Too Afraid of Dreams to Sleep

Anna’s maternal grandmother had uterine fibroid tumors, and she’d passed away due to a surgery to remove these tumor. Anna’s own mother ended up with a hysterectomy due to fibroid tumors, and as Anna suspected, she had already developed some of the same tumors when Anna went to the doctor to discuss getting pregnant. The doctor wasn’t too concerned, but Anna was, so she wanted to go ahead and start trying. She “was extremely lucky” and got pregnant right away.

Throughout her pregnancy, the doctors closely monitored her uterine tumors, which were in the upper part of her uterus while her daughter had implanted much lower, so the pregnancy was deemed fairly normal.

Anna woke up two days before her due date and “was in intense pain, constant pain.” Of course, she’d never had a contraction before, so she didn’t know if this pain was normal, but she thought contractions shouldn’t be constant.  “I was crumbled on the floor, and we were trying to time them. This is just hurting too much constantly. Maybe something is wrong.”

Anna often shifted from past to present tense during our interview, as if she was re-living the memories.

At the hospital, they checked her vitals and almost sent her home. But Anna’s back pain continued to be constant, and she thought she must have strained a muscle when she fell on the floor earlier in the night: “I have a tendency to think things are my fault, so I thought I’d caused the back pain somehow.” Then her daughter’s heart rate dropped and they decided to keep her at the hospital. Anna fought getting an epidural for as long as she could, but she couldn’t move at all due to the back pain, so she got the epidural. Her movement was still limited, which made getting into a productive position for pushing difficult. She pushed for three hours without making much progress. The decision was made to deliver the baby via c-section, and this was when Anna’s labor turns from painful to traumatic.

One of the most vivid memories for her is the reaction of the doctor and resident when they opened her up. Anna’s voice wavered as she explained “the doctor immediately asked for a more experienced resident” and even through her drugged state, Anna could tell “her husband started freaking out.” A nurse began talking with Anna, trying to keep her mind off what was going on. The fibroid tumors had burst. The blood on her diaphragm had caused the severe back pain, not the contractions. The doctor suddenly had to remove all the little pieces of tumor along with delivering a healthy baby. However, medically, the c-section ended up going relatively well.

Anna’s anxiety and crying began during her recovery at the hospital. But Anna thought this was all normal, just “the baby blues.” Her parents stayed a while once she got home and that helped, but when they left, she really began to struggle due to sleep deprivation. As much as she needed sleep, she didn’t want to dream. “My husband was trying really hard to get me some sleep, and I had dreams that had flashbacks of the birth and the c–section and that phrase of “we need a more experienced resident” kept resonating in my head. It got to the point, it couldn’t have been more than a few days, that I was scared of going to sleep because I didn’t want to have those flashbacks again.”

ptsd

Anna was studying to become a clinical psychologist at this time, and was working with veterans with post-traumatic stress disorder (PTSD), yet Anna didn’t recognize her own symptoms. “I’m an intern at a VA hospital, so I’m use to hearing about traumatic events, but I hadn’t put it together yet, for whatever reason, that a birth could be a traumatic event. To me, it’s like everyone goes through it [birth], everyone does it. It’s not like war. I’ve done treatment with people who have been to war and saw someone blow up or almost got killed themselves. That’s PTSD, so I didn’t recognize it in myself.”

Anna didn’t want to think or hear about her birth. She couldn’t even listen to her husband recount any of the details while on the phone with friends, and she definitely couldn’t tell the story of her birth to anyone either. She wanted to shut it out. However, she couldn’t stop the flashbacks, which mainly happened when she was still half awake, in that in between place before sleep.  “All of a sudden, you feel exactly like you are in that situation. I could feel how I was lying on the bed and hear all the people talking around me. And I knew that I wasn’t quite there, but at the same time it felt very much like I was there, all of the senses went back to that place.”

After her six-week postpartum visit with her doctor, Anna was referred to a therapist. It turned out that therapist didn’t take her insurance, but this one phone conversation gave Anna a lot of insight. The therapist said, “Well, it sounds like you went through a traumatic birth,” and then all of a sudden, it clicked into place. This was traumatic. This was a trauma. “That helped so much in accepting. I know what traumas can do to people, so it’s okay that this is going on. It validated what I was going through.” For Anna, just that one word– trauma — gave her everything she needed. She knew exactly how to cope once she had a label for her feelings. “As soon as I realized this was a trauma, I started to process it. I sat with my husband and discussed what happened. I began facing it.”

Her experience has made an impact on her clinical work. “I can relate more to everything my patients are going through. I had never been in the hospital before. I had never been a patient before. It helped because I had a little tiny taste of that.” Anna doesn’t compare herself to her patients who have experienced PTSD for years and decades, since Vietnam, but it’s helpful that a flashback isn’t just a description she read in a book. It’s something she has experienced.

And up to 6% of women will experience PTSD postpartum. The main causes of postpartum PTSD are a traumas during delivery, such as prolapsed cord, unplanned c-section, used of vacuum or forceps, baby going to NICU, lack of support during delivery, or a woman who has experienced a previous trauma, like rape or sexual abuse.

Anna was only warned about the baby blues during pregnancy. Since she was a psychologist, she was dismissive of PPD, thinking it wouldn’t happen to her. Postpartum mood wasn’t described to her as more than “you might get sad.”

Before my own postpartum mood issues, I only was aware of postpartum depression and the baby blues. I had no idea about postpartum anxiety (my diagnosis), postpartum obsessive compulsive disorder, or PTSD. I think providers need to start explaining all the spectrum of postpartum mood disorders to women, because “you might get sad” doesn’t describe any of them well.

Most importantly, doctors need to follow-up with women about their mental health; they need to ask women more questions; women need more support. Even if you didn’t suffer from PPD or another postpartum mood disorder, did your doctor screen you thoroughly? Did he or she explain the spectrum of mood disorders? We can make a difference by giving our doctors helpful feedback, so the next woman receives better care.

Annual checkup.

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