PTSD & CHILDBIRTH - THE WIDER ISSUES

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September 23rd 2002, Waipuna Hotel And Conference Centre, Waipuna Rd Mt Wellington, Auckland, New Zealand

140 midwives, counsellors, Government employees, community support workers, students, academics, childbirth educators came and learned so much from our speakers… "an excellent day - thanks TABS" "the real need to acknowledge this devastating condition" "we really need to link services" "there IS a difference between PND & PTSD!!" "The way forward to both minimise & help avoid trauma in childbirth, was SO helpful" - just a sample of some of the comments.

From one of the TABS mothers … "I had a good day, some of it was pretty tough going, but I hung in there, with the help of a very yummy lunch! The speakers were amazing...it's interesting to see how differently people can be so affected by what is supposed to be one of the happiest days of our lives. The mechanics of PTSD were explained: the signs of it, and the likelihood of it occurring, what happens when it does occur, and what can be done to prevent it or treat it. It helped me quite a bit in regards another up and coming birth, and helped "normalize" my anxieties. I met some lovely ladies, TABS organizers and members...and it was good to meet others with less than glowing birth stories, what a strange bond we have through our pain. I look forward to the next "gathering" very much!"

This day was made a complete success by the generosity of many: Waipuna Hotel And Conference Centre, Cheryl, Sara, Phillida, Nimisha, Rob B (TABS father on video), AUT for the use of their Power Point projector and also Glaxo Smith Kline for their generous financial gift towards staging this event. Thank you to Territory Manager, Sean Coutts for liaising between GSK and TABS. Thank you! Without all of this support and generosity, the seminar day would not have been possible. Thanks so much, from the TABS Committee.

So what did we learn ….?

Our day began with Debbie Hager (our facilitator for the day) introducing a recording of Toni reading her February 1998 letter to the Treasures Magazine, which really began the work of TABS.

We compliment Debbie on her expertise and commend her work titled "An investigation into the relationship between domestic violence and mental illness."

For a copy of this research: debbie.neil@paradise.net.nz or ph 09 818-2787.

Phillida Bunkle, a Member of Parliament until the latest General Election, got the ball rolling with a stirring opening, emphasising the importance of acknowledging PTSD in childbirth for what it is, just that!

Prof Cheryl Beck's PTSD Study

"GIVING MOTHERS A VOICE" thus far on her research project with 23 mothers telling their stories and answering the question "WHAT IS THE MEANING OF THE EXPERIENCE OF PTSD AFTER CHILDBIRTH FOR MOTHERS?"

Ten months into the data collection: Once informed consent was obtained, each mother was asked to write, via the internet, her story of PTSD after childbirth: To describe in detail their (1) birth trauma, (2) experience of PTSD after childbirth, and (3) how it has affected their lives and those of their families. Phenomenology is a descriptive inductive research method that seeks to discover the meaning of human experiences through analysis of participants' descriptions of the phenomenon under study.

"PTSD is like a loaded freight train coming at you all day long and you are trying to keep it on track and not let it run you over" "It has ripped a hole in the core of my being. No matter how carefully I am healed, there will be a scar on my heart, a line of weakness in much the same way as the scar on my uterus is a weakness" "It has taken a couple of months to get my story out, but it's been a very therapeutic exercise doing so." "I feel by writing about it, my story is outside me and not inside filling me up with anxiety."

"Every little story helps to bring the issues and concerns of PTSD sufferers out into the open, my story can help make a difference in other women's lives." "Writing this feels much healthier - trying to work towards educating others about this experience and learning that I haven't gone crazy." "It is such a relief to know that I am not the only one that this has happened to."

Parts of the presentation..

Birth Trauma related to:
Infant Death, Emergency Cesarean delivery/fetal distress - Cardiac arrest, Incompetent medical care, Congenital Anomalies, Fear of epidural, Inadequate Pain Relief, Postpartum hemorrhage /manual removal of placenta, Forceps/vacuum extraction/skull fracture, Separation from infant in NICU, Toxemia/Premature birth, Degrading Experience.

Birth Trauma: The Battlefield

  1. To Care for Me: Was That Too Much To Ask?
  2. To Communicate with Me: Why Was This Neglected?
  3. To Provide Competent Care: You Betrayed My Trust and I Felt Powerless.

Birth Trauma: The Aftermath

  1. Going to the Movies: Please Don't Make Me Go!
  2. Terrorized by Nightmares and Flashbacks: Can't Sleep, Can't Eat.
  3. A Shadow of Myself: Too Numb to Try toChange.
  4. Anger, Anxiety and Depression: Spiraling Downward.
  5. Obsessed: Wanting to Know More and wanting to Talk, Talk, Talk.
  6. Isolation from the World of Motherhood: Dreams Shattered.

For those wishing to link into this study, write direct to: Cheryl Tatano Beck, University of Connecticut, School of Nursing, 231 Glenbrook Rd, U-26, Storrs, CT 06269-2026 (860)486-0547 Or email: cbeck@uconnvm.uconn.edu or via Sue at TABS.

Dr Sara Weeks, Mensana Clinic, Roberts St, Ellerslie, Auckland, New Zealand, 09 525 7288, mensana@excom.co.nz

From Sara we heard about the importance of correct diagnosis and the various treatments of PTSD (eg, CBT, EMDR, DBT, anti depressants and peer support. We learnt that mothers have an increased risk of developing PTSD if the following symptoms are experienced during labour: disassociation, freezing, hysteria, going on auto-pilot, physiological symptoms of adrenaline overload eg diarrhea, vomiting, shaking and nausea. And that other risk factors include birth trauma, panic in birth attendants, lack of association and of being monitored. And Sara reported that PTSD can be prevented by giving a frank explanation of what is going on. Then she gave an explanation of all the different treatments for PTSD and the importance of allowing questions and answers: ventilation...let them talk.

Nimisha Waller, Midwifery Lecturer, AUT, School Of Midwifery Private Bag 92 006, Auckland 1020, New Zealand; email: nimisha.waller@aut.ac.nz.

Abstract
Blum (1980) and Raphael - Leff (1980) describe pregnancy and childbirth as a real life event: an important physical and psychological rite of passage for women, described in psychological literature as a "normal developmental" or a " transitional crisis". Most women recover quickly postpartum - some have more difficult time as their ability to cope is undermined by stressful events ranging from unexpected moving house or bereavement to childhood sexual abuse or an ongoing "battering relationship. Raphael - Leff describes these women as undergoing "double crisis adjustment".

Prevalence of PTSD varies depending on the literature from 0.2% to 7%. Though the numbers are small for these women having PTSD, it is a real issue. There are no risk factors that helps practitioners to identify women at risk of PTSD however a detailed history during antenatal period is essential to identify women with previous trauma or women whose ability to cope with childbirth may be undermined due to stressful events.

Nimisha stated that the PTSD symptoms in labour that birth attendants should look out for are: extreme fear/lack of trust, disassociation, experiencing flashbacks, need for control, a homebirth or detailed birth plan, being extremely submissive, extreme modesty or the opposite, needle phobia, extreme agitation, request for a C/S. Strategies that midwives can use to empower women were also highlighted.

Her presentation also included how midwives can help women in the postnatal period and facilities that have been setup especially in UK to support women who have had traumatic birth experience.

"The key is to ensure women feel in control of their childbirth experience and treat them with utmost respect - it's their body and their baby."

And finally… after lunch there was an excellent question and answer session for the presenters, two TABS members and also Dr Dereck Souter of Origins (thank you for coming Dereck!) The TABS presentation from Carolyn and Narelle, added to the seminar day from their own areas of expertise. Narelle shared stories from mothers, obtained from responses for the book she is writing and for Carolyn from the perspective of Multiple births and antenatal education thereof. Also the videotape of a TABS father was said by many to be a highlight and we thank Rob B for sharing his story as a husband of a PTSD sufferer. The day concluded with Sue sharing the aims and future direction of TABS.

Again, TABS would like to thank all those who gave generously to making the day such a success…. Wonder what / when our next seminar day will be!

REPORTING BACK FROM THE SMALL GROUP DISCUSSIONS AT THE CONCLUSION OF THE DAY

answering the question:
"what we learned today and how to apply it to our work practices and/or daily lives"

TABS MEMBERS:

COUNSELLORS:

CHILDBIRTH EDUCATORS:

COMMUNITY GROUPS, GOVERNMENT AGENCIES, GP:

MIDWIVES: