Birth Trauma: New Mothers with PTSD
If you’re a fan of BBC 2 show Peaky Blinders, you have watched Cillian Murphy beset by what used to be called shell-shock. Today, we use the term post traumatic stress disorder (PTSD), but it’s the same phenomenon: persistent mental stress following a severe psychological shock.
At a conference on birth trauma in London last month, psychiatrist and trauma specialist Dr Shaili Jain spoke about her work in the US with veterans battling PTSD, and shared her expertise with an audience made up of people whose job it is to try to prevent, recognise and treat birth trauma. GPs, midwives, psychologists and health visitors filled a room in Mile End Hospital. The event was the brainchild of Dr Rebecca Moore, a perinatal psychiatrist with expertise in treating the psychological aspects of birth trauma.
The loss of control mothers may experience during labour can lead to a constant mental retreading of events. A deep dread of going through the experience again can set in. Women may struggle to sleep – at a time when any sleep is needed. Vivid flashbacks can strike without warning. Mothers feel extreme anger towards themselves and others. Suicidal thoughts can occur.
A key theme emerged: perception. A straightforward-seeming birth may be traumatic to the mother. Dr Jain’s advice to professionals is that if a woman is experiencing symptoms of post traumatic stress, thorough evaluation and, if necessary, treatment should be offered. Clinical psychologists Jane Iles and Florence Bristow agreed, saying PTSD is often overlooked. “It can be difficult to tease out symptoms versus the normal new parent experience”, said Bristow, adding: “don’t exclude partial symptoms”. She cited figures showing over 30% of women report a birth that was traumatic [1].
The symptoms can be triggered by everyday things: a picture of the newborn; a midwife visit. Iles alluded to the tendency for some women to “withdraw”. She explained that for some women, social interaction becomes difficult. There is “constant comparison” between what they think they should be feeling and the reality. The impact may be more than social: it may affect physical health if the mother stops seeing healthcare professionals.
Why should we care? Because as well as the significant effect on the mother’s mental health, PTSD can have deep effects on families and even on physical health. The Everyone's Business report set out the huge financial cost of perinatal mental illness. Birth trauma is only one of the players, but when talking about her work with US veterans who have PTSD, Dr Jain suggests that the treatment and benefits bill runs to billions of dollars.
Mothers with PTSD are often misdiagnosed with post-natal depression. Emma Jane Sasaru spoke to the conference of her highly traumatic birth, which led to PTSD. Emma Jane’s struggle to find out what was happening to her – at one stage being misdiagnosed with anorexia - has led her to campaign for better care for mothers as part of MatExp. Central to her story is the poor and unsympathetic care she received at points during and after her birth.
Doula Rebecca Schiller explained the difference a doula can make. She is often hired by women in pregnancies following a traumatic birth. “Doulas provide continuous support for the whole family…we are there to listen, give confidence and not judge”.
Schiller - also the director of Birthrights - spoke of a client she took on in her second pregnancy, whose recollection of her first birth was that she “felt like a bother”. Part of Schiller’s role is “acknowledging the trauma”. She may suggest women use birth art to help process the traumatic events. She works with couples to help them understand each other: conflicting memories of the same events can cause discord. She asks women how they want to feel next time.
Dr Moore describes providing "a safe place" for a woman to tell her birth story, and "care being taken to correctly diagnose PTSD". Therapy might include Cognitive Behaviour Therapy or Eye Movement Desensitisation and Reprocessing (EMDR). Medication may be considered, but also exercise, mindfulness and peer support groups. "We aim to provide a holistic unique treatment for each individual woman and their family". She predicts an increase in patients drawing on support online from sources like the Birth Trauma Association Facebook page.
"I see many positive stories where women have a traumatic first birth, sometimes we are the first to hear their story and I mean really hear and actively listen without judgment". Dr Moore works to plan for the next birth, identifying concerns and trying to reframe prior experiences. Specialist midwives can provide additional emotional support, and perinatal teams work with obstetric colleagues. Women are supported fully after delivery.
Returning to the perception point, Dr Moore stresses "If a woman perceives her birth or postnatal care as traumatic, it was traumatic, I would never question this, it is absolutely vital that this is honoured".
Further support:
#MatExp and #BirthTraumaChat on Twitter
Creedy, D. K., Shochet, I. M., & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth, 27(2), 104-111. ; Soet, J. E., Brack, G. A., & Dilorio, C. (2003). Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth, 30(1), 36-46.
