We hear more and more about post-traumatic stress disorder (PTSD) mainly as a response to violent crime or war (especially one big one). We also hear more and more, and not just from Dr. Cruise, about postpartum depression. But now, the Wall Street Journal reports, more researchers are noticing that the trauma some women experience -- not in the trenches, but in the delivery room -- manifests itself not as depression, but as full-blown, right there in the DSM-IV, PTSD.
Earlier research outside the U.S. had estimated the prevalence of childbirth-related PTSD at between 1.5 percent and 5.9 percent. Now, the WSJ reports, in a study commissioned by Childbirth Connection, a nonprofit maternity-care organization in New York, which used an established PTSD screening tool, 9 percent of 900 mothers surveyed screened 100 percent positive for PTSD; 18 percent had some signs of it. (Symptoms can include intense anxiety, vivid flashbacks and numbness to daily life.)
I am not as skeptical about these findings as Babble and Jezebel, whose concerns, though of course we share the same overarching interest here (don't do bad things to women), about the findings and their implications rely on some pretty big conflations. Jezebel, for one, finds irksome this so-called "classification of childbirth as trauma." But actually, no: The article -- and its findings -- explicitly classifies traumatic childbirth as traumatic, with the potential for psychiatric complications (especially for women with histories of sexual abuse or other trauma). As the WSJ states: "Medical experts say [PTSD] can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die ... Even as medical advances have resulted in many more lives saved during high-risk births, extreme medical interventions can leave a mother severely stressed -- especially if she feels powerless or mistreated by health providers," the WSJ states, also quoting Shari Lusskin, director of reproductive psychiatry at New York University Medical Center (and involved in the survey): "We don't want to overmedicalize a normal part of human development. Just because you had a traumatic birth, doesn't mean you'll get PTSD."
Right. And for the relatively small number of women who do get postpartum PTSD, there's a big difference between "overmedicalizing" and, you know, proper treatment. Liv Lane, 29, whose nightmarish birth experience left her with suicidal ideations, was told by a nurse to "read parenting magazines."
Likewise, Babble wonders if "this study reflects not the inherent trauma of childbirth, but the trauma of inadequate medical care in highly stressful situations." In some cases, yeah, sure, and that's not to be minimized. But I also think it's important to tread carefully here. You could have wonderful medical care in highly stressful situations -- some births are complicated -- and still be traumatized by, I don't know, the fact that for a while you didn't know if you or your baby would live or die. It's not far from here, either, to the unfair characterization of any "medicalization" of childbirth as cold and bad and unhealthy -- and traumatic -- or to the unfair equation of "medicalized [or even "hospital"] birth" with "powerless patient."
To be sure, just as we don't want to unnecessarily overmedicalize childbirth, we also don't want to overdiagnose -- or overmedicate -- its possible aftereffects. But what about legitimizing, well, legitimate trauma -- and addressing it properly? It's worth noting that Liv Lane's ultimately accurate diagnosis is precisely what gave her power, both postpartum and next time around. After a year and a half of treatment for PTSD, the WSJ reports, she "felt ready for a second baby. But when she got pregnant, her flashbacks, anxiety attacks and panic about her son's safety resurfaced. She took measures to make this birth different. In consultation with her doctors, Ms. Lane switched hospitals and opted for a scheduled C-section, believing that a vaginal birth might re-trigger the trauma. Her doctor prescribed Zoloft at the end of her pregnancy to alleviate anxiety. She also made sure that her husband or another support person would be with her through labor. The experience was 'wonderful,' she says."