA, community.


 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.

 

Living Through Traumatic Birth: Loss, Grief, and Recovery

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

An interview with doula, mother, and board member of PATTCh, Katie Rohs

How has traumatic birth impacted your life?

An easier question to answer might be “how hasn’t traumatic birth impacted my life?”  The loss of my twins, Tess and Sam, in May 2004 continues to touch me now, eight years later.  I identify as a mother of four, but when asked the question “How many kids do you have?” I answer “two”; people generally don’t want to hear the story of two babies that died, and frankly, I don’t always want to share it.  The loss eight years ago really shut down all of my creative and spiritual sides. Before getting pregnant, I was on a bit of a spiritual journey, learning and exploring different beliefs and religions. I was raised in a quasi-Christian household (believers in Jesus, but not really church-goers), but the mainstream Christian church’s beliefs on things I held deeply – woman’s choice and marriage equality, among others – were turning me off.  I believed in something bigger than myself, and that “things happened for a reason.” After losing the twins, the journey I was on ended abruptly. I no longer believed in any higher power that would take my beloved babies from me. The whole “things happened for a reason?” What “reason” could possibly be good enough to take my babies back? I came across one quote of a religious nature that brought me comfort: “The Buddhists say miscarried and still-born babies have already learned all the life lessons they needed to in past lives, and now they only have to touch on this earth long enough to be wanted and loved before the get to go to Nirvana.” I have no idea if that is an actual true statement of Buddhists, but it felt authentic to me.

How do you see it having transformed you?

I think the biggest transformation is just a loss of innocence. I was well beyond the “danger zone” of miscarriage (if it can really be called “miscarriage” when you can feel the babies moving and know their genders), and felt like I was just riding it out until viability, and then as long as I could keep the twins inside. No longer can I have that plain, blissful joy of the two pink lines appearing, and waiting for each pregnancy milestone.  No, now pregnancy is fraught with stress and worry particularly leading up to 17w 5d (when I lost the twins). The two pink lines is merely the start of the journey.  I still, eight years later, have some “symptoms” that pop up in very stressful situations. I get very numb and have a hard time focusing and making decisions. After losing the twins, I couldn’t even decide if I should take a shower on any given day. It’s (obviously) easier now, but when things are stressful – particularly involving my children – the paralysis takes over.

Protecting options, knowledge and choice have become so desperately important to me since losing Tess & Sam. Every step of the way I felt like I had choices and a voice in my care. I had the choice of how Tess & Sam passed, I chose when it happened. When I was pregnant the 2nd time, I had choices in how to take precautions to prevent a 2nd miscarriage, I was given all the information I needed prior to becoming pregnant and knew what “the plan” would be. I hold these choices so deep, and so dear to me that this is the most important part of my doula practice; making sure women and families feel heard, understood, and that they have a choice.

 

What advice would you give pregnant women regarding giving birth confidently?

Empower yourself with your own knowledge, and choose a care provider that you trust deeply.  Listen to your intuition – you know yourself, your baby, and your body better than any test ever will.  Don’t be afraid to seek out different care if your needs aren’t being met.

 

Katie Rohs is a Birth Doula from Seattle, WA specializing in birth after a loss, multiples and children with disabilities.  Katie has been trained in disability advocacy by the ARC of King County, is a Parent Trainer through the Finding Your Voice program of the Washington State Education Ombudsman, and has founded several parent support groups for parents of children with disabilities.  Having suffered a late-pregnancy loss of twins and being the mother of a child with multiple disabilities, Katie uses these experiences to help empower others to advocate for themselves and their children during their birth and in years beyond.  Katie also works as Penny Simkin’s administrative assistant, and is Secretary of the Board of PATTCh.  Katie is the proud mother of seven year old twins Hank & Lily, and wife of forty-something singleton Todd. Katie studied Sociology at the University of Washington, and bleeds purple and gold.  Despite being a rabid UW Husky fan, she does not discriminate against Cougars. Learn more at www.birthtastic.com.



PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.


What to do During a Traumatic Labor and Birth to Reduce the Likelihood of Later PTSD

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Penny Simkin

Between 25% and 34% of women report that their children’s births were traumatic, even though the staff and their support team may not perceive it that way. Birth trauma includes physical injury, danger, or death to mother or baby, or the perception thereof by the mother or partner. It also includes feelings of extreme fear, aloneness, disrespect, lack of control or helplessness.

The good news is that most traumatic birth experiences do not result in the syndrome of PTSD. The feelings (often called Post-Traumatic Stress Effects or Symptoms), associated with traumatic births usually fade in intensity, and become resolved with time, empathic listening, and support from key people in their lives. We may be able to increase the numbers of women who do not develop PTSD if we can identify those who have pre-existing risk factors for PTSD, and recognize when risk factors occur during labor. Appropriate actions, words, and continuous supportive attendance may reduce or reverse the symptoms and prevent PTSD.

Other posts by my PATTCh colleagues have described pre-existing risk factors. If the caregiver, the doula, and/or the woman/couple know about these ahead of time, they may be able to strategize preventive approaches to reduce the likelihood that the risk factors will occur. In this post, I will discuss risk factors that may arise during labor that are associated with a negative or traumatic birth experience, and also describe specific intrapartum words or actions that are designed to reduce the trauma and prevent PTSD from developing.

What you need to know about the childbearing woman:

  • Her wishes for her birth and expectations of herself, her support team, and the caregiving staff, including her preferences for pain management, routine interventions, and for the care and feeding of her newborn.
  • Any issues, fears, doubts, or concerns about labor, her support team, her caregiver, nursing staff, and the environment for her birth.
  • Her preferences regarding participation in her care and decision-making.

By being aware of these risk factors for traumatic birth, you may be able to put a stop to some risk factors or minimize them at the time, thus reducing the odds of future PTSD. Such actions may even transform her perceptions from negative to neutral or positive, meaning that she will not later describe her birth as traumatic.

Table 1 lists some of the risk factors and ways to reduce their negative impact.

Once the birth is over, before leaving the family, be sure to comment positively on something that she did or said that impressed you, with the intention of planting a positive interpretation of her role, especially if there were traumatic or negative aspects to the birth. Later, as she ruminates on the negatives, she may also recall your kind words, and feel better about herself.


TABLE 1: What to do if. . .

Risk factor during labor for traumatic birth experience Preventive or corrective action by partner, doula, nurse, or caregiver
Unexpected complications requiring a change from the care preferences. -Explain what is happening and what is needed to correct the situation. Reassure if appropriate.-Encourage questions and discuss/consider possible alternatives.-Empathize with her feelings and questions, and acknowledge the difficulty in adjusting expectations.-Focus on what she needs to do: “What we must do now is focus on . . . (keeping a rhythm, the baby’s well-being, handling this procedure, etc.). “
Unwanted routine interventions; lack of understanding of or disagreement over reasons; feeling coerced.Powerlessness, being discounted. -Help her learn ahead of time about policies of caregiver or hospital regarding usual routines.-Negotiate, compromise, accept the usual routines, or change caregivers.-During labor is a difficult time to discuss routines. Use techniques in box above.-If inevitable, help her adjust and rise above her disappointment, to protect her memory of the birth.
Loss of control over responses to pain (panic, loss of rhythm, crying out, writhing, dissociation). -Take charge routine — calmly give her undivided attention, and guide her to maintain a rhythm during contractions.-Consider her stated wishes regarding use of pain medications.-If she is motivated to avoid pain medications, pre-plan a “Code word” to say if labor is too long or difficult and she changes her mind and wants pain medications. This allows her to complain without people misinterpreting her complaints as request for medication, If she doesn’t say it, her team supports natural birth. (The code word is not needed if she plans to use pain meds).
Perceived poor treatment, disrespect, lack of communication from staff. -Encourage woman/couple to speak to staff, or the charge nurse or caregiver.-Describe the dissatisfaction; ask for another nurse or a “fresh start.”-Don’t make the problem worse.
Poor support from partner, doula, family. -Suggest ways they may help; ask the woman if she needs some time without others in the room; explain the woman’s need for support and kindness.
Mental defeat, unable to continue, hopeless. -Empathize and try to rally her back into participating: “We need you. Don’t stop now. You’re almost there (if it’s true).”-Explain what will happen next, and help her accept an epidural, a cesarean or instrumental delivery, if she is too exhausted to continue.-Support her decision.
Profound opposite of how she wanted her birth to be. -Support her as well as possible through the difficult labor.-Recognize the above risk factors as signs that she may later feel her birth was traumatic, and offer opportunities for postpartum support and counseling.


Birth is not over when the baby is born. It goes on and on in the woman’s mind. If the birth was traumatic, it takes longer to come to terms with it. Sometimes PTSD develops. My suggestions in this blog are intended first to lessen the likelihood of the birth being traumatic, and, second, if the birth is traumatic, to intervene during labor with the intention of alleviating the trauma and reduce her chances of developing PTSD.


Penny Simkin is a childbirth educator, doula, birth counselor, author, and one of the founders of Doulas of North America (DONA), and PATTCh. To sign up for Penny’s e-newsletter or view products and events, visit www.pennysimkin.com.

 

 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.

 

Coming Soon: Traumatic Birth Prevention & Resource Guide

Next week on Giving Birth with Confidence, we will release the Traumatic Birth Prevention & Resource Guide, created by PATTCh, the non-profit organization for Prevention and Treatment of Traumatic Childbirth. The guide will provide general information, prevention tips, treatment options, and personal stories from women who have experienced traumatic birth. Traumatic birth is defined as any birth that causes psychological trauma to a woman after the birth of her child. Traumatic births range in experience, from mothers who encounter an unplanned cesarean to mothers who experience stillbirth. The effects of traumatic birth also can vary in degree and length for mothers. The Traumatic Birth Prevention & Resource Guide aims to answer questions and provide authentic resources for women, their partners, and families.