Post Traumatic Stress Disorder

I was first introduced to the concept of a midwife by my sister-in-law back in 1995 when I was pregnant with my first child. Regulated midwifery was in it’s infant stages in Ontario, and I had no idea what a midwife was, but had no intention of leaving what I had always known as the standard of maternity care—an obstetrician. The concept of midwifery was even more foreign to me when she mentioned the option of having a homebirth. “Have my baby at home?” I thought, “Why would I want to do that? The hospital is much safer and cleaner than my home. Look at all the cleaners and sanitization procedures that they have,” I protested, and thought that my sister-in-law must have lost her mind!

That was that. I went on to deliver my son in February 1996 and had a very smooth and precipitous delivery at the hospital under the care of an obstetrician. That tradition carried on during my second pregnancy and birth in 1998 to my daughter.

As life went on and my husband and I started to become aware of holistic approaches to raising our children, we naturally were lead to the option of a midwife when I was pregnant with my third child in 2001.

A Change of Heart

My very good friend who lived in the U.S. used midwives for all of her pregnancies and delivered her babies in a birthing centre. She felt informed and involved in her health care, which prompted me to consider this as a very viable option. I wanted to learn more about my options, and felt that the delivery of my Daughter in 1998 was guided by what the physician and nurses were telling me I needed, not by what I knew my body could do.

We were living in Ottawa at this time and I began my search for a midwife, with the hopes of having a homebirth! I had a plan. I knew what I wanted for my delivery and wanted to experience this pregnancy and birth under my terms with the guidance of a midwife. I wanted my voice to be heard and for my health care provider to understand my newfound outlook on life…to approach pregnancy as a normal life event. I knew I could trust someone who knew that I should trust myself. She looked after me when things went smoothly, but when we discovered at 35 weeks that my son was breech, she explained all of my options which at that time included a cesarean section. I tried the various techniques that my midwife suggested would turn my baby, and he turned at 36 weeks. I went on to labour at 37 weeks and 4 days.

I wanted my voice to be heard and for my health care provider to understand my newfound outlook on life…to approach pregnancy as a normal life event.

Three-Peat

It was a mild fall night and the leaves had already begun to turn into their beautiful crisp hues. My two older children were tucked snug into their beds fast asleep. I called my midwife around midnight when I felt that I was in labour (all of my children were born at 37 weeks and four days into my pregnancy…talk about timing!). I paced back and forth in my apartment with my husband by my side waiting for her to arrive. When she arrived, she came toting her equipment bags prepared to set up for my homebirth. After she confirmed that I was in labour and progressing quickly, she wanted to confirm my choice of birthplace. My mind worked fast and I immediately thought of my two children tucked away in the bed coupled with the fear of getting into the car for a bumpy ride to the hospital…I inevitably chose to stay at home. There was no way I was going to relive the awful experience of driving in the car while having contractions, and besides, I felt more calm and in control at that point than I did when I was in labour with the older two.

My midwife set her equipment up quickly and I continued to pace back and forth in the apartment. I felt comfortable and reassured being in a familiar environment surrounded by familiar people. I went on to deliver my son about 1 hour after my midwife arrived.

The Awakening

The older kids awoke to the sound of him crying wondering who was visiting. They came out of their room rubbing their tired eyes to see their freshly born brother. They sat on the couch staring quietly and intensely as they absorbed the reality of his presence.

This experience prompted my interest in becoming a midwife. One year later, I decided that I would apply to the midwifery education program at McMaster University in Hamilton. When I received my offer for interview, I was ecstatic and prepared to head to Hamilton a few months later.

I had my interview, but felt that I could have done better. I was a bit dismayed when I was not accepted to the program that year. I became pregnant with my daughter in 2003 and had her in December. I delivered her at home, again, with the guidance of my midwife. I am convinced that the home births helped me bond with my children which helped my husband and I transition from two to three, to four children in the space of 2 ½ years. I felt more confident in my role as a mother. I felt the need to give back, to educate, to offer women the choices that I had during my pregnancies.

My husband and I discussed trying to get into the Midwifery Education Program again, and we agreed that it was worth a try. I applied, got an interview, and travelled to Hamilton (with my husband and 4 month old daughter in tote) with the intention that this would be the last time I would try to get into the program. I settled on the thought that if I did not get into the program that year, I was not meant to be a midwife.

My interview went well and I was 90% certain I would be offered a spot in the program. I received a letter in the mail from McMaster University stating that I would be placed on the waiting list for acceptance into the program. I was half happy and half disappointed as my acceptance to the program now depended on someone else declining their acceptance. Our family went away for a week in August, and when we returned home there was a message on our answering machine stating that a spot had opened up and they were offering me admission to the program! In the excitement my husband accidentally erased the message and we scrambled to find the phone number…I had only a few days to confirm whether I wanted to accept or not! I called right away, and soon after received an admission package. We only had a few weeks to pack up our family and move to Hamilton…not an easy feat with a young family and responsibilities. We made it happen however, and low and behold…I arrived….and have been working as a Registered Midwife since my graduation in 2008.

I look forward to providing my clients the same care I received as a midwifery client during my last two birth experiences.

By Salimah Moffett

Shaima’s story is not an unusual one, but she is not a war veteran, she is a mother.

Her story plays out like that of a soldier haunted by the ghosts of the battle fields, the sleepless nights, flashbacks, the constant irritability, the inability to concentrate to name just a few. Shaima suffers from what experts describe as post-traumatic stress disorder (PTSD), a condition most of us associate with a traumatic event or events that we have experienced at some point in our lives, which includes labour and birth experiences.

PTSD

Women like Shaima who perceive their labour and delivery as traumatic are learning that perhaps it is not the experience of labour and delivery alone that plays a role in developing this disorder, but rather the symptoms of PTSD can be related to events and experiences they appraise as harmful or threatening prior to or during the pregnancy.

“(W)omen with fear of childbirth appraise the forthcoming delivery more negatively than others—thus their appraisal may be as important as the event itself,” says Susan Garthus-Niegel and others in their study “The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study.”

Depressed pregnant woman: “I have a healthy baby,” Shaima says, “and I am grateful for that, but I can’t help but look back at my birth experience as negative, and I keep wondering why I feel this way.”

Shaima is not alone in her sentiments. In fact studies have shown that up to one-third of women view their labour and delivery as traumatic, and people need to know that traumatic reactions to childbirth are an important public health issue, says Garthus-Niegel’s study.

What is important to remember is that not everyone who experiences a traumatic birth goes on to develop PTSD. Women who have experienced prior trauma in their lives whether in the form of violence, losing a loved one violently, or having the mere perception of a threat to ones life increases the chances of a woman developing PTSD after birth.

“It was my first pregnancy, I did not know what to expect,” Shaima recalls. “I only heard negative stories from other women about their deliveries, I was terrified that something bad would happen to me and my baby—I felt helpless.”

PTSD and postpartum depression are not the same. Although some of the symptoms can overlap, the causes are much different. PTSD is often a reaction to a traumatic event or a perception of a traumatic event and can be classified as a stress reaction. Postpartum depression on the other hand is a mood disorder caused by an imbalance of neurotransmitters in the brain and is mediated by hormonal changes.

The symptoms of PTSD can generally be grouped into three categories:

Re-experiencing (reliving the birth)
Avoidance (avoiding another pregnancy or anything that reminds the mother of the traumatic experience)
Increased arousal (exaggerated startle reflex, irritability, insomnia)

PTSD however can develop into postpartum depression and even postpartum psychosis if not recognized and treated appropriately.

Psychologists recommend seeking out a professional who is trained in postpartum PTSD. This will help to target the causes of the disorder and enable women to receive care that focuses on their particular needs.

All is not lost for Shaima and the women like her. Experts believe that having the right kind of support during the pregnancy, labour and delivery appears to have an effect on reducing the chances of developing PTSD when women perceive that support as caring and compassionate.

For a fee, the article The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study By: Susan Garthus-Niegel, Tilmann von Soest, Margarete E. Vollrath, Malin Eberhard-Gran can be reviewed in full. Please see the link below:

Full Article

My Birthing Evolution