” It was pretty much totally unexpected. There were some parts of it, that labor would be challenging. The sort of lack of care that was the thing that just blew my mind and how difficult it was to recover from that birth and how there was not any forum to talk about it and pretty much every book that I picked up had nothing on it. “
Dr. Kendall-Tackett is a health psychologist and International Board Certified Lactation Consultant, and the Owner and Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health.
Background History: Kathy grew up in the 60’s and 70’s in Southern California and was the oldest of 4 kids. Her father was a veterinarian and her mother stayed at home raising her kids. She never really thought much about breastfeeding until she was pregnant with her first baby.
She never planned on staying at home with her kids. She trained as an academic researcher. Kathy finished her Phd exactly one month to the day of giving birth to her first baby. She finished on March 1st and had her first baby on April 1st. I would say this was cutting it very close.
She had a very difficult birth experience which turned her world upside down and changed everything for her. This redirected the work that she did. Kathy had a totally unexpected birth experience. She expected to have some challenges such as pain with her labor but nothing to the degree of trauma that she experienced. The lack of care she received is what she said really “blew her mind.” From how difficult it was to recover from the birth and that there was no forum to talk about it. She looked for information in books and could not find any. Trained as a trauma researcher, she started looking further into mainstream PTSD information which was all about combat vets, sexual assault and Holocaust survivors. This is was what was being studied at the time.
Trying to apply birth to that and realizing that it fit. There was no framework to talk about it. She was the first one to start writing about birth and PTSD in 1992. She recognized that it really did fit even though at the time you couldn’t formally diagnose PTSD . The criteria said that you had to experience something outside the normal range of human experience. Well, birth isn’t. Well from the very first criteria you get cut off. And yet the reactions and the elements of it really does fit. So that is what she was trying to show and she heard similar things from other mothers and so she knew she was onto something.
Every place she turned she was getting rebuffed but she was so overwhelmed by the experience that she had to keep talking about it. As a trained researcher, her strength was at taking literature and making connections and showing how they overlap. Kathy started going through the postpartum literature because she was trying to understand. At the time, she was living in the Boston area, which was the epicenter of hearing that “it was all hormones”. Mothers need to wean and you need to get them on a cocktail of drugs. That was the approach and you heard this at every conference you attended. And yet Kathy said that this was not what the literature was saying. This is why she wrote her first book. She wanted to lay out the studies to show all the points she was trying to make and the results that the studies showed.
What exactly what were you experiencing that put you on this quest to find out more information?
Kathy says that she just could not let it go. She thought about it all the time and needed to talk about it. It clouded her everyday life. She also kept hearing similar stories from other mothers. As she read the literature on PTSD, she kept seeing herself in these descriptions. She had classic re-experiences that were really hard, where certain sounds and smells triggered her. It was always on her mind.
Where did she find mothers to talk to about her feelings?
Some local mothers were not helpful. One of them even said: Well, you must not have exercised during your pregnancy. These were the kind of comments I was getting. This was not helpful.
Kathy did have one friend she knew from Graduate school who was one of the first person she could really talk to about this. She had a c-section 5 months previous and they talked a lot in the weeks following her delivery. But then she had another person she knew from graduate school who also had a c-section. This person said she didn’t think Kathy’s birth experience qualified as traumatic purely because it was a vaginal birth. As if you could not suffer a traumatic vaginal birth. Kathy’s birth was a vaginal birth and yet she did suffer from a traumatic forceps delivery that caused some damage.
How she found other moms to interview:
She put an ad in the postpartum depression (PPD) organization and people contacted her by phone and email. This was a while ago before email. She talked to them in depth and even though they started talking about how it was all hormones, and yet they went into a whole story about their difficult births. The hormones seem to be blamed for everything.
We send moms off to cope with postpartum all by themselves and we are surprised by the number of women who report birth trauma and depression. We are told that we are fine and so then we tell others that we are fine. A very common reaction from moms is to not want to say anything negative because after all ” we have a beautiful healthy baby.” Kathy says that having a beautiful healthy baby is a wonderful thing, but it does not negate what happened to us in the process. This is a very important distinction and you are not jinxing it to say the truth.
She has spoken to so many women who describe all kinds of both trauma. Kathy tells us about 2 moms who had c-section with failed anesthesia. When she was telling her father, who is a veterinarian about this he was appalled, saying ” we would not do that to an animal.”
If she thinks she is going to die, it does not matter if it is true or not. Practitioners will say things like: “well she wasn’t really in danger.” They will try and downplay it. Well from the mother’s perspective, it doesn’t really matter. If she thinks she is in danger, than her body is going to react to that and she is going to have some PTSD symptoms. We have to come at it from the mother’s perspective. What was this like from her perspective?
The WHO has issued a statement demanding that mothers be treated with respect and care during pregnancy and their births. The fact that we have to say that, highlights to us that there is a problem. We have a higher rate of women developing full criteria PTSD in the US then we had people living in lower Manhattan after 9/11. Higher after birth then after a terrorist attack??? Wow!
Having a healthy baby is wonderful, but sometimes mom might feel like a shell of herself after what she had to do to get there.
One of her friends was being told that she was a selfish bitch because she was complaining about having a c-section.
Was Kathy able to work through her own psychological trauma as she did the research?
Yes, she felt like she was able to help herself and work through some of her own trauma, by doing all this research. She felt like it was helpful as she does not get triggered and has been able to put the trauma behind her. It was a process that did change her life. She is still using all the academic stuff that she learned.
Second time: What did Kathy do during her second pregnancy to help her avoid having such a birth trauma.? She changed her primary care provider so she could go to a different hospital that had nurse midwifes. This offered her lots more flexibility to labor as she wanted to. She could get up and walk around, eat and drink. She also had a friend come to help her and act as her doula. She limited her food intake so she did not gain as much. She felt this would make the birth less traumatic. She wound up having an 11 pound baby and she feels strongly that, that not have happened if she was with her previous practice.
She definitely was able to birth in a way that facilitated labor better. She walked in as a much more informed consumer. She was still nervous about it because she did not know what to expect, but she did put things in place to set herself up for greater success.
How does birth trauma affect the early days of breastfeeding?
Kathy says that there is not a lot of research available. However, there is some things that we do know.
Anytime a mom has a highly stressful birth, it can suppress lactogenesis 2, the time when the milk becomes more abundant. This prompts Kathy to tell us to pay attention to any mom who has had a very traumatic birth. You should follow her closely as this can cause a problem with her baby not getting enough milk.
For people who have experienced trauma, a lot of skin to skin contact for some of the moms can trigger them. Sometimes it can be very subtle, but I have heard enough stories like this. When babies are placed skin to skin to and you notice that mom pulls back, she might have had some trauma issues that have been triggered. I have heard enough mothers stories where they talk about this. We need to pay attention to every mother/baby pair.
Prevention – What can moms do during their pregnancy to help them become more aware about depression afterwards and to help their partners to be more aware to help avoid depression
1. Look into the providers and ask questions. There is a big difference between providers. As about their c-section rate? Their epidural rate? This information is going to tell you a lot about the practitioner and how they practice.
2. Doula: Consider hiring a doula who will be there not only for the mom but for her partner also.
2. Midwifery: Kathy firmly believe in midwives attended birth as they are low intervention and have a differrnt model of birth.
3. Learn what your practitioner considers high risk: For example – BMI over 30 and is considered high risk and pushed into the high risk healthcare system, which is not automatically necessary. This is a built in prejudice and moms who are considered high risk, often more likely to have c/sec and higher rate of birth trauma.
4. Birth plan – may not always help if you are birthing at a hospital that has a high intervention rate.
5. If we catch PPD or PTSD in the early stages we can prevent it from becoming much worse. Pay attention to the mom and her partner as both can develop PPD.
6. If you feel sad and depressed and hopeful, look into it. – Don’t ignore this. There is help available and it does not always mean taking prescription medication. You have a lot of options. You don’t need have to take antidepressants.
7. If she can’t find help easily: Keep asking. Keep searching until she gets the help she needs.
We hope that you feel empowered enough to take the steps that you need to get good care of yourself. Depression is actually quite common. 10-15% is often quoted and this number is too low. 30-50% of those mothers have ..there is no shame in it. Depression is a normal response to very difficult life situations. Keep asking for help untl you get it. You may find that you get stupid answers from practitioners, but keep at it.
Keep asking until she gets the help she needs.
Where else can she go if she feels she is not being listened to:
PPSI: Postpartum Support International is knowledgeable and has a list of practitioners. You need to find someone that you can work with. If the first person you go to is not the best match, find someone who is a good match for you.
Medical providers such as: Family practice, physician a Nurse Practioner or Nurse Midwives. These practioners can help you.
Other ideas – self help books.
1. Kathy highly recommends a few books. The first one is: Feeling good the new mood therapy – David Burns
It is Do it yourself cognitive Therapy
Ten days to better self esteem is a shorter version.
This book talks about:
* Looking at thoughts and beliefs that you have that set you up for depression.
* Women are twice as likely to become depressed then men
* We tend to do things like take responsibility for things we cannot possibly control.
Kathy shared a funny/or not so funny story. She was at a conference and talking about this.
There is a list of 10 things that women who are at risk for depression and
One person came up to her and said: “I do all ten of these things.”
Other self help ideas that Kathy passed on to us:
** Mindfulness books
** talk to other mothers
** taking Omega 3 – 1000 mgs. of EPA usp.org gives names of brands that have been tested.
naturemade – no connections to brand
** exercise – get outside while you do this.
These are things to do to help yourself that help with major depression.
Writing about your trauma. She said that a researcher from University of Texas has studies this topic. He has found that writing/journaling about your trauma can help heal you. He has found that writing in a journal just 20 minutes a day for 5 days can cause a dramatic reduction in symptom. This writing should be thought out in that it needs to be thoughtful and strategic
Breastfeeding made Simple website: Breastfeeding made simple – handouts that talk about omegas and exercise
Extreme symptoms of depression can lead to psychosis:
** Not self help needs medical attention.
** Most common cause is unidentified biopolar
** Mom is prescribed antidepressants and this along with mis diagnosed bipolar disorder
can lead to a manic episode.
** Fortunately this is very rare, however, one of the things she has learned from interviews is that no sleep for 2-3 days beforehand can lead to psychosis. So, if you know of a mom who has not slept in 2-3 days, is talking very fast, has all these grandiose ideas, appears wired and is just not acting like herself, you want to help them seek medical attention right away.
Lori J. Isenstadt, IBCLC
Lori Jill Isenstadt, IBCLC is a huge breastfeeding supporter. She has spent much of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years. Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant. She has been helping moms and babies with breastfeeding for over 25 years. Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges. She is an international speaker, book author and the host of the popular itunes podcast, All About Breastfeeding, the place where the girls hang out. You can reach Lori by email at: [email protected] or contact her via her website: allaboutbreastfeeding.biz/contact
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