I first heard the term trauma is used to describe the birth experience a year ago, as a mother of three it surprised me that I wasn’t aware of it. Dr. Koh, an Obgyn with over thirty years of experience in the field was described to me the effects of childbirth on women and the word that was used constantly was trauma.
Trauma. Should such words be associated with the best experience a woman can go through in life? Up until this point, I was only familiar with the term postpartum depression, which sparked the conversation with Dr. Koh, to begin with. Having recently discovered that I suffered it with my first two children, I needed more information on the subject to better understand how women can avoid it or be helped. I didn’t expect there was another layer of it on which I needed to be educated, Postpartum PTSD, another concept that I needed to understand.
Postpartum PTSD vs PPD
At first glance, one might think that Postpartum Depression (PPD) and Postpartum Post Traumatic Stress Disorder (PPTSD) are the same. At least that’s what I thought when I first heard of it.
A brief explanation of both concepts would be that PPTSD is triggered by stressful or traumatic childbirth experiences while PPD relates to the hormonal, social, and psychological changes that happen when having a baby.
Symptoms of PPTSD such as extreme anxiety, hypervigilance, irritability, anger, guilt, and shame are some of the few to mention. These symptoms may lead to self-destructive or reckless behavior. The use of alcohol or recreational drugs to numb themselves or forget appears to be the common theme. This in turn fueled their emotional numbness and further disconnection from the people around them.
Studies have shown that PPD is more common with 10% -20% of women experiencing depression post birth. It is estimated that 9% of women suffer PTSD after birth and untreated PPTSD may lead to PPD. The official number PPTSD is suspected to be higher, as studies are finding that women are reluctant to come forward with this condition compared to PPD. With the global birth rate at 4,620,000 per year, even 9% of women suffering from PPTSD worldwide is astounding.
What qualifies as a traumatic birth?
Trauma is defined as a deeply distressing and disturbing experience. Wouldn’t that be the case for every birth experience? I wouldn’t classify the birth for all three of my children as a walk in the park or a relaxing one. But was it traumatic?
The best description that I found in my research was from Cheryl Tatano Beck, a distinguished Professor and leading expert on Birth trauma. “Trauma is in the eye of the beholder”.
I would often downplay the stress of my birth experience. I feel that there’s always an expectation for women to tough it up when it comes to birth. Unfortunately, expectations often come from other women.
My research into this topic had me wondering, was my PPD stemmed from the birth trauma I experienced but never realised?
My firstborn was 22-hour labor with no form of pain management whatsoever (a choice that I made last minute on the day based on one comment from the nurse regarding their margin of error in the hospital!). I had this image in my head of what my birth experience would be. A short but calm birth and me looking fabulous while doing it.
In reality, I was in fits of pain for hours, looking like a train wreck, and nurses shoving their fingers up my vagina to estimate the dilation of my cervix (I have to say this is the worst out of the whole experience). I realised on the day that my cervix is made of steel, and nothing could force it to open. Since the birth plan I had in my head was to avoid getting an unnecessary cesarean, I decided to wait it out.
To say the pain was unbearable was an understatement. I begged for Epidural in the end but was told I passed the threshold for one (a little warning would’ve been nice!) Along with vaginal tears and hemorrhoids, baby and I made our way home the next day.
My daughter arrived 6 years later, with a birth plan to first try without an epidural and to be informed before I pass the threshold for one just in case, I change my mind (last call at the bar, so to speak). I had ample time for my previous birth, in active labor 22 hours after my water broke. So, I figured it will be the same for this one too. Why not, right? Life is after all that predictable! This time, I was in active excruciating labor 30 minutes after my water broke (again, missed out on the Epidural!).
I can’t say for certain which birth was more painful but judging how my whole body was shaking intensely after the birth of my daughter is indicative of the stress that my body just endured.
Both birth experiences had the same theme. Excruciating pain, miscommunication, powerlessness, and lack of support. Looking back and reliving the moment, it dawned on me. It was traumatic. I felt unseen, isolated, and irrelevant. Whatever I said was shut down with “oh, so many women before you didn’t have a problem. Or when I comment about the pain it was met with “Well our mothers never had any Epi and they’re fine”. Up until that point, all the stories I’ve heard from friends were happy and pleasant. Why was mine far from being pleasant? In fact, dare I say it? I hated the experience.
The outcome was similar, I felt disconnected from the babies. I didn’t want to be around them beyond the necessary routine (and it always felt like a chore). Motherhood wasn’t the joy that everyone promised me it would be. It continued to be so for years after, with me trying to self-medicate (not knowing what the cause was!) and constantly battling the guilt of feeling like an unworthy mother.
Stigma surrounding PPTSD
PPTSD was only formally recognized in the 1990s by the medical community. Before this, childbirth was too common for it to be considered traumatic. Studies showed that pain bias exists, where a woman’s pain is more likely to be dismissed than men’s. Lack of recognition for the condition in mothers can be a discouraging factor for women to step forward to seek help.
PPTSD is not a condition expected mothers are made aware of. I certainly wasn’t. You can almost feel the judgment being thrown at you should you so much utter the discontent of your birth experience. Comments like “well at least your baby is healthy and well” are enough to verbally stab you with guilt. Not wanting to be seen as a failure, ungrateful and whiny made me choose to suffer in silence.
Treatment
It is important to bring awareness to this topic to encourage suffering mothers to seek help. I know it would’ve saved me years of emotional battles had I’d been told what may happen and to keep an eye out for the symptoms. Fortunately for us, there are treatments available to assist with PPTSD. Studies showed that Cognitive Behavioral Therapy and Eye Movement Desensitizing Reprocessing Therapy (EMDR) have been effective in the treatment of postpartum PTSD. (insert link here)
Prevention is better than cure
Even though there are treatments for the condition, necessary steps ought to be taken to avoid going through such trauma.
Sadly, no research has been done to date on the primary prevention of traumatic childbirth. However, studies on how women evaluate their delivery experience could be used as guidelines for expectant mothers. The four factors how women rate the quality of their birth experience are:
- The availability of support from caregivers.
- The quality of relationship with caregivers.
- Involvement in decision making.
- Expectations of the birth experience.
Although it may seem unpleasant to be talking about such a gloomy topic to expectant mothers, the more informed they are the more empowered they may feel. Looking back, I would much rather be told beforehand of what to expect, or what may go wrong, and how to deal with it. Maybe it’s time to not wrap a pretty bow around it and say it like it is. First time mothers, brace yourself. It might not be all rainbow and sunshine, but with the right support system by your side and a well-prepared state of mind, you have a fighting chance.
