Looking for something? Start here.
Custom Search

 

Want The Unnecesarean in your inbox? Enter your email address:




 

   

« ACOG on Fallibility of Obstetric Judgment and Mode of Delivery | Guest Post: Why can’t we be proactive instead of reactionary? »
Friday
Feb192010

Scare Tactics, Anxiety Late in Pregnancy and PTSD After Childbirth

Bookmark and Share

Share 

The Massachusetts General Hospital Center for Women’s Mental Health posted an article in October 2008 titled “Post-Traumatic Stress Disorder (PTSD) Following Childbirth.” From the article:

Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.

These studies have reported a wide range of PTSD symptoms, including flashbacks, nightmares, hypervigilance, and avoidance of reminders of the trauma.  Women with PTSD also may experience feelings of numbness, anger, depression, social isolation, and chronic sleep problems.

While earlier reports suggested that PTSD after childbirth appeared to be precipitated by delivery trauma, a recent study by Zaers and colleagues suggests that there are certain predisposing factors which raise the likelihood that a woman will develop PTSD after childbirth.  In this study, 6% of 60 postpartum women reported clinically significant PTSD symptoms at six weeks postpartum. At six months postpartum, 14.9% reported PTSD symptoms. The strongest predictor for post-traumatic stress symptoms was anxiety late in pregnancy. Other predictors included psychiatric symptoms in late pregnancy, stressful life events, and the delivery experience. Nearly one quarter of the women in this study also reported depressive symptoms at 6 weeks and 6 months postpartum. [Emphasis mine]

One reader shared her story (posted here with her permission) about how obstetric bullying in last weeks of her pregnancy, coupled with a subsequent unnecesarean six months ago, left her with postpartum depression with symptoms of PTSD. The collaborative effort of care providers to scare women into unnecessary planned cesareans in the last month of their pregnancies is without a doubt aiding women in meeting this criterion for PTSD.

—-

I had a TERRIBLE week leading into a completely unwanted c-section. Being diabetic type 1 and having been intruded upon for my entire pregnancy, my son was looking to be in the 10 lb range around 38 weeks pg and that’s when the week from hell began. I was literally told that if I didn’t at least go along with one of their “suggestions” I would be dropped from their practice (AT 38 weeks PG!) and would have no doctor.

I declined to have a procedure done on me starting at 34 weeks pg - where I would go into the hospital every Friday and they would administer 10 minutes worth of Pitocin through an IV and hooked up to a fetal heart monitor and if the baby showed normal signs of heart rate during each Pitocin induced contraction, then I could be signed up for induction…. umm yeah right. I said absolutely not, I’ll continue with outward monitoring as I am diabetic and thought it would be wise because complications can arise with baby. I had a quick ultrasound every other week from 34 weeks on (probably a stupid idea but I was nervous).

At 38 weeks, I was adamant that I be left alone to birth when ready, but they had been pushing the whole fear thing on me the entire pregnancy “baby is too big to push out” “you have polyhydramnios, baby could die,” “shoulder dystocia” “baby stuck in the birth canal, emergency c-section - you both could die” “stillbirth” “placental death due to diabetes” Let’s not forget to mention I was a well controlled diabetic type 1 the ENTIRE pregnancy on an insulin pump…first son was induced at 38 weeks with a vaginal delivery and NO epidural. I had him after 15 hours labor and 45 minutes of pushing with no problem.

I told them this over and over again - not to mention that my mother AND her mother had 10+ lb. babies fine vaginally. They insisted I couldn’t do it. So, I set up a meeting with two of the head doctors at the practice and a nurse, and my mother for support. I literally sat in that office that day for over 2 hours, BAWLING because they were pushing me so far into a c-section they said that if I didn’t comply with at least induction, they would drop me. At 38+ weeks pregnant and diabetic, what do you do?

I was scared and they were fear mongering me. I accepted to go with induction and they put a 6 hour dilation time frame on me. I get to the hospital and because of having extra fluid, they say baby hasn’t descended and there was no point of even trying to induce. After a week of pure hell, fighting with the doctors and them pushing all the fear in the world that I or my baby would die, I reluctently accepted the c-section.

As I was prepped and walked into the OR room, I IMMEDIATELY started to cry walking into that cold, steel room. They sat me on the table and all the nurses and docs in there tried to console me. I couldn’t hold back. I felt like running away. I felt like escaping the hell I knew they were going to put me and my baby through. I felt like a failure. I felt like a weakling for giving up after an entire pregnancy of fighting that this is NOT where I wanted to be. They put the spinal in and I lost all control, hysterically sobbing the ENTIRE way through. My blood pressure was PERFECT the entire pregnancy, but only during the c-section and my sobbing was it at 150/90+. I felt like they were ripping my baby from my body. It was so awful. He was born weighing 9 lbs., 10 oz. and bloated from the polyhydramnios so he ended up weighing 8 lbs., 5 oz. leaving the hospital (he nursed wonderfully the entire time I must say and it was confirmed by the pediatrician that babies born from mothers with polyhydramnios are normally bloated slightly and don’t weigh quite as much as the scale says when born— doc estimated he weighed probably closer to the high 8 pound range)

After seeing this post and from other women, I just decided to Google PSTD instead of PPD - what I have been suffering from now for the last 5 months (baby is almost 6 months old now) and even my therapist agrees I have PPD - however, most of the signs of PSTD, I fall under or did so in the last 5 months at one point or another. I will NEVER be able to come to terms with how they pressured me and pushed me into that c-section that day. I hate them for that. And parts of me, hate myself for not being stronger.

 

PrintView Printer Friendly Version

EmailEmail Article to Friend

Reader Comments (11)

Heartbreaking.

February 19, 2010 | Unregistered Commenteremjaybee

This is my friend's story. I wish I lived closer to her so I could have supported her better. :( It's horrible how she was treated, just totally unacceptable!!!!!!!!!!

February 19, 2010 | Unregistered CommenterLauren

"You cannot abandon!" Raymond Scalettar, former chairman of the American Medical Association, explains in an email. AMA guidelines state that a doctor may withdraw from a case only after giving the patient enough notice to find another physician. State rules vary, but doctors generally must document the behavior, inform the patient what the problem is, give him or her a chance to change, then send a certified letter stating the relationship is over, while still agreeing to provide treatment as needed for another 30 days."

http://online.wsj.com/article/SB20001424052748703630404575053221001720404.html

The other thing I wanted to note was that I am sending a big HUG to the woman who suffered this tremendously sad burden. I ran into a friend of mine who shared with me that her daughter was the unfortunate recipient of very bad emergency care that resulted in a very serious malpractice ordeal with a lawsuit and all the heartache that goes with it.(not birth related) It has taken her five years to get to feel like she is in a place where she is "herself" again, and she can file a complaint. A year after my horrendous birth experience I have decided to file a complaint against a nurse at the doctor's office I saw for concurrent care during my home birth care. She fired me without following any protocol after the doc, my husband and I had conferred about what would happen should we continue to need his care. Her decision to take away our continuity of care caused major problems for us. It will be like ripping open a partially healed wound- but it has to be done. We have to hold health care providers accountable when they violate patients' rights, in all the various specialties of medicine.

February 19, 2010 | Unregistered Commenteranonymous

Oh, how many times during the last 38 weeks have I heard that I "just have big babies". After a CS delivery of a 10lb 11.5oz boy over 7 years ago, it was drilled into my brain that I was simply predisposed to having large children. Only since I have done research on all of this have I realized how very untrue this statement is. I had to go to 4 different OB's before I finally found one who seemed to genuinely believe that I would be able to forgo another CS. Every step of the way my baby girl has measured perfectly for her gestation, and it makes me want to rub the charts in those other 3 doctor's faces and say "See? I dont 'have big babies' and she is going to be just fine without another CS". I dont know that I would ever have been diagnosed with PTSD but I certainly had PPD after my first was born, and I can relate to the feelings of inadequacy afterward, feeling that my body failed me and that maybe I just wasnt strong enough for a vaginal birth. So much drivel that I lapped up because it was easier to believe that I failed than to believe the system failed me. I am so sorry that women have to feel this and worse, I only hope that someday our voices will be heard and we will be allowed to feel less like pawns in our own care. It is outrageous what this woman was coerced into by a profession that touts its oath of "first, do no harm"... I guarantee this woman feels very harmed, and no amount of consent forms make those feelings less valid. My deepest sympathies to the reader who had this done to her, and I just hope that getting the information out there will help someone else to see the warning signs in their care provider before it is too late.

February 19, 2010 | Unregistered CommenterLilRedMommy

I am so sorry for this woman. I totally know where she's coming from, and it sucks.

I had high BPs in all of my three pregnancies. (My first, I didn't even know it because they never even mentioned it.) The second one was a VBAC, and they monitored it and that was it. The third time, I was with a different practice, and they admitted me for observation. Unfortunately, my baby had also decided to turn breech, so that gave the pushy , b!tchy doctor even more of a reason to insist on a c/s right there. (Not to mention she's getting credit for it) I took great joy in pissing her off by telling her no, that I would come back when I was in labor and had given my baby time to turn on his own. I also told her I thought she was being alarmist, because my old doctor had never reacted this way. And yeah, Dr. Barbie Doll also said, "First, do no harm" when she was over the phone with me (beginning the conversation with "Do I have to come down there?!" like I'm 7 and she's my mother)

After having that comparison in care for essentially the same situation, I'm convinced that my current OB only sees dollar signs when he looks into someone's eyes. Pregnant or not, I am finding a new one as soon as I possibly can.

February 20, 2010 | Unregistered CommenterThe Deranged Housewife

{{hug}} Utterly heartbreaking.

Those doctors should be absolutely ashamed of themselves, and we need to sound the alarm over practices such as these-- it is birthrape, no two ways about it. Can you imagine the outcry if some random psycho off the street treated a woman this way? But if said psycho is wearing a white coat and has "Dr." and "M.D." after his/her name, it's supposed to be ok?? Ugh. They give all medical practitioners a bad name.

February 20, 2010 | Unregistered CommenterSabi

I will preface this story by saying that my clients with large babies (9+ lbs) are more likely to have vaginal births than my clients with small babies (7 lbs or less). I've had a client have a vaginal birth with an 11 lb 10 oz baby vaginally, a first time mom have a 9 lb 11 oz baby vaginally with no tearing, a mom who was 5 ft tall have a 10 lb 1 oz baby, a woman who was about a size 4 had a 10 lb baby--all vaginally. The common thread in all of these vaginal births--and others like them was that labor started spontaneously.

I listened with great saddness today as a woman told me about her two cesareans. She is happy with them, so I'm glad for that...but she was LIED to. She was induced with her first baby so that she could get her OB at the birth. She dilated to 10, pushed for 3 hrs, then had a cesarean for "big baby." Her baby was 9 lbs. No one ever told her that being induced could mean that her pelvis would be unready to open for her baby to pass through--that research shows that inducing labor with big babies results in more cesareans than letting those babies grow and labor to start spontaneously. No one told her that the abnormally strong Pitocin contractions that led to an epidural would mean she was immobilized and couldn't use positions that would open her pelvis more. But hey, the Dr that cut her open was "her" Dr--the Dr who probably doesn't even remember the birth, so its all great, right?

With her second baby her OB was "open to VBAC," but then did an ultrasound to check the size of the baby at 38 weeks. Guess what? Baby was suspected to be big again. Even though the 2004 ACOG guidelines on VBAC say that 60-90% of big VBAC babies can be born vaginally, her Dr. advised her to schedule a cesarean at 39 weeks, then told her confidently during the surgery "you made the right choice" after the baby had been weighed in at 9 lbs.

I'm glad she is happy with her births...but what complications will she face now from having had 2 cesareans? 95% chance of post-surgical adhesions, which means a 5% chance of chronic pain. Highly increased risk of placental problems in a future pregnancy. Increased risk of needing a hysterectomy.

February 21, 2010 | Unregistered CommenterKnitted in the Womb

I just got 'diagnosed' with gestational diabeties and I can't help but feel like it was a very contrived situation that ignored my (admittedly rather unique) physiology/metabolism just so the very paraniod OB I'm forced to work with can have a reason to declare me 'high risk' that I can't come back with "the ACOG doesn't consider that a 'high risk' factor" or "i had that with my first pregnancy and it was considered low risk then". She knows I don't consider myself a high risk pregnancy and am dismissing most of her fears over big baby and recommendations for induction/c-section. As serious as I'm taking the (potential to me) GD, I can't help but think I would never have this diagnosis if not for her attempts to 'convince' me I'm 'high risk'.

February 22, 2010 | Unregistered CommenterJespren

Wow. I stumbled across this post when doing some research and was simply amazed and touched by the story, it certainly made me think. I work with parents and individuals in the health care field frequently and often hear stores of c-sections that didn't seem necessary. A week or so ago I was at an event with a OB/GYN and a new mom was telling her story of having a breech birth and the doctor was stunned that the OB didn't elect to do a C and instead delivered vaginally (successfully with no ill effects). They said it was too "old school" not to just do a cesarean. I fear that she may have shown us the perspective the overwhelming majority of physicians have. ANY surgery should be avoided if possible. If there are unnecessary risks of litigation when we don't elect for a C, then let's fix that, but not put mothers and babies in a OR to avoid a trip to the courthouse. I never even considered the emotional effects of a C on the mother, which is really a shame on my part. Tremendous topic.

Rich
Child Anxiety Treatment

As teachers of the Alexander Technique, we know that much that goes wrong in the human creature results from an exaggerated or inappropriate startle response in the physiology. For decades the Alexander Technique has been employed in sub-clinical anxiety situations such as stage fright and other performance anxiety. While this has been great for actors and other performers, it strikes me that avoiding anxiety in expectant mothers is more important. Since AT is an educational process it is not a substitute for therapy. It should be pursued for less than clinical situations and as an adjunct to professional therapy.

July 28, 2010 | Unregistered CommenterForrest Hawkins
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.