Maternal Post-Birth Well-being Assessment / Self Assessment / De-briefing

[AnyDream]

Julie, I answered the Edinburgh Depression scale a million times and none of the questions on it even remotely identify whether there has been a trauma experienced, hence my PTSD went undiagnosed until about 2 years later when a GP named it.

The things that indicate the trauma to me was - the inability to recall large chunks of what happened (I literally blanked it out for several months), and also a total dissociation from my body from the waist down (I was literally unable to touch myself for weeks afterwards). There was also a weird time thing where I stopped being able to track time at all, even something simple like eating a sandwich would take nearly an hour and I'd have no idea that much time had passed. The biggie though, was once I finally came out of denial, I remembered that I'd left my body and gone to a place of death and had to chose whether to live or not. Whether or not this actually happened (and the Dr I saw last week happily labelled it a psychotic episode to fit his own world view) the important thing about this event was that I believed that I wasn't going to make it out of there alive. When I finally told a few ppl about my experience, several of them sort of laughed at me, like how could that possibly be. So I'm not really sure how you would go building questions that cover the entire spectrum of "normal" debriefing right through to the really severe cases.

BTW, my baby was three days old before any of the nursing staff asked me how I was feeling. I had already identified a previous instance of reactive depression (at my admittance interview) so god only knows what deficit in care was going on at that hospital.

[Julie Doula]

Julie, I answered the Edinburgh Depression scale a million times and none of the questions on it even remotely identify whether there has been a trauma experienced, hence my PTSD went undiagnosed until about 2 years later when a GP named it.

That's what I thought, too Marydean. I don't think I would find that PND questionnaire that helpful. Especially not for actual PTSD.

The following is based on the diagnostic tool for PTSD from the DSM IV. Would you have found such a questionnaire helpful as a catalyst for talking abour your feelings, experiences, needs and ways to meet those needs?

(Thank you everyone for some excellent input and suggestions.)

"Can you identify with any of the following? Often? Sometimes? Rarely? Never?

* I experienced a traumatic event/events during/surrounding the birth which involved actual or threatened injury or threat to my physical integrity or my baby’s physical integrity

* The trauma keeps coming back to me in one or more of the following ways:

- I keep having thoughts, memories, flash backs or strong feelings about the birth or events surrounding the birth, often when I didn’t want to think about it

- I have disturbing dreams or day dreams about the birth or events surrounding the birth

- I sometimes act out or feel as if it was happening again, especially at times when I am half asleep or in my sub-conscious.

- I feel distressed when something reminds me of the traumatic things that happened – something little triggers a memory and then I feel upset.

- When the memories are triggered, I feel so upset I react physically – such as changes to breathing or heart rate, sweating, feeling dizzy, feeling sick or a getting a head ache.

* I try to avoid anything that could remind me of the trauma or trigger flash backs in one or more of the following ways:

- I avoid thoughts, feelings, or conversations associated with the trauma

- I avoid activities, places or people that arouse recollections of the trauma

- I am unable to recall an important aspect of the trauma, there’s some things I just don’t remember.
- I’ve lost interest in doing things I used to enjoy and invest energy in

- I feel detached and estranged from some people

- I feel numb or detatched from my body or parts of my body

- I feel emotionally numb and less able to laugh, get excited or have loving feelings.

- I can’t imagine a future life for myself anymore. I can’t see ahead.

* I feel tense and on edge, like I’m always on guard. I wasn’t like this before. I’ve experienced:

- Difficulty falling or staying asleep

- Irritability or outbursts of anger, feelings of rage

- Difficulty concentrating

- Hypervigilance

- Exaggerated startle response. Just little things can give me a fright or set me off.

* I’ve been having these symptoms for a while now.

* I feel it has been affecting my sleep, my relationships and my daily functioning. It’s not like me.

* I started feeling this way straight away after the event that I found traumatic.

* The shock was delayed a few days before I started having these feelings.

* I have had these feelings for less than three months / more than three months.

* I feel these symptoms are getting diminishing over time / worsening over time.

* Are there any other symptoms you are experiencing not mentioned above, or anything you want to elaborate on?

* Has anything helped you find relief, or is anything helping you manage?

* Is there anything that you think would help you, that you are having difficulty obtaining?"

I feel that one main goal in putting together an assessment like this is to prompt care providers to focus more on "and how is the MOTHER feeling???" - not to make women feel that they are being rated or assessed on how well they are or are not doing. Maternity services should be consumer driven like any other service, and to give women as consumers a way to assert their voice and for our feedback to be validated and heard is why such an assessment may be helpful in our current climate. I would hate for mothers to feel that they, or their ability to cope with the massive challenges of birth, is the thing under assessment.

I am one of those women who had "manageable" births. My experience of trauma, and of that trauma being dismissed, comes from non-birth related incidences. I understand that each person's experience of our widely varying birth experiences is unique and everyone's own perspective is significant and valid.