Tuesday, March 13, 2012

Part IV: In which my son is stolen

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.


Michael and Amanda said...

Is it ok that I wish you hadn't mentioned "the incident"? I just keep thinking of the worst things possible, which could actually be possibilities. I'm so sorry for all the horrible things that happened. I'm also sorry that all of this is directly related to Ben's birth. I'm kinda glad that Ivan was born just so you could find a way out of that awful world you were stuck in. I'm so excited to see you soon!

Meags said...

Thanks for letting us all participate in this with you. I think you have amazing courage to share what you have been through. I look forward to hearing where you are now and how you feel as compared to those dark days you experienced.

Liz, Karl, Madison, Brooklyn and Aubrey said...

Laura, I love you! Really, I'm just SO glad you are doing better. Really! I am glad I get to see you this weekend. I am so ready to party. :)

PS You did a wonderful job at telling your story. I know you were worried about how you would share but I think you always have a way with words.

Tannie Datwyler said...

I've said it before (I totally agree with Liz). You have a talent for this - telling your true life events. It's amazing, and awesome, and powerful, and sad.

I wish I was there for you. Stupid job.... Just kidding... Sorta.