Tag Archive | maternal mental health

BIRTH TRAUMA

May29

Birth trauma refers to a distressing emotional or physical experience that can occur during childbirth. It is important to note that birth trauma extends beyond the events that occurred during labor and delivery. It also encompasses the feelings and emotions experienced by the mother afterward. Approximately one third of women go through such trauma. It is crucial to recognize that the perception of trauma is subjective and should be defined by the woman who has experienced it.

The Roots of Birth Trauma
1. The experience of traumatic birth is subjective. Each woman’s childbirth experience is unique, and what may be traumatic for one person may not have the same impact on another. Below, I am sharing a few potential events that can act as triggers for birth trauma:
Past traumatic experiences: Similar to how pregnancy can trigger past traumas (read my article about it here), invasive or non-consensual interventions during or after labor can make the birth experience traumatic for us.

2. Complications or emergency situations during birth: Lengthy or intensely painful labor, emergency interventions, inadequate pain relief, and experiencing injury during labor.

3. Poor postnatal care and lack of a healthy support system.

4. Postpartum complications: This includes issues like hemorrhage (excessive bleeding during or after childbirth), tears, or severe physical pain. Additionally, the birth of a baby with a disability resulting from a traumatic birth, the experience of stillbirth, or the need for your baby to stay in neonatal intensive care.


5. Healthcare system dynamics: The current health system often portrays patients as passive recipients, with healthcare practitioners holding the authority. This dynamic not only fosters a sense of control over women, but also perpetuates the acceptance of possible mistreatment.

6. Unnecessary and unwanted medical interventions: For example, undergoing a C-section to speed up the birth when it is unnecessary, or being manipulated into agreeing to certain interventions or procedures.

7. Staff attitudes during and after labor, for example, I have had numerous clients who were not traumatized by the birth itself, but by their hospital stay in the days following childbirth. Unfortunately, some staff members made them feel inadequate and instead of providing support with baby care and breastfeeding, they passed judgment. It’s important to note that this is not the case worldwide. In countries where the practice of “sitting month” is observed (as discussed in this article), women often have a different experience and receive more positive support after giving birth.

8. Lack of communication, such as not explaining what is happening during interventions. This experience of feeling unheard and disrespected by the medical team leaves them feeling unsupported throughout the birthing process. Additionally, there have been instances where women’s wishes were ignored by care providers.

9. Objectification: Some women have reported their childbirth experiences being treated as teaching moments for hospital staff without their consent. Such dehumanizing experiences can exacerbate the trauma associated with childbirth. Personally, I had a similar experience where I was not fully informed about the presence of a learning doctor during my birth. Although I felt protected by my husband and doula, it would have been nice to understand why he was just standing there.

10. Disregard for women’s bodily experiences like ignoring her pain and sending her home, minimizing their beliefs of being in labor or having the urge to push.

11. Expectation-reality gap: When our own, or society’s expectations of how our birth should look like, don’t align with the actual experience. For example, unplanned cesarean sections or the use of forceps, which may be necessary for medical reasons, can evoke feelings of powerlessness and violation.

12. Comparison among mothers regarding birth and the hierarchy of birth: Have you also felt this? I’m curious to know. There can be a subtle comparison among mothers and a hierarchy of birth experiences. Using language like ‘natural’ versus ‘unnatural’ can imply a hierarchy, which I don’t believe in. It’s important to acknowledge the diversity of childbirth experiences.

Am I experiencing birth trauma?
Women experiencing psychological birth trauma may exhibit various symptoms that can significantly impact their well-being. When any trauma overwhelms our nervous system, it manifests itself in experience symptoms of shutting down, such as dissociation, avoidance, numbness, or depression. Or in symptoms of hyperarousal, including increased vigilance and anxiety. Let’s explore some symptoms manifestation related to the traumatic experience of childbirth:

Hyperarousal and/or Reactivity: You may feel constantly on edge, easily startled, or have a heightened sense of vigilance. Difficulties in sleeping, feeling tense, or experiencing angry outbursts can occur. You might find yourself constantly being on guard, anticipating potential threats or danger, and having ruminating thoughts.

Numbness or detachment: You may feel emotionally numb or detached from your surroundings as a way to cope with the traumatic memories. It is not uncommon to avoid anything that reminds you of the traumatic event. This can include discussions about childbirth, medical settings or procedures, or even distancing yourself from friends, family and baby.

Psychological trauma often manifests in physical symptoms as well. You may experience changes in appetite, chronic fatigue, or unexplained health issues that cannot be attributed to a specific medical condition. It’s important to remember that after giving birth, some of these symptoms can be considered normal adjustments to the postpartum period. However, it is crucial to evaluate each person individually to determine if these physical symptoms are related to the trauma.

Flashbacks: You may re-experience the traumatic event through intrusive thoughts, vivid images, or nightmares. Certain triggers, such as visiting the hospital, hearing a baby cry, or even subsequent pregnancies or deliveries, can bring back traumatic memories of your birth experience.

Feelings of guilt, shame, or anger: It is not uncommon for women to experience intense feelings of guilt, shame, or anger related to their childbirth experience. You may blame yourself for not being able to meet certain expectations. It’s important to recognize that feelings of guilt and shame are often present in traumatic experiences. If you are experiencing these emotions, it can be an indication that you may be suffering from birth trauma.

If you find yourself experiencing postpartum depression, anxiety (article), or frequent angry outbursts following childbirth, it could be a sign that you have been through a traumatic birth.


How can we protect a mother from birth trauma?
Birth trauma cannot always be prevented, but there are steps that can be taken to reduce the risk. As you prepare for the birth, it is important to not only focus on the technical aspects but also on emotional preparation.

Workshop: Emotional preparation for childbirth


Take the time to reflect on your expectations and consider how you might feel if they are not met. Explore your feelings regarding possible interventions and discuss these questions with your partner, a friend, or a therapist. Engaging in stress-reducing techniques and creating a birth plan can also help you feel more prepared and empowered.

Creating a safe and supportive environment for yourself during childbirth is important. Remember, you are the most important person in this process. If possible, ensure that your birthing partner is prepared as well, serving as a bridge between you and the medical staff. Your partner can act as your voice and protector, safeguarding your space and advocating for your needs. If you and your partner are unsure or would like additional support, consider hiring a doula. A doula can provide continuous emotional and physical support throughout the birthing experience.

In addition to individual preparation, it is crucial for medical professionals to gain better understanding (and training) regarding an emotional-wellbeing of the mother and how important their role is in preventing birth trauma.

The responsibility lies not only with healthcare providers, but also with society as a whole, as the focus tends to be more on the newborn than the mother’s (mental) health. It is essential to address these systemic issues and work towards a patient-centered approach that prioritizes active participation, effective communication, and respectful treatment within the healthcare setting.

By taking these steps and advocating for yourself, you can help create a more supportive and empowering birthing experience. Remember, you have the right to be heard, respected, and actively involved in the decisions regarding your care.

In conclusion…
Birth trauma can have profound effects on women’s emotional well-being after childbirth. Unfortunately, the stigma surrounding birth trauma often leads to underdiagnosis and limited discussion of these experiences. Many women feel uncomfortable sharing their birth trauma, fearing judgment or the perception of being inadequate mothers.

By working with a healthcare professional or therapist who specializes in trauma, you can receive guidance and support in navigating the healing process. Remember, you are not alone in your experiences, and seeking help is a sign of strength.

REMEMBERING TRAUMA DURING PREGNANCY AND PARENTHOOD

Dec23

Pregnancy is a time when our body and minds go through changes. Most of this changes are out of our control-meaning our stomach and breasts are growing, our hormonal levels are changing and our body will push the baby out whether we like it or not. Body memory can be awaken when a woman’s body starts to change during pregnancy. Transformation to parenthood can evoke feelings and memories that we weren’t ready to deal with in the past or even memories that we didn’t realize that we have.  Especially early memories are not clear, but they are talking to us through our body and emotions. In early childhood we didn’t have words to express ourselves, instead we were showing things with our body and sounds.

Feelings about your upbringing
During this time it is not uncommon that good or bad memories are awoken in us. In this article I will focus on traumatic events but at the same time I want to point out that positive memories are also awaken during this time which connect us to our parents even more.
I would like to separate conscious memory from the one that is unconscious. The first one is not in our minds all the time but it comes to live when we are becoming a parent. For example: “Seeing how my husband interacts with our child reminds me of the relationship that I never had with my dad.” Looking at their interaction she was remembering the void that she felt as a child.
On the other hand unconscious memory can come to us through our body memory and feelings that can be felt also on physical level-as a tension, stomach irritation etc.
“All of the sudden I experienced a fear that I will be jealous of my daughter. I secretly wanted a boy because I was so scared that this may happen. I was going through my mother’s jealousy of me and fear that despite all the knowledge and experiences I will feel the same way towards my daughter. The memory came to me through my body. I clearly felt my mother’s jealousy and her burden of raising me. Although the fear of continuing the pattern troubled me, I felt relieve that it was not all in my head but it was actually what was really going on in my childhood.”
Becoming a parent can awaken feelings and memories that you felt as a child about your own relationship with your family.  Any developmental stage of your child can evoke memories in you. Some people doubt the accuracy of this memories. It is true that memories are not objective representation of what really happened but I believe there is a lot to it. It is your reality. You can grab the opportunity and work on long forgotten memories and feelings that have awakened in you. When my client made a sense of her fear of being jealous of her daughter it brought relieve to her. In her own mind she got a confirmation that her suspicious of her mother’s jealous was real. Maybe she would never get that confirmation from her mother. Probably also the mother didn’t realize it either.
Sometimes there is a thin line between conscious and unconscious memory. Once that unconscious (body) memory is triggered it can feel very familiar to us. It feels like it was always there in the beck of our minds. On the other hand during the pregnancy and parenthood unconscious memories that we didn’t know that were there can be awoken.

Traumatic memories-sexual abuse
Pregnancy draws attention to a woman’s body, particularly to sections of her body that she has kept private-her genitals, stomach and breasts. She is subjected to pelvis exams, a loss of body privacy, and finds herself the center of attention from strangers and (male) medical professionals. This can often trigger memories of sexual abuse or awoken feelings and memories of sexual abuse that we didn’t realize we experienced.
It is very important to take sexual abuse in consideration and to prepare as much as possible to potential complications. For example, researchers have found out that sexually abused woman:

  • has more health problems during pregnancy,
  • is more frequently in conflict with her partner,
  • experiences higher levels of anxiety and fear,
  • has more trust issues with the personnel during birth,
  • is also more prone to a caesarean section and other complications,
  • has statistically significantly higher number of complications,
  • experiences depression in the prenatal and the postnatal period much more often in comparison to others.

The following unpleasant feelings can also occur:

  • feelings of body betrayal,
  • feelings of physical intrusion and invasion,
  • flashbacks to the original abuse,
  • depression, anxiety or panic,
  • abuse memories resurfacing for the first time,
  • hostile feelings toward the fetus,
  • projecting feelings about the abuser onto the fetus,
  • feelings of guilt associated with her feelings,
  • feelings of shame associated with body changes,
  • survivor with PTSD can fear the intensity of her feelings,
  • fear that the child will be born deformed like her,
  • fear that the child will be born dead as a punishment or prophesy,
  • fear of being an incompetent parent,
  • fear of being an abusive parent.

In case the future mom is aware of abuse or starting to get flashbacks of abuse, it is very important to seek help. And if possible let other medical personnel know what is going on. The same can occur in future dads. Little research is available on the impact of sexual abuse on a man and his perception of fatherhood. But that doesn’t means that man can’t go through the same emotional crises as women.

In this article I wrote about memory that can occur when becoming a parent. Some of them are pleasant, some not so much. Some memories are very painful and we would rather avoid them and forget them once again. While pain and unpleasant emotions are very hard to hold and work through they are also a possible way to personal freedom.

Trigger
A trigger is a stimulus that triggers feelings of trauma. What triggers us is completely individual. Trigger can come from outside through one or more senses- sight, sound, touch, smell and taste. For example music can trigger an old memory. But we can also be triggered by internal processes such as stress.
Flashback
A flashback is a vivid, often negative but can be also positive memory that may appear without warning. It is usually pretty strong, meaning that you can lose track of your surroundings.
Body Memory
Body memory is a hypothesis that the body itself is capable of storing memories, as opposed to only the brain. Body memories are involuntary. Memories of incest or sexual abuse can be retained and recovered through physical sensations. Sometimes, the body memory is not always conscious because you may have been too young to remember or you have blocked the traumatic memory out.

 

Workshop: Emotional preparation for childbirth
Read about Birth Trauma

PART IV: INTERACTION BETWEEN BPD MOTHER AND CHILD

Dec21

In this article (Part IV) I want to take a deeper look at some of the research that was done regarding relationship between Borderline parent and children in comparison to mothers that don’t suffer from BPD.

Infants

Studies have found that interactions between mothers with BPD and their baby are characterized by insensitivity, high levels of intrusion, and low levels of positive response to infant distress. Mothers with BPD smile less, touch and imitate their infants less, and play fewer games with their babies. They often have difficulty identifying and appropriately responding to their children’s emotional state. These unmet psychosocial needs at critical moments of development increase risk of disorganized attachment and rob children of security, comfort, and safety from the very beginning of their lives. Newman and colleagues found that infants of BPD mothers aged 3 to 36 months were less attentive and less interested in interactions with their mother during a free-play interaction compared to infants of healthy control mothers.

Pre-school
Macfie and Swann examined mother-child attachment in 30 preschoolers (4-7years) in comparison to 30 children with healthy mother-child bond. They discovered that role reversal was significantly more likely to be present in the narratives of children with a BPD mother. More negative parent-child relationship expectations, such as the relationships characterized by danger and/or unpredictability were also found in the preschooler’s narratives. The children also exhibited greater fears of abandonment. Lastly, the children of BPD mothers also showed more incongruent (e.g. the child cleans his/her room then ruins it) and shameful self- representations (e.g. the child says he/she is bad) in the narratives.

School-age children
Different studies showed that children of mothers with BPD have more psychiatric diagnoses, such as ADHD and higher rates of BPD symptoms in childhood. These children also reported more cognitive and interpersonal vulnerability, such as a negative attributional style, ruminative response style, dysfunctional attitudes, self–criticism, insecure attachment style, and excessive reassurance seeking. Adolescents
Adolescents whose mothers had BPD exhibited more attention problems, delinquency, aggression, more anxiety, depression, and low self-esteem. In general BDP mothers reported that they feel less satisfied, less competent and more distressed with their parenting abilities.

DSM IV criteria for Borderline Personality Disorder

  1. Frantic efforts to avoid real or imagined abandonment.
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).
  5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing scars (excoriation) or picking at oneself.
  6. Affective instability due to marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness and worthlessness.
  8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress related paranoid ideation, delusions or sever dissociative symptoms. (APA, 2000, pp. 292-293)
BPD can often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

My movie recommendation for understanding BPD dynamic: 
Mommie Dearest

In case you want to deepen your understanding of your relationship with your parents, please take a look at my online workshop “Mending our childhood wounds and patterns” HERE.

This workshop will help you with understanding the patterns, roles and attachment you are having in your family dynamic and will shine the light on your behaviors and wounds you are carrying with you. It will also teach you how to deal with your emotions that will evoke through this self-discovery.