Giving birth can be traumatic! Having children is a part of life that many people fantasize about. This leads to expectations and ideals that are often not in tune with reality. Furthermore, mothers are particularly vulnerable around the time they give birth. If they are not treated properly, whether that be by health professionals or family members, they can suffer from post-traumatic stress disorder (PTSD).
This past week we had the privilege of speaking with Singapore-based counselor and psychotherapist, Silvia Wetherell. This is the second part of our interview. Silvia is one of the leaders in maternal mental health in Singapore, a field which she believes could use a lot more attention. Outside of her practice not only does she do a lot to raise awareness about mental health in general, but also focuses on emphasizing the importance of mental health for new parents.
You mentioned that you use EMDR, Eye movement desensitization reprocessing, with some of your patients dealing with birth trauma (for more on that see the previous part to this interview here). We recently spoke to another therapist that specializes in EMDR for patients suffering from PTSD. When I hear PTSD, I think of people experiencing really traumatic events in childhood or warfare. What usually isn't at the top of mind is trauma related to birth, but it must be quite common?
Oh my goodness, it's huge and it's so underestimated! There was a woman I saw a couple of years ago, I saw her twice before she had her baby, who was very attached to ideas of natural delivery and no pain management. When I saw her I tried to suggest that she be more flexible and still she had a really difficult time. She was induced at 42 weeks. She was given all these drugs trying to conduce the contractions and after two days she ended up having an epidural. One half of her body she couldn't feel anything. The other half was so painful she couldn't think straight. So she had a long period of suffering, feeling out of control and helpless. After these two days of suffering, then a C-section. This was very traumatic for her. There was a midwife there, who thought "oh she's on so many pain killers, this is pretty normal, she's doing fine."
She thought the baby is safe, mom is safe, all good. No! Trauma is in the eyes of the beholder.
So if the woman feels completely helpless, if she felt that her life was in danger, or her baby's life was in danger, she'll probably be traumatized. What people say and do when they are around the mother significantly alter the mother's experience. For example, if the doctor is watching a screen that's monitoring the baby's vitals and says to herself "oh that's not good, I don't like that," the mother is likely traumatized by hearing such a thing. She'll think that the baby isn't going to make it. And then on top of that she is being asked to make a decision: "do you want to have a c-section now? do you want to keep going and wait?" These are life and death decisions. This is a lot of pressure to put on a woman, especially when she is in a lot of pain, exhausted, and she doesn't know what the right thing to do is. After coming through an experience like that, even if the baby is healthy and safe, and the mother is recovering well, the mother can very well be traumatized. This commonly creates flashbacks and nightmares that cause them to constantly relive the experience. Or she is very anxious in everyday situations because she can still hear the sounds of the beep on the heart monitor as the doctor expressed worry. She can hardly sleep because she is so worried about the baby.
A lot of trauma afterbirth goes undiagnosed. Sometimes women reach out for help and unfortunately the medical providers brush it off, saying all is well. That usually isn't enough. Trauma needs to be treated professionally. If it's not it will have lingering effects. It will impact the mother. It will impact the baby. It will impact their relationship. She is struggling internally with her own thoughts and emotions. Sometimes I'll see these women when they become pregnant again because their trauma is triggered and they realized they're not over it. Sometimes women get misdiagnosed with anxiety after giving birth when it's actually PTSD. So we need to be probing. What happened during that experience of giving birth? You're at your most vulnerable. Your legs were wide open, there are hands in there, it's very intrusive. Especially for a woman who has a background of sexual abuse, or any other kind of trauma. She is more likely to be triggered around that time.
The interesting thing is you can watch a video of two women giving birth and it looks like the experience is exactly the same. Yet one woman ends up traumatized and the other doesn't. It's not what it looks like on the outside. It's about the internal experience: feelings of helplessness, believing you and your baby are in danger.
Sometimes things like just having that one midwife that holds your hand and looks in your eyes and tells you everything is going to be OK can be the difference between having trauma and not having trauma.
This is why I'm organizing a forum for professionals at the hospital that I'm based at on maternal mental health. I want nurses, midwives, obstetricians to hear these things– it's really important. I'm organizing another one in October as well. We've got a lot of work to do to create more awareness and promote better bedside manners.
This concludes the second part of our interview with Silvia. Follow our blog to hear more from Silvia on tips for new dads, pre-natal mental health care, and anxiety and depression as a new parent.
To consult with Silvia Wetherell in-person or remotely from her Singapore office, contact her directly through her profile.
If you're thinking "I need a therapist near me" but Silvia doesn't specialize in what you need, try the RingMD therapist directory. We will help you find the right therapist for YOU!