Raising Awareness: Postpartum PTSD

Trauma is personal. There is no room for stigma and shame here.

The psychology behind developing postpartum PTSD is complicated. Nobody hopes for or anticipates having a problematic birth, so when it happens, it can leave lasting psychological scars. Risk factors can include things like, but not limited to; managed labor, induction, feelings of loss of control, traumatic delivery, old trauma, emergency cesarean section, having baby(ies) admitted to NICU, not being believed or listened to, poor pain relief and more.

No one else can nor should they ever  tell you if what you experienced was traumatic. Unfortunately, like with many things when people find the courage to speak up, there can be a slippery slope of minimization in this arena which can sounds something like:

“Millions of women have given birth and had hard labors, suck it up.”  “Of course it was hard. Labor and delivery are supposed to be hard.”  “You knew there could be complications.”

Even if you can silence those outer critics there may arise a peskier one.  Could that nagging inner voice during those early months of sheer exhaustion sound something like:

“Don’t be so weak.  What is wrong with you?  Why aren’t you happy?  Your baby is here and healthy. What more do you want? Other women have endured harder.  I am good. I am fine.  No really, I am fine.”  
#AskingForAFriend.

I tried to ignore it. I tried to hide that I looked away from pictures of us in the emergency C-section room, every.single.time for fear of the huge gaps in my armor showing. I did not understand its distinction from postpartum depression and that it had followed me into new motherhood. 

And then one seemingly normal day, several months after my daughter’s arrival, a flood of anxiety washed over me during a routine dental cleaning.  When they tilted my chair back, the overhead light looked eerily similar to the one I vaguely remembered from the C-section operation room. It took me a few minutes to recognize that my racing heart, instant sweat and uncontrollable flood of tears were not some newfound allergic reaction to the dentist’s latex gloves.

That was it.  That day. I decided that I couldn’t muscle through whatever this was on my own anymore. I felt stuck in that room wanting so badly to go back and change how it all unfolded and at the same time wanting never to go back. Wanting to never return to that room, to a hospital, or much to my sadness to the season of bringing another baby into the world.  I had regular dreams about being in that room, my body being shaken violently to get our baby dislodged from my pelvic bones. I was often revisited by the unwelcome feeling of not feeling.  I had been in active labor for a very long time before the need for emergency C-section arose. By this time my initial epidural had worn off.  Time for round two. And even that was not enough. I was still able to feel as they tested before the incision.  So, more anesthesia and the accompanying violent shakes.  I headed into delivery with a full acceptance of one epidural. The thought of a few rounds had never occurred to me and now we were in my personal worst-case scenario — a surgical birth. 

I thought I understood before birth, but now I know at a visceral and personal level that we cannot numb our nervous system without numbing our emotions.  When we prevent pain signals from traveling to our brains, we prevent other things from traveling too. Medicated vs. non-medicated birth is a highly sensitive debate and I am not lobbying for or judging anyone for which side of that conversation they land on. Hard things are just worth thinking and talking about. 

I am a feeler, through and through. To the core. The heart drives this train.  So to not truly FEEL, know, sense, resonate, connect or root with my daughter the first moment I met her is grief inducing enough that even to this day, nearly three years later, I can’t write it without crying.  To hear murmuring but not words, to feel out of body but acutely in.  I spent nearly a year avoiding anything that might look, sound or feel like a hospital in media and life.  I took the long way around certain roads, literally and figuratively. In my defense, this season of numbness was also marked with having a new infant at home, so yea, kinda sideways in general.

I later came to understand that when a person goes through trauma, the mind moves into an unusually hyper-aroused, fight-or-flight state.  I’ve read a lot by Sharon Dekel, a professor at Harvard Medical School and a postpartum PTSD researcher.   She shares that in postpartum PTSD, 

 “The brain’s amygdala, which normally helps store memories, becomes hyper-responsive, leading to an exaggerated sense of fear. Parts of the brain that normally inhibit the amygdala stop working. When something reminds a sufferer of her traumatic experience, her unusually terrifying memories feel like more than memories; they feel like they’re still happening.”

Doctors only began researching postpartum PTSD 13 or 14 years ago. I suspect that two ugly “S” words have everything to do with why it has gone unstudied for so long…stigma and shame. The same two culprits that leave struggling mothers feeling isolated instead of recognizing that they are not alone and that cause those same women not to talk about their experiences after they do get better.  These sinister “S” words are the same two offenders that provide huge barriers in seeking and accepting support services.  As if they have not done enough damage, stigma and shame are why more women aren’t adequately educated about postpartum risk factors during pregnancy.  When symptoms get pushed down and avoided, the condition remains invisible.  It is hard to help the unspoken and unseen. 

Shame, dishonor or stigma felt by a woman for anything related to her birth story is a toxic malignance that I hope you will join me in fighting. Sister, I have three words for you: TRAUMA IS PERSONAL. How you experienced and possibly relive your birth story is highly personal, is very real, is 100% valid and it is yours.

Perhaps you are like I was and you are experiencing intrusive thoughts, flashbacks about the event and a numbing grief surrounding an irretrievable life event.  Perhaps you experience other symptoms like avoidance, anger, or overactive fear and anxiety.

But, most importantly, if any of this sounds familiar and you are tired of muscling through rearranging your life to avoid triggers that remind you of the trauma, dear friend can I please suggest you look into Eye Movement Desensitization and Reprocessing (EMDR) therapy?  What is it?  Stay with me here. It may sound odd or scary. Once upon a time, it did to me too.  But you know what is even scarier?  Not getting back to joy. Missing out on your life and your loved ones. That is the bigger risk here.  EMDR is an Adaptive Information Processing model. 

“The specific therapy facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution. After successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus.” (www.EMDR.Com)

 

I credit months of difficult but rewarding EMDR work with ending the trauma loop in my life. 
As such, I for one absolutely advocate for EMDR’s broader inclusion in the mental health field.

For a general introduction to the therapy technique, visit the EMDR International Association Client Information Page 

I will close with a note to all of you wonderful support people out there.  You know who you are.  I am sending you a digital ‘fresh out of the oven chocolate chip cookie’ for showing up for your tribe like you do.  As someone who was fortunate to have many of you, I can say on behalf of anyone touched by this type of trauma, thank you. Your genuine empathy and connection helped us find our way home.

As a support person to someone with postpartum PTSD it is important to remember they may not always have control over their behavior. Their nervous system is stuck in a state of constant alert, making them feel continually vulnerable and unsafe. Be patient as they move through anger, mistrust, irritability, depression and other postpartum PTSD symptoms. Remember your loved one can’t simply choose to “turn this off.”  But, with the right loving and patient support from therapists, family, friends and loved ones a traumatic event can be processed allowing their nervous system to move beyond “unstuck.”