I have touched upon PTSD in previous posts, discussing how people can be on that path and some of the ways that they can seek treatment. One way that helps many is therapy. In the military, there can be many barriers to a Soldier seeking assistance with Behavioral Health. These include Chain of Command conflicts, mission needs and availability of services.
Seeking assistance at the Behavioral Health Clinic on post can be as simple as calling to find out when their walk in hours are, and then going. But sometimes it isn’t that simple. The walk in hours are usually after the duty day has already started, and this can cause some Soldiers to avoid going because they must then speak with their First Line Leader about why they need to be gone. Sometimes if you get lucky, you can go on a day after Staff Duty or manage to find a day when there’s nothing going on and just let them know that you’re running an errand or two and you’ll be back in about an hour.
So what happens during the walk in? Well, you’ll most likely fill out a survey on the computer. It asks questions about how you’re feeling, if you drink or smoke, if you have any conflicts with anyone, whether you’re thinking about hurting yourself, and other questions as well. Once you complete the survey, you wait until a therapist comes and brings you back to their office. Once there, you talk with them about why you are there, what else is going on in your life, and some general back ground questions. Based on that, they will talk to you about making a followup appointment to speak with someone on a regular basis.
From there, you go to the front desk of the clinic to make your follow up appointment, and get an appointment slip. Here’s where it gets tricky for some Soldiers. In many units, it is customary for them to require you to bring your appointment slip in and then they write it on a calendar somewhere so they can help to decrease the number of “No Shows” that they have to medical appointments. Here’s the thing, posting information about your appointments in a place that can be seen by anyone is a violation of your rights under the Health Insurance Portability and Accountability Act (HIPAA). Frankly, it really isn’t anyones business if you’re going to BH or not. But in the military, it can certainly be a tricky situation.
Your unit, mainly your Commander and your First Sergeant, are responsible for ensuring the health and welfare of all of their Soldiers. As a part of this responsibility, they should permit you to seek the assistance that you desire and/or require to ensure that you recover both mentally and physically from a traumatic birth experience. However, that doesn’t mean that they won’t want to speak with you regarding the situation as a whole to ensure that you are okay. I personally don’t know all the regulations regarding this, and whether they can even ask questions or not. My advice on this would be to confide in your First Line Leader first, and discuss with them whether you have to talk to the 1SG or Commander. Best case scenario, you’ve kept your FLL in the loop so they know where you are at and you avoid an awkward conversation with anyone else.
If you are uncomfortable going to the BH clinic on post, there are other options that you can explore as well. Calling Military One Source is a great way of finding out if there are counselors in your area to speak with, and sometimes they are able to get you in with them for several sessions for free. It can be very helpful to be able to speak to a therapist regarding birth trauma, and make a plan of action to not only recover from your past but to move forward.
Over the past few months, I have started on my journey to recover from my traumatic birth experience. During this process I have often struggled on whether to categorize my journey as one of grieving the loss of my birth experience, or as a trauma recovery. I grieve that I did not birth my son, hold him skin to skin, breathe in his scent, and nourish him in the precious moments after he entered the world. Those are moments that I will never have with him, and that makes me feel heartbroken. But I also feel a nearly indescribable and paralyzing array of negative emotions when I think of his cesarean birth, the loneliness of being on the operating table, the crushing intensity of my anxiety as I couldn’t feel my body, and the indifferent conversation of the surgeons as they dissected my body. The overwhelming physical and emotional reaction to my memory of the cesarean leads me to focus trauma recovery rather than grieving.
Trauma recovery is a hot topic in the military. Many soldiers experience trauma while in performance of their duties overseas, and are then prone to Post Traumatic Stress Disorder. According to the United States Department of Veterans Affairs, Post Traumatic Stress Disorder, or PTSD, occurs after experiencing a traumatic event such as combat exposure, physical abuse, physical attack or serious accidents like a car wreck. During the traumatic event you believe that your life or others’ lives are in danger, that you have no control over the situation. Most people experience stress after a traumatic event, but if your reactions don’t go away over time and they disrupt your life, you may have PTSD.
It is not clear why some people develop PTSD and others do not. Many factors contribute to the possibility including whether or not you were injured, how close you were to the event, how much control you had over the event, how strong your reaction was, how much help and support you received after the event, and how intense or long the event lasted for. Some key markers that can indicate PTSD include reliving the event, avoiding situations that remind you of the event, negative changes in beliefs and feelings, and feeling “keyed up” in scenarios that remind you of the event itself.
There are very few resources regarding the recovery of the woman after a traumatic birth experience. According to research done by Kalina Christoff, Ph.D., Professor of Psychology at the University of British Columbia, Vancouver, around 30% of women are traumatized during the birth of their child and between 2% and 6% go on to develop Post-Traumatic Stress Disorder (PTSD) as a consequence. To put this in perspective, according to the same article, the rate of PTSD in the regular Canadian Forces is estimated to be 2.8% overall and 4.7% in soldiers with 3 or more deployments (Christoff).
A birth is defined as traumatic if the woman was or believed she or her baby was in danger of injury or death, and she felt helpless, out of control, or alone, and can occur at any point in labor and birth. It is important to recognize that it is the woman’s perception that determines the diagnosis, whether or not clinical staff or caregivers agree. Even though physical injury to mother or baby often occurs during a traumatic birth, a birth can still be traumatic without such physical injury. Unfortunately, clinical symptoms of full diagnosis of Posttraumatic Stress Disorder (PTSD) can occur for mothers andpartners following a traumatic birth, the effects of which impact attachment, parenting, and family wellness (Karraa).
Treatment options for birth trauma include trauma focused psychotherapy (counseling) and medication. The two most effective forms of trauma focused psychotherapy are Cognitive-Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). CBT includes cognitive therapy, exposure therapy and stress-inoculation therapy. Ideally, this therapy allows the patient to confront your traumatic past without triggering PTSD symptoms. EMDR is highly effective and considered a frontline treatment for PTSD. In EMDR, you are told to think about your traumatic experience while moving your eyes back and forth following the therapist’s fingers as they briefly move across your field of vision (Kendall-Tackett).
There are also several medications that can be used during recovery from traumatic birth including antidepressants and antipsychotics. These should be discussed with a medical provider to see if they are right for you. Antidepressants have been viewed as a key part of treatment for PTSD and can compliment counseling treatment as well.
After gleaning all of this information, it is even more obvious to me that recovery is not just going to happen and that as a patient I must take an active role in my recovery. If I do not confront my trauma, it could cause further problems with future birth experiences.
Have you pursued counseling or medication in your recovery from traumatic birth? How has either helped you in your journey?
“What is PTSD?” United States Department of Veterans Affairs, National Center for PTSD. 12 August 2013 <http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp>
Christoff, Kalina, Ph.D., “Vancouver Birth Trauma: connecting women who were traumatized during childbirth.” University of British Columbia, Vancouver. 12 August 2013 <http://www.vancouverbirthtrauma.ca/home.html>
Karraa, Walker, MFA, MA, CD(DONA). “Traumatic Birth Prevention and Resource Guide,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/>
Kendall-Tackett, Kathleen, Ph.D., IBCLC, FAPA. “Treatment Options for Trauma Survivors with PTSD,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/treatment-options-for-trauma-survivors-with-ptsd/>
Most people wouldn’t associate PTSD, or Post Traumatic Stress Disorder, with child birth. In fact, it’s so uncommon that I don’t even mention it to people. Ever. Who would believe me? Most people I know with PTSD have it from combat, from fighting for our country. Or maybe a car accident. But birth? No one would believe me.
But that’s what it feels like. I can’t escape it. I love my son and he is my entire world. Most people think (and usually say) that isn’t that what’s important? A healthy baby? But there is so much more to birth than that!
During my pregnancy, I did everything that I could to get ready for my birth. As a Soldier, I did PT with the other pregnant Soldiers even running up until I was 28 weeks. My husband and I went to prenatal classes. I went to all of my appointments. I watched my diet and my weight. I even did a birth plan. It was full of every detail that I hoped my birth would be. Quiet and dark room, the midwife helping me find positions to help, no epidural, no pitocin, no drugs, delayed cord clamping, immediate skin to skin and breastfeeding. It didn’t seem like too much to ask. I longed for feeling connected to my child and birthing them, holding them close, feeling the birthing high as I embrace the very thing that a woman is made to do!
As soon as we arrived at Labor & Delivery, I excitedly started telling the nurses of my birth plan. They smiled and nodded, “uh-huh” “that’ll be nice dear”.. and then it all went out the window. They constantly wanted me monitored, I felt apprehensive but they are the experts, right? They wouldn’t do it if I didn’t really need it, right? I did labor naturally until about 1am. I started to feel tired, I started to think that maybe I couldn’t do this. And that was really the turning point. Knowing what I know now, I was entering transition! I was nearly there! But at the time, I asked for the epidural.. even using the safe word that I told my husband I would only use if I were desperate.
And that is when the “If only…” things start to take over. If only he had encouraged me and told me how strong I was and that I could do it, then maybe I wouldn’t have gotten the epidural… If only I hadn’t gotten the epidural, then maybe DS wouldn’t have turned sunny side up with his head slightly tilted.. If only they hadn’t started pitocin, he wouldn’t have gotten stressed out… If only they hadn’t tried to manually turn him (um, ouch!!) then maybe he wouldn’t have had meuconeum…have come down on his own.. If only, if only, if only..
But those things did happen.
So I was told I had no choice, they had to do a Cesarean. I remember DH holding me close as I sobbed into his shoulder when they told us. The contractions still wracking my body because the epi didn’t really work for me anyways except that it made my legs tingle and feel limp. The nurse quickly shaved me, DH got a gown, and they wheeled me through the bright hallway to the OR. From there it is a blur. It was so bright, they made a joke about us not knowing whether it was a boy or girl. The anestheziologist changed out my epidural for something stronger, it made my lower half disappear, my arms felt cold and tingly, i could hardly breathe. I couldn’t see DH, but I know he was there. I was crying. I could feel them tugging on me, it was moving my whole body. This wasn’t right, this wasn’t supposed to be how it was. This wasn’t supposed to be how I met my.. son. It’s a boy! The surgeon holds him high above me so I can see before he is whisked away. I asked to hold him, to see him. No one was hearing me, it was hard to talk because it was so hard to breathe. There was something wrong with DS. They brought him next to my head, wrapped tight in a blanket and with a cap on. I ask if I can nurse him. But some doctor is there telling me that he has to take him and that something is wrong. So DH goes with him too. And I’m alone.
The surgeon is closing me up. There’s a student there too, so he’s explaining as he goes.. “put the intestine there.. the appendix looks good.. no just place that on there.. now we stitch the next layer…” I can tell when they get to my skin, as the conversation changes.. “it was nice enough to golf this past weekend… yeah we were able to go up to the mountain…” It felt like forever, laying there with my arms tingling, tears streaming down my cheeks.. it’s probably the worst thing you can do to a claustrophobic. Strap them to a table and make it impossible to move or feel anything.
In recovery, the spinal began to wear off. I desperately wiggled my toes and legs to get it to go away.. they wouldn’t let me see my son until I was able to stand and then sit in a wheelchair since he was in the NICU.. Six hours after my amazing son came into this world I got to hold him in my arms. He was beautiful. He was amazing. And that’s the first time I heard it, from the nurse, “well as long as you and baby are healthy, that’s all that matters.”