I’d like to heartily welcome Stacy Biscardi as a guest on Postpartum Progress today. Stacy has written an illustrative article about postpartum PTSD, her traumatic childbirth experience and how she is being treated for this disorder.
Women forget the pain of labor and delivery. That’s what everyone says. But it’s been more than one year since my traumatic delivery and painful postpartum complications, and I am still trying desperately to forget.
For one hour, every other week, I sit in a therapist’s office, squeezing pulsing electrodes in each hand, reliving my experience vividly, in an effort to release the trauma from my body and mind and get on with my life.
I have postpartum post-traumatic stress disorder (postpartum PTSD) an illness typically associated with combat veterans. The only battles that I fought were in the delivery room and the ER, but the trauma I experienced triggered anxiety, depression, flashbacks and nightmares that left me drenched in a cold sweat night after night.
I know that I am not alone. Up to nine percent of postpartum women meet the criteria for a diagnosis of PTSD, according to a recent study by Harris Interactive for Childbirth Connection.
What is Postpartum PTSD?
“Postpartum PTSD is a postpartum anxiety disorder,” explains Karen Kleiman, MSW, LSW, author, and Founder and Executive Director of The Postpartum Stress Center, which provides treatment for prenatal and postpartum depression and anxiety. “PTSD can emerge when a woman experiences actual or perceived threat of death or severe injury to herself or someone she loves,” says Kleiman. “Events such as these cause intense emotional reactions, such as fear, horror or feelings of helplessness.”
My birth experience fits this description precisely.
As my labor progressed, my baby turned in the wrong direction and his heart rate dropped, along with mine. Without warning, a nurse fastened an oxygen mask over my nose and mouth. Doctors told us that they needed to get the baby out quickly and the only options were an emergency c-section or forceps delivery. Both had their risks and neither was what I had expected for my first delivery, especially after smooth sailing through pregnancy.
My doctor thought forceps would be the preferable option because of the baby’s low position. The forceps looked like a medieval torture device. They were gigantic metal tongs, running the length of my arms. I gagged at the sight of them. “The baby’s heart rate is dropping,” one nurse reported in a panic. “We need to do this quickly,” the doctor instructed the team.
My mind went numb and my body was no longer my own. Four doctors, a few nurses, and residents poked and prodded me as if I was a 4th grade science experiment. I watched them from a place high above my bed. It felt like my life was in limbo and I was terrified that my baby might not survive either. I drifted away while the doctor flipped the baby around with the forceps and everyone chanted, “Push, push, push!” One doctor yelled, “Here comes the baby! It’s a . . . boy!”
I felt nothing. I saw nothing. I heard nothing. I waited for the cry. I squeezed my husband’s hand and waited. The deafening silence overwhelmed the room, pained my heart. I watched the medical team rushing around. I waited for the cry. And waited. And waited. “This must be a nightmare,” I told myself. Finally, at last, I heard a cry.
I did not get to see or hold my baby for a few agonizing minutes. “Is he OKAY?” I screamed, over and over again, hysterically, as tears poured down my cheeks.
Who Is At Risk for Developing Postpartum PTSD?
Women may be at higher risk for developing postpartum PTSD if their delivery included:
- an unplanned C-section
- use of vacuum extractor or forceps
- baby going to Neonatal Intensive Care Unit
- feelings of powerlessness, poor communication and/or lack of support and reassurance
In addition, women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD, according to Postpartum Support International.
How Is Postpartum PTSD Diagnosed?
“There are three clusters of symptoms that must be present in order to be diagnosed with PTSD,” Kleiman explains:
“1) Re-experiencing of the trauma: This refers to the experience of intrusive memories of the trauma, nightmares or flashbacks about the trauma, and/or distress when something triggers memories of the trauma.
2) Emotional numbing and avoidance of reminders of the trauma: At least three of these avoidance and numbing symptoms are required for a PTSD diagnosis, including efforts to avoid reminders of the trauma, difficulty remembering aspects of the trauma, diminished interest in pleasurable activities, detachment from others, a restricted range of emotions, and a sense that the future will somehow be cut short.
3) Increased arousal or anxiety: Symptoms include signs of increased arousal, such as sleep impairment, irritability /anger, difficulty concentrating, hypervigilance, and a sensitive startle response.
Despite reassurances that my baby was perfectly healthy, my spirit was shattered. For days, I could not stop crying hysterically. For weeks, I could not stop horrible images from racing through my mind. I avoided driving past the hospital where I delivered and watching television shows about childbirth.
I swore I’d never have another baby. I lost faith in the doctors whom I had trusted for a decade. Family and friends told me in vain to focus on my beautiful, healthy baby, and to forget the delivery and horrific postpartum complications that landed me in the ER a week later. It was easy for them to say and they did so with the best of intentions. But, they did not understand the depth of my despair.
I knew that I needed help and I got it within weeks of my son’s birth. I visited a therapist who specializes in postpartum stress and began talk therapy and an antidepressant, which provided almost instant relief from my worst symptoms. After a few therapy sessions, I thought I was healed. But, the trauma continued to haunt me.
I replayed the delivery and complications over in my mind day after day, week after week. Although it took a full six months for me to recover physically, emotionally, my scars lasted much longer. Reminders were everywhere: pregnant women at the supermarket, sounds of suffering on television, even newborn babies. Nightmares shook me to my core for more than one year.
I was overcome with anger, sadness, and terror. As my son neared nine months old, I returned to therapy and revealed new details about the intrusive thoughts and nightmares I had been having all along. My therapist believed I was suffering from postpartum PTSD and suggested I see a trauma specialist.
“The primary reason that PTSD is frequently misdiagnosed or undiagnosed is that women are reluctant to disclose the details of their experience or scary thoughts and healthcare providers are equally disinclined to probe for details of this nature,” explains Kleiman. “Sadly, this impasse can lead to prolonged suffering.”
What Kind of Treatment Is Available?
After nine months of suffering from postpartum PTSD, I began a groundbreaking therapy called “EMDR,” (Eye Movement Desensitization and Reprocessing). “EMDR is a treatment which allows traumatic memories that are locked in the brain to be unlocked and reprocessed,” explains Sue Milbourne, MS, LMFT, an EMDR-Certified therapist and senior staff therapist at Council for Relationships. “A person undergoing EMDR will focus on the worst parts of the memories to allow them to unblock, and that may include experiencing them again briefly in order to reprocess them in a positive way,” says Milbourne.
EMDR helped me reprocess my traumatic memories and feel more empowered. Although my memories are still present, they no longer have the devastating impact on me as they once did. This comes as no surprise to Milbourne, who has had much success bringing resolution and relief to clients battling postpartum PTSD since she began EMDR work in 1996.
How Can You Lower Your Risk of Developing Postpartum PTSD?
First, ditch the idea of a “birth plan,” Milbourne suggests. “Birth plans are a bit dangerous because they set women up for disappointment. Often times the ‘plan’ is not a possible choice.” Milbourne recommends that women discuss their “birth hopes” instead, and remember that a birth experience “is not a failure if it does not go as planned or hoped.”
Additionally, “be free to ask your doctor questions” so that you can make informed decisions, Milbourne adds. “Stay in the moment and breathe and, no matter what is happening in the delivery room, say to yourself, ‘This is happening as it should,’” so that you can process even a complicated birth as a positive memory.”
Finally, “whether your birth experience is like a merry-go-round or a rollercoaster ride, keep your eye on the prize,” Milbourne says.
My prize is a healthy baby boy who reminds me of the beauty in life every day. I am hopeful that he will become a big brother in the near future and, whether I’m on a “merry-go-round” or “rollercoaster,” I will be better prepared for the ride.