I agree that questionnaire would be good at the 3-4 month mark; that's when you know it's not because of your baby not sleeping or just getting used to being a Mummy, that's when you know it's something else.
If it was earlier, I was worried people would think me a bad mother (although at the 6-week check I was told this was "normal" after plucking up the courage to mention to my GP I was emotionally numb and just felt like I was babysitting DS) for not doing the whole bonding thing, for forgetting my son's early days and for giving him such a crap start to life. I've forced the mask of perfect motherhood off, and it has helped, but I still feel like I'm not good enough most days.
Yes I can relate to that Marydean. I think PTSD doesn't fully kick in while you're still in shock. I tend to have delayed reactions anyway. I found while I was still in massive survival mode, I didn't notice the PTSD. That came later. I self-diagnosed it. Because I had some Psych training I recognised it. I also had some spectacularly unhelpful advice from counsellors who should have known better, such as "don't be a victim"; "you are re-traumatising yourself" (how can I be "re-traumatising" myself if no inital trauma has even been acknowledged to date???) and "just scream into a pillow, that's what I did."
????
I decided that I had PTSD because some of the weirder feelings I realized were a bit beyond feeling stressed and blue over what had happened.
Just that acknowledgment was the first step to healing.
Marydean how are you doing now? Are you feeling OK? Were you able to find effective help and support? I think your experience of going to a place of death and having to make a choice to live is very real and significant. I tend to think that was a spiritual event more than a psychological one.
Love and strength to you.
Ryn, I'm really moved by your courage in forcing off the mask of the "perfect" mother. That takes guts for anyone, especially when you're already feeling vulnerable. More power to you.
Berry I like this: "The woman should be able to direct the session around what she feels is important and is impacting her." Very true. We need woman-centered, woman-led birth and woman-centred, woman-led birth review. (I believe it is self-evident that this is what is safest for our babies - as Marsden Wagner articulated so well).
We have got a lot of work to do but I hope we can come up with something that will be helpful and sensitive.
Last edited by Julie Doula; July 2nd, 2007 at 10:55 PM.
Hi Julie - your ideas are great; the woman-centred birth and review sound great. I think there is too much focus, well at least as birthing women are often perceiving it, on assessing what seems to be how good a mother you are at the start. If the focus was changed to "congratulations, you have made the major achievement of being a mum, but what can we do to support you?", women would be more receptive and honest.
The PTSD tool sounds good - at least it could help a woman to inwardly say either, no that is not applicable to how I am feeling, or yes there are things I am noticing there which I hadn't really acknowledged before and should address.
By the way, I studied psychology for years and even graduated with a Master of Forensic Psych while pregnant with my firstborn, yet still suffered ante-natal depression, PND and perhaps PTSD asssociated with that birth and, although I felt something wasn't right I had trouble stepping back and recognising it in myself until others expressed concern.
Similar to another poster I felt this enormous pressure to look like an easy-go-lucky, all-under-control mum with my firstborn and wanted to shield the reality that the birth experience and surrounding felt traumatic. I absolutely wanted, always adored and felt bonded with my baby and this didn't rest easy with feeling traumatised; I wish someone had told me that was ok and actually very common after becoming a mum first time and that I wouldn't stay trapped in that emotional state but could be supported to emerge from it and feel normal again.
Here is what we have so far. All input is welcome - we can make this what we want it to be.
Birth Review
The opportunity to de-brief after your birth, with a supportive listener, is an important part of the birth process. It is really the “4th Stage of Labour”. Any birth is an intense, impactful experience. The need to process this huge event in one’s life is felt by most women. In New Zealand and most other countries, such a de-brief is a mandatory part of maternity care. In New Zealand, it is called a Birth Review.
We believe that each woman’s own perceptions, opinions, responses and feelings about her birth experiences are valid, significant and extremely important for improving and optimizing maternity care in this country.
This is your Birth Review. You may use this document to inspire thoughts and ideas if you wish, or if you prefer, you can toss it in the rubbish and do it your way. Ignore any questions that don’t interest you. Add any questions you think should be in there. Please feel free to use other paper, or make your responses verbally – do whatever is helpful for you.
Part One: How Was Your Birth?
1. What was your birth like for you?
2. What happened in the events leading up to the birth?
3. What happened after the birth?
4. What was the best part of the experience for you?
5. What was the worst part, or the hardest part, for you?
6. Is there anything you would want to do differently another time?
7. Is there anything you are glad and relieved that you did /chose / consented to?
8. Is there anything you regret that you did / chose / consented to?
11. Which factors do you think had the most impact on the outcome of your birth?
12. Did you gain any valuable insights or lessons from the experience? Did you gain new awareness?
13. Did the experience change you in any way? For better or for worse?
13. What are your feelings about your birth now?
Part Two: Feedback for Maternity Services and Care Providers:
This part of your review is to help you evaluate the care you received from your careproviders and support people. Your feedback will be helpful in improving maternity services in Australia.
1. What feedback / criticisms / recommendation / suggestions would you like to give to the birth services and caregivers involved in your birth experience?
2. What did you find helpful during/surrounding the birth?
3. What did you factors did you find to be unhelpful?
4. Do you need any help on directing your feedback to the relevant personnel and authorities?
5. Is there any information, notes, or data that you would like to obtain regarding the events concerning your birth? Have you had any difficulty in obtaining this information?
Part Three: Your Post-Natal Well-being:
Having a baby is a huge adjustment. With time, rest, nourishment and support, most new parents adapt well to the many new challenges. But if after some months have gone by, you feel that you have not been able to recover from the birth and are still experiencing distress, you may wish to consider the following questions to determine if you are experiencing symptoms of Post Traumatic Stress Disorder. Do you feel that any of the following apply to you? Never? Sometimes? Often? A lot?
Partners may also wish to consider the following on their own behalf. The impact of a traumatic birth on fathers is also something that needs to be considered.
1. I experienced a traumatic event/events during/surrounding the birth:
- actual or threatened injury or threat to my physical integrity or my baby’s physical integrity.
- I felt as if I and/or my baby would not make it through alive.
- I experienced extreme physical pain and/or emotional distress for an extended length of time that exceeded my natural abilities and resources for coping with stress.
- I felt that the help I needed and requested was not provided for an unreasonably long period of time
2. 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.
3. 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 kind of numb and less able to laugh, get excited or have loving feelings.
- I can’t imagine a future for myself anymore. I can’t see ahead.
4. 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.
5. I’ve been having these symptoms for a while now.
6. I feel it has been affecting my sleep, my relationships and my daily functioning. It’s not like me.
7. I started feeling this way straight away after the event that I found traumatic.
8. The shock was delayed a few days before I started having these feelings.
9. I have had these feelings for less than three months / more than three months.
10. I feel these symptoms are getting diminishing over time / worsening over time.
11. Are there any other symptoms you are experiencing not mentioned above?
12. Have you found anything has helped you find relief, or is helping you manage?
13. Is there anything that you think would help you, that you are having difficulty obtaining?
Part Four: Getting Help:
The following is a list of resources which may be helpful for obtaining further de-briefing support and treatment. Remember – every new mother needs and deserves support. Some people don’t reach out for help because they feel their problems are too trivial. They’re not. Some don’t reach out because the problems seem too huge or complex. They’re not. Trauma and / or depression can be very isolating. It may be tempting to withdraw, but please take heart, reach out, and keep speaking up for your needs until you find the right person for you, who will truly listen to you.
1. Trauma After Birth Support, New Zealand: http://www.tabs.org.nz/
Birth Trauma & Stress Support Group
email: birth-trauma@tasmail.com
Voluntary support group for mothers who have had traumatic birth experiences. Support offered through email and phone Australia-wide.
Julie, I think wht you have so far is great. I would have loved to hve something like that after my daughters birth.. if only just to think everything through and get my head around everything. I meaan, I didnt hve massively traumatic birth experience, but I do remember not being told wht was going on when they called two obs and another midwife into the room and they all started talking about my babys heart rate and what they were going to do for me, just far enough and quiet enough away that I couldnt quite hear them.. so i felt left out, iykwim? I hd a huge problem with that and I am the type of person that stews over things, so that whole aspect really still annoys me. To be honest though, I have been thinking about it more and more often in the last 2 months or so, so I think Ryns idea of doing this after 3 months is good. Perhaps you could get the questionnire while still in hospital (when everything is still fresh in your mind?) and then schedule and appointment for 3 months time to sit down and talk about it if you feel the need to. Thing is though, it woudl probably be good to do something in the couple days after as well so if you hve questions you cn ask your caregiver as I doubt they'd remember you 3 or 4 months later.
Anyhow, I especially like some of the Q's in the first part like, 'how do you feel about your birth now", "did the experience change you in any way" and the ones bout the hardest/worst and best parts of birth. The way I felt about my dughters birth in the days after it is so differnt to the way I feel about it now. After my daughters birth, as I was leaving the birth suite, the midwife asked "are you happy with your birth"... What a dumb time to ask a question like that!! It ws only a couple of hours after her birth, I was still on a high and hadnt had the time to process everything yet, so I think timing of the debreif is important too.
I like the part about the feedbck forthe caregivers. I have quite a few things to say about the care I recieved, some good things, some bad things.
I think I am just still not over it, even though in comparison to other peoples expeiences it probably wasnt all that bad. I suppose its all relative though. Some people cope with things much better than others...
ok I am just rambling now...
Ok thats ll for now. I might thnk bout it some more later on nd if I can think of anything good to dd I will come bck and ramble some mroe.
Julie, that is fantastic and comprehensive and you have obviously put a lot of time and thought into it.
If there was an option I would prefer someone to talk the questionnaire through with me rather than fill in the form on my own and not discuss it. Even if nothing further came out of it, its nice to feel listened to and that somebody is interested in your responses. I think that would be very therapeutic.
Last edited by Berry; August 5th, 2007 at 03:56 AM.
I think I will move this and start a new thread. Thank you for your valuable comments, Karina and Berry. I agree that 3 months after the birth would be a good time to re-visit the Birth Review, and that being listened to, validated and feeling that you are being heard is vital.
I hope that people will feel free to cut and paste this and fill it out and put it in the post as a way to give feedback to careproviders; and take it along to post-natal checks. I'm hoping that if careprovides go, "Where the heck did she get THIS from - it's not one of our official approved documents!?" - maybe they might get the hint. And copy, edit, plagiarise away. Use it in whatever way is helpful, change it to suit yourself. If your careprovider does not provide ways or means for you to de-brief or to screen for PTSD to the degree that your needs are not reasonably met, then feel free to use this - at the very least, it might help open up discussion about your feedback, your experience, and your on-going needs. I hope so anyway.
Last edited by Julie Doula; August 5th, 2007 at 01:00 PM.
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