PTSD after Childbirth

AIMS Journal 2007, Vol 19, No 1

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Post Traumatic Stress (PTS) is a set of normal reactions to a traumatic experience. Reactions such as dizziness, feeling faint, elevated blood pressure, feeling numb or dreamlike, fear, denial, irritability, anxiety, intense anger with self or others, poor decision making, panic attacks, intrusive thoughts, flashbacks, tearfulness/emotional outbursts, sleep problems, reluctance to talk about the event or wanting to talk about it all the time¹.

Sometimes stress reactions appear immediately after the event, sometimes days, months or even years later. Only if these symptoms persist for more than a month is it referred to as a disorder and called PTSD². For fur ther information, support and self-help in surviving trauma visit www.traumaticstress.freeserve.co.uk

PTSD after childbirth is a phenomenon inflicted on women by the inadequate NHS. I do believe it is possible to get good NHS maternity care but it's a lottery and unfortunately a huge majority of women including myself are not winners. The Birth Trauma Association (BTA) have done a lot to raise awareness of PTSD after childbirth. However, a lot of health professionals continue to remain blissfully ignorant and consequently women are not getting the immediate help they so desperately need. This is very sad because with understanding and support stress reactions have been found to pass more quickly¹. After the birth of my son in September 2003 at times it felt like I was going mad. I have since discovered that PTSD is a psychological phenomenon, and an emotional condition, from which it is possible to make a full and complete recovery. I was not going mad but I did require specialised help², unfortunately I received none.

I booked a hospital birth in Sheffield because I believed this was the safest option. Unfortunately giving birth turned into an event that shattered my deeply held beliefs about hospitals being safe and benevolent. Like a lot of other pregnant women I was deceived, neglected, insulted, assaulted and ignored by hospital staff. The months that followed were the worst of my life when they should have been the best. Following a traumatic, potentially life threatening event the body is in chaos. It takes some time for the brain to accept that the danger has passed. It took months for me to accept that Michael wasn't going to die and over two years to discover that he was never really in danger in the first place.

My husband and I arrived at hospital and were taken to a room then left for over an hour with no explanation or reassurance. I overdosed on gas and air because nobody bothered to show me how to use it. I was told off by the anaesthetist for this when she eventually came to administer the epidural which I had requested on arrival. I wish somebody had told me sooner because I was so high I had no control over what happened next. I was progressing well (7cm dilated) and contractions were regular. The midwife artificially ruptured the membranes (ARM) without my informed consent because it is a routine procedure. My baby's heart rate dropped significantly after this unnecessary intervention, one of the many risks of ARM nobody told us about.

I was seen by the consultant and his entourage who I can only assume were students. He thought that an emergency caesarean was indicated and I signed the consent form because I believed my baby would die if I didn't. I was rushed through to theatre with relief because I wrongly believed the pain would soon be over. I had to have a general anaesthetic because they said there wasn't enough time to increase the dose of epidural. His heart rate had actually started to pick-up by that point but nobody bothered to tell me about that either. I woke briefly after the operation to see if my son was alright and the pain I felt was horrific. Not only did they rob me of his birth but also of those precious first moments of his life.

Months later I discovered many things including the fact that the hospital was extremely busy and short staffed the day he was born. They also confirmed that there was no obvious cause for the fall in his heart rate such as bleeding or problems with the umbilical cord. In fact they never established the cause of his distress, however, more fetal heart abnormalities are reported with early amniotomy³.

After the operation I was unable to lift or hold my baby and just felt helpless. I just wanted to be able to look after him and bond with him but I couldn't. I had to rely heavily on the hospital staff and I praise some but not all of them. On one occasion my baby was crying so I called for assistance. A nurse came and told me in an unfriendly manner that I would have to wait.

Tell that to a hungry baby whose mother couldn't get out of bed to feed him! I was devastated and when my husband came to visit shortly after that incident we both cried. On another occasion I was insulted as I struggled to walk; one member of staff sarcastically asked me 'What's wrong have you just had a baby?'

Three days after he was born my family were visiting and we were all laughing and then I just burst into tears. Looking back I now realise that was the start of the PTSD and that night was the first of many sleepless nights. After four days of affliction I desperately wanted to go home and was told I could. Then I was told I couldn't because my blood pressure was high. I became very distressed by this news and the staff who dealt with me from then on were all cold and heartless. I was made to spend another sleepless night in hospital against my wishes backed up by my family who thought it was for the best.

During my stay in hospital nobody came to talk to me or reassure me that my son was alright. It took months to discover he didn't need resuscitating and years to find out he was born fighting fit with Apgar scores of 9! A doctor came to see me in the middle of the night and asked me if I knew why I'd had a caesarean. My response was what they had told me when I signed the caesarean consent form that his heart rate had dropped. He nodded and left as quickly as he had appeared. I now realise the point of that visit was to ensure his own back was covered. It didn't matter that for months I tossed and turned unable to sleep. Each night I listened for Michael breathing willing him to wake up even though I was exhausted. Even in the day time my mum would offer to watch him while I rested but I couldn't. It was like a dark cloud was hanging over me and I was worried and anxious about everything. I heard fireworks outside and it filled me with dread, I couldn't even watch television and had to keep turning the sound down. I was obsessed with good hygiene and became tense and on edge if visitors came and wanted to hold him. Even though I wanted to protect him I was unable to bond with him because my emotions were numb. I lost my appetite, people even commented now on how quickly I lost weight.

Everyday it felt like I was taking one step forward and two steps back, the smallest task was a struggle. By the time the health visitors came I was too scared say anything because I felt that bad I truly believed I might have to go back into hospital, or that they might try to take my baby away from me. I know they thought I had postnatal depression but it was never discussed I was just made to complete about six of those questionnaires. After six attempts at trying to label me as postnatally depressed they finally accepted that I wasn't but just assumed I must be alright. My reaction it would seem is quite common according to netmums.com who carried out a 'screening for postnatal depression' survey in 2004. This survey showed that many mothers are covering up the fact that they are feeling unwell often because they think it will reflect badly on them personally, and might even have consequences for their families⁴.

Luckily and not uncommonly the severe symptoms spontaneously subsided after a couple of months⁵. I have since cherished every moment with my precious little boy and the bond we have is now twronruly amazing. I wrote an extremely nice letter of complaint to the hospital about my care and received a very detailed response. I then spent a long time avoiding thinking about what happened but then my husband and I decided we wanted more children and inevitably the memories resurfaced. I was scared to conceive because I couldn't bear the thought of the same thing happening again. I met with one of the consultants and a midwife from a service called 'birth after thought'. Together they unknowingly helped me to piece together what happened whilst still trying to cover their wrong doings.

Luckily I found AIMS and through them the vaginal birth after caesarean (VBAC) egroup health.groups.yahoo.com/group/ukvbachbac. Both have given me the much needed information, emotional support and encouragement to have another baby.

References

1. ASSIST Trauma Care, What is Post Traumatic Stress (PTS)? A leaflet from the ASSIST information pack available free of charge from http://www.traumaticstress.freeserve.co.uk/Inforequest.htm (2007), 11 Albert Street, Rugby, Warwickshire, CV21 2RX, Helpline: 01788 560800.
2. Post Traumatic Stress Disorder, The Invisible Injury, 2005 edition, David Kinchin, DSM-IV and Kinchin 1998 (Page 5 and 10).
3. British Journal of Obstetrics and Gynaecology 104: 340-346, Early amniotomy increases the frequency of fetal heart abnormalities, Goffnet F, Fraser W, Marcoux S, Breart G, Moutquin J, Daaris M (1997).
4. Finding mums with postnatal depression a survey for BBC 1's 'Real Story' (April 2004) http://www.netmums.com/lc/pndscreening_survey.php
5. Clinical Obstetrics and Gynecology,Volume 47, Number 3, September 2004 - Delivery as a Traumatic Event: Risk Factors, and Treatment for Postnatal Posttraumatic Stress Disorder, Susan Ayers (Page 554).