| Have you recently found out that your baby will | | | | time I tried to talk with someone about my |
| need to be born by caesarean? Did you labour for | | | | feelings the answer was always...but you have a |
| hours or days only to have a surgical birth in the | | | | healthy baby, move on. Eventually I moved on |
| end? Do you have concerns about the decision? | | | | emotionally or so I thought. I realized the truth |
| Perhaps you are even angry or depressed? Do | | | | though when over eighteen months later I found |
| you feel as if somehow you failed as a mother | | | | out that I was pregnant once again. All of my old |
| and a woman? | | | | fears and feelings re-surfaced. I sat and cried for |
| A mild form of depression, called the baby blues | | | | hours; not because pregnancy was unplanned or |
| effects as many as 70% to 80% of new mums. | | | | the additional strain that another child would place |
| Usually beginning on the third or fourth day after | | | | upon our finances or troubled relationship, but |
| the birth, the baby blues are a reaction to | | | | because I would have to endure another |
| hormonal changes in the body following the birth. | | | | caesarean. I began to look for alternatives and |
| Less common, but still effecting as many as 20% | | | | eventually found a midwife that would consider a |
| of new mothers is the more serious Post Natal | | | | homebirth. Our first pre-natal visit lasted almost |
| Depression (PND). Unlike the baby blues, PND | | | | three hours and was more about debriefing from |
| usually has a gradual onset over several days or | | | | the trauma of my first birth than my physical |
| weeks. For some women, PND can resolve itself | | | | condition. |
| in a few weeks, but for many others it requires | | | | But even the successful VBAC homebirth of my |
| months of professional assistance and perhaps | | | | 7 lb. 14 oz. daughter did not lessen my anger at |
| even medications. The symptoms of PND are | | | | what I thought was an unnecessary intervention. |
| similar to depression. There are no studies which | | | | In fact, a casual comment by my midwife that |
| show that caesarean mothers are more likely to | | | | my pelvis was more than adequate caused my |
| suffer from PND. | | | | anger to intensify. In a classic Post Traumatic |
| Birth trauma or Postpartum Post Traumatic | | | | Shock Disorder experience, that comment |
| Stress Disorder (PTSD) on the other hand does | | | | re-ignited all the feelings that I had experienced |
| show a dramatic increase following a caesarean | | | | right after the surgery. I tried to channel my |
| birth when compared with a vaginal delivery. One | | | | anger in a constructive manner. I became a |
| study (PTSD and cesareans, Childbirth Resource | | | | crusader for natural birth; taking a lay midwifery |
| Network) reported as many as 28% of the | | | | course. I tried to find an attorney to sue my |
| mothers had PTSD following a caesarean birth. | | | | doctor, but the statute of limitations had expired. |
| According to the Fourth Edition of the Diagnostic | | | | In stark contrast is my second caesarean birth |
| and Statistical Manual of Mental Disorders says: | | | | some fifteen years later. I had planned a midwife |
| "The essential feature of Posttraumatic Stress | | | | assisted hospital birth. I was confident that I would |
| Disorder is the development of characteristic | | | | have no difficulty with another VBAC. I stayed |
| symptoms following exposure to an extreme | | | | home during early labour and went to the hospital |
| traumatic stressor involving direct personal | | | | only once labour was well established the |
| experience of an event that involves actual or | | | | contractions close together and so intense that I |
| threatened death or serious injury, or other | | | | was having difficulty managing them. I was sure |
| threat to one's physical integrity; or witnessing an | | | | based upon my earlier labours that the baby's |
| event that involves death, injury, or a threat to | | | | birth was imminent, but when checked I was only |
| the physical integrity of another person; or | | | | 2 cm dilated. |
| learning about unexpected or violent death, | | | | The baby was posterior and my intense back |
| serious harm, or threat of death or injury | | | | labour was not effectively dilating my cervix. I |
| experienced by a family member or other close | | | | tried labour upright in the shower. I tried walking. I |
| associate (Criterion A1). The person's response to | | | | tried lying on my side. Nothing worked. The pain |
| the event must involve intense fear, helplessness, | | | | was more intense than any of my previous |
| or horror (or in children, the response must | | | | labours. I knew that if I choose to have an |
| involve disorganized or agitated behaviour) | | | | epidural I would significantly increase my chances |
| (Criterion A2). The characteristic symptoms | | | | of having another c-section, but the pain was so |
| resulting from the exposure to the extreme | | | | intense that I made the decision to have it |
| trauma include persistent reexperiencing of the | | | | anyway. Several hours and several interventions |
| traumatic event (Criterion B), persistent avoidance | | | | later, I did indeed have another caesarean. This |
| of stimuli associated with the trauma and numbing | | | | time though rather than anger and resentment, I |
| of general responsiveness (Criterion C), and | | | | owned my decision. I was confident that I had |
| persistent symptoms of increased arousal | | | | done the best I could for me and my baby. |
| (Criterion D). The full symptom picture must be | | | | I believe that the two differing perspectives of |
| present for more than 1 month (Criterion E), and | | | | my caesarean births illustrate the power of |
| the disturbance must cause clinically significant | | | | educating yourself about your options and actively |
| distress or impairment in social, occupational, or | | | | participating in the decision-making process. After |
| other important areas of functioning (Criterion F). | | | | my first birth, I felt powerless and the result was |
| In other words: | | | | anger, depression and PTSD that lasted five |
| - There must be a traumatic birth experience that | | | | years. With my second caesarean, I had educated |
| involves intense fear, helplessness or horror. | | | | myself about labour and birth. I knew with each |
| - There are flash backs or re-living the birth. | | | | decision I made what the pro's and con's were |
| - There may be avoidance of anything associated | | | | and I made the decision with my midwives and |
| with the experience such as hospitals, doctors, | | | | doctors. The result was a birth that left me |
| the baby or pregnancy. | | | | contented and fulfilled as a mother and woman |
| - There may be anxiety or panic attacks following | | | | with no regrets. |
| the event. | | | | So if you are facing a caesarean, determine |
| These symptoms must last for more than one | | | | today that you will learn all you can about your |
| month and result in an impairment of function to | | | | condition, the baby's and the procedures involved. |
| meet the definition of PTSD. | | | | If you discover something that concerns you, |
| So what can you do if you are having or have | | | | discuss those concerns with your doctor. Bring |
| had a caesarean birth to minimise the impact of | | | | research with you. And together make |
| PTSD? | | | | compromise that you can both agree with. Or |
| As a mother who has had three caesarean births, | | | | perhaps change doctors. |
| the first of which resulted in PTSD that lasted | | | | But even if you have already had a caesarean |
| almost five years, I believe that the most | | | | birth, you can still apply these principles. Begin by |
| important thing you can do is to prepare for your | | | | talking openly and honestly with your doctor or |
| birth and actively participate in the decision-making | | | | hospital. Not in an accusatory way, but just tell |
| process. The defining characteristics are intense | | | | him how you are feeling and ask for his side of |
| fear and helplessness. If you have prepared for | | | | the situation. Then do more research, realising |
| the birth by reading about caesarean procedures, | | | | that rarely is the old adage once a caesarean |
| talking about them with your doctor and even | | | | always a caesarean true anymore. You may be |
| taking special childbirth education classes that | | | | able through education and empowering yourself |
| focus upon caesarean births and recovery, then | | | | to have a different type of birth next time, |
| you will minimise fear of the unknown by | | | | whether that be a Vaginal Birth After Caesarean |
| educating yourself. Likewise if you discuss your | | | | (VBAC) or a family-centred caesarean. |
| concerns with your doctor, research the issues | | | | In either case, by educating ourselves we can |
| and then compromise on the issues that concern | | | | reduce the fear of the unknown and by actively |
| you most then you will be an active participant in | | | | participating in decisions we can eliminate the |
| your birth and minimise the sense of helplessness. | | | | sense of helplessness. Without the fear and |
| My oldest son was born in 1986 via emergency | | | | helplessness, the catalysts for birth trauma or |
| caesarean after over nine hours of natural labour. | | | | Postpartum Post Traumatic Stress Disorder are |
| I was hugely disappointed. I felt as if I had failed. | | | | removed, thus minimising or eliminating your |
| And I was angry with my doctor, blaming him | | | | chances of developing this functionally impairing |
| somehow. I was frustrated too because every | | | | mental disorder. |