Birth Matters: A Collaborative Research Project Exploring Birth Trauma

trauma; traumatic

The most humbling part of being a staff member at Postpartum Progress is meeting moms and hearing their stories. Whether a mom is newly diagnosed, or is recovered from a perinatal mood and anxiety disorder there is something special about being entrusted with her story.

The more I listen the more I notice common themes; many women tell me about events during pregnancy or birth they consider to be traumatic. These often contribute to their later diagnosis of postpartum depression, anxiety or another mental health concern.

One of most common issues that comes up is birth trauma. So many of our moms experience something traumatic that leaves them feeling scared and alone. And trauma doesn’t look the same for everyone.

Trauma can occur if your wants and needs are ignored and you are treated without respect. Poor communication from your doctor that leaves you uncertain about your health or that of your baby can be traumatic. Protracted labor, poor pain management, medical interventions, emergency c-section, a baby in distress, a stay in the NICU; any of these can be traumatic and each of us responds differently.

Because responses to childbirth can vary from very positive to negative and traumatic, Postpartum Progress is teaming up with Dr. Sharon Dekel from Harvard Medical School/Massachusetts General Hospital to collect information about emotional responses to childbirth. We want to learn about different reactions to childbirth, why they happen, and what their long-term impacts to mom and baby are.

We want to survey as many women as possible, with all kinds of childbirth experiences – to find out what is the emotional impact of childbirth on women.  Our goal is to know how we can help women overcome their negative experiences and improve positive ones. This information can help to develop assessment and prevention tools for traumatic childbirth reactions.

No matter your birth experience, if you are at least 18 years old and have had a baby in the past six months can take our survey. It is completely anonymous and will take about 20 minutes to finish.

Together we can start to better understand and treat traumatic birth experiences.  Click here to find out more about the survey and to participate!

Every June: A Story of Depression During Pregnancy

[Editor’s Note: Today’s guest post comes to us from a Warrior Mom in Kenya. It’s a beautiful, hard, and tiny bit scary look at an unplanned pregnancy, depression during pregnancy, and postpartum depression. We know other moms have felt this way, thought these thoughts. You are never alone. -Jenna]

Every June: A Story of Depression During Pregnancy

Every June, I have a silent anniversary of sorts.

This June was no different.

It doesn’t help much the fact that this blurry anniversary coincides with my birthday.

* * *

I have vivid memories of that day back in June 2011. In the months that had passed, I lived in a bubble of sorts; reality still hadn’t dawned on me. How’d I been drinking Famous Grouse & Malibu all along without knowing it. It never crossed my mind, at least not at 22. I had these lofty dreams, my career was on an upward trajectory, and there were all the signs of a well-heeled lifestyle. The realization that life as I knew it was going to change had me floating in a palpable fog.

I’d had nightmares every so often since I saw those two lines—piercing screams in the dead of the night, a bloodied mess on my hands, an obsessive worry-packed train of thought that seemed to amplify my incapability to transcend life’s hurdles, and the very nagging thought that I probably wouldn’t pull through alive. I was scared. With every new day that drew me closer to one of my life’s most changing turning points, I grieved at the life I had left behind yet couldn’t embrace with gusto what lay ahead.

It was a yo-yo of sorts. I was going to be a mom—totally unprepared, and completely flustered by life as I knew it. As the days whizzed by, I felt like a puppet in life’s hands; going through the motions, pretending to be unfazed, but really squirming on the inside.

* * *

That Wednesday morning began like any other: a stark indecisiveness in reporting for work (I had some inexplicable fatigue and some cravings that can only be likened to those of a one year pregnant elephant). (Funny how none of these cravings were costly, you know. No croissant cravings, or gelato, or pizza or something. Just #teamavocado, peanuts, copious amounts of tea, occasionally steak… and beans, of all things! I digress…)

In the background, the hustle and bustle of the working class drowned in a cacophony of blaring matatu (public buses) horns, kids giggling excitedly as they boarded their school vans and the unmistakable rumble of heavy road work machinery on the then unfinished Super Highway a few meters from my apartment. The smell of fresh mandazi by the roadside wafted into the air. Yet amidst this entire normalcy, something felt terribly off. And it was not just because I was growing one year older. I’d find out soon.

The urgency of bathroom breaks when one is pregnant is as amusing as it is annoying. I trudged sleepily to the toilet, and that is when the horror of all the queasy feelings unraveled. There it was, a bright red blob right staring back at me. For a moment, my world stopped. All the sounds of normalcy faded into a distant horizon. Tears welled in my eyes. I knew something was wrong immediately I saw the blood because, two months along, I was not meant to be bleeding.

I remember sitting down and breaking down—heavy mucus-filled crying, ugly crying only punctuated by a rumbling stomach. I needed to eat, but how could I when it was evident I was almost losing my baby? How could this be happening? Was it because I still imbibed (unknowingly) a few weeks into my pregnancy? Or was it because, a few days before, I had tripped and fallen by the roadside? Wasn’t I good enough a mom-to-be? Oh no, dear God!!

All I could think of was: I am losing my baby. This emotional turmoil I cannot quite capture in words. I was scared; scared and alone. Alone because, for the most part, I had only disclosed the news to my unborn’s dad (and I use the term dad very loosely) and a few friends. I had to muster courage and go to hospital, immediately. But my feet felt like they had been cemented to the cold apartment floor that dusty dry morning.

In between getting dressed, making a few phone calls, and arriving at the hospital, all that remains of these memories is pretty hazy. I checked into hospital, glad to be in the company of my heavily pregnant friend (forever thankful for her support in the days that followed). It made for solace, really. Tests, scans, physical examination, questioning. In the end, the report read: threatened abortion. The moment I read those words, a hard lump knotted in my throat.

Part of me kept thinking: You are to blame. Loud, audacious voices in my head, placing the blame squarely on my inability to be more receptive of the journey I was on. I couldn’t hold back my tears, sitting in the doctor’s room, trying to wrap my thoughts about the report he had placed on my hands. Prescription medication and mandatory bed rest to ensure that I had a viable pregnancy were provided. I went home, still dazed.

My thoughts swirled around the fact that there was a possibility I would lose my baby. There was some silent grief of sorts, but mostly a cloud of guilt hanging above me. For not doing enough for my unborn child, for making the wrong decisions, for the inability to be excited I was going to bring forth new life into this world, for the fact that I would be facing this alone.

* * *

While the rest of my pregnancy went seamlessly, the guilt of it all continued to haunt me. Looking back, this was one of the triggers for the postpartum depression that would later ravage my life. Coupled with the trauma of labor and childbirth, this guilt plunged me into the miasma of confusion, scary anger, intrusive thoughts, and the intense hatred for motherhood that I could not seem to shake free. Postpartum depression had a vice-like hold on me, a position which often felt like the infamous choke-hold, always feeling like I was peering through chlorinated water in the glare of the midday sun, suffocating, flapping my hands to survive to no avail.

In my son’s first year, I got help online from Postpartum progress. I have always been encouraged to do what Katherine Stone has done with this organization, because I know it gave me a lifeline, for which I am eternally grateful. I hope to do something in this regard here in Kenya.

~Samoina Wangui
PPD Island

Why Aren’t We Screening Every Mom?

Why Aren't We Screening Every Mom for Postpartum Depression?

Yet another study has been published stating that universal depression screening is effective and feasible. This one covered 9000 women and showed that women who were screened in pregnancy were much more likely to get treatment. Once again we see a link between screening and good outcomes for moms. So why aren’t more doctors screening every mom? Were you screened?

I wasn’t. I’m pretty sure that I cried at every single prenatal appointment that I had. At first I blamed it on shock. We’d only been dating about five months when we found out I was pregnant. Then I blamed it on hormones. My OB never gave me the EPDS (the most widely used screening tool) or spoke to me directly about depression. She did ask how I was feeling, and she was very reassuring that the three of us would be okay. Looking back now I can see that she was worried about me: I was the classic definition of a depressed woman. So why didn’t she screen me?

I have a history with depression and anxiety. I was diagnosed in my early 20’s and medicated for almost a year. That information was in my chart. So why didn’t she screen me?

Adam and I went to all of the birth classes offered at our local hospital. I was extremely anxious, almost terrified of the process, of everything that was happening to us and of everything that was to come. No one mentioned postpartum depression or anxiety in any of the classes. They very definitely didn’t mention anxiety or depression during pregnancy. Why did no one tell me the ” title=”Risk Factors for Postpartum Depression and Anxiety” alt=”Risk Factors for Postpartum Depression and Anxiety”>risk factors?

If I had been screened I definitely would have been flagged. I definitely would have gotten help. Inside I was hoping and praying for someone to save me, but I didn’t have the words; I didn’t know what was happening to me. If Adam and I had ever seen a list of risk factors for postpartum mood and anxiety disorders (PMADs) it could have changed everything. Looking at it now I see just a long list of, “Yup, that’s me!”

Studies like this one are so necessary. They back up the lived experience of moms and families all across the country.

“The results of this study suggest that routine depression screening in women, both during pregnancy and postpartum, can lead to high levels of mental healthcare use among women who screen positive.”

For just one moment let me speak to any Obstetricians, Midwives, Doulas, Nurses, and anyone reading this who interacts with pregnant women and new moms: Please screen every pregnant woman and every new mother you come in contact with. Please tell pregnant women and new mothers the risk factors for PMADs. Please explain the prevalence of antenatal depression and anxiety. Early detection and treatment can save lives, it can change lives, it can work miracles. Women do not have to suffer in silence. You can save us.

To all the moms out there who weren’t screened: I’m sorry. I want you to know that I am one of you. I want you to know that I have promised my daughter that if she is ever pregnant, this will NOT happen to her. I, and so many other mamas, am working at the community level to ensure that every mom is screened. Postpartum Progress is helping to lobby for legislation that will move us towards universal screening. There is so much that you can do to help!

Call your doctor and ask why you weren’t screened. Ask if they are planning to implement a screening program for pregnant women. Share studies like the one discussed here that show how effective screening is.

Call your hospital and ask if the risk factors for PMADs are discussed during birth classes.

Call your midwife or birth center and ask if they screen every mom.

Call your doula and ask if she discusses risk factors with moms and screens moms.

Contact your Senator or Representative and ask if they are voting for the Bringing Postpartum Depression Out of the Shadows Act.

Help me keep the promise I made to my daughter. Let’s get screening for #EveryMomEveryTime.

6 Things Moms Need to Know About Labor & Delivery

6 Things Moms Need to Know About Labor & Delivery -postpartumprogress.com

Pregnancy is a miracle, they said. You will love your journey, they said. Be grateful, they said.

Well I say however magical it can be at times, pregnancy is gross, my friends. That’s right. I’m calling it. There are too many bodily changes to keep up with and too many hormones to help us cope with those changes. Creating human life is so not fun for a lot of us, and I for one am glad some are choosing to speak up about it. Recently, model Chrissy Teigen came out of pregnancy with a beautiful bundle of joy and a tweet that said her baby wasn’t the only one wearing diapers. She shouted, “No one told me about this!” and it got me and a whole lot of other women responding “right?!” It opened the floodgates of chatter.

Back when I was pregnant over three years ago, I was inundated with so many pieces of advice because of my New Mom status, but no one really told me the gross aspects of bringing forth human life via vagina. Everything I was told was either positive or teasingly negative, but almost none of it was authentic. In the spirit of being honest, I think it’s time we let other moms—and partners—in on what really goes on.

I don’t want to share just my experiences, so I took to a local mom group that I’m part of and asked the legion of experienced ladies: what do you wish people had told you when you were pregnant and giving birth as a new mom? Here’s what they had to say.

Babies and poop go hand in hand.

My particular experience is what made me think of this and had a lot of moms agreeing. I heard rumors that you would poop on the table when you’re delivering, but no one told me about the uncontrollable diarrhea that my intense contractions would cause. Embarrassing to admit (but kind of funny in hindsight), I leaked all over my hospital bed because contractions turned my insides to liquid. I thought my water broke. Then when my water did break, I thought I pooped again. Oh boy.

Aside from that, many moms like Heather G. report that when you push, either poop or a baby or both will come out- and that it can make for a confusing delivery. She says, “Push like you have to poo! No one ever told me that. It would’ve been much quicker (of a delivery) if I had been visualizing/pushing right.” There is no telling which one you’re going to get until it greets you with cries or gets discreetly tucked away by a compassionate nurse.

Game of Thrones isn’t the only place where blood is in abundance.

Everyone tells moms, “You’re so lucky not to have a period for like, a year.” What they fail to be envious of is postpartum bleeding, where you basically have all the periods you were “so lucky to miss” catch up all at once. This is actually what Chrissy Teigen was referring to when she said her baby isn’t the only one wearing diapers. The pleasant horror show is known as “Lochia” and in addition to blood, this heavy discharge contains mucus and uterine tissue. It can last for up to six weeks postpartum.

Moms like Jennifer D. and Bethany W. warn that it’s not as easy as just letting yourself bleed: Clots can pose a risk, and your doctor should advise you which types to look out for. It’s a stressful six weeks. Mom Ashley M said, “My postpartum periods were physically horrible, much worse than anything I had ever experienced.”

Sex with your spouse is going to take a long time to resume or feel right.

Most doctors recommend holding off on tumbling in the sheets until at least six weeks postpartum, longer if you had a C-section. Aside from the delay in fun times, other things can greatly impact your sex life. Breastfeeding can sometimes make you drier than normal; hormonal changes, perinatal mood disorders, and sleep deprivation can put you out of the mood; and tension can happen in your marriage because of the sheer stress of having a new baby. Amanda B. laments, “Postpartum sex… How excruciating! And that it’s normal (to be)!” It’s hard for your partner to understand sometimes, which can add to the frustration. Your body and mind went through all sorts of trauma, with lasting effects. Intimacy can be hard to achieve for awhile.

You may not feel immediately attached to your new baby.

In fact, you may not feel that strong bond of love and attachment for a while. Postpartum blues can turn into postpartum depression or anxiety, and these feelings sometimes block out any positivity trying to make its way in. Because so many people talk about the bliss of motherhood, and there is still a stigma attached to perinatal mood disorders. You’re expected to love your baby instantly and feel intense guilt when you don’t. This leads to not being honest about your feelings and seeking help because in an environment that shames mothers for these feelings; it’s hard for a mom to feel safe being open.

When mom Jennifer D. brought this up, almost all the moms I spoke with wholeheartedly agreed. Tanya H. said, “I remember lying on the bed with (spouse) crying my eyes out and saying to him that I thought we had made the biggest mistake of our lives… if you’re not head over heels in love with your baby after you have it, that’s totally normal.” You just went through something very traumatizing, and it is okay if exhaustion and suffering are on the forefront of your mind. Just don’t be afraid to reach out if this feeling lasts.

Your birth plan might go out the window and things can go wrong.

C-sections are reality. Things can go wrong, like your baby being breech, their heart rate rising, or even just being induced when you planned a natural birth. Sometimes, doctors and nurses don’t listen to you. Sometimes your doctors are amazing and they guide you through every step, but it can still go wrong.

Mom Nicole H. mentions “the guilt and shame from within if things don’t go ‘naturally.’ Such as gestational diabetes, induction, C-section, inability to breastfeed…” It can be very difficult to navigate your feelings when you hear so many suggestions about what to do and what not to do. She continues with, “any helpful suggestion made me feel like a total failure as a woman. I felt like my body should just do this! Women have been doing this forever!”

Breast-feeding can be painful, unsuccessful, and ultimately not what happens for you and your baby.

This is something I and the other moms struggled with. I was unable to feed my daughter my breast milk. Not only was she allergic to it, but I barely produced and she couldn’t latch properly. We spent three weeks crying, struggling with consultants, eliminating food from my diet, and she still lost weight and ended up in the hospital. The first night I gave her formula was after I screamed at the consultant that I couldn’t do it anymore. And my baby and I both slept for five hours straight after that bottle I was so harshly judged for. It was the best decision I could have made.

Mom Brittanie E. chimes in, “The breastfeeding books I read did not prepare me for struggling with low supply.” Another mom, Tiffani R. gave another insight: “Tetting thrush… my nipple pain… the whole peaceful bonding thing that never happened and then me hating myself for not being able to feed.” A LOT of the moms I spoke with voiced their hardships with breastfeeding and said it was the biggest thing they were not prepared to struggle with.

There are so many other things that the moms and I were chatting about, but these instances where what we all agreed about in unison. Some moms brought up a good point about shame in having a good experience, too.

Mom Meghan D said, “I want to add feeling guilty for having a relatively great breathing experience. Sometimes it’s difficult to share the positive things that happen when you were worried that you might make others feel worse about their experience.”

It can be hard to share your beautiful experience when you know of so many women who had the opposite, but it’s important to celebrate your birth, as it is to be honest and raw about how it went down the drain for you.

Mom Caitlyn A. puts it beautifully, “Labor often does not go exactly as we have imagined, but it does teach us that in life things don’t always go the way we had planned. It’s okay to not be okay. This one moment in time will not define your being so if you don’t have that beautiful, natural delivery you dreamed of, it is okay. Reach for help if you need to discuss what happened to you.”

In the end, everybody has their own unique experience. We encourage you to speak up about yours. I had a great time talking with over thirty moms about our struggles, and it was a great relief for us to hear how so very not alone we are. We all agreed: We can be a little less scared as moms when we have each other to lean on and share with.