The birth of Helen Dunn’s first son didn’t go nearly as smoothly as she had envisioned. Induced two weeks early because of concerns about the baby’s health, the Vancouver clinical counsellor endured 17 hours of painful contractions before her baby went into distress. As nurses ran in and out of the room, a doctor yelled, “We have to get this baby out now.” She had an emergency caesarean section, the whole experience proving to be a traumatic one with terrible, lasting effects.
“I immediately felt disconnected from him when they showed him to me,” Dunn says over a cup of tea at a Commercial Drive cafe. “I didn’t recognize him. I wasn’t attached to him; in fact, I had an aversion to him. I wanted them to take him away, which is hard to admit. After that it was very difficult for me, it was a long process of panic attacks, which I’ve never experienced before, and full-blown agoraphobia.
“I didn’t want to tell people how I felt; I felt a tremendous amount of shame about how I felt toward my child, the difficulty I was having bonding with him,” she adds. “I was diagnosed with postpartum depression, but I had no idea about postpartum posttraumatic stress disorder.”
Looking back now, she can see that those panic attacks were among the condition’s telltale signs. According to Mental Health America, PTSD after childbirth is characterized by two key elements: experiencing or witnessing an event involving actual or threatened danger to oneself or others and a response of intense fear, helplessness, or horror. Symptoms include obsessive thoughts about the birth; feelings of numbness, detachment, or panic; disturbing memories of the birth experience; nightmares; flashbacks; and sadness, fearfulness, anxiety, or irritability.
According to a study published in the journal Nursing Research in 2004, the reported prevalence of postpartum PTSD ranges from 1.5 percent to 6 percent—a wide enough margin, the journal noted, to provide “the impetus for increased research efforts in this neglected area”.
Dunn was even more struck by the effects of her traumatic birth following the delivery of her second son six years later. She laboured for 17 hours again, but this time delivered vaginally with the assistance of a midwife in hospital and went home soon after.
“I didn’t have any problems,” Dunn says. “He immediately looked familiar to me—he looked like my sister—I felt bonded to him, attached to him.” The stark differences between her two childbirth experiences prompted her to explore other women’s feelings of attachment to their newborns among those who delivered via emergency C-section as well as vaginally in her Master’s thesis. Now she wants to raise awareness among health professionals and the public alike of two pressing issues: postpartum PTSD—in particular signs, early intervention, and effects on maternal-infant attachment—and the high rates of C-sections in this country.
Although C-sections clearly play a vital role in maternal health and can be life-saving, about 26 percent of deliveries in Canada take place this way, which is nearly double the rate recommended by the World Health Organization.
Then there is the way postpartum PTSD is so widely misunderstood and overlooked, in Dunn’s view.
“When I did reach out for help, people would say, ‘You’ve got a healthy baby; what do you have to complain about?’ or ‘This was so long ago; why is it still bothering you?’
“I would love for doctors and nurses and therapists and mental health professionals to recognize the signs,” Dunn adds. “When someone says, ‘I don’t want to see my child… I really wish someone would have said to me at that point, ‘Can we help you?’ When I told a nurse I was feeling strange, having panic attacks, she said it was because of the medication. Even one gesture of support or kindness from somebody on the front lines can go a long way to help a woman gain a sense of control of what’s happening to her. I think it could have been handled a lot better in my case. I think I would have benefitted from more support had there been more knowledge around it.”
Maternal-health expert Michael Klein, emeritus professor of family practice and pediatrics at UBC and senior scientist emeritus at the Child and Family Research Institute’s Centre for Developmental Neurosciences and Child Health, says that in general, women who have emergency C-sections without adequate support or communication from their caregivers suffer from posttraumatic stress disorder far more frequently than those who don’t.
“What we know about the psychological experiences of women is that women who have a sudden, unexpected, emergency caesarean section without any chance to really adapt to it are the most likely to suffer psychological distress,” Klein says in a phone interview. “Posttraumatic stress disorder is much, much, much neglected.”
However, Klein emphasizes that the primary determinant of whether a woman will suffer PTSD after child birth is not the mode of delivery. Rather, it’s how she’s cared for. In other words, the condition can occur in women who have vaginal births, deliveries that require forceps, midwife-assisted labours, and in other situations. The crucial factor throughout is how her care team responds to her needs.
Other factors come into play as well, such as prior psychological and psychiatric disorders and the woman’s prepregnancy mental state.
When women do end up requiring an emergency C-section, Klein adds, it would be helpful for health-care workers to acknowledge their feelings and arrange for support and counselling after the fact if they need it and to follow up on that offer.
“We know that women never forget their childbirth experiences,” says Klein. “They can be transformative in a positive way or transformative in a negative way. Talk to any 50- or 60-year old woman and she can tell you every minute of their childbirth experience.” (Klein is father to journalist Naomi Klein and Seth Klein, director of the B.C. branch of the Canadian Centre for Policy Alternatives.)
Dunn, meanwhile, who hopes to build on her thesis research and write a book, is brainstorming with other health-care workers to come up with concrete ways to raise awareness and make a positive change in the way women are cared for during birth, particularly in instances where their dream of delivering vaginally disappears only for the operating-room lights to flash on.
“I want therapists and doctors to understand what a woman may have gone through,” she says. “I hope women themselves who’ve gone through this will reach out and get help, and if they don’t get help the first time to keep looking for it and not get discouraged. I want to advocate for change, to say what happened to me wasn’t right. I want to push for change.
“Not feeling attached to your child is just heartbreaking,” she adds. “There’s isolation and this really deep sense of failure. And I wonder who’s in their home right now, alone, keeping this shame to herself.”