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Monday, February 22, 2010

How childbirth caused my PTSD - Motherhood -


I thought the diagnosis was for war veterans, not new mothers. Then I had a baby

By Taffy Brodesser-Akner

The delivery of my son didn't start with a rush of water, or cramps that left me hunched. It was a decision, an edict, and with it, the drip Pitocin, a drug that induces contractions. The contractions came big and loud, almost immediately at one minute apart. My cervix wouldn't dilate, though. I was eventually given the narcotic Stadol, which caused me to hallucinate through a very long night. Twenty-four hours later, clear-headed but still not dilated, I told my doctor I didn't believe the induction was working, that I wanted to discuss other options. But before I knew it, he began painfully separating the membrane guarding my bag of waters.

"He isn't examining me," I yelled at my husband. "He's doing something."

In a hushed tone, the doctor asked the nurse for the hook, a mechanism that breaks your water.

"Why did you do that?" I asked when it was done. "I thought we were going to talk about it!"

His voice was cold, flat. "You're not going anywhere," he said.

My C-section came 30 hours after admission. It was a middle-of-the-night affair: a chilly operating room, an oily anesthesiologist, a clock on the wall that would not tell me when this would be over. I didn't think I would make it out of that hospital alive.

This is a vignette in the story of modern medicine, which allows many of us to survive childbirth, and for which we should be grateful. There is no doubt I needed it, either by me or the three obstetricians I've had examine my case since (though there is doubt as to whether I should have been induced). Both my life and my son's life were in danger by the time I ended up in surgery. And so why, when I returned home — a little sore, but with a healthy baby — was I not grateful?

Within a week of my son's birth, I was diagnosed with postpartum depression (PPD), which afflicts 15 percent of new mothers. I was diagnosed by three healthcare professionals, including the psychiatrist specializing in PPD to whom I was finally sent. It was a diagnosis that, at least on the surface, appeared to fit: I was sad and hopeless. I met most of the criteria on the checklists. But my sadness didn't explain the fits of anxiety to which I was prone, the ones that kept me writhing on my bed. "It's postpartum anxiety," said the psychiatrist, checking off a box on her clipboard. "Sometimes you get both," she told me, as though I'd happened upon a grocery store during double-coupon day.

But something more was going on with me. When I spoke to other women who had PPD, our symptoms didn't match up. I didn't have resentment or contempt for my baby. Further, the women I spoke to and the books I read made no mention of the things plaguing me: Just lying on my back opened a trapdoor to those horrible moments of my C-section. I would wake up from two-hour fits of sleep breathless and scared; I felt that I was stuck in fight-or-flight. Certain words and images were like a tripwire in my brain; driving past the hospital where I gave birth, I started shaking so much I had to pull over. I went to emergency rooms to evaluate pains that may or may not have been real, I consulted another psychiatrist, and another, I took a low dose of Zoloft, but none of it worked. Desperate, I consulted yet another psychiatrist — but this time, I chose a generalist, not a specialist in PPD. It was my husband's advice to try someone whose livelihood did not revolve around a certain disorder: "Never ask a barber if you need a haircut," he said.

Dr. K's office was bare, with ugly wall-to-wall carpet, not the comforting art of the first three psychiatrists, or their shelves of books. It was just him and his desk, a legal pad, a manila folder, and a Lexapro pen. He sat back and asked me what had brought me there. For the first time, the room wasn't crowded with questions from a checklist. I felt I could speak, that I could tell my story.

Toward the end, he started zeroing in on specifics. Was I having intrusive thoughts? Flashbacks? Did I feel that I was often reliving my son's birth? Did I avoid places that recalled the birth? Yes, I said. Yes, yes, yes.

He confirmed that I didn't have PPD or any of its cousins. Yes, I had depression. Yes, I had anxiety. Yes, I was postpartum (four months at this point). But what I had was something else, something those specialists, so married to their own territory, couldn't see. I had post-traumatic stress disorder…

How childbirth caused my PTSD  - Motherhood -

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