Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

 

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 Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

 

 

 

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.

 

Having a Baby 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 Suzanne Swanson, PhD, LP

You’re pregnant again. You’re excited to meet your baby and—if you’ve already had a difficult birth—you may be nervous about labor and birth. Or you want another child, but the memories of an earlier traumatic birth are so acute and painful that you sometimes think you can’t bear to get pregnant and give birth again.

You’re not alone. Eighteen percent of women in the 2008 New Mothers Speak Out survey experienced some of the characteristics of post-traumatic stress syndrome (PTSD): flashbacks of the birth, nightmares, difficulty sleeping or concentrating, anxiety or panic, anger or irritability, numbness or avoidance. Nine percent of the mothers surveyed met all the criteria for PTSD. (Childbirth Connection, 2008)

Still, what matters is how you define your birth experience. Your labor lasted days, or maybe it was quick and excruciating. You feared for your baby’s safety, or your own. You felt unheard and disrespected. You have a history of sexual assault, or not. You had your baby vaginally or by emergency Cesarean. No matter what the external circumstances of the birth, you might be left feeling inadequate or unsafe, physically or emotionally.

How on earth to prepare to give birth again?  Look for resources that will help you

  • Find company and support
  • Build awareness: Look backward and forward
  • Educate yourselves with evidence
  • Connect with your partner

Alone, with a partner, with a local or online community, with providers, you can learn to

  • Claim the strengths you brought to your earlier birth
  • Commit yourself to recognizing and addressing without judgment any core beliefs you may carry –  “I have to be perfect,” “I need to please,” “I’m not good enough,” — are only a few  that can have an impact on your birth.
  • Calm yourself (using breathing, mindfulness, self-hypnosis, prayer,  among many ways) when fears or flashbacks flare
  • Cultivate the ability to identify what you want, ask for it, even insist on it in a respectful and direct way.
  • Create collaboration:  find practitioners –  doula (yes, get a doula!); midwife or doctor — who will:
    • work with you to acknowledge and name the experience of your earlier birth instead of minimizing it
    • encourage you to make decisions
    • respectfully offer their own evidence-based expertise

Include your partner.  So many partners feel like they blew it when birth turns traumatic:  “I was lost. I didn’t know what to do.”  “She needed me and I let her down.” The two of you need to be able to feel as though you’re in it together when labor starts this time.

  • Consult:  Meeting with a specialized psychotherapist or bodyworker allows you to focus on beliefs, emotions, sensations and/or past experiences that may influence your upcoming birth. Choose a therapist who is familiar with evidence-based birth practices.
  • Attend a class or meeting
    • If you can, find an ICAN (International Cesarean Awareness Network) chapter near you for local support and resources
    • Another Birth, Another Story classes for pregnant couples are designed to be led by a doula or childbirth educator and a mental health professional).  Created and offered (currently inMinnesota) by Susan Lane, CD, LCCE, CLC, and Suzanne Swanson, PhD, LP.  Curriculum and training opportunities will be available soon. (salane@visi.com)
    • Other local classes:  for instance, in Minneapolis, Healing Birth Stories Workshops offered by Maureen Campion, MS, LP, and Sarina LaMarche, Life and Wellness Coach.
  • Find community online. Giving Birth with Confidence and ICAN offer a wealth of information about VBAC.  Solace for Mothers offers two online communities — one for women who have personally experienced a traumatic birth and one for families, caregivers and advocates.  Start with these — they can link you to others.

Use the resources that suit you. Every day women are having satisfying births after a traumatic birth. Explore your options to find a pathway to reclaim your body, your confidence and your birthing power.

 

Suzanne Swanson, PhD, LPis a psychotherapist who has been working with pregnancy, labor, postpartum, loss and mothering for over 30 years, and also Founding Director of Pregnancy and Postpartum Support Minnesota and a Minnesota Co-orrdinator for Postpartum Support International. She is the author of What Other Worlds: Postpartum Poems.

 

 

 

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.

 

Fathers and 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 Walker Karraa, MFA, MA, CD(DONA)

A 2012 study published in the Archives of Disease in Childhood: Fetal Neonatal Edition contributes to the growing awareness that partners are negatively impacted by traumatic childbirth. The first study of its kind, “Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery” (Harvey & Pattison, 2012) is a retrospective analysis of semi-structured interviews with 20 fathers who had witnessed the resuscitation of their baby immediately following delivery. While small in number, this study sheds invaluable light on the experience of fathers in the presence of trauma in childbirth.

Semi-structured, private interviews were audiotaped with consent, and the transcripts were analyzed for thematic content using the NVIVO-7 software in sequence. Analysis generated four themes (1) ‘preparation’; (2) ‘knowing what happened’; (3) ‘his response’; and (4) ‘impact on him’ (Harvey & Pattison, 2012, p. F2).

 

Theme One: “Preparation”

While over half of the fathers (n =12) had been given information prenatally regarding potential causes and instances for neonatal admission for their baby, none of the fathers had  been given information about newborn resuscitation. Fathers did not realize before birth that their baby might require this level of support at delivery, and most were only told by health care professionals (HCP) immediately before the birth that their baby would require resuscitation, if at all. Information was often vague, not forthcoming, or overheard and second-hand.

 

Theme Two: “Knowing What Happened”

The majority of fathers were unaware of the type of resuscitation given at time of interview, were unaware at the time, and had not been subsequently told. Contributing factors to the theme of not knowing what happened were his position in the room, and not having asked HCP directly what was happening during or after the event. Most fathers did not view the resuscitation due to obstructed view, or being focused on partner. When fathers attempted to stand up to see the baby, they were told to sit down. Those who did posed questions went unanswered, and still other fathers only learned about what was happening through cross-conversation among staff. Does this sound familiar to anyone?

 

Theme Three: “His Response”

Themes of conflict between partner and baby emerged from the father’s experience.  All fathers expressed doubt regarding their focus of concern, their partner or their baby. Many fathers reported that they thought either or both would die. In the interviews themselves, recalling the event caused fathers to become visibly upset. One father stopped the interview process momentarily during this line of inquiry.

Continued distress occurred for fathers regarding the conflict of whether to stay with partner or go to their baby being resuscitated. Most reported wanting to go to their baby, but felt they should stay with partner for reassurance. In some cases, staff contributed to this conflict by telling fathers to stay put. A variety of coping strategies were employed by fathers to endure the event—but most commonly emotional-controlling strategies were used, where they avoided looking at the baby, tried not to think about what was happening, leaving the room, or self-reassurance that there would be a positive outcome.

 

Theme Five: “Impact on Him”

  • There was general lack of memory of the event. While none reported regretting being there, all fathers reported feelings associated with the birth in terms such as: worried, distressed, petrified, scared, panic-stricken.
  • None of the fathers reported feeling supported from HCP’s during resuscitation
  • The majority of fathers who wanted to discuss their experience with someone after did not do so.
  • None of the fathers were given an opportunity to discuss the event with HCP’s afterward
  • Some reported symptoms of post-traumatic stress such as flashbacks, nightmares, agitation and hyper vigilance.

 

Conclusion and Discussion

The authors concluded:

“There is a growing awareness that meeting the needs of fathers facilitates their involvement in the lives of their children. Supporting fathers before, during and after newborn resuscitation could be a step towards achieving this.” (Harvey & Pattison, 2012, p. F5).

Hopefully this study will generate increased awareness the largely overlooked partners’ experience of traumatic events in childbirth.

Resource

Harvey, M., & Pattison H. (2012). Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Archives of Disease in Childhood: Fetal Neonatal Edition Arch Dis Child Fetal Neonatal Ed (2012). doi:10.1136/archdischild-F2 of F5 2011-301482.

 

Walker Karraa is a doctoral student at the Institute of Transpersonal Psychology. She is a birth doula, maternal mental health advocate, and researcher. She currently writes for the Lamaze research blog, Science and Sensibility. She presents at conferences, trainings, and organizational retreats pertaining to perinatal psychology, postpartum mood disorders, childbirth education, and labor support. Walker also is the President of PATTCh, a not-for-profit dedicated to the prevention and treatment of traumatic childbirth.

 

 

 

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.

 

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.

 

10 Questions for a Partner of PTSD Survivor

 

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 Walker Karraa, MFA, MA, CD(DONA), President PATTCh

This is an interview I did with my husband, Tony. His perspective on the events of my traumatic birth and subsequent PTSD speak to the impact of these issues on partners, but is not a statement of suggested treatment. It is an honest snapshot of a partner’s experience of birth trauma and his partner’s PTSD, hopefully shedding light on recovery from traumatic birth and reclaiming life post trauma.

 

Were you aware of the PTSD in my birth?

I think that my first clue that something was beginning to happen was during labor. It was specifically during transition that I noticed a slow but clear change in your presence. It appeared as though you began to dissociate from not only me but the world, as if your body had been left behind to experience the rest of the experience without you. It changed after we were home with the baby but for me, that was the moment it began.

 

When did you realize something was wrong?

I knew something was wrong right away. But I didn’t realize the extent of the problem. I kept thinking it would get better. But instead it got worse. I didn’t know where mild baby blues ended and where postpartum depression began. Nor did I have any information on how to get help.

 

What was that experience like for you?

Extraordinarily frightening. I didn’t know what was happening during labor. We were so connected as a couple and it began to shift in a way that was very scary. Once the full force of the PPD began to level itself in our lives in the first few weeks of being home with the baby, I felt confused and helpless and I was experiencing extreme anxiety. When you passed out from lack of sleep and fell to the floor behind me as I was holding the baby, my anxiety changed to terror.

 

What would you do differently now that you know about postpartum depression?

I would have reached out immediately to health care professionals for help. I would have encouraged formula feeding and weaning of breastfeeding right away to facilitate more ease of movement for you to be away from the baby for treatment or even just a break. I would have encouraged proper prescribed medication under the guidance of a psychiatrist to begin to ease the terrible burdens of the disease. It is so difficult to remember how helpless I felt and how under the influence I was of all the media hype about breastfeeding and bonding. That really affected my ability to act

 

What surprised you about my PTSD and postpartum depression?

The insomnia. I was used to seeing depression and how it affected your daily life due to your chronic condition, but the affects of the insomnia were devastating.

 

What scared you the most?

The scariest thing was the constant fear that you may try to hurt yourself.

 

What advice would you give a partner?

To act quickly. To know that no matter what the level of depression, anxiety or insomnia your partner is experiencing, they should be seen by a health care professional and there are lots of options.

 

What do you think women need most if they have PTSD following birth?

They need people in their lives who are willing to acknowledge it for what it is and are willing to be there with them no matter how scary it is.  They also need good professional medical care as quickly as possible. Whether it is therapy or medication, they need to be under the care of a professional. They also need to know that they are not permanently damaging their baby and that they can take time away during the day or night, whenever possible, for a break.

 

How did you see the interaction with our son?

I was worried about him a lot at first.  Not just because of your depression but also because of my own stress and anxiety. I was very afraid that it would affect him adversely. But having watched him grow and mature over the last ten years, I am completely convinced that having the treatment that you finally did receive, starting around his third month of life was an invaluable change in the dynamic between the three of us. It was not all smooth sailing after that but it continued to improve because of it. I shudder to think of what might of happen, had you not found and accepted the treatments of the wonderful therapist and psychiatrists that first saw you.

 

How did you see the interaction with our son?

I was worried about him a lot at first.  Not just because of your depression but also because of my own stress and anxiety. I was very afraid that it would affect him adversely. But having watched him grow and mature over the last ten years, I am completely convinced that having the treatment that you finally did receive, starting around his third month of life, was an invaluable change in the dynamic between the three of us. It was not all smooth sailing after that but it continued to improve because of it. I shudder to think of what might have happened, had you not found and accepted the treatments of the wonderful therapist and psychiatrists that first saw you.

 

How did the next pregnancy and birth of our daughter differ?

Everything was different, but for me, the most notable difference was choosing to be open to bottle feed with formula from the start. That gave you a much greater sense of freedom. You were able to be away without the constant fear that the baby would starve without you. I can’t recommend that enough to other parents. I know it goes against the conventional wisdom of the day regarding breastfeeding. But in my humble opinion (which is grounded in personal experience) they are flat out wrong. Our daughter is attached, loving, kind, deeply in touch with emotions and easily able to connect to others. Not to mention she is flipping brilliant (state test score fact…not merely a parental opinion) and she was bottle fed from infancy.  And once you were diagnosed with breast cancer when she was only 7 months old, we were able to transition her so easily. You just never know what is going to happen—and having that option saved our lives.

__________________________________________________________________________________________

Final Thoughts

Trauma impacts everyone, and the experience of trauma subjective — in the eye of the beholder, the person experiencing an event as traumatic. This is true for partners and care providers as well.  The perception of sudden, life-threatening circumstances by partners in the birth room merit deeper understanding. Neurological dynamics, and biological responses to trauma perception are on the forefront of much of the trauma research today. And champions in the field are asking the important questions about the effect of birth trauma on partners. And PATTCh will continue to promote ongoing discussions, symposia, and opportunities to share this research. We have a lot to learn.

Preventing the occurence of traumatic birth experiences, through consideration of risk factors for both parents is key. Partners in the military, law enforcement, with a history of trauma or interpersonal violence deserve to be considered with respect in the birth room, and birth process. Support in both information from qualified professional, and instrumental support during birth and at home during postpartum period are necessary for partners to understand the normal range of emotions and what to do if they or their partner experience symptoms of distress beyond that range.

More information on PTSD can be found on the PATTCh Resource Support page.

Disclaimer: Tony’s experience, and feelings regarding treatment, and bottle/formula feeding are his, and should not be misunderstood to be those of the Board of PATTCh.

 

Walker Karraa is  a doctoral student at the Institute of Transpersonal Psychology. She is a birth doula, maternal mental health advocate, and researcher. She currently writes for the Lamaze research blog, Science and Sensibility. She presents at conferences, trainings, and organizational retreats pertaining to perinatal psychology, postpartum mood disorders, childbirth education, and labor support. Walker also is the President of PATTCh, a not-for-profit dedicated to the prevention and treatment of traumatic childbirth.

 

 

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.


Pre-Existing Risk Factors for PTSD and Childbirth

 

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 Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

 

 

 

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.

 

The Traumatic Birth Prevention & Resource Guide

Lamaze International and PATTCh (Prevention and Treatment of Traumatic Childbirth) are proud to announce the newest resource on Giving Birth with Confidence, the Traumatic Birth Prevention & Resource Guide. We hope that this new collection of resources will help women and families in their journey through pregnancy, birth and beyond. 

 

Dear Giving Birth with Confidence Readers,

The members of PATTCh (Prevention and Treatment of Traumatic Childbirth) would like to thank Lamaze International and Giving Birth With Confidence for the opportunity to share a series of posts addressing traumatic childbirth. This initial Traumatic Birth Prevention & Resource Guide is a preliminary collection of reflections written by many of the PATTCh Board members. The goal is to begin a conversation that explains the components of traumatic birth, increases awareness, and promotes prevention. Through multiple professional perspectives, our hope is to begin to shed light on the symptoms, risk factors, treatment and prevention of traumatic birth.

A birth is defined as traumatic if the woman was or believed she or her baby was in danger of injury or death, and she felt helpless, out of control, or alone, and can occur at any point in labor and birth (Beck, 2004a).  It is important to recognize that it is the woman’s perception that determines the diagnosis, whether or not clinical staff or caregivers agree.  Even though physical injury to mother or baby often occurs during a traumatic birth, a birth can still be traumatic without such physical injury. Unfortunately, clinical symptoms of full diagnosis of Posttraumatic Stress Disorder (PTSD) can occur for mothers andpartners following a traumatic birth, the effects of which impact attachment, parenting, and family wellness.

Current research has demonstrated rates of full Posttraumatic Stress Disorder (PTSD) due to traumatic childbirth ranging from 5.6% (Creedy, Shochet, & Horsfall, 2000) to 9% (Beck, Gable, Sakala & Declercq, 2011).  The rates of having experienced post-traumatic stress symptoms, but not a fully screened diagnosis of PTSD are as high as 18% (Beck, et al. 2011).

Studies have demonstrated common themes in the experiences of PTSD due to childbirth as: (a) perceived lack of communication by medical staff; (b) fear of unsafe care; (c) lack of choice regarding routine medical procedures; (d) lack of continuity of care providers; and (f) care being based solely on delivery outcome (Beck, 2004a).  These experiences occur globally. Preliminary studies in the United States, United Kingdom, Sweden, Australia, Israel, Switzerland, Italy, Germany, Canada, the Netherlands, and Nigeria have reported rates of PTSD from 1.25% to 14.9% (Beck, 2011). Long-term effects of PTSD secondary to childbirth include attachment and parenting difficulties (Bailham & Joseph, 2003).

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.

PATTCh hopes to educate childbearing women and families and maternity care professionals; develop effective prenatal, intrapartum and postpartum care practices to prevent or reduce traumatic birth and post-birth PTSD; and identify and promote effective treatments to enhance recovery. We hope this series of articles will educate, inspire, and reassure you, and we look forward to your comments.

Walker Karraa, MFA, MA, CD(DONA)
President, PATTCh

www.pattch.net
info@pattch.net
twitter: @PATTCh_


Traumatic Birth Prevention & Resource Guide

What to Do During a Traumatic Labor and Birth to Reduce the Likelihood of Later PTSDPenny Simkin, PT

Pre-Existing Risk Factors for PTSD and Childbirth
Heidi Koss, MA, LMHC

Living Through Traumatic Birth: Loss, Grief, and Recovery
An interview with Katie Rohs

Breastfeeding after a Traumatic Birth
Teri Shilling, MS, LCCE, CD(DONA), IBCLC

10 Questions for a Partner of PTSD Survivor
Walker Karraa, MFA, MA, CD(DONA)

Treatment Options for Trauma Survivors with PTSD
Kathleen Kendall-Tackett, PhD, IBCLC, FAPA

Fathers and PTSD
Walker Karraa, MFA, MA, CD(DONA)

Having a Baby after Traumatic Birth
Suzanne Swanson, PhD, LP

No “Typical” Birth: NICU Experiences and PTSD
Leslie Butterfield, PhD

Trauma and Personal Growth: New Frontiers in Research
Walker Karraa, MFA, MA, CD(DONA)

 

The Traumatic Birth Prevention & Resource Guide© is the property of PATTCh (Prevention and Treatment of Traumatic Childbirth). It is not a medical or psychological treatment recommendation and is only intended for educational purposes. Please consult your care provider for further diagnosis and/or treatment. For more information regarding PATTCh, please contact info@pattch.net.
References
  • Bailham, D., & Joseph, S. (2003). Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice. Psychology, Health, & Medicine, 8, 159-168.
  • Creedy, D. K., Shochet, I. M., & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth, 27, 104-111.
  •  Beck, C. T. (2004a). Birth trauma: In the eye of the beholder. Nursing Research53(1), 28-35.
  •  Beck, C. T. (2004b). Posttraumatic stress disorder due to childbirth: the aftermath. Nursing Research53(1), 216-224.
  •  Beck, C. T. (2011). Metaethnography of traumatic childbirth and its aftermath: Amplifying causal looping. Qualitative Health Research21(3), 301-311.
  •  Beck, C. T., Gable, R. K., Sakala, C. & Declercq, E. R. (2011). Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey. Birth, 38: 216–227.doi:10.1111/j.1523-536X.2011.00475.x