Monday 18 November 2019

Life after postnatal Post Traumatic Stress Disorder

Post-traumatic stress disorder is most often associated with combat. Rarely is it connected to child birth. One mother tells Shane Cochrane her account of living with the condition.

Fionnuala Leonard with son Ethan and daughter Aleesha Mae
Fionnuala Leonard with son Ethan and daughter Aleesha Mae

Shane Cochrane

Bernd Kemmereit woke early one morning to find that his partner, Fionnuala Leonard, was already up. She was in the living room, dressing - hurriedly.

"Where are you going?" he asked.

"I have to get out of here!" she replied. "I have to get out of here! I have to get out of here!"

"I walked out," recalls Fionnuala, "and I walked and walked and walked. And I don't even remember that walk, to be honest with you.

"I only remember, at some point, sitting in a field and realising, 'I'm sitting in a field; why am I sitting in a field?' And then I made my way home."

In the preceding weeks, Fionnuala had been feeling increasingly anxious.

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"I was questioning everything I did. I was thinking everything I did was wrong. And I was crying a lot. Crying. Crying. Crying. I was trying to hide it from people, and that made it worse.

"This is supposed to be the happiest time in your life. You want a child, you have a child - you're supposed to be happy. But I felt like I was dying inside."

Post-traumatic stress disorder is an anxiety disorder caused by a traumatic event.

It's normally associated with events such as major road accidents, violent or sexual assaults, and terrorist attacks; and it's a condition experienced by those who have seen - and done - terrible things in combat situations. But it's also a condition that can be caused by childbirth.

At the mid-pregnancy scan, Fionnuala was told that her baby had a cleft lip - and possibly a cleft palate.

"That was a bit of a shock for us. There was no history of it on either side of the family. We had no idea where it came from.

Read more: 'I had all of my life's desires - a beautiful son, a lovely house, great husband, but I was depressed'

"But it started me on a downward spiral. There was so much more to it than I realised. His hearing and speech could be affected.

"I was having nightmares. Nobody wanted to talk to me about what I was going through.

"I was struggling with the fact that my little boy wasn't going to be as perfect as every other baby."

Two weeks past her due date, Fionnuala was brought to the hospital to be induced.

The process was started at 11am. By 4pm, Fionnuala's waters had broken and her contractions were two minutes apart.

Worryingly, the baby's heart rate was dropping with each contraction.

Periodically, to check on his heart rate, an internal monitor was placed on the baby's head.

Fionnuala was in incredible pain each time this was done.

"You don't really know what you're in for when you have a baby," says Fionnuala.

"You hear stories - but people try not to frighten you. But it is frightening. The pain is very overwhelming.

"It's like no pain I'd ever experienced in my life. I was begging for an epidural."

But there was no anaesthetist available to administer an epidural, and Fionnuala had to endure the pain until nine o'clock that night.

By this time, the baby's heart rate had dropped considerably.

Fionnuala was taken to theatre for an emergency Caesarean section.

"They put a mask on my face and I was gone."

When Fionnuala regained consciousness, she was in the recovery room - alone.

"I didn't know if my baby was alive or dead. I didn't know what had happened. I was calling for my baby.

"Someone came in and told me to stop screaming. They said my baby was grand, but they didn't really explain what had happened."

Unfortunately, Fionnuala's experience is not unique. Each year, thousands of Irish women have a traumatic birth experience, and many develop PTSD.

But it's hard to get an accurate assessment of the scale of the problem. Ireland's two leading charities in this area, PND Ireland and Nurture, encounter many women exhibiting the symptoms of PTSD - constantly reliving the birth, nightmares, flashbacks and panic attacks - but find that few have been diagnosed by a GP or mental health professional.

"One of the first questions I always ask is, 'how was your birth experience?'" says Madge Fogarty, founder and chairperson of PND Ireland.

"They would come to us with postnatal depression. But when we dissect it, we find that it may have been PTSD originally."

The lack of reliable stats for PTSD is not solely a failing on the part of medical practitioners.

Many women are reluctant to reveal the true extent of their postnatal health problems.

"They're terrified," says Irene Lowry, founder of Nurture.

"And they're also afraid that if they admit they're battling a mental illness their baby might be taken off them.

"And that's a fact. We got that from the maternity hospitals."

There are any number of ways in which a birth can be considered traumatic, but a lengthy or painful labour, poor pain relief, and high levels of medical intervention are frequently cited in cases of PTSD.

Stillbirths and delivering a very sick baby are also risk factors.

But, according to the UK's Birth Trauma Association, hospital procedures and the aptitude and attitude of hospital staff can also contribute to a traumatic birth experience.

The association believes that impersonal treatment, lack of information and poor postnatal care increase the risk of a mother developing PTSD.

"I think debriefing is really important," says Madge Fogarty.

"And I've been saying this for a long time. If you've had a bad experience and then you go home, you're carrying all this stuff with you.

"Whereas, if a nurse or a midwife sat down with you before you left the hospital and asked if you would like to talk about the birth, about what happened and why it happened, we might not have as many cases of PTSD."

Treatment options for postnatal PTSD are limited - and scarce. While GPs can prescribe medication, the support and services that can really make a difference are harder to access.

"You can go to a counselling centre," says Irene Lowry, "but you'll be on a waiting list for at least nine months. If you go through the HSE you'll be waiting for at least a year."

It falls then to charities like PND Ireland and Nurture to fill in the gaps. Both provide telephone helplines and access to counselling, but they also try to provide more than emergency measures.

"We try to give them tools and resources to help them through it," says Irene.

"There's no point in sitting there and being a parrot, parroting back to them what they're saying to you."

Nurture runs support groups for women with postnatal PTSD. Each group lasts for 10 weeks.

"Every woman who phones our charity thinks she's the only person in the universe with this problem.

"She's not! At our support groups they can meet like-minded women. They're not isolated."

And because Irene knows that a lot of the women fear a return to isolation at the end of the 10 weeks, Nurture have arranged discounts in cafés around Ireland to encourage the women to continue to meet and support each other.

Perhaps if Fionnuala had had access to this support she might not have had to endure two years of struggling with her mental health.

"The medication didn't help, it just numbed the pain," recalls Fionnuala.

"And Bernd pushed me to go to counselling a few times, but I never really felt that it helped.

"I never felt that anyone truly understood what I was feeling. They listened, but I never felt they had that level of understanding that made me feel that I wasn't alone. I didn't feel like that at all."

For Fionnuala, it was the two men in her life that helped her along the path to recovery.

"Bernd's a very positive person and he was just there for me - whenever I needed him. I was very tough on him, and I was very difficult to deal with, but he was there.

"And I realised that Ethan was a happy little boy - a lovely little boy. I told myself, 'he's a little boy who's depending on you, so you've got to try and get over it.'

"I started to let myself let go of it. I think I had clung on to it. I felt so hard done by that I clung on to it for a long time."

Fionnuala's recovery may not have been a miracle, but it was remarkable - and 12 months ago, Fionnuala gave birth to Aleesha Mae.

"I felt sure that I'd never have another child. I was too terrified to have another child," she says.

"But I had my little girl, and that was my happy experience. I got to see my child being born. It was really special for both of us."

What is PTSD?

Postnatal post-traumatic stress disorder — also known as birth trauma — is an anxiety disorder caused by a traumatic birth experience, such as a long, difficult or painful labour.

Symptoms of the disorder include, flashbacks, nightmares, panic attacks, insomnia and emotional problems.

Potentially, any woman experiencing a traumatic birth is at risk.

Anyone experiencing any of the above symptoms should talk to their GP, midwife or health visitor — or a close friend or relative.

Help is also available from Nurture (Tel: 01 8430930) and  PND Ireland (Tel: 021 4922083).

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