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“Helping you gain control over the things you want to change”

Fiona Nicolson

Post-natal PTSD what we know and what we can do to help

Posted on 29 June 2021

I am back in my consulting rooms in central London, seeing clients face to face at long last, and when I am not in London I have my clinic in Henley upon Thames. It feels really great for me to be working face to face again.

It is good to be able to write about client experiences, with their permission of course and this month I want to concentrate on post-natal PTSD.

Post Natal PTSD or Birth Trauma is traumatic stress disorder following a difficult or traumatic birth. I have seen several clients with some form of this in the last few weeks. What struck me is that, although all are highly aware women, who keep up with the news and have spent a long time before the birth working out birth plans etc, they had no idea about this terrible condition. When I explained it is actually quite common they were all astounded.

I know Post Natal PTSD is getting more coverage in the press and a number of celebrities have bravely talked about their own experiences but I thought I should do my bit by writing a blog that runs through what Post-natal PTSD is and what we can do about it. This is a complex subject so I have broken it down into two parts. This month I am going to look at the facts, the causes and the symptoms of Post-natal PTSD. Next month I am going to explain how it affects the brain and how we can treat it. (The good news is that the treatments work well!).

The truth about birth

Let’s start with the obvious, but often unstated facts. Birth is usually painful, often extremely so, and sometimes things can go wrong. Many women I have seen with post-natal PTSD feel that the nitty gritty side of birth is often ignored. One said to me: ‘Everything I was told was so rose-tinted, I do feel I was unprepared.’ One important factor could be that we live in a society where women have far fewer children so some of that very important folk wisdom of our grandmothers has been lost and the reality can come as a shock. Natural birth can be a great thing, and home birth can make some women and partners feel safe and protected but possibly some of the information around these good choices can perhaps cover up the truth about birth.

Lack of control

Birth can be painful and frightening. Most women who suffer from post-natal PTSD experienced a very difficult birth in some way and were terrified that they or their baby could die during the birth. They often remember the noise around them, the rush and stress of the medical team, and a feeling that they did not know what was going on. Feelings of complete loss of power, of fear, of pain and extreme anxiety have stuck in their minds, sometimes coming back as flashbacks, (very vivid images which make the person affected feel as if they are still there in the traumatic event).

Evidence does show that a perception or feeling of lack of control is often a factor in whether a woman will develop PTSD. Unfortunately with the pressure on maternity services and the medicalisation of birth, it can mean that women are not listened to or heard before the birth or during it. Many women who report PTSD say things like, their baby was taken away immediately after the birth and they did not know what was happening. Others say that they received no empathy from midwives or other staff, or that they had to give birth with a midwife they did not know. Often, and there can be good medical reasons for this, women can feel they were denied the type of birth they wanted and that they had no choice or voice in what actually happened. Things have been exacerbated even further in the last year or so when women have had to give birth alone and without partners due to covid restrictions. I fear that post-Covid, when our health services are going to be under massive pressure, staff will be even more over-worked and things could get worse.

Taking women’s health seriously

Some of my clients (and many experts in the field) point to the fact that women’s health experiences generally, and experiences to do with reproductive health and birth in particular, are often not taken seriously or are swept under the carpet. Women are often denied choice in their own care and may also feel guilt for ‘making a fuss’. The old idea that if you have delivered a healthy baby you have nothing to worry about is still around, unfortunately. This can mean that many women suffer in silence and do not seek help. It is hard to know how widespread this is, but many in the field estimate over half of women who are suffering from some mental health issue following birth do not seek help.

What are the symptoms of PTSD?

The American Psychiatry Association includes in its definition events where a person has been confronted with something which made them fear they were at serious physical threat and reacted with fear and helplessness.

This perfectly sums up what many of my clients who are suffering from PTSD have experienced.
PTSD was originally recognised in the First World War and it was often referred to as shell shock then. It has only been in the last few years that the term has been applied more widely. Now traumatic experiences off the battlefield as well are recognised as putting people at risk of developing PTSD.

Whatever the triggers for PTSD, the symptoms described are very similar. Post-natal PTSD has a lot in common with the experiences of frontline soldiers or emergency workers who have been put in dangerous situations.

Feeling hypervigilant (on high alert to any danger) experiencing flashbacks, going out of your way to avoid anything which reminds you of the trauma, are very common.

Who is at risk of post-natal PTSD?

Of course, each birth is different. Some women may experience trauma, yet a similar birth may seem fine to another.

The figures do seem to bear out that where a birth has been difficult and dangerous and where emergency medical intervention has been necessary, up to a third of new mothers can suffer at least some symptoms of post-traumatic stress. The events can also affect partners who have witnessed the events as if they have experienced the trauma themselves. Often this can be very difficult for the traumatised partners as they frequently feel guilty because they didn’t actually directly experience the pain and trauma and they then tend to downplay their problems.

We know some life experiences can make it more likely that a woman will suffer postnatal PTSD. Having suffered a prior trauma is a risk factor as is a history of depression or anxiety.

What are the consequences of post-natal PTSD?

If not treated the symptoms of PTSD can be devastating and impact hugely on what otherwise can be a positive life experience, enjoying those first months and years with a new baby. At its worst it can leave victims too traumatised to bond with baby because the baby actually triggers the bad memories of the birth itself. Post Natal PTSD can have devastating consequences for the existing family and sometimes sufferers will avoid friends and family members as they do not want to or are unable to discuss their condition.

If this is you are sounds familiar you do not need to suffer in silence. Modern techniques for post-natal PTSD work very well. I will tell you more next month. In the meantime, if you want to know more please get in touch.

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