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- Post Traumatic Stress Disorder in Birth

Last Updated: 10/3/2011

Post traumatic stress disorder has been around as long as trauma, probably since the dawn of time.  It was called by different names initially, such as: "battle fatigue, shell shock”.  "Soldier’s heart” was the term used with soldiers who developed the PTSD symptoms after the Civil War.  In WWI the symptoms were referred to as "combat fatigue” and in WWII it was "gross stress reaction”.  Soldiers from the Vietnam War were classified to have "post-Vietnam syndrome” PTSD has only been recognized as a formal diagnosis since 1980.

PTSD is an emotional illness, classified as an anxiety disorder.  It is the result of a horribly frightening, life-threatening, or otherwise highly unsafe experience.  PTSD suffers re-experience the traumatic event in different ways, and tend to avoid places, people or things which remind them of the event.  They are extraordinarily sensitive to normal life experiences, having what is termed as "hyperarousal”.

Any trauma, defined as a life-threatening or that potentially compromises the physical or emotional well-being of an individual or causes intense fear may precipitate PTSD.  Some such events may include:  being the victim of kidnapping or torture; exposure to war combat or a natural disaster; a plane crash or terrorist attack; being a victim of rape, mugging, robbery or assault; enduring physical, sexual, emotional or other forms of abuse.

These three groups of symptom criteria are required for the diagnosis of PTSD:

  • Recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by reminders of the traumatic events, recurring nightmares about the trauma and/or dissociative reliving of the trauma)
  • Avoidance to the point of having a phobia of places, people, and experiences that reminds the sufferer of the trauma or a general numbing of emotional responsiveness
  • Chronic physical signs of hyperarousal, including sleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, increased tendency and reaction to being startled, and hyper-vigilance (excessive watchfulness) to threat

 

In one study of troops who fought in Iraq, it was learned that 12.5%, (one in eight) reported PTSD symptoms.  Soldiers from the Vietnam War were found to have 15% PTSD and Gulf-War veterans experienced PTSD 2-10% of the time.

Of all rape victims approximately one third (31%) suffer from PTSD sometime during their lifetime, and more than one in ten (10%) of them will not see their PTSD resolved.

We would expect to find this disorder among those people who fight in wars, experience natural disasters and are victims of violent crime. We do not, however, expect to find it among women giving birth to their children.  Perhaps it might be understandable when it is an emergency situation in which the life of the mother and/or baby is in danger.  It is not understandable, by contrast, in women that are low-risk and have no complications.  For a normal physiological process that most times can be completed with little to no assistance, you would imagine that having a dedicated medical team present would lessen the chances of a traumatic experience. By contrast 33% of women identified a traumatic birthing event and reported the presence of at least three trauma symptoms, while 5.6% met the criteria for acute PTSD  Also responsible in part is the fact that, in the US 31% of women are giving birth by cesarean section, more than twice the acceptable rate published by the WHO.  

It wasn’t until 1994 with the changes in the definition of what constitutes a traumatic event in the DSM-IV that difficult childbirth began to be recognized as a precipitating event.  The revised criterion included: "an event in which the person witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.

Some results of PTSD from childbirth in women include:

  •                 Sexual avoidance and fear of childbirth
  •                 Mother-infant attachment and parenting problems
  •                 Continual fear for herself and her baby
  •                 Perceptions of loss of control continue
  •                 Decreased functioning in family relationships and in society
  •                 Poor health behaviors
  •                 Increased substance abuse
  •                 Memory problems
  •                 Recurrent nightmares
  •                 Other emotional problems

 

Birth Trauma lies in the eye of the beholder, and mothers perceived that their traumatic births were viewed as routine by their clinicians.  It is estimated that PTSD from birth occurs in 1.5-6% of women experiencing a vaginal birth, and in as many as 33% of women experiencing an emergency cesarean birth.  Of note is the fact that 76% of women experiencing an emergency cesarean birth experience the event as traumatic.  8% feel that they were treated badly by the delivery staff and were subsequently angry. 25% blamed themselves for the event to some degree.

According to Solace for Mothers, an organization which provides support for women who have experienced childbirth as traumatic, "Postpartum Post Traumatic Stress Disorder (PTSD) was once estimated to only affect 1.5% to 6% of women. Many researchers and clinicians now feel that the number of women experiencing trauma following childbirth may actually be much higher”. 

There are varying estimates of incidence of PTSD in birthing women, but one thing is certain.  It is unnecessary, abusive and inexcusable.  Dare I say, even reprehensible and criminal. Women who have unexpected outcomes, but understand their complications, feel as though they are a part of the process of decision-making, and have adequate support will not have PTSD as a result of a traumatic birth experience.  Women should be free to make their own choices regarding their birth, including: whether or not to submit to an induction, especially in the absence of any medical indications for one; unlimited access to support, especially during medical procedures; unlimited access to nutrition and hydration; freedom to move at will and choice of position for laboring and birth; whether or not to submit to vaginal exams, IV administration, perineal and cervical manipulation; delayed or no cord-clamping at mother’s discretion; unlimited access to baby for bonding and breastfeeding; where and with whom to give birth including home - with or without midwifery support.  Because of LIBERTY and the right to govern her own body as guaranteed by our Declaration of Independence, and Constitution of the US, her choices should not be dictated by anyone other than herself.  She alone owns the right to her own body.

Join Birth Freedom Network and if you're in Ohio BFNoO, to stand up for the rights of women to birth who, where and with whom they choose.  If you don’t stand up for them, then who will?

 

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