The Road to Recovery from Birth Trauma

A person with PTSD (post traumatic stress disorder) does not have to look forward to a life-time of unrelieved suffering and maintenance therapy.

Unlike many mental illnesses, most people can gain permanent, significant, if not substantial relief and freedom from PTSD through a variety of non-chemical options. What follows covers some of these options - how you can help yourself, and what sort of professional help has been found to be of assistance. Even as a scar will seldom completely disappear, neither will the effects of your trauma, however, you can enjoy life again in a meaningful and fulfilling way.
SELF-HELP

These measures are not an alternative to professional treatment but they will assist with how well you are able to cope before, during and after treatment.

Create your own support network of friends, family and professionals. Use people to help you in the way that they can eg. a family member may not understand your illness but is only too willing to offer babysitting whenever it's needed. Avoid spending time with people who are critical or unsympathetic or those who have a negative outlook on life.

Be aware of your limitations: Don't try to do too much and don't blame yourself for not coping. Accept help when it is offered no matter how small. If you don’t like to ask for help try leaving a list of “jobs” on the fridge that you can refer to when someone asks if there’s anything they can do to help. Prioritize tasks and on bad days stick to only what must happen on the day eg. caring for baby, preparing meals. Leave any non-urgent tasks such as vacuuming the hall or folding the laundry, for your keen volunteers, or for another day.

Take care of yourself. Tend to your own needs and don’t feel guilty for doing so. Making use of a volunteer to mind a grizzly baby so you can shower in peace or eat a meal while it’s hot can make a huge difference to your day. Make time for some “time-out.” Use aromatherapy, homoeopathy, yoga, exercise, relaxation techniques; anything that works for you to soothe the mind, body and soul. And don’t neglect your spiritual needs either.

Establish some normal routines. Sometimes, sticking to a routine involves less thought and planning. Along with the routine of feeding and bathing baby in the morning, include time for brushing your teeth, combing your hair, getting dressed and eating a nutritious breakfast. These may seem like obvious and insignificant tasks when we are well but during the bad times they can seem like insurmountable chores to add to an already overloaded day and yet they will help you greatly in your sense of well-being.

Good nutrition is vital. You need to eat well in order to care for others, especially if you are breastfeeding too. Adjust your shopping list to include healthy, easy snacks like fresh fruit and vegetables, dried fruit, nuts and cheese and simple to prepare meals including tinned and frozen foods. If you cook a dish that can be easily frozen, cook it in bulk and freeze it in meal-size portions for tougher days. Fill a thermos with a hot drink and set it aside with a snack to have in the early hours when you are breastfeeding. Also have a water bottle on hand to keep you hydrated, as breastfeeding is thirsty work.

Eat a well balanced diet. Eat to maintain your optimum energy, which means keeping your blood sugar levels constant. A low blood sugar level leaves you feeling tired, listless and shaky while a high blood sugar level gives you a short-lived buzz. Avoid simple carbohydrates like sugar and refined white flour which are easily digested and metabolised rapidly, giving an almost immediate energy high, followed later by a significant energy slump. Avoid also caffeine, which is found in tea, coffee, chocolate and some fizzy drinks; also avoid smoking, alcohol and added salt.

B vitamins are essential for effective sugar metabolism and energy release. Alcohol, caffeine, smoking, oral contraceptives and stress can all deplete your body of them. As B vitamins are not stored in the body it will probably be necessary to use a supplement during these times of stress especially vitamins B9 and Bl2. Feelings of depression, irritability and tiredness can be symptoms of a B vitamin deficiency. Fresh fruit and vegetables, wholegrain cereals, wholemeal bread, yeast extract, liver, beans, lentils and tofu are all excellent sources.

An iron deficient diet will also leave you feeling tired. Good sources are cereals, liver, kidneys, dried apricots, eggs, watercress, beef, lamb and wholemeal bread. Vitamin C improves the way your body absorbs iron so combine this in your meals.

Consult your pharmacist, health shop rep, a nutritionist or dietitian, etc. for specific advice concerning your particular nutritional needs.

Allow yourself some simple pleasures. Try to do at least one thing each day that isn’t a “should”; something that you get some enjoyment from such as reading a magazine in the morning sunshine for 10 undisturbed minutes or going for a leisurely walk around the block while listening to your favorite music. If necessary, plan it into your day but don’t berate yourself if it doesn’t happen. Try not to feel that the minute that you put the baby down for a sleep, you need to race around catching up on all the jobs that need doing. Prioritize and be willing to let some things go.

Be adaptable. New babies invariably mean a lack of sleep and sleep deprivation can make you feel like your going crazy some days. When the going gets tough, accept that it’s not forever and ease up on your expectations of what “needs” to be done each day. Conserve your energy, sleep when and where you can and put off anything that’s not essential.

Be unsociable when you need to be. Don’t feel that you have to always answer the door or the phone. Put a note on the door that says “Mother and baby sleeping, please do not disturb” and put the answer phone on or leave the phone off the hook if the ringing will wake you. Chances are that the minute you get your unsettled baby to sleep and you dive for your pillow, the phone will ring!

Exercise. Forget trying to keep up to your previous schedule at the gym or worrying about if you are “pushing play” for the required time each day. Simply, a little fresh air, sunshine and gentle exercise, no matter how small will do wonders for your stress levels and to help you to feel connected to the world outside your four walls. Include your exercise as one of your simple pleasures.

Find a trusted person(s) to talk to about the trauma. They need to be empathetic, non-judgmental, and attentive listeners. Your partner may be this person. Be aware, however, that he is likely to be affected by the trauma too and may feel blamed or at fault for things that happened. He may also need to have his feelings heard. Speaking with someone who isn't emotionally involved may be a better option.

The need to debrief. After any highly emotional event, good or bad, there is a strong need to share the experience and to have one's emotions acknowledged. Having a baby is a monumental experience in any woman's life.

Every woman needs to debrief; even after the most normal of births. Those who had a stressful experience will need to talk it through many times. Friends and family may be initially sympathetic but may not understand the continuing need to talk.

Debriefing has been shown to reduce the occurrence of PND. It is also effective in reducing the severity of PTSD.

We believe all women should have the chance to talk over their birth experience in the early postnatal days, preferably with a health professional who was present for the labor and the birth.

From TRAUMA AND BIRTH STRESS - PTSD AFTER CHILDBIRTH

Solace for Mothers with Birth Trauma

Birth can be beautiful for some women. And for some women, difficult deliveries bring fear, pain, grief, isolation, anger, and shame for months or even years.

Talking by phone to a trained and sympathetic peer counselor can help a mother to come to terms with the feelings and thoughts she is afraid to say aloud to anyone else. Calls are free and confidential. Monthly in-person facilitated support meetings allow women to come together to cry and to laugh. Call 877-SOLACE4 – sharing, understanding, and healing.

Please browse our web site to learn more about Solace for Mothers. If you work with birthing women, please offer us as a resource. We are please to have launched two online communities where women and those who support them can connect around birth trauma concerns.

VISIT SOLACEFORMOTHERS.ORG

Pregnant in America

Very informative movie. Available on netflix for rental

www.pregnantinamerica.com

Personhood USA and how it affects ALL Pregnant Women

CDC Birth Rates for 2007 - 50% increase in the last 10 years!

The preliminary cesarean delivery rate rose 2 percent in 2007, to 31.8 percent of all births, marking the 11th consecutive year of increase and another record high for the United States (Table 8; Figure 3). This rate has climbed by more than 50 percent over the last decade (20.7 percent in 1996). Increases between 2006 and 2007 in the percentage of births delivered by cesarean were reported for most age groups (data not shown), and for the three largest race and Hispanic origin groups: non-Hispanic white (32.0 percent in 2007), non-Hispanic black (33.8 percent) and Hispanic (30.4 percent). The rise in the total cesarean delivery rate in recent years has been shown to result from higher rates of both
first and repeat cesareans (1).

VBAC and Scar Integrity

VBAC and scar integrity,
or "Why my uterus isn't going to explode"

Myth: It takes two years or more for uterine scar tissue to heal.
Fact: Your uterus is just like any other cut that is bound with stitches or staples, and does all the healing it's going to in the first few weeks. While a few studies suggest that the risk of rupture (more on what "rupture" is later) is higher if you get pregnant within 18 months, it is still far less than 1%, and while it is often recommended to wait, this does not reflect whether or not a real risk exists following initial healing. Most authorities agree that by the time your fertility returns (2-3+ months), conception happens and the uterus begins to expand (12 weeks), healing is done. The gentle pressure of a slowly expanding uterus is unlikely to cause any damage, and since we don't go into labour immediately following conception it's likely a year or more would have passed since the surgery. Healing can continue even during pregnancy.

(taken from Birthlove.com)

From BIRTH AFTER CESAREAN by Bruce Flamm: "Rumor has it that its safer to wait several years after a cesearen section before attempting a vaginal birth. There's absolutely no evidence for this belief. Studies on wound healing have shown that tissue regains the majority of its strength within a few weeks of an operation. The tissue that gives a healing wound its strength is called collagen. According to a general surgery textbook, 'Collagen content of the wound tissues rises rapidly between the sixth and the seventeenth days but increase very little after the seventeenth day and none at all after the forty-second day.' Since the uterine scar is almost fully healed within weeks after a cesarean section there is no reason to postpone plans for another baby."

Myth: If you rupture, you and your baby will die.
Fact: Catastrophic ruptures are extremely rare, and much more likely if you have oxytocin induction, cyotec, prostaglandins or lay flat on your back unable to move around. Included in rupture statistics is harmless and asymptomatic dehiscences, which unfairly skews the numbers. When people think of rupture they think of a uterus imploding, they don't think of scar tissue pulling away from where it's gotten stuck, or a small break that heals easily and poses no risk to mother or baby. Dehiscences are the most common type of "rupture", by far. It is usually diagnosed when a second c-section is performed or the doctor physically puts his hand inside a woman's uterus and feels around after birth. Some evidence suggests that many dehiscences actually occur before labour begins.

Catastrophic rupture (the dangerous kind) more often happens due to uterine integrity as a whole (with the vast majority following labour augmentation). The cases of true rupture are not the 1-2% figure we hear all the time, that is for dehiscences. When a true rupture occurs, a cesarean must occur within 30 minutes (ideally 20) to prevent neurological damage to the baby. Death does not occur immediately. Most women attempting a home VBAC are well within 20-30 minutes of a hospital, particularly if 911 is called.

'A Guide to Effective Care in Pregnancy and Childbirth', which is a well-respected summary of evidence-based practice, says that the rate of reported uterine rupture has ranged from 0.09% to 0.8% for women with a single baby, head-down, who planned a vaginal birth after one previous lower-segment cesarean. The authors comment:

"To put these rates into perspective, the probability of requiring an emergency cesarean section for acute other conditions(fetal distress, cord prolapse, or antepartum hemorrhage) in any woman giving birth, is approximately 2.7%, or up to 30 times as high as the risk of uterine rupture with a planned vaginal birth after cesarean"

What does this mean for women who want a VBAC? Up to 99.91% of you will labour normally.
True rupture is not asymptomatic, and the first signs are a steadily falling heart rate (now heavily debated over whether or not this is a true indicator) and/or intense pain that you'll feel even with an epidural. While external fetal monitors, in theory, are meant to catch this kind of thing as it happens - they often do not. External fetal monitoring has not been shown to save any lives, and has only been shown to increase the amount of unnecessary c-sections being performed. It is just as effective, and safer overall, to have a nurse or midwife come in every so often and have a listen with the doppler or fetoscope - particularly during a contraction. This also keeps you off your back, where you are often strictly told to stay if you are hooked up to EFM. This position increases your chances of complications. Move around! Stay hydrated! Stay strong! Avoid drugs! Labour isn't made so you that you can lie back with your feet up.
Home dopplers and fetoscopes are available to rent or buy. Fetoscopes can be purchased online or at any medical supply store for $30 or under, and home dopplers can be rented for as little as $35-$40 a month. Do keep in mind that dopplers, being ultrasound, carry risks. A fetoscope poses no risk to the baby.

Risk of rupture also depends on the type of incision you received. Except in rare cases, modern c-sections are performed by low transverse incision (a horizontal scar just along your pubic bone, usually hidden by a bikini). The risk is highest with a vertical incision over the middle of the stomach. This requires more healing time as well.

VBAC.com reads:

Overall, attempted vaginal birth for women with a single previous low transverse cesarean section is associated with a lower risk of complications for both mother and baby than routine repeat cesarean section. The morbidity associated with successful vaginal birth is about one-fifth that of elective cesarean. Failed trials of labor, with subsequent cesarean section, involve almost twice the morbidity of elective section, but the lower morbidity in the 80% of women who successfully give birth vaginally means that overall women who opt for a planned vaginal birth after cesarean suffer only half the morbidity of women who undergo an elective cesarean section.

What does this mean? A repeat c-section is more dangerous than a VBAC. The problem is we don't hear that very often. Some women are only ever offered a repeat c-section by their doctors. If they are truly only ever done in event of "emergencies", how can one justify the risk of denying a woman a VBAC when it is clearly the safest route for both mother and baby?

A 10-year population-based study of uterine rupture.
Obstet Gynecol 2001 Apr;97(4 Suppl 1):S69
Baskett TF, Kieser KE.
Dalhousie University, Halifax, Nova Scotia, Canada
Objective: To review the incidence, associated factors, and morbidity associated with uterine rupture.Methods: A 10-year (1988-1997) population-based review of 114,933 deliveries in one province.

Results: There were 39 ruptures: 16 complete and 23 dehiscence. Thirty-seven cases had undergone a previous cesarean delivery (34 lower transverse, 2 classical, 1 low vertical). Of the 114,933 deliveries, 11,585 (10%) were to women with a previous cesarean delivery. The incidence of uterine rupture in those undergoing a trial for vaginal delivery (4,516) was complete rupture (3/1000) and dehiscence (5/1000). Induction or augmentation of labor with oxytocics was associated with 50% of complete ruptures and 25% of dehiscence. There were no maternal deaths, but 33% of patients with complete ruptures required blood transfusion. There was one neonatal death attributable to uterine rupture.

Conclusion: Induction and augmentation of labor are confirmed as risk factors for uterine rupture. Fetal heart rate abnormality was the most reliable diagnostic aid. Serious maternal and perinatal morbidity was relatively low. PMID: 11275210

Shamelessly stolen from Norwegian_wood's journal:

Here are some statistics to put the risk of rupture in perspective:

* Your risk of rupture from a horizontal LSCS scar is: 1% = 1 in 100 VBAC deliveries (this is the highest statistic)
* Your risk of being diagnosed with dystocia (baby too big) is: 10 - 12% = 10 in 100 vaginal deliveries
* Your risk of a breech baby at full term is: 3 - 7% = 3 in 100 deliveries
* The risk of your baby being diagnosed with fetal distress during labour: 2% = 2 in 100 deliveries
* Your risk of having twins is : 0.4% = 4 in 1000 births
* Your risk of dying from a rupture of the uterus is: 0.0095% = 9.5 in 100 000 VBAC deliveries
* Your risk of dying during any vaginal delivery is: 0.0098% = 9.8 in 100 000 vaginal deliveries

( re-read that one, "Your risk of dying in ANY vaginal delivery is 9.8 in 100,000, compared to a death risk of 9.5 in 100,000 with a VBAC" )

* Your risk of dying during an uncomplicated vaginal delivery is: 0.0049% = 4.9 in 100 000 uncomplicated vaginal delivery.
* Your risk of dying during any ceasarean section is: 0.0409% = 40.0 in 100 000 ceasarean sections
* Your risk of dying during an elective repeat ceasarean section: 0.0184% = 18.4 in 100 000 elective csecs
* The risk of your baby developing cerebal palsy is: 0.25% = 2.5 in 1000 births
* The risk of your baby developing cerebal palsy after fetal distress: 2.84% = 2.8 in 100 fetal distress births
* The risk of your baby dying from a rupture of the uterus is: 0.095% = 9.5 in 10 000 VBAC deliveries
* The risk of your baby dying during any VBAC delivery is : 0.2% = 2 in 1000 VBAC births
* The risk of your baby dying during any type of delivery is: 0.12% = 1.2 in 1000 births



Articles & Links:
Vaginal Birth after 2 or More Cesareans An excellent and informative research-based read analyzing studies, pitocin use and risks of true ruptures versus that of dehiscences. Addresses risks in both VBA1C and VBA2+C.
Twin VBAC not associated with increased risk of rupture
VBAC safe for women with twin pregnancies
Mothering: Fighting VBAC-lash
The Integrity of Caesarean Scars - Originally posted as a reply in a forum, is now an article with a thought-provoking look at the idea that the uterus doesn't heal the same way the rest of the human body does.
Mothering: Cesarean and VBAC index
Birthlove: VBAC is safe!
ICAN: International Cesarean Awareness Network

For those of you convinced that a doctor would only ever have your best interests in mind, I suggest you read articles like this one published in October 2000 entitled, "Getting a Stubborn Patient to Say Yes". This article has since been reposted in many VBAC communities to make women aware of the manipulation tactics that may be used against them.

Don't take your doctor's word for it when he says, "You can't have a VBAC" or, "A VBAC is dangerous". Don't take anyone else's word for it when they say "no one in this town will let you have one". Interview, ask, push and shove - you have the right to the safest birth for your baby. Many midwives will oversee a home, center or hospital VBAC and you can switch to a midwife at any point during your pregnancy, even when your due date is approaching.
Remember, home is safest as far as your risk for dangerous interventions. There's no chance of pitocin induction, epidurals or being kept on your back when you're pacing your own bedroom. Homebirth has been proven to be as safe if not much safer than hospital birth.

Read, educate and inform yourself of the facts so you can be prepared the next time someone tries to scare you out of the best birth for your baby with myths and wives tales. Knowledge is power.

2007 Cesarean Rates for MS

34.9 % Cesarean Rate in MS, slight decrease from 2006 data. US rates will be posted when released from CDC