Personal Support: Post Traumatic Stress

Have you been traumatised by your birth? Post Traumatic Stress Disorder (PTSD) explained.

Mia Scotland, Clinical Psychologist and Birth Doula
January 21, 2013

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The word “traumatised” has become like the word “starving” and the word “depressed”.  It has been watered down,  from something quite serious and potentially life threatening, to something we flippantly say when chatting about our experiences.  We might say “I am absolutely starving” instead of “I’m famished”.  We might say “I was so depressed” because our Christmas pressie turned out not to be the long awaited diamond ring.  And we might say “it was traumatic” when we mean “it was horrible”.  But we all know that to actually be starving means something very different.  And we might or might not know that to actually be depressed is a miserable state of being, a condition, not a fleeting  emotion.

So what about trauma?  If something was really scary and upsetting and horrible, were we traumatised?  Well, to a psychologist, trauma is as much about the aftermath of an experience, as it is about what actually happened. It is about how it leaves us feeling, long after the event.  It is not always about what actually happened, or even about how bad it was at the time. I’ve heard some birth stories that are so horrible, my insides are shrinking when I hear them.  But the mums are fine with it.  In fact, sometimes, the mums are remembering the experience fondly (I kid you not!  It must be the oxytocin).  I hear other birth stories that sound wonderful when described.  But the mums are sobbing with grief and horror while they tell me, even when the birth was years before.  How can that be?

Trauma is about the injury, not the event.  It’s like breaking a bone.  I might fall down a big flight of stairs, and walk away unscathed.  On the other hand, I might trip up over nothing, and break my ankle.  One cannot predict this, or control it.  The person who broke their ankle is not weaker or more stupid, and they cannot “pull themselves together”.   They are injured, and they were unlucky. Sure, the level of the incident will have a part to play in the chance of being injured.  If you fall off a cliff, you are more likely to have serious injuries.  If your family is raped and murdered in front of your eyes, you are more likely to have serious psychological injuries (spare a thought for some asylum seekers).  Also, if you had a former weakness in your ankle, you are more likely to re-injure it when you trip up.  This follows for psychological injury too.  For example, if you have an injection phobia, you might be more vulnerable to developing PTSD when you have a baby.  Or if you have been sexually assaulted as a child, you might bemore vulnerable to trauma while you have your baby as an adult.

I work as a Clinical Psychologist.  Sometimes, my job is to answer the question “is this person traumatised” for the court, or a solicitor.  When I am answering for the court, I need to follow a rigorous set of guidelines (usually from the Diagnostic and Statistical Manual of Psychiatric Disorders).  Ticking the boxes according to DSM, and using my clinical experience, brings me, after a few hours, to a conclusion.

When I am working with parents and their babies, I can just use my clinical experience.  I listen to the story, I listen to the mother, I take in her emotional reaction, and sometimes I ask a few pertinent questions. By listening to her, I want to know “can you talk about it without crying”.  I want to know “does it impact on your dreams”.  I want to know “do you try to shove it to the back of your mind, but you find it impossible”.  I want to know “what impact is it having on your life”.  I want to know “how long ago did it happen”.  If it is less than a few months, and the person is telling me about it, the chances are, she will be okay.  Usually, I’m hearing the story years later, because the person is pregnant again, and this flares up the previous trauma.

So, is it treatable?

Yes.  I have been treating trauma for over 20 years, with an enormous amount of success.  It is treatable.  I promise you.  Don’t fight on your own, because some people go all their lives traumatised, until they receive treatment.  War veterans have suffered for decades with PTSD , until a short course of treatment lifts it.  And it can really feel like something has been lifted.  As one person once said to me “it was here – in my forehead – I couldn’t get rid of it – always there – always in my way.  It has gone.  I can’t believe it, it has totally gone”.    There are treatments out there that work.  We aren’t exactly sure what the treatments actually do, we just know they work.  They seem “move” the memory from the “I’m not safe” (threat activated) part of the brain, and lay the memory to rest in the “it was awful but it’s over” part of the brain.  While traumatised, the person feels as if it as just happened, and the body and brain are in a state of hyper-arousal.  This might involve nightmares, flashbacks, irritability, moodiness, tearfulness,  sleep problems , anger with your loved ones, constant memories of the incident, and efforts to push it out of your mind unsuccessfully.  If you are a new mother, it has even more consequences, because it interrupts the process of bonding with your baby.  Furthermore, the normal chaos that comes with adjusting to a new baby is heightened to create a potentially miserable cocktail.  Fathers can be traumatised by the birth too, but they often go under the radar, so we know very little about this. Mothers have been going under the radar for a long time, because many cases of PTSD were misdiagnosed as post natal depression.  We are only just beginning to realise how common post natal depression is in fathers (almost equal to mothers, in some studies) and the fact that this might be related to birth trauma in fathers has not even been raised, to my knowledge. Well, actually, it has, because I just did it.

In our society, we are led to believe that we should be able to control our emotions, but if we have been traumatised for 6 months or more, then trying to control it may exacerbate the problem. This is because, with PTSD, the more we try to “control” the emotions (in other words, the more we try to push the memory to the back of our minds), the more the problem anchors itself in the brain, because you are preventing the brain from processing  the event properly.  This is where therapy can help.  Therapy enables the brain to change the memory, so that it becomes processed into the “history” part of the brain rather than the “I’m not safe” part of the brain.  Before that, the memory seems to be stuck in the “oh my god I’m not safe and this is awful” part of the brain, leaving the person with “symptoms” as outlined above.

In my experience, the NHS is not always the best place to go for treatment.  Take your time finding a private therapist with relevant training and experience.   I use the rewind technique (a hypnotic technique, taught to me by the Human Givens Institute) which seems to be the most effective, the quickest, and the least distressing.   It can be one session.  I also use cognitive behavioural techniques (CBT) which is also “evidence based” (NHS jargon to say that it has been through rigorous research to demonstrate that it works).  EMDR is known to be effective too.   If you are seeking help within 6 months of the incident, non-directive counselling can sometimes help (this might be on offer within your GP practice, but bear in mind it can sometimes make things worse).  Non evidence-based therapies which I’ve also heard good things about include Emotional Freedom Technique.

For Do-It-Yourself care, make sure you reach out to people.  Let them look after you.  Tell them what is going on for you.  Cry when you need to.  If you can, it can really help to write down what happened to you in great detail, focussing on how you felt and what you thought at every stage.  Don’t hold back on your anger, if people treated you badly (this is highly likely, because we know that the chances of being traumatised at birth are much higher if the staff were not warm and lovely towards you).  Finish with a strong statement about how strongyou were to cope with what happened, even if you don’t quite believe that .  Then, when you have done this, burn it, tear it up, or ceremoniously bury it.

Whatever you do, don’t hide this – you have nothing to be ashamed of.  This is not your fault.  Give your body and mind time and space to recover, by getting help to eat and rest, and by letting people be kind to you.  Your smile, your love, your laughter, will come back.  Bit by bit.  And if, after 6 months, it still isn’t beginning to come back, get help.