Nearly a Year Ago

My babies will be ONE tomorrow.  I can’t hardly believe it.  I never thought I’d be the type of woman who would say that the year just flew by or grieve the passing of such a special year, but I guess I am.  I take my babies for granted every day . . . and yet, every day they are a miracle to me.  I can hardly believe that after several years of heartache and pain, that I have two one year old girls and one five year old daughter.  I am blessed.

So why do I feel so crappy?  My mother in law is worried because I look pregnant.  No, I don’t think she’s rude for saying that . . . she said what I had been thinking, so I have to take it that much more seriously.  Why does my lower abdomen still hurt to be touched?  Why do I not EVER want to have sex?  And the constant spotting and cramping – I’m so tired of it.

Tonight I began researching the side effects of the Mirena IUD.  I tried to schedule an appointment with my OB/GYN, but he referred me to a GI person.  I’m going to cancel that appointment.  Perhaps I’m having GI trouble, but I really think it has something to do with the way Baby E was positioned, or the fact that my bladder was nicked during the cesarean, or a fibroid, or the reappearance of adenomyosis, or something.  I also suspect the Mirena.  It seems like there is an adjustment phase, an ok phase, and then a shit phase that continues to worsen.  I’m in the worsening shit phase, I’m sure.  So, I called and scheduled an appointment with my GP.  I’ll have her take it out and hopefully change my depression meds.  If that doesn’t work, Lord help me.

I have so much to be thankful for . . . why am I in so much mental and physical pain?

PTSD After Pregnancy Loss

I have taken the bones (and admittedly, most of the meat) from the post, PTSD after childbirth, to construct this post. I know personally and from talking to others that women can experience Post-traumatic Stress Disorder (PTSD) and Post-partum Depression (PPD) following birth losses. We enter our pregnancies with the fear of loss in the background – some worry more than others – but ultimately expect to be holding our beautiful babies in a mere 8 months after getting that BFP (big “fat” positive) on the home pregnancy test. I myself have been pregnant 4 times and have one living child. I have a lot to be thankful for. But 3 consecutive losses were almost too much for me.http://www.flickr.com/photos/parapet/

Yes, women can and do experience PTSD and PPD after miscarriage, pre-term birth loss, and still birth. The Florida Psychotherapy blog applies the DSM-IV-TR to childbirth related trauma. Let me apply the criteria outlined in that post to PTSD after loss(es).

According to the DSM-IV-TR, the following criteria must be met to be diagnosed with Post Traumatic Stress Disorder (PTSD):

A. The person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND the person’s response involved fear, helplessness or horror.

How a prospective mother views early pregnancy can contribute to PTSD. One of my sister-in-laws had an early loss but wasn’t terribly affected by it. I was shattered after my first loss. How did the prospective mother react to her loss? Did she panic? Did she cry a lot? Does she remember the entire experience? Has she withdrawn from her life? These and other reactions can be stress responses to her loss.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

  • Recurrent and intrusive distressing recollections of the event.
  • Recurrent distressing dreams of the event.
  • Acting or feeling as though the event were recurring (including flashbacks when waking or intoxicated).
  • Intense psychological stress at exposure to events that symbolize or resemble an aspect of the event.

Women who have experienced pregnancy losses can have nightmares about her losses. Strong images and flashbacks may occur at random moments, or she may have trouble NOT thinking about her experiences with pregnancy loss. Women who do participate in support groups and especially on-line forums need to be careful here. By continuing to relive and replay the experience, you may slow down your recovery.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the event) as indicated by at least three of the following:

  • Effort to avoid thoughts or feelings associated with the event.
  • Efforts to avoid activities or situations which arouse recollections of the event.
  • Inability to recall an important aspect of the event (psychogenic amnesia.)
  • Markedly diminished interest in significant activities, such as hobby or leisure time activity.
  • Feeling of detachment or estrangement from others.
  • Restricted range of affect; eg, inability to experience emotions such as feelings of love.
  • Sense of a foreshortened future such as not expecting to have a career, more children or a long life.

Here are some examples of how this many manifest. She may avoid places where she is most likely to encounter other pregnant women – play groups, gynecologist, church, heck . . . even the grocery store. She may have trouble relating to other friends with children and friends who are currently pregnant. She may be unable to watch shows that feature pregnancy and birth, look at milk cartons, hear about abused or murdered children, etc. She may no longer find pleasure in activities she once enjoyed. She may avoid sex and/or intimacy with her partner. She may not remember that she was bleeding all over the bathroom and that her young daughter saw the blood . . .

D. Persistent symptoms of increased arousal (not present before the event) as indicated by at least two of the following:

  • Difficulty in falling or staying asleep.
  • Irritability or outbursts of anger.
  • Difficulty concentrating.
  • Hyper-vigilance.
  • Exaggerated startle response.
  • Physiological reactivity on exposure to events that resemble an aspect of the event, eg breaking into a sweat or palpitations.

Moms may have an anxiety reaction when driving past their birth centers or hospitals. They may get anxious when discussing the birth or when birth stories come up in conversation. They may also feel detached from their baby, partner, family, or friends.

E. B, C, and D must be present for at least one month after the traumatic event.

I certainly experienced many of the above symptoms. I had an outright panic attack shortly after my first loss. After my second and third losses I was taking medicine to keep that from happening. I’ve had an incredibly difficult time concentrating since my losses began. I’m doing better now, but last Spring was agonizing.

F. The traumatic event caused clinically significant distress or dysfunction in the individual’s social, occupational, and family functioning or in other important areas of functioning.

Like postpartum depression, PTSD is highly treatable, meaning the woman can get better, sometimes very quickly. Treatment options include

  • talk therapies such as cognitive-behavioral therapy
  • medications and herbs
  • acupuncture
  • body therapies such as Eye Movement Desensitization and Reprocessing (EMDR), biofeedback, and hypnosis

I wasn’t able to recover quickly or easily and was prone to relapses. My last relapse was in August 2008. I went to a therapist and got tired of being told that “this is normal.” There is nothing normal about considering suicide. That is NOT an acceptable response, in my opinion, to any situation – merely “stressful” or absolutely traumatic. There is nothing normal about excessive drinking. There is nothing normal about not wanting to be around your partner or child (children). There is nothing normal about being nearly incapacitated for months and months. There is nothing normal about going out drinking and accidentally getting so drunk that you throw up in public, have to be driven home, black out, and want to kill yourself all over again. Of course, this last paragraph is MY situation, and I’m sure it may seem a normal response to recurrent pregnancy loss, but that doesn’t make it ok. I share these deep dark secrets with you so that you know if you experience these same or similar things, that you’re not alone. It may be normal, but it’s not ok. Please get help!

Additional resources:

Loss Never Ending

I can’t hardly breathe tonight.

My phone rang today.  Our good friends are in need.  She’s about to have their third baby, and since baby Y-H is about a week early, my friends parents haven’t arrived yet.  Other good friends are out of town, and I feel honored that they turn to us for support during this most important time.

But now as I clean up around the house . . . and am faced with new baby coupons and childbirth books and gmail friends’ status messages updating us on pregnancies and new babies . . . I am overwhelmed by my losses.

June 4 was a lifetime ago.  Geez, no, early April, my first loss due date was a lifetime ago.  That’s right, my June baby was my “perfect timing baby.”  And the unimagineable still happened.  I lost another baby.  My baby was due around September 15.  I (should) have a 4-week-old baby, and my best friend is about to have her baby.  She found out about her baby a few days before I lost mine.  No wonder she was such a wreck when she first saw me after my loss.  She was pregnant and pukey and in agony since her dream was coming true and my dream was dashed yet again.

She’s about to have her baby.  Her third baby.  I have coupons.

Gardens, Boga, and Mental Health

A couple of weeks ago I decided to go see the psychologist again.  I was starting to flip out, mostly because my health insurance company was being stupidly noncompliant regarding my benefits.  My amazing chiropractor was the one to suggest that I talk to the psych again.  It was a good but tough session.  He told me that I need to schedule – as in write it in my calendar – self-care time.  “Why will that work?” I stubbornly asked.  “I can just decide NOT to do it like everything else I blow off on a daily basis.”  The difference, I discovered yesterday, is that instead of asking myself what I would like to do, I need to tell myself what I should do.  Aha!!  So, today I have my list and am already crossing things off.

This morning I attended a “boga” class.  The class combines ballet and yoga and really kicked my flabby ass.  I’m certain to be sore in the core, legs, and lower back.  I DID IT, DR. S!  I scheduled a class and DID IT!  The instructor told us to pick one thing to focus on during the class.  I chose RESTORATION.  In my mind that word combines healing, calm, energy, blood flow, breath.  So, perhaps I “killed” a few birds with that stone.  (Not such a great metaphor for yoga, but too bad.)

I have spent more time with family, more time outdoors, and more time in my garden recently.  I have avoided e-mail.  I haven’t been keeping up on my google alerts.  I haven’t been frequenting the blogs I normally read.  Instead, I am focusing on nature over technology, organic healing over technologically-reproduced grief, relationship over escape.

Next week I start on new paths of inquiry, both professionally and personally.  I’ll blog about it from my summer home, Denver.

where am i

where am i

Some days I know where I am and why.  I know who I am.  I have a purpose.  Some days nothing makes sense.  Today my mind is scattered – responding to different on-line groups, procrastinating some big projects, half-way through editing a friend’s article, drinking coffee and not water, still not ready for my parents’ visit, avoiding calling the insurance company, twiddling my fingers until my appointment with the reproductive endocrinologist on June 5.

Ack.

It’s been a few weeks since I have read an ICAN post.  It’s been a few weeks since I have worked through my usual google updates.  Perhaps the shift from professor to simply mom and wife has thrown off other aspects of my routine.

Then again, it is more than time to begin establishing new habits.

Choosing cesarean limits future choices

I was irritated to discover that Time magazine published an article entitled “Choosy Mothers Choose Cesareans” in their special Environmental Issue. Since cesarean surgery is an over-used procedure[1], it is quite inappropriate for this type of article to appear along-side articles dealing with the Presidential candidates’ climate change positions and how the US can be more green.  Needlessly consuming medical services is anything but green, and Time magazine should take responsibility for its poor choice in content.

According to the article, more women are choosing cesareans, a trend doctors expect will continue.  I do not know nor have heard of anyone actually choosing a cesarean, save the stories I read or hear about through the media.  I believe that the media is creating this belief that women choose cesareans, and that this is a trend we should expect to see continue.  But perhaps it is true that women are choosing major surgery for reasons cited, such as (1) fear of ripping/tearing the perineum, (2) fear of incontinence, (3) fear of pain, (4) fear of birth, (5) or fear of having a stretched-out vagina.  Time‘s article feeds into the misperceptions of birth generated by Hollywood blogs and reality shows like A Baby Story.

Fear of ripping/tearing:  from what I have learned over the years, women rarely rip or tear during childbirth if they push following their body’s signs, are given appropriate time to labor and birth their babies, and/or have the perineum massaged or supported during pushing.  Episiotomies can cause more damage to the perineum, vagina, and anus than a natural tear anyway.  I wonder if this fear stems from botched episiotomies?

Fear of incontinence: cesarean delivery does not prevent incontinence.  Sorry!

Fear of pain: I wonder why so many women are taught to fear the pain of childbirth.  Granted labor was one of the most challenging things I have ever done, but I think my exercise habits and outdoor enthusiasm (road biking, hiking, backpacking, running) had prepared me for childbirth.  I don’t look back on my labor and regret the pain – I regret the fact that a cesarean became necessary.  Anyone who has done a little bit of study on the purpose of pain in childbirth can tell you that it is actually beneficial – it can indicate problems that need attention as well as provide important feedback to the mother and her careproviders regarding her progress.

Fear of birth: there actually is a term for women who have a fear (phobia) of childbirth – lockiophobia.  If a woman is not phobic, then she should work with a psychologist or psychotherapist to determine the root causes of her fear and overcome those.  Pregnancy can bring up psychological pains of the past, but they are not avoided through cesarean surgery.

Fear of a stretched-out vagina: do I really need to address this?

The title of my post suggests that cesareans will limit future choices.  This is true – women who have had a cesarean are at risk of being pressured into repeating surgery for future births, have a slightly more elevated risk of uterine rupture and other poor birth outcomes, are unable to have normal birth at most birth centers [2], may not be able to have a normal birth at their local hospitals [3], will be pressured to comply with hospital protocols that may lead to interventive birth outcomes for future births, may have difficulty finding providers who will support their choices in future births to name a few limitations.

Other things you may not know about cesarean aftermath [4]

  1. Risk of post-partum depression and post-traumatic stress disorder
  2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
  3. Stillbirth, miscarriage, infertility
  4. Pain, adhesions, slow recover, unsightly scaring
  5. Negative impact on relationships with other family members, particularly partners/spouses
  6. Rejection of birth – some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape

Thankfully I have come to learn about the viability and appropriateness of vaginal birth after cesarean.  I was encouraged to subscribe to the ICAN Yahoo list where I learned much of what I know now about birth that I didn’t know before my daughter was born.  I know the dangers of choosing cesarean for the first, second, or fifth time.  I have experienced stress, depression, and other tangible and intangible outcomes related to cesarean surgery.  I worry that my current trouble with recurrent pregnancy loss is related to the cesarean.  I resent that I have to consume more medical services to rule out uterine defects caused by the cesarean.  Tomorrow I will have a hysterosalpinogram performed.

It is regrettable that women such as Ms. Chung are led to believe and accept that cesarean birth is risk free, complication free, and consequence free.  It is simply not the case, and it does not take more than 30 seconds with an internet search engine to learn that much care should be taken when deciding if cesarean surgery is right for a woman and her baby.  The March of Dimes states that cesarean surgery should only be performed when the mother’s life or baby’s life is at risk.  Cesarean surgery is a blessing when used appropriately, but its safety is not justification for indiscriminate use.

[I sent a slightly abridged version of this post to Time magazine’s Editor.]

[1] The World Health Organization maintains that an acceptable rate of birth via cesarean surgery is 10-15%.  When the cesarean rate exceeds this range, the risks outweigh the benefits.
[2] To read the AABC’s recent statement on VBACs at birth centers, click here.
[3] Go to http://www.ican-online.org to see if your hospital allows VBACs.
[4] See also http://www.childbirthconnection.org/article.asp?ck=10166; read ICAN’s book, Cesarean Voices to learn how cesareans have impacted real women and real babies.