Birth Trauma: Stress Disorder Afflicts Moms

[question everything]

The Wall Street Journal

Birth Trauma: Stress Disorder Afflicts Moms
Study Suggests That PTSD May Be More Common Than Previously Believed
By RACHEL ZIMMERMAN
August 5, 2008; Page D1

Amid the debate over how to effectively manage maternal mental-health disorders, a new type of postpartum illness is gaining attention: post-traumatic-stress disorder due to childbirth. PTSD is most commonly associated with combat veterans and victims of violent crime, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die. Symptoms can include anxiety, flashbacks and a numbness to daily life. Even as medical advances have resulted in many more lives saved during high-risk births, extreme medical interventions can leave a mother severely stressed -- especially if she feels powerless or mistreated by health providers. PTSD is much less common than postpartum depression, which has become better-understood by the public as celebrities like actress Brooke Shields and former CIA agent Valerie Plame have spoken out about their experiences. The National Institute of Mental Health estimates that postpartum depression affects 15% of mothers.

The incidence of childbirth-related PTSD hasn't been widely studied. But a new survey suggests the disorder could be more widespread than previously believed. Of more than 900 U.S. mothers surveyed, 9% screened positive for meeting all of the formal criteria for PTSD set out in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, a handbook of mental-health conditions. And 18% of respondents had some signs of the disorder. The survey, which included an established PTSD screening tool, was conducted by Harris Interactive for Childbirth Connection, a nonprofit maternity-care organization in New York. Separate earlier studies outside the U.S. had estimated the prevalence of childbirth-related PTSD at between 1.5% and 5.9%.

(snip)

A history of sexual abuse or other trauma can also put women at greater risk for PTSD from childbirth, says counselor and childbirth educator Penny Simkin, of Seattle. She says discussing such information with a health professional before giving birth can help reduce the risk. Maternity-care providers say the increase in the number of medical obstetric procedures in labor and delivery, like Caesarean sections and premature births, could be contributing to PTSD. These providers also note that childbirth-related PTSD became more of a focus of study only after 1995, when the American Psychiatric Association broadened criteria for the disorder. PTSD, whether brought on by childbirth, natural disaster or some other trauma, can happen immediately, or months after the event. It may occur when someone has experienced an event that involves actual or threatened death or serious injury, and responds with intense fear, helplessness or horror.

Cheryl Beck, a professor at the University of Connecticut School of Nursing who researches birth trauma and was an adviser on the Childbirth Connection survey, says the mothers who reported signs of PTSD in the survey appeared to have a higher rate of medical interventions and describe feeling powerless in a threatening environment. The survey also found that African-American women, those without private health insurance and women with unplanned pregnancies were more likely to have PTSD symptoms. The survey, called New Mothers Speak Out, available at childbirthconnection.org, also covered a range of other post-birth issues. Executive Director Maureen Corry noted the majority of mothers with PTSD and depression symptoms didn't seek professional help.

(snip)

A federal law on postpartum mood disorders, would fund research, treatment and public awareness, is working its way through Congress. Opponents say the law would lead to more "drugging of mothers." The proposed federal legislation on postpartum mood disorders, called the Melanie Blocker Stokes Mothers Act, named after a woman who jumped to her death from a Chicago hotel with postpartum psychosis, was approved by the House of Representatives in October. Last week, the proposal got caught up in a package of bills that failed to reach a final vote on the Senate floor. Democratic supporters say the measure, which doesn't include mandatory screening but does authorize a study about its benefits, could be back later this fall.

(snip)


URL for this article:
http://online.wsj.com/article/SB121789883018612223.html (subscription)

[marylanddem]

1. Thanks for posting this - like so many health issues related to

women, the trauma of childbirth has been minimized.

[Iris]

2. I was thinking the same thing.

While in the more distant past, many women must have felt lucky to make it through and this sort of thing might have been expected, these days we women are supposed to trust without question the medical establishment and believe that the results are just what they should be.

[knitter4democracy]

3. Well, duh. Of course it can be traumatizing.

This is only news to those who've never been through it, I would think. I'm not saying my births were traumatic and caused PTSD in me, but I can definitely see how they could have.

You're put in an uncomfortable position while bright lights are shone in your face and you have people yelling at you all the while you're in massive pain (if it's natural, like mine were) and your body doesn't seem to be listening to you. How's that not traumatic, especially if anything goes wrong?

[pnwmom]

4. And poor women are less likely to receive epidurals and other effective

pain medication, which would increase their risk even further.

It's about time someone did this kind of research.

[knitter4democracy]

5. That kind of thing infuriates me.

Every preggers mama should be treated like a queen, regardless of her life circumstances.

When Hubby was in med school and on his Ob/Gyn rotation, he found that most of his poor patients ended up with C-sections. The vast majority, in fact. They were at higher risk for so many reasons, and with it being a major surgery, it put them at higher risk for complications. Huge Catch-22.

[spinbaby]

6. Right, let's medicate some more

Pain is part of the birth process. I'm of the opinion that women are more traumatized by medical procedures than normal childbirth. And, yes, I've given birth--the last one was 10 pounds 12 ounces of natural childbirth.

[pnwmom]

7. Natural childbirth is great if you're psyched for it, and prepared for it,

and educated about it. And you have the proper support at the hospital.

It's a nightmare when it means screaming in a labor room by yourself -- which is what often happens to these women. And there also seems to be a punitive motive behind it (besides the financial motive, that not giving epidurals saves money.) The attitude seems to be that by allowing a woman to suffer, they will decrease the chance of the woman having another baby.

It's despicable.

[Mushroom]

10. Pain

is part of the impacted molar process too.

[knitter4democracy]

13. I went natural both times myself, but I don't think it's everyone's answer.

It's really not for everyone. I didn't have back labor, I didn't need to be on pitocin, I didn't have breech babies--I had normal labors, normal births, and so it was a good option for me. That, and I can't take narcotics (get all the side effects and no pain relief). We didn't know the extent of the painkiller issue when I had the kids, but we knew about a couple of drugs and were worried about a bad reaction in the middle of giving birth. Now that we know even Duramorph doesn't work, I'm glad we made that decision.

I know what my body can do, and I know how much pain I can handle, but I don't think everyone's the same as me in that regard. I wouldn't presume to judge.

[Bonobo]

8. Great! Let's medicalize childbirth even more. It is now akin to a battlefield!

How much further away from nature can we get I wonder?

Lots of things are stressful. How about suicide? That's stressful for mothers, fathers and siblings. Everyone.

What about seeing a pet run over? Shall we treat that experience as a PTSD moment as well?

[woo me with science]

9. It is really getting disgusting.

The trauma industry will not be happy until we all are assigned therapists to hold our hands from birth until the day we die.

What is sad is that so many people end up seeking "help" because they are told they need it, and these ghouls turn them into permanent victims.

[pnwmom]

12. The article's writer agrees with you. I think you must have missed this:

"Even as medical advances have resulted in many more lives saved during high-risk births, extreme medical interventions can leave a mother severely stressed -- especially if she feels powerless or mistreated by health providers."

[knitter4democracy]

14. PTSD about medical procedures is real.

I've had to deal with it, and it's not fun. Please don't make light of other people's suffering just because you've never had a similar experience and reaction.

They promised me that the Duramorph would work for my kidney surgery. Surely morphine right to the spine would work, right? I woke up with no pain control of any kind--10" incision, a pound of flesh gone, and 3" of rib sawn off all without even a bullet to bite on when I woke up. Something tells me you'd be pushing that morphine button and thanking your lucky stars you had it, rather than going a more "natural" route like I did.

[Bonobo]

15. Naturally no single opinion can cover every case.

I am sorry about your experience. I was, of course, speaking in generalities.

[knitter4democracy]

17. I've found there are no generalities in medicine.

At least, they hardly ever apply to me. *sigh* I get to be walking medical mystery woman, and it's caused more than a little anxiety and trauma over the last few years. Not easy to deal with at all.

[question everything]

16. The article does not advocate that every childbirth be treated as a trauma

but a few women do suffer, so why not recognize it and be ready to handle it instead of just continue to tell women, as was done generations ago, that it was all "in their heads?"

Or, worse, that they were hysterics and required a.... hysterectomy?

Your comment is like that of Scientologist Tom Cruise who went on national TV to deride women with a post-partum depression.

So what if it is in their heads? We should encourage women to get whatever treatment they need so that they can be a nourishing mother and a supportive spouse. What is wrong with this?

[SoCalDem]

11. Medicalizing something "natural" usually has consequences, but

as mothers get "older", I can see why it has happened.. When a first birth is to a healthy 19-24 yr old, things are usually not all that complicated, but a first-birth to a 30 or 40-something who has paid $100K for in vitro..well that;s another thing..

and since they have invented all the modern machinery connected to pregnancy, they will certainly use it..

I was a high-risker, so I had no choice, but I really would have loved the home-birth experience...

[knitter4democracy]

18. Did they take post-op depression into account?

It's real, though not as studied as it should be. It seems to correlate to how much anesthesia was used and how long someone was under. Those drugs are powerful and have powerful effects on the brain that we're only now figuring out. My surgeon flat-out admitted that he knew next to nothing about it, but when I finally found a therapist, she told me that much of their business was because of medical issues, including PTSD and post-op depression.