24h-payday

Archive

Archive for the ‘Birth Trauma’ Category

Kathy Morelli Shares Highlights from the 2014 Postpartum Support International Conference

July 15th, 2014 by avatar

Regular contributor Kathy Morelli attended the Postpartum Support International conference in Chapel Hill, North Carolina this past month.  In today’s post, Kathy shares her thoughts, some big take-aways and checks in with the keynote speakers, who share important messages on postpartum mood disorders with our S&S readers.  We all have a responsibility to increase awareness and treatment options for pregnant and postpartum women.- Sharon Muza, Science & Sensibility Community Manager.

PSI QuiltI want to shout from the rooftops that there are so many well-educated, caring and ethical professionals who are focusing on Maternal Mental Health! I was so fortunate to be able to attend this year’s Postpartum Support International 27th Annual Conference at the University of North Carolina (UNC) campus at Chapel Hill on June 18 – June 21, 2014.

PSI’s theme this year was “Creating Connections between Communities: Practitioners and Science: Innovative Care for Perinatal Mental Health.” It was a wonderful meeting where scholar-practitioners in the Perinatal Mental Health field met and exchanged information and best practices in order to hone their collective craft. Researchers, clinicians and identified survivors met and shared their professional and personal stories. PSI’s outgoing president, Leslie Lowell Stoutenburg, RNC, MS, reports that PSI had its largest attendance ever this year.

The keynote speakers were a group of experienced professionals, researchers and clinicians presenting on clinical, scholarly and advocacy topics: Dr. David Rubinow, of UNC Chapel Hill, Dr. Samantha Meltzer-Brody of UNC Chapel Hill, Dr. Marguerite Morgan, of Arbor Circle Early Childhood Services in Grand Rapids, Michigan, Ms. Joy Bruckhard of California’s 20/20 Mom Project, and Dr. Susan Benjamin Feingold, clinical psychologist, all presented about their work in the different aspects in the field of Maternal Mental Health. Advocate Katherine Stone of Postpartum Progress served as emcee at the Saturday night banquet.

Dr. David Rubinow presented on his team research regarding female hormonal fluctuations and the relationship to postpartum mood disorders in sensitive women. Dr. Rubinow is an internationally known expert in the evaluation and treatment of women with mood disorders that occur during periods of hormonal change. Regarding the team’s research, he states “Our data demonstrate that normal changes in reproductive hormones can produce affective disturbance in a susceptible group of women.” The study (Bloch et al, 2000) examined the role of endocrine factors in the etiology of postpartum depression (PPD) by comparing women with a history of PPD and without PPD. Progesterone and estriadiol was measured at baseline, addback, withdrawal, and folIow-up. 67% of the women who had PPD had a recurrence of significant affective symptoms, including a constellation of depressive and hypomanic affect, while none of the control group experienced significant affective symptoms. This indicates that women who suffer from PPD may have a trait vulnerability that isn’t present in women who do not suffer from PPD.

Dr. Susan Benjamin Feingold, the keynote speaker on Saturday evening, presented on her clinical work around the transformational nature of surviving postpartum depression, documented in her newly released book, Happy Endings, New Beginning: Navigating Postpartum Mood Disorders. Dr. Feingold presented inspirational journal entries from women in her clinical practice. She says: “ In my book, I focus on a new view of the postpartum experience and how this difficult time can be a catalyst for change, personal growth and positive transformation. Postpartum depression can be the opportunity for not only healing, but ultimately, it can be a life-changing event.”

Ms. Joy Bruckhard, MBA, of Cigna, presented on her advocacy work in as one of the founders of the Maternal Mental Health Care Collaborative in California called the 20/20 Mom Project. The 20/20 Mom Project is a national campaign and movement for moms and by moms to create specific pathways to treatment for maternal mental health disorders, to address barriers to mental health care. The 20/20 Mom Project has teamed up with Postpartum Support International, a sister non-profit to launch first-of-a-kind web-based training for clinical professionals with the aim of addressing the shortage of mental health and medical professionals who specialize in maternal mental health. Joy says: “I’m so honored to be a part of this important work. Three years ago, my worlds collided: my training through Junior League, my experience in health care working at Cigna and having had two babies myself (and perhaps mild postpartum depression), and some family experience with mental illness, I felt compelled to step up and do more.”

Dr. Samantha Meltzer-Brody, a psychiatrist at UNC Chapel Hill, presented about the ongoing stigma about using psycho-pharmaceuticals during pregnancy and breastfeeding. She expressed frustration that other medications are readily accepted for use during pregnancy, but that there is an ongoing stigma against using medications that treat the mother’s mental health.

Dr. Marguerite Morgan, LCSW, presented on her successful program with African American women at the Arbor Circle Early Childhood Services in Grand Rapids, Michigan. She emphasized that she drops her “PhD-Dr” demeanor and constantly strives to connect at a human level with the people she serves. She is well versed in Christianity and quotes biblical passages about helping oneself during dark times, thus normalizing the experience of depression to her population in an accessible manner.

The psychodynamic approach to perinatal mood disorders was presented by Ms. Lorraine Caputo, LMFT, which addresses the mental health of women across the lifespan. Research and clinical practice indicates that a woman’s previous life experiences can have an impact on her transition to parenthood. On the lifelong care of a woman’s mental health, Ms. Caputo says: “I believe it’s crucial to help women with a history of trauma to make connections between the past and present in a way that psychodynamic treatment is uniquely poised to provide. The perinatal period is a natural time of enormous change, and in the best of circumstances will cause dysregulation, psychological transformation and re-identifications and dis-identifications with one’s own parents. And, given how entirely a pregnant woman and a postpartum mother surrenders her body to her child, childhood sexual traumas in the mother’s past can be triggered by this intense period of physical and emotional bonding with her baby. A psychoanalytic intervention that involves the development of a coherent narrative about how she was parented, and making connections between unrelenting anxiety, ruminations, self blame, and her past history can free a new mother from self doubt, guilt, and fear that she will not be a good mother. This work is done in a carefully paced way, using self reflection and the relationship with the therapist to help the mother feel safe and her powerful feelings contained and held by the therapist.”

Dr. Kelly Brogan, of Womens Holistic Psychiatry, discussed holistic clinical pathways to reproductive mental health.

Of note was the unique reproductive psychiatric sharing session, where reproductive psychiatrists came together to discuss clinical situations which they have encountered. This session was an extension of the collaborative professional LISTSERV that PSI hosts for clinical member reproductive psychiatrists.

Sessions on Healthy Postpartum Relationships were presented by both Ms. Elly Taylor and Ms. Karen Kleiman, LMFT, of the Postpartum Stress Center. Karen Kleiman has recently published her book, Tokens of Affection: Reclaiming Your Marriage after Postpartum Depression, informed from her extensive clinical experience with postpartum couples. Ms. Kleiman presented her overarching framework for treating distressed postpartum couples, identifying 8 tokens to be cultivated in the therapeutic encounter. One of the tokens she refers to as a “Token of Affection.” Ms. Kleiman notes: “Recovery from postpartum depression does not happen overnight, thus, creating a lag between the crisis and a sense of well-being for the couple. During this transitional period both partners are anxious to return to normal while they are simultaneously challenged by buried negative emotions and unmet expectations. Tokens of Affection are gift-giving gestures on behalf of the relationship. As a reparative resource, the Tokens lead the way toward renewed harmony and reconnection.”

Elly Taylor remarks: “It’s common for couples – even happily married ones – to find that the bond between them becomes stretched following the birth of their baby. This comes as a shock for most and increases the risk for perinatal mood disorders for some. But prepare for this, and its possible not only to protect the bond, but build on it as the foundation for family.” She has recently published her book about the postpartum couple’s experience called, Becoming Us, in the United States.

Included here are some closing thoughts from the incoming PSI president, Ann Smith, RN, MSN, CNM:

“PSI is the original and leading organization dealing with perinatal mood disorder which we now know affects approximately 1 in 7 moms. It’s the leading complication of childbearing. All women can be affected regardless of age, race, socioeconomic status and whether the pregnancy was wanted. When treated promptly and by someone who has familiarity with these disorders, moms get better quite quickly. PSI has training programs nationwide which train providers in evidence based treatments. Many women need a combination of medication and talk therapy to get better as quickly as possible. There are a number of medications which have been proven safe for pregnancy and breastfeeding. Support groups are also helpful.

PSI wants everyone to remember three things:

You are not alone, you are not to blame, with help you will be well.

For assistance, call the PSI Warmline at 800-944-4PPD or visit online

References

Bloch, M., Schmidt, P. J., Danaceau, M., Murphy, J., Nieman, L., & Rubinow, D. R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry157(6), 924-930.

.

Babies, Birth Trauma, Childbirth Education, Guest Posts, Infant Attachment, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, PTSD, Trauma work , , , , , ,

Every Day Should Be Maternal Mental Health Awareness Day! What Educators Need To Know!

May 27th, 2014 by avatar

Friday_may_campaignMay is Maternal Mental Health Awareness month, when agencies on the local, state and federal level along with private and public organizations promote campaigns designed to increase awareness of perinatal mood disorders.   While it is good to increase awareness of the symptoms, sources of help, treatment options and impact of perinatal mood disorders on parents, families and communities during the month of May, the focus really needs to be 365 days a year!  Over 4 million babies are born every year in the USA.  Pregnancy and birth happen every single day to women and families.  Perinatal mood disorders affect women and their families every single day!

Recently, the tragic death of three young children in Torrence, CA was in the news and the children’s mother was arrested on suspicion of murdering her three daughters.  While many details have yet to be made public, this was a new mother  whose youngest child was just two months old.  This woman may have been experiencing a crisis as a result of a postpartum mood or anxiety disorder (PPMAD).

Take this quick ten question quiz and test your knowledge of perinatal mood disorders.  Then read on to find out more and what you can do to help the families that you work with.

While PPMAD can affect a mother during pregnancy or the first year postpartum, there are some risk factors that may increase the likelihood of a woman experiencing this complication:

The above list is from the resource: Postpartum Progress

There is a wonderful three minute video from the 2020 Mom Project that explains more about why so many women are not receiving the help they need. This video was released by the National Coalition for Maternal Mental Health. We do not have the infrastructure in place that screens every woman or enough skilled providers who can recognize the symptoms and provide or refer to suitable treatment options.

Some typical (but not all inclusive) symptoms of Postpartum Mood and Anxiety Disorders

  • Are you feeling sad or depressed?
  • Do you feel more irritable or angry with those around you?
  • Are you having difficulty bonding with your baby?
  • Do you feel anxious or panicky?
  • Are you having problems with eating or sleeping?
  • Are you having upsetting thoughts that you can’t get out
  • of your mind?
  • Do you feel as if you are “out of control” or “going crazy”?
  • Do you feel like you never should have become a mother?
  • Are you worried that you might hurt your baby or yourself?

Childbirth educators and others who work with women during the childbearing year have a responsibility to discuss, share, educate and provide resources to all the families they work with.  Ignorance is not bliss, and the more we discuss the symptoms, risk factors and resources that are available to help families in need with those we have contact with, the fewer women will suffer in silence and go without the help they need.

Resources for Women and PartnersPostpartum Progress

 Postpartum Psychosis Symptoms (in Plain Mama English)

Postpartum Support International 1-800-944-4PPD

 National Suicide Prevention Lifeline 1-800-273-TALK

Mother to Baby (formerly OTIS)

Medications & More During Pregnancy & Breastfeeding.

(866) 626-6847

Text-4-Baby Health Info Links

How do you talk about perinatal mood and anxiety disorders in your classes?  What activities do you do to convey this information effectively?  Do you bring up this topic again at the childbirth class reunions you attend?  Can you share what works well for you so that we can all learn?  What have your experiences been in helping women and their partners to be knowledgeable and informed? What do you do to be sure that every day is Maternal Mental Health Awareness Day?

 

Babies, Birth Trauma, Breastfeeding, Childbirth Education, Depression, Infant Attachment, Maternal Mental Health, Paternal Postnatal Depression, Perinatal Mood Disorders, Postpartum Depression , , , , , , , , , ,

Book Review: Traumatic Childbirth and an Interview with the Author – Cheryl Beck

January 9th, 2014 by avatar

By Walker Karraa, PhD

It is thought that traumatic childbirth affects up to 34% of all birthing women, but frequently there is inadequate prenatal preparation for what to do if an individual woman has this experiences and scant resources for women seeking support and help.  The experiences are minimized and our society creates a fence of isolation that women with birth trauma are surrounded by.  Today, Walker Karraa, PhD reviews a new book geared for professionals and interviews the author, Cheryl Beck, DNSc, CNM, FAAN,  so that we can be better prepared to recognize trauma, support women and provide resources. What are you doing as a birth professional and childbirth educator to help women who may be at risk or or who have experienced birth trauma? – Sharon Muza, Science & Sensibility Community Manager

 …a fascinating and full-bodied presentation of the emerging understanding of the impact of traumatic childbirth on mothers, fathers/partners, and providers.

Traumatic Childbirth1 should be required reading for any birth professional. The trifecta of midwife, pre-eminent researcher and Distinguished Professor at the School of Nursing, University of Connecticut, Cheryl Tatano Beck, clinical nurse specialist in psychiatry, psychotherapist and author Jeanne Watson Driscoll, and survivor, activist and founder of TABS Sue Watson, provides the most comprehensive resource on traumatic childbirth for health professionals to date.

© Cheryl Beck

© Cheryl Beck

Since Cheryl Beck’s ground-breaking research, Birth trauma: in the eye of the beholder2 (2004a), health providers, researchers, and birth professionals have applauded the relevance and strength of Cheryl Beck’s research regarding traumatic childbirth. Her research has covered PTSD following traumatic childbirth3-4, the experience of the anniversary of birth trauma5, breastfeeding after a traumatic birth6, subsequent birth after a previous traumatic birth7, secondary trauma experienced by labor and delivery nurses exposed to traumatic birth8, and multiple publications on research methods and birth trauma 9-12.

In 2006, Cheryl and Jeanne Watson Driscoll (co-author of the landmark Women’s moods: What every woman must know about hormones, the brain, and emotional health13) collaborated on what is still considered a clinical tour de force in perinatal mood and anxiety disorders, Postpartum mood and anxiety disorders: a clinician’s guide14.

TABS (Trauma and Birth Stress) was founded by Sue Watson and colleagues in 1998 and continues to offer current resources and support regarding traumatic childbirth.

In Traumatic Childbirth, Cheryl, Jeanne, and Sue offer their individual expertise as researcher, clinician, and activist and combined wisdom of nearly two decades of work in the field. The result is a compelling read and review of current literature. The case studies are profound examples of the lived experiences of traumatic childbirth. Additionally, after each case Jeanne and Sue offer their own perspectives. It is a fascinating and full-bodied presentation of the emerging understanding of the impact of traumatic childbirth on mothers, fathers/partners, and providers.

I am honored to have had the opportunity to ask Cheryl some questions for Science and Sensibility regarding how childbirth professionals might use Traumatic Childbirth in practice. I know that you will find her insights both useful and encouraging.

Walker Karraa: How has the definition of traumatic childbirth evolved since you began your work?

Cheryl Beck: In the beginning of my research traumatic childbirth was viewed as an event that occurs during labor and delivery that involved actual or threatened serious injury or death to the mother and or her infant. After my first 2 studies on birth trauma and its resulting PTSD what I learned was that traumatic childbirth can also occur even if a woman does not perceive that she or her infant is at risk for serious injury or death. Women can perceive their birth as traumatic if they perceive that they were stripped of their dignity during the birthing process.

WK: How does loss of dignity play a role in the traumatic birth?

CB: One of the most frequent phrases I hear mothers using to describe their traumatic their birth to me was “I felt raped on the delivery table with everyone watching and nobody offering to help me.” Some women shared that they felt like a piece of meat on an assembly line. Women did not feel cared for by the obstetrical team. To me this lack of caring stripped women of a protective layer during their labor and delivery and left them prime to perceive their birth as traumatic.

WK: How important is it for childbirth professionals to understand the subjective experience of childbirth trauma when working with clients?

CB: It is essential for childbirth professionals to hear and really listen to the voices of mothers as they describe what it was about their labor and delivery that was so traumatic. As the title of my first research study tried to impress upon health care providers, birth trauma is in the eye of the beholder. What one woman perceives as a traumatic birth may be viewed quite differently through the eyes of obstetric staff that may see it as a routine birth.

WK: What are some of the ways childbirth educators, doulas, and lactation consultants might use Traumatic Childbirth in developing curriculum or direct service to clients?

CB: Childbirth educators, doulas, and lactation consultants can use the various chapters in Traumatic Childbirth to develop a series of classes for education. Examples of some of these chapters in the book include:

  • Risk factors for postpartum posttraumatic stress
  • Assessment and diagnosis
  • Instruments to screen for PTSD
  • Impact of traumatic childbirth on breastfeeding
  • Anniversary of birth trauma
  • Subsequent childbirth after a previous traumatic birth
  • Treatment methods for PTSD
  • Fathers and traumatic childbirth

WK: As doulas are increasingly becoming a part of birth team, they too are exposed to traumatic births that may lead to distress, impairment and disability in their work. Given the findings in your recent study11 regarding secondary traumatic stress for labor and delivery nurses, I wonder what your thoughts are regarding how doulas might prepare, or even prevent secondary trauma for themselves using Traumatic Childbirth?

 

© Cheryl Beck

© Cheryl Beck

CB: In 1989 Charles Figley15  first wrote about the “cost of caring” for supporters of traumatized victims. He called it secondary traumatic stress or compassion fatigue. Doulas who have built up such a close relationship with the women they are supporting through labor and delivery certainly are at risk of developing secondary traumatic stress. Continuing education is a must for doulas to learn about their risk of secondary traumatic stress and the symptoms they should be watching. Self-awareness of these symptoms is essential so that doulas can get the help they need. Doulas need to learn how to nourish their mind-body-spirit. Debriefing sessions, support groups, and opportunities for doulas to share the traumatic childbirths they have been present for are necessary.

WK: I so appreciate the inclusion of fathers in your book. When I was practicing as a doula I had several fathers who they themselves had risk factors for traumatic stress due to experiences in military or law enforcement. Knowing that upfront, we were able to strategize labor and birth in ways to mitigate exposure to triggers (i.e. < seeing too much blood, not being able to see an open door, etc.). How could Traumatic Childbirth help childbirth educators include partners in the conversation about traumatic childbirth?

CB: Researchers are finding that fathers can also develop posttraumatic stress symptoms as a result of being present at their partner’s traumatic childbirth. This possibility for fathers should be address in one of the childbirth classes. As one father in a research study of mine and Sue Watson’s shared “I am on an island watching my wife drown and I don’t know how to swim! I not only do not know how to swim but I was drowning myself. But I am a man, I do not need help-John Wayne, you know. I was fooling myself at the expense of my wife and myself.” This quote impresses on childbirth educators their responsibility to also be helping the fathers and support them if he and his partner have experienced a birth trauma.

WK: One of the things I note is that we don’t yet have support systems within childbirth organizations to help our childbirth educators and doulas seek support for themselves, or colleagues who suffer extreme distress after attending traumatic births. This is particularly devastating for new doulas who may not know their own risk factors, or the signs and symptoms of traumatic stress following exposure to traumatic childbirth. What are some ways childbirth organizations such as Lamaze can use Traumatic Childbirth to inform policy and prevent secondary traumatic stress in doulas and childbirth educators?

CB: At the annual conferences of these organizations, workshops, sessions, or keynotes on secondary traumatic stress due to traumatic childbirth are a must. The first step in helping to prevent this or minimize secondary traumatic stress is education. Breakout sessions at the conferences could be offered by a mental health care professional for doulas, lactation consultants, and childbirth educators to provide an opportunity for them to share their traumatic experiences.

Conclusion

For those who have followed the research on traumatic birth, this book has been a long time coming! Traumatic Childbirth is a highly readable, compelling and comprehensive collection of research, practice, and perspective that speaks to the birth professional’s sensibilities. I highly encourage the discussion of implementing this material as required reading, and instituting the suggestions of debriefing workshops for professionals. I look forward to hearing your thoughts on this, as well as the book!

I know I speak for so many in thanking Cheryl Beck for her input, and to both Jeanne Driscoll and Sue Watson for their tremendous contributions in Traumatic Childbirth, and their dedication to the prevention and treatment of traumatic birth.

References

  1. Beck, C. T., Driscoll, J.W., & Watson, S. (2013). Traumatic childbirth. New York, NY: Routledge.
  2. Beck, C. T. (2004). Birth trauma: in the eye of the beholder. Nursing research, 53(1), 28-35.
  3. Beck, C. T. (2004). Post-traumatic stress disorder due to childbirth: the aftermath. Nursing Research, 53(4), 216-224.
  4. Beck, C. T. (2011). A metaethnography of traumatic childbirth and its aftermath: Amplifying causal looping. Qualitative Health Research, 21(3), 301-311.
  5. Beck, C. T. (2006). The anniversary of birth trauma: failure to rescue. Nursing research, 55(6), 381-390.
  6. Beck, C. T., & Watson, S. (2008). Impact of birth trauma on breast-feeding: a tale of two pathways. Nursing Research, 57(4), 228-236.
  7. Beck, C. T., & Watson, S. (2010). Subsequent childbirth after a previous traumatic birth. Nursing research, 59(4), 241-249.
  8. Beck, CT, & Gable, RK (2012). A mixed methods study of secondary traumatic stress in labor and delivery nurses. Journal of Obstetric Gynecological and Neonatal Nursing, 41, 747-760. doi:10.1111/j.1552-6909.2012.01386.x
  9. Beck, C. T. (2005). Benefits of participating in Internet interviews: Women helping women. Qualitative health research, 15(3), 411-422.
  10. Beck, C. T. (2006). Pentadic cartography: Mapping birth trauma narratives. Qualitative Health Research, 16(4), 453-466.
  11. Beck, C. T., Gable, R. K., Sakala, C., & Declercq, E. R. (2011). Posttraumatic Stress Disorder in New Mothers: Results from a Two‐Stage US National Survey. Birth, 38(3), 216-227.
  12. Beck, C. T. (2009). Critiquing qualitative research. AORN journal, 90(4), 543-554.
  13. Sichel, D., & Driscoll, J. W. (1999). Women’s moods: What every woman must know about hormones, the brain, and emotional health. New York: William Morrow.
  14. Beck, C. T., & Driscoll, J. (2006). Postpartum mood and anxiety disorders: A clinician’s guide. Jones & Bartlett Learning.
  15. Figley, C. R. (Ed.). (1989). Treating stress in families (No. 13). Psychology Press.

 

 

 

Birth Trauma, Book Reviews, Childbirth Education, Guest Posts, Trauma work , , , , , ,

What is Pregnancy Negation? What is the Childbirth Professional’s Role?

November 14th, 2013 by avatar

Today on the blog, regular contributor Kathy Morelli shares information on an uncommon but very serious mental health disorder called pregnancy negation (pregnancy denial and pregnancy concealment) that can occur in women.  This unusual phenomena may never have crossed your radar or you may have met women who have experienced this situation.    Learn more here about this illness and what you can do as a childbirth professional, should you meet a woman or family dealing with this situation. –  Sharon Muza, Community Manager for Science & Sensibility.

Original Painting © Johann Heinrich Füssli

The research studies about negation of pregnancy generally consist of small sample sizes, so there isn’t a lot of data available about negation of pregnancy. More study is needed in order to understand this topic more thoroughly. I do see this phenomena in my psychotherapy practice, so I believe it’s a topic that birth professionals might see it in their community as well.

Negation of pregnancy, a term that encompasses both pregnancy denial and pregnancy concealment, are rare, but not uncommon, disorders of pregnancy. One in 475 pregnancies result in negation of pregnancy. A very minute portion of this statistic results in neonaticide- the act of killing a baby in the first 24 hours of life (Beier et al, 2006).

As with other psychological conditions, the underlying etiology of negation of pregnancy exists on a spectrum. The person can suffer from a lifelong, persistent “splitting” of the self due to trauma, she can suffer from a persistent biological mental illness, such as schizophrenia, or she can be experiencing a type of severe adjustment disorder.

Current research indicates that not all women who experience negation of pregnancy have previous diagnoses of serious and persistent mental illness. Some women who experience negation of pregnancy have pre-existing diagnoses of biploar with psychotic features and schizophrenia, and psychosis is part of their life experiences. But others do not have a previous diagnosis and after integrating the episode of negation of pregnancy, they adjust to their life situation and cope realistically.

Definition 

Pregnancy denial is defined as a woman’s unawareness, in varying degrees, of her pregnancy. Pregnancy concealment is defined as actively deciding and hiding the pregnancy from others. Pregnancy denial and pregnancy concealment often co-occur and occur intermittently. There is usually a great deal of shame, fear, guilt and dissociation, a strong psychological and emotional defense, accompanying this disorder. Due to the level of emotional conflict around the pregnancy, there are gradations of denial and complexity and subtlety of emotional response from both the pregnant woman and those around her.

The term negation of pregnancy is also used to encompass and describe these co-occuring disorders, whereas the internal process is called denial and the external process is called concealment. Therefore, it is considered the same process, but the woman’s defense mechanisms vary in intensity.

Neonaticide, the killing of an infant on the day of birth, is a form of infanticide that is often preceded by pregnancy denial. Neonaticide can be one of the complications of pregnancy denial.

Pregnancy denial is a real phenomena that has a long history of documentation, by doctors, mothers, their families and artists.

One famous literary exploration of pregnancy denial and neonaticide is illustrated in George Eliot’s novel, Adam Beade, published in 1859. It is the novel of a woman’s experience, examining the intersection between women’s unique emotions around reproduction and their disempowered social standing. Taking place in 1799, the story is about a love triangle involving Hetty, a 17 year old girl. She becomes pregnant out of wedlock. Hetty knows she is pregnant, but never openly acknowledges this. She knows she will face extreme shame and ostracization by the town, should anyone find out. She successfully hides her pregnancy and gives birth to her baby in a field. She commits neonaticide, abandoning her baby boy where she birthed him.

Characteristics of Women Who Negate Pregnancy

Early research indicated that pregnancy denial and neonaticide is more likely to occur  in women who are young and unmarried, where the relationship with the father is dissolving or non-existent and the woman lives at home with relatives.

However, more recent research shows that pregnancy denial and neonaticide occurs in women of all age groups, cultures and marital status in response to a conflicted pregnancy. Many women already have several other children, so it is not always the first time mother who negates her pregnancy.

Research by Shelton and colleagues (2011) indicates that pregnancy at an early age, multiple young children, a history of childhood abuse and trauma, current fear of abandonment (even if in a stable relationship), and a deprived social situation are all risk factors and common characteristics for women who negate their pregnancy.

The pathway to pregnancy denial and concealment often begins with an unplanned pregnancy. The woman has accompanying feelings of extreme fear and shame. She begins with pregnancy concealment. She hides her pregnancy with baggy clothes and isolates herself in her room. To help facilitate concealment, she sees less and less of people. Thus, she becomes more and more emotionally isolated.

Eventually, she finds she has no one to confide in. This results in a vicious cycle, and her emotional defenses develop a sense of pregnancy denial. The pregnancy denial is described by researchers as intermittent, her lack of self-awareness comes and goes and she is able to compartmentalize her pregnancy. She successfully dissociates from her body sensations.

The denial and dissociation is so potent that women often describe beginning birth pains as flu symptoms, gas pain and menstrual cramps. Women often go to the bathroom and deliver the baby silently, with others nearby. Women often describe the feeling of giving birth like having to defecate and are shocked when a baby appears.

Women in this type of delivery report dissociative symptoms at the birth and afterward when coping with the newborn. Women also often report a fantasy that the infant was preterm or stillborn. Often, sadly, the outcome for infants born to women who are experiencing negation of pregnancy are death a short time after birth, either from drowning in a toilet bowl, or hitting their head on the floor in a precipitous, unassisted birth.

Another fascinating aspect of pregnancy concealment and denial is that the family and even doctors are drawn into “community denial” by the emotional intensity of the denial. Interestingly, in one study, only 5 out of 28 women studied who negated their pregnancy had any family members inquire about their pregnancy at all (Amon et al, 2012)! Another study indicates that even long term family doctors who know the woman well will sometimes fail to diagnose the pregnancy (Amon et al, 2012).

Treatment

Treatment for negation of pregnancy is as nuanced and varied as each individual case. Whenever there is dissociation of parts of reality and parts of the self, the treatment path can include techniques used to treat post-traumatic stress. Such techniques would include EMDR, guided imagery, object relations techniques embedded in an overall therapeutic structure that balances leaving a woman’s psychological defenses intact, while at the same time helping her through her issues of denial (Anonymous, 2003).

Depending on the cause and severity of the negation of pregnancy, the processing of dissociated emotional material, the buried shame, the confusing physical symptoms, and the integration of the parts of her self could take place over an extended period of time in a safe, therapeutic atmosphere.

In general, directly asking or accusing a woman who is negating her pregnancy about her situation isn’t an effective treatment method. In order to survive, the person has most likely developed a method of dissociative “splitting” or “compartmentalizing” differing parts of the self. It is a normal psychological response to dissociate from trauma in order to survive. Dissociative coping exists along a continuum, from intermittent denial to having developed separate parts of the self to contain the trauma (Amon, 2012; Anonymous, 2003).

For example, in order to survive complex emotional trauma, such as childhood abuse, incest, rape, pregnancy from rape/incest, a woman would survive by dissociating. She may have unconsciously developed a way to “split” or “compartmentalize” parts of her self. Her unconscious coping mechanism assigns one part of the self to be covertly sexually active while another part of the self overtly maintains the social and familial facade that she is not sexually active. The psychological defenses can be so strong that she has intermittent dissociative awareness about her pregnancy and even amnesia around childbirth.

On the other hand, a woman may be experiencing a less mild form of dissociation and negation of pregnancy. She may need time to integrate her pregnancy into her life and shift towards healthy adjustment, coping and planning.

What birth professionals can do

If you suspect you have encountered a woman with this condition, be aware of your own reactions to her situation. Convey an accepting attitude about her situation. It’s best not to ask her overt questions about her circumstances. Ask open-ended questions, wait for her responses. 

Importantly, convey an accepting attitude about sexuality, pregnancy and motherhood, without being overt.

Have a good set of referrals to health professionals, including mental health professionals,  in your area. You may not be able to help her in the moment, but there may be another time you’ll see her and she might be open to accepting help. Your accepting attitude could be part of her healing and reaching out.

Conclusion

To sum up, negation of pregnancy has been documented in the popular literature and in medical literature for many years. It was once thought that negation of pregnancy only occurs in young and unmarried women, but current research shows that older women with multiple children experience this as well. It is a condition of many emotional and psychological nuances. In a very rare number of cases, can lead to neonaticide.

As a birth professional in your community, you can help by developing an awareness and understanding of negation of pregnancy as a real condition, with many emotional and psychological nuances. By being accepting and by having a solid set of referrals for her and her family if she reaches out to you. More study is needed in order to understand this topic more thoroughly. 

References

Amon, S., Putkonon, H., Weizmann-Henelius, G., Almiron, M.P., Gormann, A.K., Voracke, M., Eronen, M., Yourstone, J., Friedrich, M. & Klier, C.M. (2012). Potential predictors in neonaticide: the impact of the circumstances of pregnancy. Archive of Women’s Mental Health, 15, 167-174.

Anonymous (2003). How Could Anyone Do That? A therapists struggle with countertransference. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 201 – 208). American Psychiatric Publishing, Washington, D.C.

Shelton, J.L, Corey, T., Donaldson, W.H. & Dennison, E.H. (2011). Neonaticide: A comprehensive review of investigative and pathologic aspects of 55 cases. Journal of Family Violence, 26, 263-276.

Miller, L. J. (2003). Denial of Pregnancy. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 81- 103). American Psychiatric Publishing, Washington, D.C.

Spinelli, M. G., (2003). Neonaticide: A systematic investigation of 17 cases. In M.G. Spinelli (Ed.), Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill (pp. 105 – 118). American Psychiatric Publishing, Washington, D.C.

About Kathy Morelli

Kathy Morelli is a Licensed Professional Counselor in Wayne, NJ and the Director of BirthTouch®, LLC. She provides Marriage and Family counseling in Wayne, New Jersey with a special interest in perinatal mood disorders, sexual abuse and its impact on parenting. EMDR is one of the mindbody therapies she uses to address trauma.   She blogs about the emotions of pregnancy, birth, postpartum and couples. Kathy is the author of BirthTouch® for Parents-To-Be and BirthTouch® Healing for Parents in the NICU. Kathy has lectured on BirthTouch® at the University of Medicine and Dentistry of New Jersey’s Semmelweis Conference for Midwifery and at birth conferences. She presents trainings to allied health/birth organizations about maternal mental health, family systems and good-enough parenting and is found on web media, such as PBS’ This Emotional Life, writing and speaking about this subject. She volunteers on Postpartum Support International’s warmline. Kathy co-moderates #MHON , a psycho-educational and supportive Twitter chat led by credentialed Mental Health professionals around mental health issues, working to reduce the stigma around mental illness.

 

 

 

 

 

Babies, Birth Trauma, Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternity Care, News about Pregnancy, Parenting an Infant, Prenatal Illness, Trauma work , , , , , , ,

EMDR Part Three: Listening to Women; Personal Experiences of EMDR for Treating PTSD

February 28th, 2013 by avatar

In this series about EMDR (Eye Movement Desensitization and Reprocessing), Part One looked at qualitative research evaluating EMDR as treatment for post-traumatic stress disorder (childbirth onset). In Part Two, EMDR clinicians weighed in on their feelings about the safety of EMDR during pregnancy. When those EMDR posts were published, I received a lot of behind the scenes feedback from women who either loved or hated their experiences with EMDR; there didn’t seem to be a middle ground!

Women Thrive When They Learn Emotional Skills Istock/GoldenKB

I felt these women’s voices need to be heard (many thanks to Sharon Muza, S&S Community Manager, for her gracious agreement!) The results are here: four interviews conducted with four real women who suffered from trauma in the perinatal period and tried EMDR.

It’s unfortunate these lovely women suffered extreme emotional turmoil at such an important time in their life; when they were working and hoping to build their emergent family and when they were primarily responsible for the safety and care of their infants.

Through sharing their stories, all women indicated to me that they hope that their voices will contribute to the collective movement to incorporate mental health care into the overall care of women and their families in the childbearing year.

Characteristics of Their Trauma

All of the women interviewed experienced trauma in the early postpartum period. Three suffered specifically from birth trauma; all experienced a severe perinatal mood disorder. Three of the women additionally were coping with complex, long-term, multi-layered emotional trauma, stemming back to abuse in childhood.

All of the women interviewed were seeing licensed therapists who incorporated EMDR into their overall treatment plan for trauma. Some asked to have their identities masked, so identifying details and names are obscured, but the overall personal statements and feelings are preserved.

They are empowering to all of us in that ALL of them valued their mental health and were brave enough to seek professional help!

Personal Healing Processes

The women interviewed are all emotionally mature adults. They’re aware of their life situations and the impact of trauma on their well-being. They’ve worked hard to explore and develop life-long skills and methods of managing their emotions. Thus, these are all women who are proactive, sophisticated and intelligent about their emotional healing processes. Before they used EMDR, all of the women had already incorporated many forms of healing into their personal self-care plans.

Their self-care plans included: long-term psychotherapy, journaling, expressive therapies such as art, music and movement, yoga, exercising, gardening, cognitive behavioral therapy, goal setting and medication. One woman indicated she was in so much pain from long-term, severe, past abuse she had seriously discussed electroconsulsive therapy with her psychiatrist. So, when their trusted therapists suggested trying EMDR, specifically designed to treat trauma, all the women agreed.

Personal Perinatal Traumatic Events:

In their own words, the women share their individualized, personal perinatal trauma experiences below.

Birth Trauma:

Kim (not her real name) shares her traumatic birth story:

“My son was born after an easy pregnancy but a complicated birth. I’d very nearly had a vaginal birth; the nurses could see the top of his head, but it was turning to the side each time I pushed. After nearly 2 hours of this, I underwent a c-section because I had spiked a fever and things were not progressing. During my c-section, I was overcome by anxiety and completely paralyzed by fear.

I literally thought I was dying as my son was being born, yet due to the panic, I was unable to verbalize this fear to anyone.

I spent that time shaking and having what I thought were my last panicked thoughts and breaths. It was the the most afraid I’ve ever been in my entire life, and also the most alone I’d felt, despite being surrounded by others.

After the surgery, I wasn’t able to hold my son for 3 hours. I spent the time in recovery, scared that something were wrong and nobody was telling me. I am still not sure of the reason for the delay.

My maternity leave felt long, due to postpartum anxiety and depression and a baby who barely slept and I cried nonstop some days. I felt like a terrible mother who was unable to console her child or enjoy him. I felt tremendous guilt. In addition to the emotional aspects, my c-section scar was not healing properly, so I felt as if I were constantly making a 30-mile trek (newborn in tow) to my ob-gyn’s office for checkups. “

Birth Trauma Layered on Childhood Trauma:

Karen (not her real name) said:

“My very traumatic birth triggered already active memories of severe childhood abuse, parental suicidal attempts in front of me, active alcoholism & substance abuse in the family and severe childhood neglect.”

Helen (not her real name) said:

“I was working on birth trauma at the start of the EMDR, but later on, abuse, illnesses, and marital distress. I was mainly focused on the birth trauma I had experienced when I used EMDR.”

Postpartum Traumatic Event Layered on Childhood Trauma:

Jessica Banas explained her perinatal trauma as such:

“I was traumatized by my childhood with my father. He was very emotionally abusive. Seeing him overdose (on a drug called GHB) the first night my parents were to supposed to have been watching my infant son for me, so I could rest, felt like the ultimate betrayal. Once again, not only were they NOT there for ME, but I had to SAVE them (again) instead!!!”

Women’s Experiences Show Us Moms with PTSD Suffer Co-morbid Perinatal Depression & Anxiety

It is fascinating and sad that all three women with pre-existing trauma stated their prior trauma was re-triggered by a perinatal traumatic event (traumatic birth or other traumatic event postpartum). And all four suffered from severe postpartum depression and anxiety after their traumatic perinatal event. A woman’s mental health is an important aspect of the childbearing year.

As discussed in a previous blog post, one in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006). Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year. 

Having a personal history of a mental illness in her lifetime, such as depression, anxiety, PTS/PTSD, OCD or bipolar disorder (remember, this is whether it was diagnosed & treated or undiagnosed & untreated) increases a woman’s risk of postpartum depression. A previous history of previous postpartum depression increases a woman’s risk of a recurrence to 50 – 80 % risk of recurrent PPD, as compared to a 10- 20% risk factor without having had a prior episode.

It’s important to note that the women’s constellation of PTSD symptoms intensified and they developed severe postpartum depression and anxiety.

Jessica eloquently states how important women’s mental health is to the postpartum period:

” One important symptom of my PTSD that complicated and worsened my PPD was when my infant son would cry and interrupt my ruminations of my father Od-ing. I’d get angry….that would trigger thoughts of wanting to harm my son and cause me great anxiety and incredible guilt…..there were many times I was too afraid if I went to tend to him, I’d treat him harshly, or hurt him This created such a sense of worthlessness and shame, I thought of suicide one night. Instead, I told my husband and we reached out and got help.

It is a very important aspect of PTSD in that I am personally aware how detrimental it is on PPD. My PPD rapidly escalated after getting PTSD. And one seemed to feed on the other. Getting treated for BOTH issues was very important.”

Women’s Experiences Show Us the EMDR Outcomes

Two very positive experiences

Kim’s Experience with Traumatic Birth & Postpartum Anxiety & EMDR

Kim, who suffered from birth trauma and postpartum anxiety, had a positive experience with EMDR. Here is her story of healing.

Kim said that her therapist incorporated EMDR into her current psychotherapy sessions. She said she hadn’t realized that she’d been suffering with PTSD until almost a year after the incident. She says she discovered her anxiety was stemming from a traumatic birth experience at a therapy session:

Kim says:

“…of course I’d had PTSD from thinking I was dying while my son was being born! My anxiety, which had a lot to do with waiting for something terrible to happen to me or my son, started to make sense in light of this new revelation.”

Kim experienced the EMDR itself as calming. She held tappers in her hands while her therapist led her through visualizations. Her therapist warned her that EMDR could be emotionally triggering and if she needed to call her, she was welcome to do so. And it was triggering for Kim. After her first session, she suffered from an anxiety attack and had to call her therapist, and received the help she needed.

Ultimately, Kim’s overall experience with EMDR was emotionally freeing and healing.

She goes on to say:

“Up until the EMDR, I was unable to speak about my c-section at all. I couldn’t see anything related to the birth experience (with or without c-sections involved) on television, either. If I caught a glimpse of a birth on TV, I cried. I had a lot of anxiety on the few occasions I tried to watch A Baby Story on TLC, as a test to see how I felt watching another woman’s experience.

After EMDR a few times, I became more comfortable thinking about and processing my experience, and even eventually talking about it with others. I no longer viewed my scar as something horrible and ugly. Having EMDR gave me back my confidence because it helped me stop seeing myself as a failure (because I needed a c-section instead of birthing vaginally). “

Kim would recommend EMDR to another person trying to recover from trauma, but with some warnings about the emotional response.

Jessica’s Experience of Postpartum Traumatic Event, PPD, Suicidal Ideation & EMDR

Jessica, who experienced the trauma of her father’s overdose while her parents were supposed to be watching her baby, had a positive experience with EMDR. Here is her story of healing:

Jessica said that her therapist incorporated EMDR into her current psychotherapy sessions. Her therapist suggested she try something “new” that would remove the sting of the trauma from her mind. Jessica was skeptical but thought she’d give it a try.

Jessica says:

“The EMDR was pretty much wrapped around by talk therapy in that we’d start out by talking and end up by talking… EMDR took the emotional ties from the traumatic memories away. I no longer find myself reliving any of those memories that were treated with EMDR. I no longer feel any emotional pain from the OD event. I have no loss of sleep, anger, depression, or any anxiety over that event.”

Jessica says she did not find the EMDR emotionally triggering at all, but many childhood memories came flooding back. .

“Not at all…frankly, I thought it was lame at first (wiggling a finger in my face? REALLY?) and had no hope it would have ANY effect at all. Once we (quickly) healed the OD trauma, memories from my childhood did come flooding back! I found that to be very interesting! Fortunately, my childhood was not as terrible as many, so I could handle this phenomenon.”

Jessica recommends EMDR:

“…as long as the person is seeing a well trained, compassionate therapist! EMDR helped me and I have gone on to suggest it to other people who were in pain as I was….those people have been healed by EMDR as well….I find it a useful treatment and extremely non-invasive compared to other treatments!!”

Two very negative experiences

Karen’s Experience with Birth Trauma, Past Trauma, PPD, PPA & EMDR

“My experience was physical and emotional and in both cases negative. I felt physically ill, vertigo, nausea. Disorientation, short-term memory loss, headache. Emotionally, it was detrimental as it brought up my most difficult trauma and I felt completely triggered. I tried to hang in there with the process, but only did a few sessions. The EMDR sessions were not processed with in-between traditional talk therapy sessions. The EMDR made my symptoms worse, my anxiety worse, and the neurological side-effects were horrible. While my therapist did a wonderful job at regrouping,  after we decided to stop doing it, I actually went up on my medications and saw her 2x a week for a while. It was just too much. What I think had happened to me was more resurfacing of old memories that I had compartmentalized in years of talk therapy and medication. I actually think I needed a medication adjustment when I was so desperate for relief. “

Karen would not personally recommend EMDR to another.

Helen’s Experience with Birth Trauma, Past Trauma, Postpartum Mental Health Complications & EMDR

“My therapist suggested the EMDR may be helpful for both traumas (birth and childhood). I had 6 sessions that were each an hour long. Some of this process was also traditional talk therapy in between the EMDR. I found EMDR not helpful in treating my traumas.”

“It was extremely triggering and the therapist pushed me into a lot of it. She would try to help me regroup by taking deep breaths and little breaks in between. But I always felt drained after each session and even more triggered with PTSD.”

Helen would not recommend EMDR for another person:

“I do not think I would personally recommend EMDR to another person for a trauma. I believe the therapist shoved me into it too soon and left me for days swirling in the emotions of that. I have heard it can be wonderful and healing for others. For me, it triggered too much to soon and my experienced left me more traumatized. I can’t think of those (EMDR) coping skills and techniques without feeling overwhelmed with memories.” 

Conclusions

As we can see from real women’s experiences, EMDR was extremely triggering to two of the women, but resolved emotional distress well for the two other women. Again we are reminded that one size does not fit all when it comes to treating mental health.

The women’s experiences indicated that when working with EMDR for trauma, even experienced and trusted therapists encountered strong triggering responses in their clients. In these instances, these therapists needed to know how to appropriately re-group and therapeutically support their clients either in the session and/or be appropriately available outside of scheduled sessions.

It was not appropriate for a therapist to urge a client to try or keep using EMDR if the client did not really want to, or if the client was having an overall non-therapeutic effect.

As we can see from these real women’s experiences, the treatment of post-traumatic stress has the potential to be devastating to the client as far as awakening or re-triggering compartmentalized past emotional distress.

In this small article and small example, it is interesting to me that the four women who volunteered to share their stories in this small had extreme reactions to EMDR, none neutral. These results reinforce my usual conservative approach to managing emotional distress, that is, if one is suffering from debilitating mental and emotional distress, it is best to consult with a licensed professional.

What I find empowering about these interviews is that ALL of these women VALUED their mental health and were brave enough to seek help. Fight the stigma! Don’t be afraid to get help!

Author’s Note: None of these women were or are my clients. I sought out non-clients for the purpose of these interviews.

References

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Birth Trauma, Cesarean Birth, Childbirth Education, Depression, Do No Harm, EMDR, Evidence Based Medicine, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, Pregnancy Complications, PTSD, Research, Trauma work , , , , , , , ,