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Post Natal Post Traumatic Stress Disorder

post Natal post Traumatic Stress Disorder post Natal post Traumatic Stress Disorder What is post Traumatic Stress Disorder ? post Traumatic Stress Disorder and birth trauma The term post Traumatic Stress Disorder (PTSD) refers to a Disorder that can occur following the experience or witnessing of life-threatening events. We usually recognise events like terrorist incidents, serious accidents, or violent personal assaults as being capable of causing such trauma, so, it has proved difficult for people to understand that a natural process like childbirth can also be traumatising. The fact is that a Traumatic event can actually be any experience which involves the threat of death or serious injury to an individual or another person close to them ( their baby).

Post Natal Post Traumatic Stress Disorder What is Post Traumatic Stress Disorder ? Post Traumatic Stress Disorder and ‘birth trauma’ The term Post Traumatic Stress Disorder (PTSD) refers to a disorder that can occur

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Transcription of Post Natal Post Traumatic Stress Disorder

1 post Natal post Traumatic Stress Disorder post Natal post Traumatic Stress Disorder What is post Traumatic Stress Disorder ? post Traumatic Stress Disorder and birth trauma The term post Traumatic Stress Disorder (PTSD) refers to a Disorder that can occur following the experience or witnessing of life-threatening events. We usually recognise events like terrorist incidents, serious accidents, or violent personal assaults as being capable of causing such trauma, so, it has proved difficult for people to understand that a natural process like childbirth can also be traumatising. The fact is that a Traumatic event can actually be any experience which involves the threat of death or serious injury to an individual or another person close to them ( their baby).

2 A person must then respond with intense fear, helplessness or horror for a diagnosis of PTSD to be made. Hence, it is now generally accepted that PTSD can be a consequence of a Traumatic birth experience and, although this was only medically acknowledged in 1994,1previous studies, going back many years, had already demonstrated that women did in fact suffer this type of Traumatic Stress after birth. We call this type of PTSD, post Natal PTSD (PN PTSD) or birth trauma . What are the symptoms? A person who has been diagnosed with PTSD will find their normal life interrupted in many ways by a strong and powerful set of emotions and feelings over which they have no control. General symptoms typically include: The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares.

3 A person will usually feel distressed, anxious or panicky when exposed to things which remind them of the event Avoidance of anything that reminds them of the trauma (this may include talking about it). This can lead to emotional detachment or numbing. Bad memories and the need to avoid any reminders of the trauma will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time). These are called hyperarousal symptoms It is important to understand that, following a Traumatic event, sufferers of PTSD are left with a world view which has been altered profoundly and which often leaves them deeply afraid and anxious. The world is no longer considered to be a safe place and it can be difficult to trust the very individuals (health care professionals) who are 11 PTSD was recognised as a Disorder by the 1980 Diagnostic and Statistical Manual of the American Psychiatric Association guidelines.

4 In 1994 revised guidelines (DSM-IV) changed the definition of the Disorder to include subjective perceptions, with the result that childbirth could be recognised as causing PTSD supposed to be there to help. For those who develop PTSD, the future may look bleak as they struggle to liberate themselves from the images of the trauma they have endured. This can be particularly hard for women with birth trauma because they often suffer these problems at a time when everyone expects them to be happy and positive. As a result, they often end up feeling guilty and this lowers self-esteem. Unfortunately, this situation is exacerbated by the fact that women are frequently struggling to articulate these damaging emotions in an environment which cares predominantly only for the physical outcomes of the birth experience and not the emotional ones.

5 When post Natal PTSD develops, its symptoms may start soon after childbirth or they could be delayed for months. The symptoms may persist for a long time and can result in other problems such as depression but the two disorders have clinically different origins. This is why the Birth Trauma Association believes that PTSD has a profound significance in the post Natal setting and that it requires specialised attention and treatment. What causes post Natal PTSD? Currently, research into this field is limited and, to date, it has largely focused on the importance of the type of delivery a woman has undergone. However, recent studies have begun to look at the significance of women s perceptions of their birth experience. For example, it has been noted that psychiatric outcome actually depends as much on a woman s subjective perception of the event as the objective experience itself.

6 2 Others have suggested that the degree of distress is often less associated with the events themselves but rather with the perception of control, the attitudes of people around them, relationship with the maternity care provider, feelings of not being heard, level of information provided and ability to consent. Consequently, it is not always the sensational or dramatic events that trigger childbirth The Birth Trauma Association believes that there is an urgent need for extensive and properly funded research into the scale and nature of this problem which, in reality, represents a complex interplay of objective and subjective factors. We have set out some of the most significant causes of post Natal PTSD below, but we have punctuated our explanations with the words of women who have contacted us to tell their This is because we believe that is only through the eyes of women who have suffered trauma that we can see the truth of the problem.

7 2 Beck (2004) Birth trauma is in the eye of the beholder 3 Associate Professor Gillian White, Massey University, Wellington, New Zealand 24 All names have been changed for anonymity s sake. Mode of delivery. 5 For me the hardest thing is that I blame myself for what happened. The care was dreadful, the doctors and midwives didn't have any time and I didn't question what they were doing. I was induced without properly understanding why or whether it was the best and safest thing to do. I was in pain for hours after having the prostin and didn't tell anyone how bad it was because I wanted to be tough . (Natalie) Women can be traumatised by labour regardless of the method of delivery. Indeed, some women have reported truly horrific home births to us. However, it is clear that invasive obstetric procedures such as emergency caesarean sections, inductions and instrumental deliveries are more likely to be perceived as Women have frequently described feelings of violation as a result of invasive medical procedures.

8 Fear for their own safety or that of their child The midwife was listening for my baby's heartbeat and asking me what was wrong then she panicked. The heartbeats too low we have to get this baby out now, your blood pressure is too high, we need to get a drip into are going to bleed too much. She was so unprofessional I completely freaked out and was screaming out for help. My mum and husband were panicking too although they were telling me that everything was okay and that it d be alright but I could tell that something was wrong..At the same time I had a doctor trying to get a drip in my hand and the doctor and midwife arguing that they needed more help and the midwife saying that all the other midwives were busy. That s when they pressed the alarm and suddenly there were loads of people in the room. I really thought at this point that my baby was dead, in fact I was telling myself you have 2 beautiful children already you are so lucky.

9 It was the most awful feeling in the world and one I wouldn t wish on my worst enemy. (Lucy) I didn't come round properly until the following morning and I remember lying in bed with the August sunlight streaming in the window and wondering who was going to break the news to me that my son was dead. I was so utterly convinced he would have died in the night and I couldn't believe it when I was told he was doing well and given these rather crappy Polaroids of this strange baby all wired thought he looked like a (Jane) Fear for a child s safety is a hugely powerful emotion and some women come face to face with the horrifying possibility of their child s death during the birth process. It can take a long time to come to terms with these frightening perceptions and the potential risk for mother-baby bonding is obvious.

10 This can be a particularly important concern with mothers of premature 5 MACLEAN et al (2000) Method of delivery and subjective distress: women s emotional responses to childbirth practices. Journal of Reproductive and Infant Psychology, 18, 153 162. This indicated that those who have instrumental deliveries may see birth as more Traumatic than caesarean section or a normal delivery. 6 Planned caesarean sections with consent and spontaneous deliveries are negatively associated with PTSD. See RYDING et al (1998). Psychological impact of emergency caesarean section in comparison with elective caesarean section instrumental normal vaginal delivery. Journal of Psychosomatic Obstetrics & Gynecology, 19, 135 144. 7 AFFLECK et al (1991). Infants in crisis: how parents cope with newborn intensive care and its 3aftermath.


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