I thought the diagnosis was for war veterans, not new mothers. Then I had a baby
The delivery of my son didn’t start with a rush of water, or cramps that left me hunched. It was a decision, an edict, and with it, the drip Pitocin, a drug that induces contractions. The contractions came big and loud, almost immediately at one minute apart. My cervix wouldn’t dilate, though. I was eventually given the narcotic Stadol, which caused me to hallucinate through a very long night. Twenty-four hours later, clear-headed but still not dilated, I told my doctor I didn’t believe the induction was working, that I wanted to discuss other options. But before I knew it, he began painfully separating the membrane guarding my bag of waters.
“He isn’t examining me,” I yelled at my husband. “He’s doing something.”
In a hushed tone, the doctor asked the nurse for the hook, a mechanism that breaks your water.
“Why did you do that?” I asked when it was done. “I thought we were going to talk about it!”
His voice was cold, flat. “You’re not going anywhere,” he said.
My C-section came 30 hours after admission. It was a middle-of-the-night affair: a chilly operating room, an oily anesthesiologist, a clock on the wall that would not tell me when this would be over. I didn’t think I would make it out of that hospital alive.
This is a vignette in the story of modern medicine, which allows many of us to survive childbirth, and for which we should be grateful. There is no doubt I needed it, either by me or the three obstetricians I’ve had examine my case since (though there is doubt as to whether I should have been induced). Both my life and my son’s life were in danger by the time I ended up in surgery. And so why, when I returned home — a little sore, but with a healthy baby — was I not grateful?
Within a week of my son’s birth, I was diagnosed with postpartum depression (PPD), which afflicts 15 percent of new mothers. I was diagnosed by three healthcare professionals, including the psychiatrist specializing in PPD to whom I was finally sent. It was a diagnosis that, at least on the surface, appeared to fit: I was sad and hopeless. I met most of the criteria on the checklists. But my sadness didn’t explain the fits of anxiety to which I was prone, the ones that kept me writhing on my bed. “It’s postpartum anxiety,” said the psychiatrist, checking off a box on her clipboard. “Sometimes you get both,” she told me, as though I’d happened upon a grocery store during double-coupon day.
But something more was going on with me. When I spoke to other women who had PPD, our symptoms didn’t match up. I didn’t have resentment or contempt for my baby. Further, the women I spoke to and the books I read made no mention of the things plaguing me: Just lying on my back opened a trapdoor to those horrible moments of my C-section. I would wake up from two-hour fits of sleep breathless and scared; I felt that I was stuck in fight-or-flight. Certain words and images were like a tripwire in my brain; driving past the hospital where I gave birth, I started shaking so much I had to pull over. I went to emergency rooms to evaluate pains that may or may not have been real, I consulted another psychiatrist, and another, I took a low dose of Zoloft, but none of it worked. Desperate, I consulted yet another psychiatrist — but this time, I chose a generalist, not a specialist in PPD. It was my husband’s advice to try someone whose livelihood did not revolve around a certain disorder: “Never ask a barber if you need a haircut,” he said.
Dr. K’s office was bare, with ugly wall-to-wall carpet, not the comforting art of the first three psychiatrists, or their shelves of books. It was just him and his desk, a legal pad, a manila folder, and a Lexapro pen. He sat back and asked me what had brought me there. For the first time, the room wasn’t crowded with questions from a checklist. I felt I could speak, that I could tell my story.
Toward the end, he started zeroing in on specifics. Was I having intrusive thoughts? Flashbacks? Did I feel that I was often reliving my son’s birth? Did I avoid places that recalled the birth? Yes, I said. Yes, yes, yes.
He confirmed that I didn’t have PPD or any of its cousins. Yes, I had depression. Yes, I had anxiety. Yes, I was postpartum (four months at this point). But what I had was something else, something those specialists, so married to their own territory, couldn’t see. I had post-traumatic stress disorder.
My diagnosis should have been a relief, the “aha” I’d been looking for. But instead, I started objecting. “PTSD?” I asked. “Like war veterans get?”
The doctor explained that anyone who has had a trauma can experience PTSD, depending on their predisposition for anxiety and their coping ability. “And you certainly had trauma.”
I was dumbstruck, suddenly nostalgic for my previous diagnoses. While PPD and postpartum anxiety were nightmares, they were also typical, manageable by medicine and time. I’d read stories about PTSD, how it stays. How it endures.
Besides, I had never been a lightweight. I hadn’t even been that scared of childbirth. Yes, things go wrong sometimes, but we live in a time of advanced technologies, when very few mothers die in labor. Women have been enduring childbirth forever. What gave me the right to call it a traumatic event? I hated what the diagnosis said about me. Am I so unstable, such a mess, that I can’t recover emotionally from what was ultimately about 35 hours of my life, from beginning to end?
Just around the time I was figuring this all out, the Wall Street Journal published an article discussing postpartum PTSD. It referenced a now-famous study by Harris Interactive for Childbirth Connection, in which 9 percent of postpartum women screened met criteria for a diagnosis of PTSD, according to the mental-health diagnostician’s Bible, the DSM-IV.
Not surprisingly, it elicited a giant eye-roll from bloggers. “Something about applying the term PTSD to childbirth irks me,” said Hannah Tennant-Moore, a blogger for Babble’s Strollerderby. “PTSD is most commonly associated with war veterans and victims of extreme violence; applying it to new mothers makes maternity seem like a pathology.”
Over on Jezebel Jessica Grose sneered, “Have we become so precious and hyper-conscious that something women have been doing for time immemorial is now ranked alongside war as a painful event?” She went on to say: “Certainly having a bowling ball of a baby shooting out your vag isn’t a picnic for anyone, but the hysteria surrounding something so matter-of-fact is troubling.”
Because neither of these women, to my knowledge, has a psychiatric or medical degree, I decided to go to someone who did. Dr. Cheryl Beck, nursing professor at the University of Connecticut, is at the forefront of studying PTSD in postpartum women and author of the Childbirth Connection study that was mentioned in the WSJ article.
“There is resistance to this diagnosis,” agrees Beck, who has since published two additional studies on the topic. “Especially if the mother had a baby that has no birth defects, and the mother is OK. How could it be that traumatic? People can understand trauma from men and women coming back from the war, or if a woman’s been raped. But in childbirth, the public and clinicians have difficulty accepting it.”
But if women have been giving birth since forever, why is there suddenly a new diagnosis? What has changed?
“Fifty years ago, women were anesthetized for childbirth,” says Dr. Benjamin Van Voohrees, a pediatrician, internist, and medical researcher at the University of Chicago. But now we have a whole new awareness of what is going on in the delivery room. And while advanced medicine has made the experience safer than ever, it has also shifted expectations. “Now, if there’s a misadventure in the delivery room, it’s traumatic. Our culture is not accustomed to those outcomes anymore, whether it’s the mother’s life at risk or the baby’s. These events are very rare. When you have an unanticipated event, and against the social expectations, you are going to intensify the risk of PTSD.”
“Ninety-eight percent of births are uncomplicated,” he continues. “When you’re in the other 2 percent, you have very few people to turn to and share the experience. When you have a baby, you’re opting into an experience that is normative. When you find it’s totally different from what you were told it would be, it’s traumatic.” According to current research, it’s actually 30 percent of deliveries that meet the criteria for trauma. However, only 9 percent of women emerge traumatized and meet the criteria for PTSD. It makes sense: Some people become clinically depressed over the death of a parent, but many people don’t. The point is, not everyone reacts to trauma the same way.
Remember that at the root of trauma is fear. The fear you have during childbirth, strapped to various machines, unaware of what might happen next, at a complete loss of control, is that you or your baby might not live. In war, in rape, in any of the events we agree induce trauma, and therefore PTSD, the first and foremost criterion for the disorder is: Did the person experiencing the event believe that his or her life was at risk?
In my case, intervention after intervention left me more scared, more sure that no one was looking out for me. When they told me that both my baby and I were in distress — my heart rate was off the charts, and he’d been experiencing contractions for more than a day — I could not see an outcome in which things turned out OK. That feeling that you’re in danger, when it stays with you, is the essence of PTSD.
Once you have PTSD, you have it forever. “You can definitely improve from it, but something can always bring it up,” says Van Voorhees. The treatment varies from that for PPD: different, higher doses of medication, long-term talk therapy, and special therapies like eye movement desensitization and reprocessing, and addressing flashbacks and intrusive thoughts.
But what my diagnosis has given me is a sense of relief: relief from wondering what was wrong with me, relief from a pricey conveyor belt of specialists who dismissed me as a hormonal, overwhelmed woman. Relief that I don’t have to be a person who can handle everything. Relief that other people have gone through this, and survived.
Recently, I went to a gathering of women who were trying to overcome their birth trauma. As we sat and shared our story, I realized I am no longer the frightened woman who couldn’t get anyone to listen. Long gone is the feeling that I am the only person who survived a normal life cycle event damaged and ruined. Now I have something else: community.
Taffy Brodesser-Akner has written for the New York Times, Los Angeles Times, Self, Redbook, and other publications. More Taffy Brodesser-Akner.
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