Rates of C-sections and postpartum posttraumatic stress disorder on the rise

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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 ... 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,” ... “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 ... 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.

... the reported prevalence of postpartum PTSD ranges from 1.5 percent to 6 percent ...

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?’

... “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 ... says that ... 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,” ... “Posttraumatic stress disorder is much, much, much neglected.”

... 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.

... “We know that women never forget their childbirth experiences,” ... “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.” ...

Continuity of care - that is, being cared for by one person who is trusted and liked throughout the pregnancy, birth and postnatal period - is vital for minimising the chance of PTSD. Continuity models include private obstetric care, where a woman has all of her pregnancy care with one obstetrician and that same obstetrician is on-call for her birth. Continuity models also include private midwifery care where a woman has the same midwife for all of her pregnancy, birth and postnatal care. Obstetric care can be accessed through eligible midwives who have collaborative arrangements with obstetricians.

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