Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Postpartum Depression and Maternal Birth Trauma

Why women shouldn't fear home birth
by Mayim Bialik, Ph.D.
This short essay is humorous, honest, insightful and inspiring.

See also:

Subsections on this page:



Online Video Support Groups

Regroup - offer online video support groups for moms with postpartum depression and anxiety.   You are not alone and support is now even closer and easier to access.

We offer online support groups for new moms who are having difficulties with the adjustment to motherhood. Together you can share the realities of motherhood and its difficulties without judgment or shame. You will get support and learn new tools to help you cope.

Normally groups will cost $39.99. During our launch period, we are offering free sessions. We'll ask for 1 minute of feedback after the session.


ONGOING RESEARCH

The impact of traumatic birth experiences on breastfeeding.

Humiliation - If you had a birth experience that involved humiliation, please contact research Belinda Diamond about her research project, "Humiliation in the Medical Setting and Its Relationship to PTSD".  The e-mail domain is yahoo.com, and her username is diamondbelinda.  Please make sure to put the words "birth trauma" in the subject line.


Share Your Personal Story To Help ICAN

Folks involved with ICAN at the national level are seeking a grant in order to develop a program designed to train psychotherapists who see women in the postpartum period about the effects of traumatic birth on perinatal mental health.  Unfortunately, not all therapists are supportive of the idea of treating birth trauma as a "legitimate" problem.  The request is for personal stories about trying to find professional support in your local area from someone who understands AND can treat trauma following childbirth.  Sadly, they are also collecting stories from folks whose trauma was worsened by finding a therapist who didn't know what s/he was doing in that area and said/did the wrong thing entirely.  E-mail: sstorton@comcast.net


How to Nurture a Mother



Postpartum depression may be caused by  a variety of factors, but nurturing the mother can only help!  It's very important to realize that this does not always mean "taking care of the baby so the mom can rest".  The mom's strongest instincts are going to be nurtured if she is supported in caring for her own child.  Obviously, if the mother is unable to connect with the baby during some periods of time, someone else may need to be caring for the baby.  But taking over the baby's care can worsen a mother's feeling of inadequacy.


A fabulous book - MOTHER NURTURE - A Mother's Guide to Health in Body, Mind, and Intimate Relationships

Mother Nurture offers




Preventing Postpartum Depression



One of my very wise clients said that when she started to feel any kind of postpartum blues, she would then refocus on her children and bring the family circle closer together.  This seems like a very good first remedy.


This study concludes that omega-3 fatty acids are less helpful than supportive psychotherapy, but if you aren't able to get supportive psychotherapy, the omega-3 fatty acids may still be a good idea.  And we know they're good for baby's brain development.

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study.
Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJ.
J Affect Disord. 2008 Sep;110(1-2):142-8. Epub 2008 Feb 21.

CONCLUSIONS: There was no significant difference between omega-3 fatty acids and placebo in this study in which all participants received supportive psychotherapy. The manualized supportive psychotherapy warrants further study. The low intake of dietary omega-3 fatty acids among participants is of concern, in consideration of the widely established health advantages in utero and in infants.


A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health
Kathleen Kendall-Tackett
International Breastfeeding Journal 2007, 2:6     doi:10.1186/1746-4358-2-6

Breastfeeding fights depression
08 May 2007
International Breastfeeding Journal 2007; 2: 6

MedWire News: Breastfeeding can help new mothers fight depression, research shows.

Kathleen Kendal-Tackett (University of New Hampshire) says that depression is common among new mothers, and affects anywhere from 10 percent to 20 percent of postpartum women.

"Since depression has devastating effects on mother and baby, it's vital that it be identified and treated promptly," she adds.

Kendal-Tackett says that new mothers experience an increase in inflammation due to high levels of pro-inflammatory cytokines.

Common experiences associated with new motherhood such as disturbed sleep and postpartum pain can also act as stresses that cause pro-inflammatory levels to rise, she says.

Breastfeeding can reduce women's stress levels so that their inflammatory response systems remain inactive. This then reduces their risk of depression.

But Kendal-Tackett notes this is only true when breastfeeding is "going well."

"When breastfeeding is not going well, particularly if there is pain, it becomes a trigger to depression rather than something that lessens the risk."

She concludes: "Mother's mental health is yet another reason to intervene quickly when breastfeeding difficulties arise."


Dietary folate and vitamins B(12), B(6), and B(2) intake and the risk of postpartum depression in Japan: The Osaka Maternal and Child Health Study.
Miyake Y, Sasaki S, Tanaka K, Yokoyama T, Ohya Y, Fukushima W, Saito K, Ohfuji S, Kiyohara C, Hirota Y; The Osaka Maternal and Child Health Study Group.
J Affect Disord. 2006 Jun 29

CONCLUSIONS: Our results suggest that moderate consumption of riboflavin may be protective against postpartum depression.


Postpartum treatment key for depression: study - Jul 6/05 -- The key to preventing postpartum depression may be individual support provided after birth by a health professional and tailored to a mother's needs, says a University of Toronto researcher.

"The evidence suggests postpartum depression may be preventable, says Dennis. In analyzing the prevention strategies used, Dennis found an overall 19 per cent reduction in postpartum depression. Individual assessment and intensive support provided by a health professional to at-risk women after they give birth was the most successful approach to preventing postpartum depression; group-based strategies weren't as effective. Risk factors for postpartum depression include past psychiatric history, a significant number of life stressors and lack of support."

Contact:  Cindy-Lee Dennis, Faculty of Nursing, (416) 946-8608; e-mail: cindylee.dennis@utoronto.ca

Psychosocial and psychological interventions for prevention of postnatal depression: systematic review.
Dennis CL.
BMJ. 2005 Jul 2;331(7507):15.

CONCLUSIONS: Diverse psychosocial or psychological interventions do not significantly reduce the number of women who develop postnatal depression. The most promising intervention is the provision of intensive, professionally based postpartum support.


Evaluation of the Edinburgh Post Natal Depression Scale using Rasch analysis.
Pallant JF, Miller RL, Tennant A.
BMC Psychiatry. 2006 Jun 12;6:28.


Psychological interventions fail to prevent postnatal depression - " . . . intensive postpartum support provided by a healthcare professional showed a clear preventive effect."


Baby Blues Mood Remedy from Cascade



Resources



Depression After Delivery (Postpartum Depression) - this has an easy-to use detailed chart to help you evaluate your own postpartum depression.



Local Resources and Support Groups from Jenny's Light


Postpartum Support International is dedicated to helping women suffering from perinatal mood and anxiety disorders, including postpartum depression, the most common complication of childbirth.  California Resource Page for PSI may help to find Medi-Cal providers.


The Monroe Institute has three relaxation/guided imagery CDs to address trauma:
The Surgical Support Series
Hemi-Sync® Relaxation
The Network of Light Series


The Mechanisms of Postpartum Depression [Medscape, 3/1/12]

The Complexity of Postpartum Mental Health and Illness: A Critical Realist Study
Sword W, Clark AM, Hegadoren K, Brooks S, Kingston D
Nurs Inq. 2012;19:51-62

The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal-oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts.

Beck Depression Inventory - a sytem of assessing level of depression that is considered much more accurate than the Edinburgh PDS.


Edinburgh Postnatal Depression Scale (EPDS)


Beyond the Blues by Pec Indman EdD, MFT is a concise and up-to-date book for women needing help with prenatal (pregnancy) and postpartum depression and anxiety.


Handouts and Short Articles on Depression in New Mothers


Resourcess For Prenatal and Postpartum Mood and Anxiety Disorders from Pec Indman EdD, MFT
Help, information, and support for prenatal and postpartum illness

What Is Postpartum Depression? by Pec Indman EdD, MFT

Pregnancy and Postpartum Myths by Pec Indman EdD, MFT

Support or Postpartum Dad by Pec Indman EdD, MFT

Perinatal Medical Updates by Pec Indman EdD, MFT - With the right treatment, you will be well again.

Omega 3 Fatty Acid for treatment of prenatal and postpartum depression

Articles by Pec - helping you cope in pregnancy and postpartum


Knowledge Path: Postpartum Depression has been compiled by the Maternal and Child Health (MCH) Library at Georgetown University.


MedEdPPD - Comprehensive resources about postpartum depression.
http:


Postpartum Stress Center - The Center was established to provide a better understanding and comprehensive clinical intervention for any woman who suffers from the range of postpartum psychiatric disorders.


postpartumprogress.typepad.com/ - An award winning blog by a surviovor and board member of postpartum support intl.


Katherine Wisner discusses some of the medical issues surrounding the correct treatment for postpartum depression. (video)


Solace For Mothers, An Online Community For Healing Birth Trauma is for women who have experienced trauma around the process of giving birth. For these women, giving birth has left them feeling deeply disappointed, traumatized, or even violated.  We want these women to know that they are not alone, that birth trauma is very real, and that other women have had similar experiences and feelings.  We have created an online community as a place for women to begin or continue their healing journey.


Postpartum Distress Support from Postpartum Education for Parents in Santa Barbara.



Tess Landey - ovenbuncoaching.com - in Berkeley but all sessions can be conducted in person, on the phone, or via Skype.

PRENATAL ? POSTPARTUM 'BLUES', DEPRESSION, STRESS ? ANXIETY from radiantmother.com


PSI: Postpartum Support International  (They used to be Depression after Delivery)


The Postpartum Depression Center of San Antonio


Tips for Addressing the Baby Blues by Lois V. Nightingale, Ph.D.


Notes from a Talk on Postpartum Depression


Sacred Window Ayurveda for Mothers and Children, where You May Discover  How to Avoid Depression and Colic And How to Enjoy Profound Rejuvenation!


This study by Pauline Dillard, M.S., focused on Post Traumatic Stress Disorder (PTSD) differences between women who have had cesarean sections versus those who have had natural childbirth.


"Letters to Our Sisters."

From Sharon Storton - a marriage and family therapist in Campbell, CA, specializing in perinatal mood disorders (ppmd), adjustment and trauma.: " (In the past, I was also an IBCLC, CBE and doula).   I have recently begun a project entitled, "Letters to Our Sisters."  I am collecting first person accounts in the form of letters/emails from women who have recovered from perinatal depression, anxiety (actually, in my mind, a bigger problem than depression!), birth trauma, a baby in the NICU, etc. and who want to throw a life line of support to mothers initiating the same battle.  I will keep the letters anonymous and will strike all potentially identifying dates, names, and details unless the author specifically asks me NOT to.  I would like this eventual collection to be available to anyone who asks for it, perhaps on a website.

Women are encouraged to e-mail a letter of hope and recovery to add to this collection.  Thank you!


Postpartum Depression - Overview article [12/4/07] [Medscape registration is free]


PSI: Postpartum Support International


The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982.


What Does Safe Motherhood Mean? - Safe Motherhood means that no woman should die or be harmed by pregnancy or birth.


Emotional Recovery After Birth - a homeopathic approach


Pregnancy blues worsen with age [10/12/04] - Older mothers are more anxious during their pregnancy and less likely to have the social support younger mothers enjoy, a study has found. But they are also less starry-eyed about parenthood, and will perhaps make better mothers for it.


Postnatal Depression or Childbirth Trauma? - For some women, childbirth has all the characteristics we associate with trauma. Professionals should abandon the easy assumption that childbirth is not traumatic just because it is within the normal range of experience, and adjust their treatment accordingly.



Postpartum Symptoms of PTSD Are Higher Than Expected By Jamie Habib | September 24, 2012

"More than 25% of women may exhibit symptoms of post-traumatic stress disorder (PTSD) after childbirth, a new study reports."

"The study results indicated that 3.4% of women (n=3) had full PTSD 1 month after giving birth, 7.9% (n=7) had nearly complete PTSD, and 25.9% (n=23) had significant partial disorder."

None of the women who had postpartum PTSD symptoms reported a previous traumatic event, but more women with PTSD symptoms had previous psychiatric treatment compared with those without PTSD symptoms (60% vs 29.8%, respectively). Of note is that 80% of the women who experienced PTSD symptoms had an analgesic-free birth. Other factors associated with the development with PTSD were a poor body image, a previous difficult birth experience, complications during their pregnancy, a high level of fear of giving birth, a feeling that their or their babies lives or health were endangered during delivery, and a lack of confidence in their ability to handle labor.

Overall, 25.9% of women in this study experienced some PTSD symptoms after giving birth. The authors noted that being a first-time mother did not predispose women to postpartum PTSD. A significant protective factor against PTSD was perceived social support.

Although it is impossible to accurately predict which patients will experience symptoms of postpartum PTSD, the authors suggest that obstetricians can help mitigate these symptoms in patients who may be predisposed to this disorder by discussing options for analgesia during delivery early in the pregnancy. According to the authors, this is the first study to link postpartum PTSD with a discomfort with nakedness during delivery.

- Sufficient social support was a protective factor against postpartum PTSD.

Editor: I'm a little amazed by these findings for a number of reasons. 


Action On Puerperal Psychosis (APP) from the University of Birmingham


The Effect of Birth Experience on Postpartum Depression by Michelle A. Bland

The Effect of Birth Experience on Postpartum Depression: A Follow-Up Study by Michelle A. Bland


Postpartum Depression Handout


Puerperal Psychosis/Postnatal Depression


Tahlor Dawn's Homepage


The Postpartum Stress Center in Rosemont, Pennsylvania - Clinical Director is Karen Kleiman, MSW, author of "This Isn't What I Expected: Overcoming Postpartum Depression"


This brief article on Deep Tissue Vaginal Massage has some really good information for women experiencing physical or emotional pain in their genitals after birth.


The Mystery of Postpartum Depression - By Pamela Gerhardt, Washington Post, Tuesday, March 14, 2000


Great set of links about birth-related psychology and emotions




Thyroid Problems Causing Postpartum Depressions



1.       As a Functional Medicine oriented Chiropractor, I am seeing more frequent women with pre and post pregnancy sex hormone, adrenal and thyroid hormone imbalances.  This would in and of itself predispose to increase PTSD.  I do not however attribute correlation with higher PTSD to un-medicated childbirth,  but to imbalances in measurable levels of 2-hydroxyestrones and 16-alpha-hydroxyestrones, which predisposes and is associated with depression.  This is becoming more common, according to research because of exposure to hormonal disruptors in the environment such as pesticides, BPA in plastic exposure, exposure to GMO foods, and even "hidden environmental" exposures like outgassing  from new carpets and materials in new buildings.

2.       I'm seeing more frequent and previously undetected Hashimoto's thyroid disorders, partially I suspect from the above environmental and personal exposures, as well as the fact that often by the time the woman sees me, they have been frustrated because they have seen their primary care physician or OB-Gyn who does not have a Functional Medicine approach, and they have had "all the tests, but they came back normal", but the doctor didn't test a total thyroid panel including TSH, totT4, totT3, freeT3, reverseT3, TPO and Thyroglobulin Antibodies.  Therefore they are literally being "Miss Diagnosed".they are missing the real diagnosis!  They are erroneously being told nothing's wrong, but they know something is, and then they are put on antidepressants because the doctor attributes it to being "all in their head" or to depression!

3.       The fact that adrenal dysregulation problems are associated with depression and at the underlying cause of many PTSD issues.  But again many are being "Miss Diagnosed".  Adrenal gland dysregulation is not even acknowledged unless the standard methods of blood testing show up abnormal, but checking adrenal function via standard blood tests misses all but the most severe disorders of adrenal hormone dysregulation.  And "Adrenal Exhaustion" is still thought of as not a real condition by most conventional medical doctors (unless they have been trained in the Functional Medicine approach).  Adrenal dysregulation is becoming more prevalent for various reasons, including the hormonal disruptors noted previously.  This will manifest often as depression.  I talked about thoughts #2 and #3 in my free e-book available at http:
4.       If the above factors are not identified before pregnancy, they will often be aggravated by the toll on a woman's body during pregnancy, and manifest post-pregnancy, especially in the first few months post-partum!


Douglas Husbands, DC, CCN
Holistic Health Bay Area (in Rivera Chiropractic Group)



Birth Rape



Traumatic birth as Legal Rape by sheila stubbs



Birth Rape Is Real by Christie Haskell [11/10/10]

Not a happy birthday - Threatened, intimidated, bullied, violated: this is hospital birth as many mothers experience it. Amity Reed reports on the little-recognised crime of birth rape.



Birth Trauma and PTSD from Birth



See also: Post-Traumatic Stress Disorder


Yahoo! group ptsdafterchildbirth for women who have gone through traumatic births.


Yahoo! group BirthTraumaSupportGroup - A safe place for women who have had trauma during childbirth.


Parasites of the Mind - A healing blog for PTSD awareness, education, treatment and self-empowered healing.


Solace For Mothers, An Online Community For Healing Birth Trauma is for women who have experienced trauma around the process of giving birth. For these women, giving birth has left them feeling deeply disappointed, traumatized, or even violated.  We want these women to know that they are not alone, that birth trauma is very real, and that other women have had similar experiences and feelings.  We have created an online community as a place for women to begin or continue their healing journey.


The Pink Kit folks offer an informational CD for women who experienced trauma from giving birth (TABS):


Trauma and Birth Stress - PTSD After Childbirth


PTSD After Childbirth Blog by Jodi Kluchar, who is a major activist in awareness of PTSD after childbirth.  She has published a number of related articles.


The Birth Trauma Association supports all women who have had a traumatic birth experience.


Bad times make for more accurate memories

"Pleasurable experiences are more fun to relive than negative ones, but a new study by psychologists at Harvard University reveals that memories of good times can be less accurate than those of bad times.  Not only that, a person with a positive memory is more likely to be more confident of her or his distorted memory than someone who has a negative memory of the same event. "

Research by Elizabeth Kensinger at Harvard.



Birth Trauma and Breastfeeding Difficulties



See also: Effects of Birth Practices on Breastfeeding


Do you think there is a correlation between problems with being able breastfeed and traumatic birth/PTSD? For me, breastfeeding would trigger a replay of the birth experience. I dreaded and avoided breastfeeding, or at least as much as the mother and newborn can avoid a hungry infant. I was not able to establish a good supply, and I've even wondered if this is hormonal, specific to PTSD, somehow.


Oxytocin is the hormone that is common to all of our reproductive functions: sexual arousal/intercourse; labor and birth; breastfeeding. A trauma in any one of these areas could result in an aversion to increasing levels of this hormone which accompany any of these functions. This could lead to an anxiety that increases adrenaline, which inhibits lactation, so . . .  yes, PTSD could cause breastfeeding problems.

This is similar to one of the mechanisms proposed for the relationship between inductions and autism:



Post-Pregnancy Hysterectomy



Post-Pregnancy Hysterectomy



Postpartum Integration of Birth Experience / Resolving Birth Issues



See also:  Resources for Overcoming Past Abuse in Future Birth Experiences

Jamie Stouffer offers Birth Renewal workshops - Birth Renewal is a seminar aimed at beginning or supporting a healing process for women who have had traumatic births.  It is not specific to Cesarean birth, but can certainly be helpful to women who have had them.

Childbirth and Narratives: How Do Mothers Deal with Their Child's Birth? by Paola Di Blasio and Chiara Ionio
JOPPPAH 17(2), Winter, 2002, p. 143

"ABSTRACT: This research focuses on post traumatic stress disorders which arise after childbirth and adds to the literature on psychological post partum diseases.  The hypothesis of this study was that psychological expression of negative emotions could reduce the occurrence of stress symptoms after labour and delivery.  A group of 64 women with a healthy pregnancy was examined.  Half of them were asked to express their emotion experienced during labour and delivery through a written account.  The results indicated a significant difference in the number of post traumatic stress symptoms between the two groups, underlining the positive effect of the emotional disclosure."


How to Overcome a Disappointing Birth Experience By Kristi Patrice Carter


Integrating A Difficult Birth from Karen Melton's site


What if Your Homebirth Doesn't Happen at Home?


Grief within the Miracle Society for Women - This society has been created to give support and compassion to women who feel they have experienced trauma and abuse at the hands of professionals during the birth of their child or children. . . . If you feel any regret, pain, feelings of humiliation, visions of moments in birth that you cringe to remember but can't seem to forget...then you are in the right place.


I have just received a copy of a book titled, "Reclaiming the Spirituality of Birth: Healing for Mothers and Babies" by Benig Mauger. It was released in USA in March/00, but was previously released in the UK in 1998 with the title "Songs of the Womb; Healing the wounded mother". I have only read the intro and 1st chapter so far, but it is quite good.


"Recovery from Childbirth: An Emotional Healing" by Lynn Madsen - I give it to all my 2nd time or more moms if they even hint that they were less than totally happy with their prior birth experiences.  [Ed: I'm not sure whether there was ever a book by this title, but there is a book by Lynn Madsen called Rebounding from Childbirth: Toward Emotional Recovery.]


"Rebounding from Childbirth: Toward Emotional Recovery" by Lynn Madsen is a good book for those wishing to resolve issues related to their birth experiences. Topics include:

The book is 1994: Bergin ? Garvey 

Nancy Wainer is occasionally offering workshops on "Grieving and Healing After a Disappointing, Upsetting, or Traumatic Birth Experience"
Contact (781) 449-2490  for more information.


 Psychotherapy Services for the Childbearing Year - Linda Cozzolino, M.Ed., CPM -  Specializing in counseling for:
          Survivors of childhood abuse, now preparing for birth and parenting.
          Women or couples with traumatic previous birth experiences.
          Women or couples with high levels of fear of childbirth and/or parenting.


BirthWorks Reading List - books to help women overcome the negative effects a difficult past can have on pregnancy and birth


See this recounting of Six Birth Stories for a true testimonial of overcoming birth trauma.


The VBAC Companion by Diana Korte has  a section on dealing with previous traumatic births.


Cesarean Art - for all the scarred mothers


Pregnant Feelings by Rahima Baldwin (and a friend?)
Transformation Through Birth by Claudia Panuthos


Birth Counselors

What is a Birth Counsellor?

A Birth Counsellor is a counsellor who is well-versed in the area of birth. The Birth Counsellor helps women and their families in three ways:

  1. We help the expectant family make informed choices about their preganacy, labour, and birth, as well as act as a resource for information on breastfeeding and parenting;
  2. We help women overcome any fears or concerns they may have related to pregnancy and birth;
  3. We help women and their families cope with emotional pain or grief from previous births.
As birth specialists, we have the responsibility to ensure that our clients get the best care possible. Please contact us for more information on certification as a Birth Counsellor or for a  program calendar with a complete list of communication and  counselling courses.

For more information, please email birthcounsellingskills@bc.sympatico.ca, or call: 1-800-755-3377


I've been wondering about resolving my own birth experiences. Is there anyone out there who has actually done it and could explain the process they took to do that? I know I need to do it, but I'm not quite sure where to start. Any suggestions?

Keeping journal of your thoughts is one thing. Writing letters (to mail or not) to everyone including yourself in which you share your feelings about the birth.

A few books I like:

Attend a grieving and healing workshop by someone like Nancy Wainer Cohen, Polly Perez and other childbirth people. I know both of the above also do telephone counseling. I can give you information if you want to contact either for more information.

Attend a Birth Works class if you are planning another pregnancy or if you are pregnant.

If your emotions about your birth seem to be overwhelming- consuming you nearly every moment of the day, something that can be helpful is to begin to confine those feelings and thoughts to certain parts of the day. For example, say to yourself, you can worrying and think about this all day, EXCEPT from 9am- 11am. That's when I am going to think about different stuff, do other things. If the thoughts start creeping in, you say, "No, I'm not going to think about that now, that's for later". Then, as time goes on, you expand your "clear" times, and shrink your grief time. This is at a pace that is right for you. It may feel good to feel that you have some control over your emotions. Eventually you can put them in a small box and deal with them as you need to.


When a bad birth haunts you by Sheila Kitzinger

Notes from Sheila Kitzinger Talk - "Crisis in the Perinatal Period".


I can't seem to help HATING myself for being "Stupid enough, at my age", to prevent/stop this from happening to me.


Has anyone else tried to channel these feeling into something else?  Something that may alleviate feelings like this?  I have been so angry for many years concerning my births that I want to stand at the hospital entrance and tell birthing Mom's that there is a better way; Inside lies danger!  Instead, I am a student midwife and educate everyone I can on hospital and medical interventions.  I think if I could just save one woman and child from a horrid birth it would atone for mine.  I always wished someone had told me how it really was BEFORE I gave birth.  Now I make sure I tell who ever will listen.  Don't get me wrong, I don't stand at the mall next to the Salvation Army guy with his ringing bell, stopping shoppers to tell them of the horrors of medicalized childbirth, but those who seem interested in my studies and those who are eager to talk of their own pregnancies open up a perfect window of opportunity!


Getting Answers About What Happened

You can get copies of all your records - you may need to make separate requests of your care provider and the facility where you received care.  You can also ask questions at some of the online women's forums that have doctors and midwives answering questions:

Post questions or answers to the "Dear Midwife' forum at Pacific Northwest Midwives - send e-mail to: hdw4@msn.com

For a response from professionals that is particularly sensitive to the emotional issues around childbirth, check out the "Ask the Pros" section of Association for Pre- ? Perinatal Psychology ? Health (APPPAH).

Midwifery Today Forums

"Dear Midwife" Forum

You can ask questions from The Midwife Pro (Midge Jolly, LM, CPM) (formerly at Moms Online - oxygen.com)

The obgyn.net Women's Health Forum

There are also some midwives and doctors reading misc.kids.pregnancy who occasionally respond about specific cases.

There are other references at Web Florida - Women and Their Health  and T-net inc.

On-Line Medical Advice - this is an extensive meta list!

There are also some women's forums where you might be able to get information from other parents:

Labor of Love Message Boards



Midwife Assistance with Postpartum Integration of Birth Experience



debriefing after childbirth: a randomised controlled trial.
Priest SR, Henderson J, Evans SF, Hagan R.
Med J Aust. 2003 Jun 2;178(11):542-5

controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth.
Small R, Lumley J, Donohue L, Potter A, Waldenstrom U.
BMJ. 2000 Oct 28;321(7268):1043-7.

We have it worked into our 2-3 week visit to ask similar questions: "Do you have any questions about what happened at your birth? How did you feel about your birth experience in general? What could we have done to improved our services?..." This is a good time to get initial impressions and clear up any technical misunderstandings about what really happened during a birth, but I think a mom's overall feelings about a birth take much, much longer to process. If the birth has been traumatic the mother is probably working out her feelings about it long after our last official contact with her.


Rather than ask the mother specific questions about the birth, I learned to do a birth review where I just guide the mother to tell me the whole story of the birth, as if I hadn't been there. It's amazing some of the feelings that come up when she has control of the story and where it goes.


Some moms end up dealing with a lot more than they expected.  Especially for a hospital transport, the drama doesn't help, even when the transport was warranted.  Even unmedicated vaginal births can be a lot to process afterwards. Sometimes "tincture of time" is the best remedy.  AND listening to her, so that she gets to tell her story (over and over is great) in order to make meaning out of it.

Sometimes EMDR is helpful; I don't need to see someone more than a half-dozen or so times for that, if that is their preference.  Sometimes, "counseling" sounds like it will be traumatic in itself.  It really involves what you are already doing - listening with respect.  I usually see the process as offering a doula to the feelings or thoughts.  [Ed: The August, 2007, issue of the Birth Trauma Association newsletter has a great piece about EMDR on page 2.]

 can also teach "mindfulness based stress management" techniques.  This can be helpful in sitting WITH the disappointment, regret, sadness, guilt, or whatever until that can be processed.  Sometimes the feelings tie in with other life events that moms don't even realize are re-surfacing until they feel "into" the feelings and see what's there.  Once again, it's really similar to birthing - riding the feeling as you would a contraction.  (Since we are still paying off my student loan - I'm reluctant to say that my birth work has been at least as valuable as my masters - reluctant to say it to my husband anyway...)  You are probably already doing that for her.  Letting her FEEL what she is feeling, and not pushing it away is often the best remedy.  Often then it will dissipate on its own with time.  And your being patient while she does that is the gift.

Comments by Sharon Storton, MA, MFTI, IBCLC



Finding a Therapist or Counselor



Here are some resources in the Silicon Valley area.


STAR is a profoundly transformative 10-day personal growth retreat, a carefully structured program of accelerated self-healing and transformation.

Resource Directory Of Practitioners and Programs in  Pre- ? Perinatal Psychology ? Health - Year 2001


I have heard that Phyllis Klaus offers phone counseling sessions for birth trauma.  (She's one of the founders of Doulas of North America).  510-559-8000, phyllisklaus@aol.com


I was helped by EMDR - Eye Movement Desensitization and Reprocessing.  Basically, by moving your eyes back and forth you can stimulate your brain to integrate right brain and left brain activity, which helps process memories.  You can doEMDR while confronting highly emotional memories and it helps to release some of the emotion.  Also, some counselors do EFT or Emotional Freedom Technique which has a similar philosophy to accupuncture, except that you just apply pressure with your finger tips.  The idea is that we are electrical as well as chemical and strong emotions cause electrical disturbances in the body.  Applying EFT while saying affirmations or working through the trauma can release a great deal of emotion. I think massage, prayer, yoga, meditation are all wonderful -- anything that helps the nervous system relax.  I think the major challenge for recovery is that it is so hard for mothers to find the time/money to take care of themselves!!!!!


Shekinah Birthing offers EMOTIONAL FREEDOM TECHNIQUES: EFT TELECLASSES FOR BIRTH TRAUMA


It can be difficult to find a mental health professional who understands the issues of birth trauma.  It is essential to avoid working with someone who will deny that you were harmed by a negative birth experience.

Here are some resources that might be helpful:

Center for Creative Growth

Finding a Therapist Outside the San Francisco Bay Area



Complaining About Your Care



DrScore is a web site that collects and displays ratings of doctors.  You can contribute your ratings or read others' ratings.


RateMDs.com is changing the way the world looks at medicine by providing patients with the unique opportunity to rate and read about their doctors.


Unhappy With Your Maternity Care? File a Complaint! from Citizens for Midwifery


Privacy concerns may prevent a professional midwife or doula from filing a complaint about the quality of care at a birth, or even a hostile or punitive attitude towards a homebirth transport.  One option is for the birth professional to write a letter of complaint and then have her client sign it.


In a situation where the parents are concerned about the care they were or are being provided I suggest speaking with the Charge Nurse, hospital Ombudsman, hospital chaplain, Head of the department, (oB or Peds) and also out in the wider world. The nursing Board and the California Medical board also have mechanisms of action to complain about care given.


How Complaints Are Handled from the Medical Board of California


Childbirth - The Rights of Childbearing Women from the Boston Women's Health Book Collective, Inc., reposted with permission from Childbirth Connection


It is so important to provide feedback to your care providers - how else will they ever learn what helped and what hindered your birth experience?

I know it can be incredibly hard to look back on a difficult birth experience.  Who really wants to give another second's worth of energy to thinking about the physical trauma, the emotional trauma, the betrayal by seemingly benevolent care providers?  Some women feel violated on every level - physical, mental, emotional and spiritual.  Writing letters of complaint may even feel like a perpetuation of the trauma, much as victims of stranger assault can feel victimized by having to testify against their assailant.

So . . . why bother?

The answer is simple.  You're doing it for your sisters, your cousins, your daughters, your nieces, and your eventual grand-daughters.  If we don't start working now to change the system, your loved ones are likely to have the same horrible experience when they're ready to give birth.

At the very least, simply write a letter expressing your disappointment that your experience was so different from what you were led to expect.

And don't forget to write thank-you letters to the care providers who treated you well!  I especially like to address the letters to an entire practice or to the entire nursing staff, giving honorable mention to those who deserve it.  When it's addressed to  multiple people, it's often posted in an employee lounge or somewhere where everyone will see it and wish they'd been nice enough to be mentioned.  If you address it just to the nice people, they might be reluctant to show it about or post it publicly.


Criminal Assault

In a situation where somebody touched you after you specifically refused consent, I would at least send a letter to your local DA and copy it to the doctor, hospital and medical board.

If somebody had walked up to you on the street and done this, you can bet they'd be interested in pressing charges; being a doctor doesn't give somebody permission to assault you any more than a stranger on the street.


In addition to writing a letter of "concern" to the relevant provider, it is essential that you send copies to public boards and medical societies.  This is important because it's the only way to make sure the individual practitioner will ever have to worry about any consequences.  And, perhaps more importantly, it will help put the fear of god/dess into every other OB who realizes that women really, really don't like having their bodies and their lives messed with against their will.

Please, do use your energy to write letters and to help educate other women in the e-mail lists, Web forums and Usenet newsgroups instead of taking it out on yourself or your loved ones!


How to File a Complaint in California


How to Respond to Bad Hospital Treatment


Writing Letters to Caregivers About Your Birth Experience


Letters of Complaint about Hospitals

The accreditation for hospitals in America is done by the Joint Commission on Accreditation of Healthcare Organizations   located at One Renaissance Blvd,  Oakbrook Terrace, IL 60181  tele 630-792-5000.

These people DO investigate pt complaints. Complaints are taken from any one who wishes to file one, and can be made without giving your name. It is best to give the pt name and date of stay as well as what happened that you think was wrong.

Not all complaints result in a 'punishment'. However, the hospital is put through a 'ringer' every time the JC comes in and the hospital will often 'fix' the problem before the JC comes in and destroy the evidence. This makes it harder top punish, but makes it easier for the next pt.

Not all hospitals are accredited, and a simple call to the hospital administration receptionist will let you know if they are or not.


ACNM - American College of Nurse-Midwives

818 Connecticut Avenue NW, Suite 900
Washington, DC 20006
(Main) 202-728-9860 | (Fax) 202-728-9897
info@acnm.org
www.acnm.org 

MANA - Midwives' Alliance of North American

Post Office Box 175
Newton, KS 67114
316-283-4543
MANAinfor@aol.com 

ACOG - The American College of Obstetricians and Gynecologists

PO Box 96920
Washington, D.C. 20090-6920
E-mail to: Mark Graves (mgraves@acog.com)
www.acog.com 

Make sure you have the woman's permission before using her name in a complaint.


There is a great book by Christopher Norwood "How To Avoid A Cesarean Section" wherein the author suggests what she believes an effective alternative to suing is sending "detailed, written complaints to administration of the hospital, its chairman of obstetrics, the local and state health departments, and to the professional society regulating obstetricians in your area." She suggests that in the end the doctor will feel more pressure to rethink his cesarean decisions than if he/she was sued.

This is a gentle, forthright book about vaginal birthing that is not outdated even though written in 1987.


Mom Writes Letter to OBs Who Did Unnecessary Cesareans



Treatment



One of my favorite mild preventives or treatments for PPD is the herb, Blessed Thistle.  I like the non-alcoholic version from Tri-Light herbs; it's slightly sweet and can be used as a sweetener in tea if moms find it too sweet to take directly.  It has the bonus of being a galactagogue, stimulating milk production.  It's worked wonders for second-time moms who had PPD and difficulty breastfeeding a first baby.  Motherwort may also work wonders for helping to induce a more mellow mood.


Renee Smith's music is a wonderful combination of more traditional lullaby styles with more nurturing lyrics.  My personal favorite is her Angels ? Mermaids CD, with her Lullabies For My Little Angels a very close second.  Her Seeds ? Songs To Make 'em Grow is a wonderful collection for "older children", i.e. toddlers and pre-schoolers, not to mention their parents!  I don't know what it is about this music, but it always makes me so happy!  Cheaper than therapy and lots more fun; I call it my "audio prozac".


Ellen Roos - Passion Flower Music - Songs that see and stir, love and forgive, lift, bless and free! Her first album is Lavender and Morning Sun.


Natural Progesterone for Post-partum Depression and PMS Psychosis - general dose is 20-60 mg/daily (applied anywhere on the body) for 2 weeks each month.


Counseling As Effective As Prozac for Postpartum Depression



A Woman Tells Her Story of PPD



Unnecessary Cesarean with General Anesthesia resulting in severe postpartum depression


Jenny's Tale - Saga of a Birth Gone Wrong
or Yes, It Can Happen To You


Jenny Strikes Back - A Set of Letters and a Meeting about the Unnecessary Cesarean


I went to hear Anne Dunwald (?) speak a few years ago. She's got a book out now available through Cascade's book catalog I believe. She's a psychologist who specializes in women's concerns and does lots of counseling for post partum depression. From what I remember post partum psychosis involves major things like religious or satanic beliefs that are irrational, such as 'my baby was the devil and an angel told me to kill it' type of hallucinating AND the woman is acting on such beliefs. Unless PPD has progressed to acting upon thoughts of harming herself or her baby, the speaker did not recommend hospitalization.

I've known a mother with severe PPD. A hospital birth experience made her remember being raped many years before and she believed that triggered her PPD. It is true that PPD is more common in women who've had interventive births. Also much more common in women with a history of depression. DHA found in long chain omega-3 fatty acids is effective in prevention of PPD according to researchers at the Children's Nutrition Research Center however their studies are not complete. DHA is found in fish oils, cold water fish, flaxseed oil, carrots, spinach, and some supplements. I might be able to copy the tape I have of Anne Dunwald's speech if you need it. Most all antidepressants can be safely taken by breastfeeding mothers. St. John's Wort might also be tried.


Child sexual abuse that has been buried deep in the psyche can sometimes be brought up during the powerful physical and emotional feelings in labor and birth. This also explains the "type a " personality traits of wanting to be perfect. This energy is used to keep those nasty memories at bay sometimes. Sexual abuse is so rampant that I'm more likely to believe it has occurred in a woman's past than not these days.

This would be my first suspicion with a woman suffering this type of psychotic episode.



Postpartum Depression Support Groups and Professional Help Referrals



New - online support group - BirthTraumaSupport at egroups.com


Resourcess For Prenatal and Postpartum Mood and Anxiety Disorders from Pec Indman EdD, MFT
Help, information, and support for prenatal and postpartum illness


Postpartum Support International
www.postpartum.net
Call the PSI Postpartum Depression Helpline: 1.800.944.4773


Postpartum Adjustment Support Services(PASS-CAN)
Canadian Resource
(905)844-9009

The Postpartum Stress Center
Rosemont, PA Office, 610.525.7527
Voorhees, NJ Office, 856-745-8847

National Anxiety Foundation
(for both Professional referral list and information resource)
1-800-755-1576

National Institute of Mental Health
Hot Line about Panic
With info on support groups
1-800 64-PANIC

For information about "safe" anti-depressants postpartum: Medical Professional Involved in Relevant Research on PPD. MD who is known for her research on the use of Medication for PPD during breastfeeding. She is a good resource about Meds.
KATHERINE WISNER - Pittsburgh Mind-Body Center
Professor of Psychiatry, OB/GYN, Epidemiology, and Women’s Studies

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