- AUGUST 5, 2008
Birth Trauma: Stress Disorder Afflicts Moms
Study Suggests That PTSD May Be More Common Than Previously Believed
By RACHEL ZIMMERMAN
Amid the debate over how to effectively manage maternal mental-health disorders, a new type of postpartum illness is gaining attention: post-traumatic-stress disorder due to childbirth.
PTSD is most commonly associated with combat veterans and victims of violent crime, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die. Symptoms can include anxiety, flashbacks and a numbness to daily life. Even as medical advances have resulted in many more lives saved during high-risk births, extreme medical interventions can leave a mother severely stressed -- especially if she feels powerless or mistreated by health provider.
PTSD is much less common than postpartum depression, which has become better-understood by the public as celebrities like actress Brooke Shields and former CIA agent Valerie Plame have spoken out about their experiences. The National Institute of Mental Health estimates that postpartum depression affects 15% of mothers.
The incidence of childbirth-related PTSD hasn't been widely studied. But a new survey suggests the disorder could be more widespread than previously believed. Of more than 900 U.S. mothers surveyed, 9% screened positive for meeting all of the formal criteria for PTSD set out in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, a handbook of mental-health conditions. And 18% of respondents had some signs of the disorder. The survey, which included an established PTSD screening tool, was conducted by Harris Interactive for Childbirth Connection, a nonprofit maternity-care organization in New York. Separate earlier studies outside the U.S. had estimated the prevalence of childbirth-related PTSD at between 1.5% and 5.9%.
Shari Lusskin, director of reproductive psychiatry at New York University Medical Center, who wasn't involved in the survey, cautions that many aspects of PTSD still aren't understood, especially as it may apply to childbirth. "We don't want to overmedicalize a normal part of human development," she says. "Just because you had a traumatic birth, doesn't mean you'll get PTSD."
Still, the survey results are likely to add fuel to a debate about how to better identify and treat maternal mood disorders and whether widespread, systematic screening is warranted. New Jersey in 2006 passed a law that requires every new mother be screened for risk of depression prior to discharge from a hospital and again at her first post-birth doctor's visit, although women can decline the screening.
'Drugging of Mothers'
Other states, including Illinois and Texas, have passed laws to promote greater educational efforts about postpartum mental illness. And now the first federal law on postpartum mood disorders, which would fund research, treatment and public awareness, is working its way through Congress. Opponents say the law would lead to more "drugging of mothers."
Gena Zaks, of Baltimore, became suicidal with violent nightmares after the premature, emergency birth of twins in 2004, one of whom faced life-threatening respiratory problems. Ms. Zaks was diagnosed with several postpartum conditions, including PTSD and depression. "I was crying nonstop for six days in the hospital," says the 34-year-old mother. "Nobody said anything to me about depression."
Monica Bristow, a clinical psychologist in Redmond, Wash., who counsels mothers with PTSD, says one key to treatment is sharing the story of the trauma with a professional who can understand and validate the experience. Medication can be used to alleviate symptoms like insomnia and anxiety, she says, but nondrug techniques, like relaxation or gradual re-exposure to the trauma through memory in a constructive setting, can be more long-lasting and effective.
A history of sexual abuse or other trauma can also put women at greater risk for PTSD from childbirth, says counselor and childbirth educator Penny Simkin, of Seattle. She says discussing such information with a health professional before giving birth can help reduce the risk.
Maternity-care providers say the increase in the number of medical obstetric procedures in labor and delivery, like Caesarean sections and premature births, could be contributing to PTSD. These providers also note that childbirth-related PTSD became more of a focus of study only after 1995, when the American Psychiatric Association broadened criteria for the disorder.
PTSD, whether brought on by childbirth, natural disaster or some other trauma, can happen immediately, or months after the event. It may occur when someone has experienced an event that involves actual or threatened death or serious injury, and responds with intense fear, helplessness or horror.
Cheryl Beck, a professor at the University of Connecticut School of Nursing who researches birth trauma and was an adviser on the Childbirth Connection survey, says the mothers who reported signs of PTSD in the survey appeared to have a higher rate of medical interventions and describe feeling powerless in a threatening environment.
The survey also found that African-American women, those without private health insurance and women with unplanned pregnancies were more likely to have PTSD symptoms. The survey, called New Mothers Speak Out, available at childbirthconnection.org, also covered a range of other post-birth issues. Executive Director Maureen Corry noted the majority of mothers with PTSD and depression symptoms didn't seek professional help.
In 2003,Liv Lane spent 29 hours in labor. After a painful, vacuum-assisted delivery, she gave birth to a son whose lung had collapsed and whose heart had moved to the right side of his body, a condition known as pneumothorax. Ms. Lane, 33, of Shorewood, Minn., says the baby was whisked away and she was left alone, scared and unsure if he would survive. She says the hospital staff also ignored her calls that pain medication wasn't working. The baby, Ryder, eventually recovered.
At her eight-week postpartum checkup,Ms. Lane told the nurse practitioner she'd been sobbing every day and "fantasizing about driving off a bridge." She says the nurse suggested reading some parenting magazines. "I felt ashamed that I'd even asked for support," Ms. Lane says.
A therapist later diagnosedMs. Lane with PTSD. She began a year and a half of treatment that included psychotherapy.Ms. Lane says she then felt ready for a second baby. But when she got pregnant, her flashbacks, anxiety attacks and panic about her son's safety resurfaced. She took measures to make this birth different. In consultation with her doctors,Ms. Lane switched hospitals and opted for a scheduled C-section, believing that a vaginal birth might re-trigger the trauma. Her doctor prescribed Zoloft at the end of her pregnancy to alleviate anxiety. She also made sure that her husband or another support person would be with her through labor. The experience was "wonderful," she says. Baby Truman is now 3 months old.
Bill in Congress
The proposed federal legislation on postpartum mood disorders, called the Melanie Blocker Stokes Mothers Act, named after a woman who jumped to her death from a Chicago hotel with postpartum psychosis, was approved by the House of Representatives in October. Last week, the proposal got caught up in a package of bills that failed to reach a final vote on the Senate floor. Democratic supporters say the measure, which doesn't include mandatory screening but does authorize a study about its benefits, could be back later this fall.
Amy Philo, of Frisco, Texas, is using her Web site, uniteforlife.org to help galvanize opposition to the measure, which she believes is designed to enrich pharmaceutical companies. "This bill will result in an increased number of women being referred and treated with drugs," Ms. Philo says. Ms. Philo, who calls herself a "Zoloft survivor" because of the adverse reaction she experienced after being prescribed the drug following a postpartum panic attack, believes antidepressants are unsafe and sees mental-health screening as an invasion of privacy.
Susan Stone, a clinical social worker in New Jersey and past president of Postpartum Support International, a nonprofit proponent of the Mothers Act, says the law's intent is to provide effective care, whether it's talk therapy, medications or some combination, to suffering mothers. "Every woman needs to be assessed individually," she says.
Write to Rachel Zimmerman at firstname.lastname@example.org
Printed in The Wall Street Journal, page D1
Contact information for this author (article below) is not available. The author would not reveal her identity.
A new survey says that 9% of postpartum women suffer from post traumatic stress disorder. You know, the same disorder that Iraq vets and plane crash survivors get. Something does not compute here, especially when you read further into the Wall Street Journal piece about this increasingly common affliction. "Childbirth-related PTSD became more of a focus of study only after 1995, when the American Psychiatric Association broadened criteria for the disorder," the Journal notes. In addition, the treatment is the same for childbirth-related PTSD and regular postpartum depression: talk therapy and sometimes anti-depressants like Zoloft. At the bottom of the WSJ article, there is a list of symptoms of PTSD vs postpartum depression, and while the PTSD symptoms are more specific, they also fit the criterion for regular old postpartum blues. Of course, women should feel comfortable speaking up and getting help about whatever issues they have in those difficult post-birth months, but something still irks me about this classification of childbirth as "trauma."
Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event? Besides, according to the Canadian Mental Health Association, the kind of anxiety experienced by people with PTSD is felt by 1 in 10 people — about on par with the 9% of women who get postpartum PTSD. Even Shari Lusskin, director of reproductive psychiatry at New York University Medical Center, tells the WSJ, "We don't want to overmedicalize a normal part of human development…Just because you had a traumatic birth, doesn't mean you'll get PTSD."
It's sort of a pat explanation to say that the diagnosis of PTSD in women post-childbirth is all a big pharma conspiracy to get women hooked on anti-depressants, and I think that it's much more complicated than that. Certainly, having a bowling ball of a baby shooting out your vag isn't a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.
At Jezebel, Jessica writes: “Is Having A Baby A Traumatic Event?”
“A new survey says that 9% of postpartum women suffer from post traumatic stress disorder. You know, the same disorder that Iraq vets and plane crash survivors get. Something does not compute here,[...]
Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event?[...]
Certainly, having a bowling ball of a baby shooting out your vag isn’t a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.”
“Hysteria”. Yes, “hysteria”. She went there. She used the prime misogynist slam against women, blaming wandering uteruses. Unbefuckingllievable.
I’m only surprised there wasn’t a “princess” or a “delicate flower” thrown in there too. Or maybe a few accusations of insurance fraud, hm? That would just put the icing on the hateful cake.
Get back to me when you’ve been stripped, dehumanised, isolated, forcibly starved, and strapped to a table for 12 or more hours during the hardest work of your life. Get back to me when you’ve been subjected to a series of non-emergency procedures on your body with neither consent nor medical justification. Get back to me when you’ve been imprisoned in hospital.
Get back to me when you’ve been held down by two or three people while someone – or more than one someone – pushes their fingers into your vagina while you say “No”. Get back to me when you’ve been screaming “NOOOO! STOP!!!” and been ignored while someone cuts your body open and shoves metal forceps into you. Get back to me when you’ve been strapped to a table and operated on and had your protestations about the anaesthetic not working being ignored. Get back to me when you’re left bleeding and vomiting on a table, without access to help, wondering if you’re bleeding to death, and you’ve had your newborn baby taken away from you without explanation or good reason except an over-the-shoulder “we don’t have enough staff right now”.
Get back to me when you’ve spent months of your life – the months you thought would be a joyful, perhaps sleep-deprived, milky daze – having violent flashbacks and nightmares. Shambling through the day barely able to function, unable to bond with your newborn. Bursting into tears and panic attacks many times a day. Avoiding public places lest you suddenly start sobbing and need to run. Not able to have anyone touch you.
Get back to me when you’re hunched in a corner, unable to work, unable to care for yourself, unable to speak, and all anyone can say to you is “All that matters is a live baby”.
I hope you never experience these things. Because they can be horrifying, life-changing, deeply traumatic events. The only promise I can make you is that I won’t call you “precious” or “hysterical” if you’re ever in this terrible position.
Medical assault is assault. Obstetric rape is rape. Trauma is trauma. Some people who have experienced these things get PTSD.
And it’s not up to you, or anyone else, to instruct them that they haven’t – especially in explicitly woman-hating terms.
You don’t get to judge.
No, no, no, no, no.