Amanda Spakowski Owner/Founder The Nesting Place
On Friday Sept 28th, I was interviewed on CBC radio regarding a recent study
indicating that 1 in 13 women in Canada experience full Post Traumatic Stress Disorder (PTSD) following childbirth. Even more women experienced partial symptoms of PTSD within 1-3 months following their delivery.
While the study was specifically looking at the presence of PTSD in women who have given birth, it’s important to note that either parent may experience PTSD or another postpartum mood disorder. Please do not disregard symptoms in your spouse simply because they were not the one’s who gave birth to your child.
With findings like this (and with only 4-6 min per interview), it’s understandable that many of you had more questions about what this means for parents preparing for birth and for those currently struggling with PTSD or something similar.
From parents I’ve heard:
What are the risk factors of PTSD?
Am I at high risk of PTSD?
What symptoms would I be showing if I was experiencing PTSD?
What is the difference between PTSD and Postpartum Depression (PPD)?
Who would I go to for help?
From the birthing community I’ve heard:
Should we be worried that these findings will instill a greater sense of fear in our clients before birth?
What does this indicate about the way prenatal classes and other birthing materials prepare parents for childbirth and postpartum?
To explore this topic further, we’ve elaborated on these questions and consulted with counselor Maya Hammer of The Health Psychology Clinic in Toronto.
Who is at risk for PTSD?
Verrault et al. found that there were four dominant risk factors that indicated a woman may be more likely to experience PTSD following childbirth.
-a history of previous sexual trauma
-a sensitivity to anxiety
-a lack of perceived help following childbirth
-a more negative childbirth experience than expected
*It’s important to note that a history of depression was not included in the risk factors associated with PTSD specifically, although it can be a risk factor for Postpartum Depression.
What are the symptoms of PTSD?
A parent experiencing PTSD will exhibit an exaggerated emotional or physical response to references to their childbirth. They may see their child or their spouse as a symbol of their trauma and distance themselves from that person to prevent themselves from re-living the event. They may experience flashbacks where they feel as though they re-live the event again or have lingering anxiety that prevents them from sleeping or engaging in day-to-day activities with their family, friends or work.
What is the difference between PTSD and PPD?
PTSD is exhibited with very severe emotional and physical responses to references of the childbirth or sometimes their child. This is sometimes described as a heightened state of arousal in the individual. They will feel agitated and keyed up when they are triggered.
With PPD, the symptoms present themselves as an overall sense of overwhelm which may or may not be connected with the childbirth itself or the child. Someone with PPD may cry excessively whether they’re speaking about their childbirth or not, have intrusive thoughts about themselves or their child and have little motivation to care for themselves, their child or their work. Their sleep may also be disrupted.
Who would I go to for help?
Postpartum mood disorders are difficult to understand and the symptoms of each fall on a spectrum of severity. The symptoms often overlap with one another leaving it difficult for parents themselves to identify if a mood disorder is present or which one it is. For a full listing of possible mood disorders, please visit Postpartum Support International.
That being said, a parent doesn’t have to be diagnosed with a mood disorder to benefit from therapy that simply helps them to adjust to the normal emotions that accompany the immense changes to their life, relationship and self-identity. For more information about private or group support for your adjustment to parenting please contact Maya Hammer, psychotherapist (in Toronto) or a postpartum counselor in your city.
Try searching your location on Psychology Today to receive a listing of counselors in your city.
Won’t these findings cultivate a sense of fear in parents preparing for birth?
This is a concern for both birth educators and parents. As birth educators and doulas familiar with the factors that influence how comfortable and safe parents feel during delivery, we are intimately aware of the influence that fear can have on parents in labour.
When a pregnant woman is afraid in birth, her body is more likely to tighten in an effort to protect herself. This tension, in turn can influence the way the woman experiences her sensation – she is more likely to identify her sensation as pain when she is tight and fearful of it.
Whereas in other life experiences, the sensation of pain is an indicator that something needs attention in the body or that the individual is in some need for help, in labour, the sensation of labour is not an indication that anything is wrong. The sensation is not something to fight. It is not something that is done to you, it is you. It is your body opening and your body doesn’t ‘want’ to take you to a place that is dangerous for you, even if it is very challenging for you to experience it.
Although it’s realistic to expect moments of fear in birth and moments when the body is tense, the practice of coping with labour is in letting go of tension in the body; of reminding oneself or the labouring woman that she and her baby are safe and that this is a safe process to be experiencing. As she softens her body and let’s go of the need to control her bodily urges, her feeling of coping increases and the sensations can feel much more manageable.
Prenatal classes that focus on coping and labour support for childbirth can be a great place to develop your coping skills for birth. In particular, many parents have found the practices of Birthing From Within and Hypnobirthing (together or separately) to be useful in helping them address their fears of birth and reinforce their coping mindset. Visit their websites for a listing of classes in your area.
With studies like this one, it’s important that we use the results in the way that they are meant to be used; as a tool to help us identify those parents who may be more at risk for PTSD so that we can better prepare and support them, as an indication to parents exhibiting symptoms of PTSD that additional support is necessary and to emphasize to all parents the importance of proper birth preparation and postpartum support.
What does this indicate about the way prenatal classes and other birthing materials prepare parents for childbirth and postpartum?
There are two findings in this study that that I’d like to highlight for parents and birth educators. One, that parents were more likely to identify trauma in their birth if they experienced a more negative birth experience than expected and two, that the perceived lack of support following childbirth increased the symptoms of PTSD. Let’s look at these one at a time.
Expectations for childbirth
How does your understanding of birth influence how you prepare for your own delivery?
Some parents are very afraid of birth and go to great lengths to avoid the situations that they are afraid of. They may employ a particular practitioner that they believe will help them to avoid the birth they don’t want, engage in a prenatal class and take up coping practices that emphasize the birth they’re hoping for or choose a birthing location that lowers the likelihood of their fear unfolding for them.
Other parents who have great trust in birth may prepare for their delivery in a similar way. Their innate trust in their bodies manifesting as “I trust I won’t need that intervention” or “I trust that that won’t happen because I am built to give birth.”
This trust is inspiring and truly amazing. Similarly, choosing support people and a location of birth that feels safe and supportive for you makes a world of difference to how you feel during your labour. My hope is that all parents feel confident and strong in themselves however they are delivering. However, the problem with both of these approaches is that these parents are preparing for the birth they hope for to the exclusion of the possibility that it might not go as planned.
Birth educators do their clients a disservice and parents do themselves a disservice when they prepare for one birth possibility to the exclusion of another. It is a very unrealistic approach to birth preparation that insinuates a parent has so much control of their delivery that if they make all the ‘right’ choices and do all the ‘right’ exercises that they’ll guarantee themselves a particular birth experience.
There are many factors that influence the way that a labour unfolds and the options available to parents. Each birth is unique, it happens over it’s own period of time and can be different not only between women but between births for the same woman.
You’ll notice that in this section I am describing parents as preparing for “their desired birth” and avoiding “their unwanted birth scenario.” This is not to be interpreted as every parent preparing for an unmedicated, vaginal homebirth, but rather to acknowledge that while some parents’ ideal birth is just that, others’ include the support of an epidural. Still others would much prefer the challenges of cesarean delivery to those of a vaginal delivery. For these women, their unwanted scenario may be an unplanned, unmedicated birth, an unplanned home birth or a vaginal delivery.
We cannot ever make sweeping statements that insinuate that mothers who choose to birth at home without an epidural will have an easier or more empowering delivery than a mother who birth in the hospital with an epidural. We cannot even state that all women who have cesarean deliveries will experience trauma or that all who have vaginal deliveries will not. A trauma is influenced by the way a woman relates to her birth experience, whatever it is, not simply by the presence or absence of medical support.
I invite all parents preparing for birth to prepare for the birth they hope for in addition to the possibility that they’ll need to stray from that plan.
So what is the best way to prepare for birth?
Pam England describes her first birth experience in her book, Birthing From Within. As a midwife she felt she had all the information she needed to birth her own way. She new the statistics of home birth vs hospital birth, she did a tonne of yoga, ate well and trusted birth. There was no part of her that believed she would birth any way but vaginally. But birthing is not about ‘making sense’ of things. We can’t put all the pieces together to guarantee ourselves a certain birth scenario and like many women, Pam found herself experiencing a cesarean delivery that she was quite unprepared for.
After this experience, she questioned herself. With all of the knowledge she had around birthing, she still didn’t birth vaginally. She began to ask herself, “What information really is important for birth preparation if not the information that she already knew? And if it wasn’t just book knowledge she needed for birthing, what was it that she really needed to know about birth to give birth with the understanding of a mother opposed to the understanding of a clinician?
Then, it came to her when she was pregnant with her second child. What she really needed in order to feel prepared for this birth, was to prepare for another cesarean delivery.
In other words, part of fully preparing for birth is preparing for the delivery you hope won’t happen in addition to the birth you hope for yourself.
When parents are kept in the dark (or keep themselves in the dark) about the birth possibilities they’re nervous about, they are left unarmed with knowledge and coping tools that can help them feel grounded and resourceful in their delivery. With an awareness of all birth scenarios, parents speak with more confidence, come prepared with words and items that will allow them to feel more connected to each other, their birth and their baby no matter which path of birth unfolds for them. It is with preparation for the unknown, not avoidance of the unknown that feelings of competence and confidence follow.
As parents, I invite you to really ask yourself, what is that YOU need to know about to feel fully prepared to birth.
Doulas and birth educators, what topics or activities are you nervous to bring up with your clients.
I’m betting the answers to those questions quite possibly will be the most important things you’ll need to consider for your birth preparation.
Perceived lack of support in postpartum was another factor influencing the presence of PTSD after childbirth. This should be read as both “lack of support” and “perceived lack of support.” For some, the support may be there but the individual may not actually feel supported by those in their life. Perhaps she has difficulty accepting or asking for help or maybe the support offered is not appropriate to the needs of her or her family.
Many parents feel an overwhelming sense of pressure to do it all themselves and struggle with a sense of being “not good enough” if they find that they can’t do it all on their own. In the bigger picture, Canada and the US are some of the only countries in the world that do not have a cultural or traditional practice of caring for a family who has welcomed a new baby over more than 2 weeks.
In Latin-America, new mothers are cared for by female relatives for fourty days following birth. In China, it’s 30 days; in Mexico, India and the Middle East it’s 40 days. But here, we allow partners up to two weeks off and the mother at home is often left on her own around the same time. We can be very isolated here and in Canada and it is very much up to the parents themselves to cultivate a comfort in asking and receiving help. I invite parents who have difficult asking for help to consider how help actually allows them to be better parents. I challenge you to actively put your circle of support in place to permit you the freedom of enjoying your new family in amongst the numerous tasks that need to be done.
Some ideas to start:
-Email all of those family and friends who say “call me anytime” and ask them to sign up for the circle of support tasks. You might make a list for meal angels, child care angels and errand angels (have them sign up for a particular schedule so that they don’t make other plans and you can depend on them when you need them)
-Post a list on your fridge of things visitors can do to help (Many people want to help but don’t want to insult you by just cleaning up around you. While you may be waiting for them to offer to help, they may be waiting for you to ask for it!)
-Contact a counselor in pregnancy and set up bi-weekly or monthly phone calls for your first year following baby. A third set of eyes who knows what signs to look for to identify postpartum mood disorders will me much more effective than your sleepy parent-brain
-Consider hiring a birth and/or postpartum doula who can alleviate fears as they arise, provide in home support for feeding baby and take on some of the day-to-day tasks that allow you to spend more time with your family and get more rest as you recover from birth
-Print out a postpartum depression checklist provided by your counselor or physician to screen yourself for PPD in the first year following delivery
Simply being physically well cared for after a baby means that your mind will be in a better place to cope with the challenges of adjusting to a new baby. Enacting this help is not an indication that you’re not good enough, it’s a necessary measure in self care that allows you to be the present, patient and loving parent you so badly want to be.
Prenatal Classes, Birth Doulas and Postpartum Doulas:
Birthing From Within
The Mother’s Guide to Self Renewal
The Labyrinth of Birth
The Postpartum Husband
Birth as a Hero’s Journey
Birth Story Circle
Cesarean Birth Healing
Counselors and Support People:
Postpartum Support International
Pacific Postpartum Support – Vancouver
Victoria Mom – Victoria
Families Matter – Calgary
Women’s Health Clinic – Winnipeg
Healthy Babies and Families – Thunder Bay
Postpartum Support List – Toronto
Family Services Moms Group – Ottawa
Counselors in Halifax
Listings of Counselors in your area: