Most of what I write here comes from years of experience treating trauma victims, training in Cognitive Behavioral Trauma Therapy through MUSCs Project Best and the UCLA Trauma Assessment as well as the Traumatic Events Screening Inventory, but for the purposes of this article we are referring to a previous article right here on Myrtle Beach Birth Services.
Last month there was international controversy over an article written here about a birth experience that was written by Katherine Hunt. Many people wondered why she did not bounce back, after all she had a new baby and all was well. I also noticed a similar story online several days ago by another mother. In fact it’s not at all uncommon for women to have these feelings after having unexpected outcomes and trauma occur during birth.
The first part of diagnosing PTSD is to ask some questions about traumatic experiences like: “Have you ever been in an earthquake, a flood or a hurricane or tornado.” Obviously many people have experienced some of these and they don’t suffer from PTSD. Another of those questions is: “Have you ever had a painful and scary medical treatment in a hospital.” This could fit a difficult birth and or cesarean birth. Another, “Have you ever known someone who got really hurt or sick or even died.” We often think of family members and for a mother, her new baby is someone she loves, wants to protect, and has empathy for.
So with a yes on these questions we can move on to the next part of the assessment.
In the first section there are questions like “Were you afraid you would die?” and “Were you scared someone else would die.” When Katherine told her birth story she wrote of being so ill that she worried for the safety of her baby. So for this question the answer would be “Yes.” There are eight questions total in this category, but only one needs to be answered yes to qualify as a traumatic experience.
Other questions include “Did you feel that you could not stop what was happening?” “Did you feel out of control?” “Did you feel confused?” “Did you feel like what was happening did not seem real?” In order to get a full trauma exposure you must be able to say yes to one statement in each of these categories. It’s easy to understand how a woman giving birth with complications for herself or her baby would be able to acknowledge these experiences. But we still don’t have a diagnosis of PTSD.
The final section is a series of symptoms that occur for some people who have suffered a trauma. There are three different categories of symptoms to PTSD – Re-experiencing, Arousal and Avoidance – and each category contains several symptoms. To have a full PTSD diagnosis you must have at least 2-3 significant symptoms in all three categories.
If you have 2-3 significant symptoms in at least two of the categories you may be suffering from partial PTSD or traumatic grief and you will find relief from these symptoms through Cognitive Behavioral Therapy. Cognitive Behavioral Therapy consists of: education, relaxation, thought stopping, emotional regulation and telling your story in an accepting nonjudgmental environment.
Often treatment can be completed in short therapy, 6 -18 sessions. It depends on the person, it depends on the number of other traumas that the person has experienced and it depends on the first 5 years of that person’s life – that is a different subject and an important one. The first five years builds resiliency, but we will leave that for another article.
What Katherine, and many other women describe is more than the usual birth experience. It is more than an unexpected surgery. It is a situation in which the individual becomes afraid for themselves and someone they love and the brain, in an effort to protect that person, goes through significant changes. It is these changes that cause the symptoms that we refer to as PTSD.
There are things that can be done in the situation that can help prevent PTSD in the medical field. Giving the patient as much control over their treatment and care is one of those. Giving them as much education and decision making power as possible and giving permission for them to have only those people in the birthing room that make them feel safe, confident and comforted are some others. It isn’t always possible thought to protect a birthing Mom from the protective actions of her own brain when it goes into survival mode. It is best not to judge people for their emotional experiences. As care givers, friends, family members, and professionals the best thing we can do is listen.