Links to Part
I-III to the right
I read and reread the lists of symptoms of postpartum
depression. Sure, I fit the list to a T—depressed mood, extreme fatigue, zero
pleasure in anything, inability to make any kind of decision. PPD gave me
something to work with, a reason for the hell I was trapped in inside my own
mind. And yet, it didn’t fit.
I knew there was something else going on. There was a
bigger issue hiding somewhere inside my mind, I just couldn’t find it or
understand it. I was lacking the information and the tools to figure it out,
but I knew that my feelings went beyond only depression—as if that wasn’t bad
enough already.
I found my answer the night that my nephew Ivan was born.
Michael and Amanda had each been texting me throughout the day with consistent
updates on appointments, decisions, and ultimately the induction. (By the way,
Amanda knows about this part of my story already.) I was glad to be included
along the way. It was nice to know what was going on, even though they were up
in Idaho and I was nowhere near enough to actually be helpful.
I couldn’t sleep that night. (Neither did Michael and
Amanda, but they had a good reason.) All night long, as I thought about Amanda
being in labor, I had one intensely overwhelming thought: I want to trade places with her. It was such a desperate, powerful
feeling. There was nothing I wanted more in the entire world at that moment
than to have the chance to go back to two months before and give birth to Ben
again. So I could do it right.
I didn’t give birth to Ben. He wasn’t born. He was stolen
from me.
My mind raced over and over through the events of the day
I had gone to the hospital, expecting to have a c-section, having that option
removed from the table, going into intense back labor for sixteen hours, only
to again be faced with a c-section. Even now, writing about this over seven
months later, my muscles tense up and my breathing becomes shallow and my hands
start to shake just from thinking about it.
All told, I might have slept for 20 minutes that night. At
5:30 in the morning on September 30, I finally figured out how enormously
troubled and bothered I was about the events surrounding Ben’s birth (or the
apparent lack thereof).
It was through some emailed website links from Lisa—thank
you—that I learned about traumatic birth and the pursuant post-traumatic
stress, though I didn’t make all the connections for a few weeks still.
The Diagnostic and Statistical Manual, 4th
Edition, gives the criteria for a diagnosis of PTSD. While I had not officially
received this diagnosis from a medical professional at this time, I did
experience the necessary nine areas for a clinical diagnosis. To ease my
explanations of what my PTSD looked like, I am going to use the DSM IV-TR
criteria and draw that picture in pieces.
From the DSM IV-TR,
the criteria for PTSD are as follows:
Criterion A: Stressor
The person has been
exposed to a traumatic event in which both
of the following have been present:
1. The person has experienced, witnessed, or
been confronted with an event or events that involve actual or threatened death
or serious injury, or a threat to the physical integrity of oneself or others.
2. The person’s response involved intense fear,
helplessness, or horror.
There are two parts to my trauma with Ben’s birth. One
was my complete lack of control throughout the entire situation. At almost
every turn, I prepared myself for one of two eventualities—try the version, it
works and we stay pregnant or it doesn’t work and we deliver today; go the
hospital and have a c-section or go into labor on my own; be induced and have a
baby—and every time, the situation played out with that third eventuality that
I never even considered—the version fails and I’m still pregnant; denied a
c-section and get induced; labor for hours and hours and still have the
c-section I never really wanted in the first place. Talk about helplessness. I
could not control anything that happened at any stage, through no fault of my
own.
The second part of Ben’s birth is something that I still
cannot talk about. To this day, there are only three other people who know what
happened to me on the operating table immediately before the c-section actually
happened. It involves horribly strong feelings of intense fear, helplessness,
and horror. For the sake of writing, we’ll refer to this particular moment
(which actually lasted much longer than just a moment) as “the incident” just
for ease of reference.
Criterion A met.
Criterion B: Intrusive Recollection
The traumatic event
is persistently re-experienced in at least one
of the following ways:
Deep breath. This is hard.
1. Recurrent and intrusive distressing
recollections of the event, including images, thoughts, or perceptions.
Thoughts of the hospital experience popped into my head
all the time, triggered by all kinds of things or nothing at all. I couldn’t
stop thinking about what happened and how desperately I wanted it to be
different. I would replay that video in my mind over and over, rehashing every
detail and remaking every decision, wishing I could go back and do it right.
All the time.
2. Recurrent distressing dreams of the event.
I have always been a vivid dreamer. Every single night, I
dreamed about some element of the birth. Every time I woke up, it was the first
thing I remembered. The dreams morphed into scary and twisted manifestations of
my emotions, with vibrant colors and harsh details that accentuated the parts I
most feared. Every night.
3. Acting or feeling as if the traumatic event
were recurring (includes a sense of reliving the experience, illusions,
hallucinations, and dissociative flashback episodes, including those that occur
upon awakening or when intoxicated).
The flashbacks were the worst. Everything around me
seemed to disappear and my mind was completely taken over by images of being in
the hospital. I never knew when those moments would come, and once they were
past, I felt like I had just barely had surgery and had to recover all over
again.
4. Intense psychological distress at exposure
to internal or external cues that symbolize or resemble an aspect of the
traumatic event.
If I just say yes, does that sum it up enough for you?
5. Physiologic reactivity upon exposure to
internal or external cues that symbolize or resemble an aspect of the traumatic
event.
Any comment about hospitals brought on shortness of
breath, muscle tension, and blurred vision. Any reference to birth or pregnancy
or even new babies brought on panic attacks. So yes.
Only one of those five is required for diagnosis—I fit
all five. Criterion B met.
Criterion C: Avoidant/Numbing
Persistent
avoidance of stimuli associated with the trauma and numbing of general
responsiveness (not present before the trauma), as indicated by at least three of the following:
1. Efforts to avoid thoughts, feelings, or
conversations associated with the trauma.
2. Efforts to avoid activities, places, or
people that arouse recollections of the trauma.
It was at this point that I basically stopped reading
blogs. I had too many friends who were pregnant or who had recently had babies
and I couldn’t handle reading their happy stories of how wonderful birth was
and how amazing their babies were and how much they just loved being mothers. I
fully acknowledge that my problem had absolutely nothing to do with any of
those women—I still greatly admire and want to be friends with all of you!!—but
I first unconsciously and then very consciously stopped reading anything that
might bring up anything to do with birth or babies.
I also stopped having playdates. Having a newborn always brought
the seemingly obvious topics of conversation—pregnancy, birth, babies. All the
things I couldn’t talk about. So I just didn’t talk to anyone.
3. Inability to recall an important aspect of
the trauma.
I’ve always thought this one was just a little ironic—how
do you know if you’re doing this if you can’t remember?
I was, in fact, missing a very important part of my
trauma. I had completely, 100% blocked out the incident for months. There was
one night when I was going to go to a movie with Deborah. I met up with her at
her work, with the plan of leaving there and going to the theater. I was too
upset and confused by everything on my mind to go to the movie and I just
wanted to talk. Deborah was great and just listened to me. I talked for two or
three hours, first in her office and then at dinner, during which time I
unloaded anything and everything that came to mind. It was in telling her the
story that I suddenly remembered what had happened. Holy cow. I had so
completely forgotten about it. It was shocking to remember again, a shock that
I didn’t recover from for days. Still haven’t, really.
4. Markedly diminished interest or participation
in significant activities.
5. Feeling of detachment or estrangement from
others.
6. Restricted range of affect (e.g., unable to
have loving feelings).
Yes. To all of the above.
7. Sense of foreshortened future (e.g., does
not expect to have a career, marriage, children, or a normal life span).
For once, no. At least I thought I would still live.
Three required, I had six. Criterion C met.
Criterion D: Hyperarousal
Persistent symptoms
of increased arousal (not present before the trauma), indicated by at least two of the following:
1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating
4. Hyper-vigilance
5. Exaggerated startle response
Yes to 1, 2, 3, and 5. It took me at least an hour or two
to fall asleep every time, which is particularly problematic when woken up by a
newborn several times during the night. I averaged 3-4 hours of sleep per
night, all in chunks of one hour or less. I was very quickly extremely angry
with my kids, especially Jane. I couldn’t get anything done. I felt like I was
constantly walking in a fog, unable to concentrate on anything. If someone
bumped me or came around the corner, I was so startled that I often lost my
breath for several minutes, as though I had had the wind knocked out of me.
Criterion D met.
Criterion E: Duration
Duration of the
disturbance (symptoms in B, C, and D) is more than one month.
I didn’t understand until well in October, but the
symptoms started when I was still in the hospital, in the first days
immediately following the birth. At the time of my learning about traumatic
birth and PTSD, it had already been almost three months.
Criterion E met.
Criterion F: Functional Significance
The disturbance
causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
In Utah terms, heck yes. Criterion F met.
And for completeness and interest’s sake—
Specify if:
Acute: if duration
of symptoms is less than three months
Chronic: if
duration of symptoms is three months or more
By this count, chronic. What an oddly powerful word.
Specify if:
With or Without
delay onset: Onset of symptoms at least six months after the stressor
There was definitely no delay in the onset of symptoms,
even though it took me a lot longer to realize and understand.
Post-traumatic Stress Disorder was first studied and
diagnosed in relation to war veterans of World War I. It still sometimes seems
odd to me to make such a dramatic connection between something as horrifying
and tragic as war and combat and something generally considered as wonderful
and amazing as the miracle of birth. But, in my journey, I have learned that
there is a very powerful universality of emotions that connects everyone. I may
not have witnessed death and violence, but I was placed in a situation that was
horrific to me. My body and my mind were violated by others whom I thought I
could trust. I had no control over what was being done to my body, in forcibly
real ways. It makes sense that my mind would be so bothered by what happened
and respond in ways as dramatic as PTSD.
I don’t like to leave my story hanging, as I don’t know
when I’ll get back to writing again, but next time, I will get into what has
actually helped me. I promise, there is hope in all of this.
