Monday, November 4, 2013

Birth In Crisis

Why is this statement so profound, so true? 

Does birth really matter? 

Does it have a lasting effect on a mother? 

Even on their relationship? 

Yes, the answer to all of those questions is a resounding yes.

PTSD is a relatively new diagnosis; criteria for diagnosis include death or threatened death, actual or threatened serious injury, actually or threatened sexual assault. Birth trauma occurs when the event can be defined as sudden, dangerous, or overwhelming; frequently birth can become all of these things. This trauma affects her day to day life, including but not limited to how she feels about herself, bonding with her baby, arousal and reactive behavior and her interactions with others, including baby. One mother has said,
The first 5 months of my baby’s life (before I got help) are virtually blank. I dutifully nursed him every 2-3 hours on demand, but I rarely made eye contact with him and dumped him in his crib as soon as I was done. I thought that if it were not for breastfeeding, I could go the whole day without interacting with him at all.
 Some offsetting factors for birth trauma include but are not limited to, perceived level of care and the amount of power and control one feels.  In our culture it is not uncommon extensive amounts of intervention to be pressed upon women while they labor. One earlier criterion of PTSD is that the event in question must be outside of the normal realm of life events; the routine care implemented and interventions in place to supersede the natural birth process, it may not be an excessive reach to deem birth outside the normal realm of life events.  With all of this in mind, today’s birth looks far more at risk than empowering.  Care providers are the ones too often taking  control of the birth process, opening up the possibility for traumatic experiences where women report feeling “dehumanized” and “disrespected” as well as sexually assaulted in some cases.

Sexual trauma in birth is usually perceived as rape. There are cases reported in which women have declined a vaginal exam, or internal fetal monitor and were not respected; an exam was forced leaving a woman feeling not only sexually violated but powerless over her situation. Another form of birth rape happens when health care providers perform rough and painful vaginal exams, often for the purpose of stripping a woman’s membranes, stretching her cervix or even breaking her waters, most all without consent.  Women who felt sexually traumatized during birth often elicit hypervigilance and report difficulty in arousal within their relationships.  At a time when women are most vulnerable, they are being taken advantage of and the effects are lasting.

Doulas provide continuous, compassionate care for women and can aid in giving a woman her voice in the birthing room, empowering her in her birth resulting in a safer and more satisfying birth experience. A midwifery model of care is usually less medically oriented with a health care provider “walking beside” a woman rather than in front of her. With both of these birth options, families have a better understanding birth and are included in the choices being made. Currently, in the United States, midwives are attending a mere 8% of births and doulas only 3% of births, 45.5% of women are reporting a traumatic birth. 9% of those mothers in the United States meet the diagnosis for PTSD and 18% score above the cutoff for PTS according to Listening to Mothers II.  

Why such a high rate in trauma? It is interesting to note that the United States has the highest maternal health care costs in the world and ranks 40th in maternal mortality. When compared to the United Kingdom, where a midwife model of care is practiced and birth is more commonly happing in the home, PTSD is cited in 1.2% of births and 9% of mothers consider their birth traumatic. Is birth itself traumatic? It can be; things happen that are outside of our control, sometimes disastrous things. In these circumstances a mother’s perceived level of care and amount of power or control she has will play into her perception of the experience. Doula support of the midwifery model of care, implying a woman being cared for by someone she trusts, whom she has built a relationship with, being nurtured and treated with dignity and respect can lesson her risk for a traumatic birth. A doula brings an exceptional role of balance to help prevent birth trauma by helping a woman to understand what choices she has, find information to make decisions and be empowered in her birth experience no matter what arises. A doula provides a safety net of sorts to soften the medical model of care we have grown accustomed to in the United States. Currently, women are saying
I had little control over the course of my labor since my water broke before it began. The worse thing is that I feel that the induction and subsequent drugs and cesarean were a greater risk to the health of my baby than the risk of infection from a broken amniotic sac.  I think they use Pitocin to hurry up your labor so the doctor/staff can get done.
Both of these statements reflect of lack of perceived care and control over one’s situation.

By allowing a woman power over a situation and continuous, more compassionate care, preferably with less unnecessary medical interventions, we could lessen birth trauma. Would crises still arise on occasion? Yes. But they could be handled while maintaining a woman’s autonomy.

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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