Wednesday, August 22, 2012

Unmedicated birth leads to PTSD?

A reader of my blog, Carol, emailed me and shared a link to this study, which was conducted in Israel and concentrated on occurrence of PTSD after giving birth. The study found an alleged link between unmedicated births and PTSD:

"...there was a greater incidence of PTSD symptoms among women who did not receive an epidural."

I believe such a hasty conclusion might serve to promote the unnecessary use of epidural and other medical interventions, even more than it happens today. Moreover, I am convinced the results of this study are skewed. Here is why.

The only participants in this study were women who had hospital births. I think I have mentioned before that home births are extremely rare in Israel, and very expensive - while hospital births are 100% government funded. Therefore, the only ones who can, and insist to, afford a home birth with a qualified midwife are the select few who feel very strongly about natural uninterrupted birth, and have a couple thousands to spare.

Incidentally, the hospital in which the study was conducted was the same from which I ran as fast as I could, being 9 months pregnant and actually in the process of labor, after they have tried to pressure me into an utterly and absolutely unneeded induction (I gave birth naturally in another hospital not 24 hours later). This, of course, is anecdotal evidence, but I do feel that if I had remained there, and if I had to put up with the ignorance and callousness of the staff, and if I had no one around to support my choice of natural birth - then yes, I might very well have ended up with PTSD.

As for those women who "did not receive an epidural" - what alternative methods of going through the labor were offered to them? Were they free to move around? To eat and drink, to use a birthing ball, to soak in a tub or use a warm shower? Or were they, perhaps, strapped to a monitor because someone on the staff noticed something "alarming" and required constant supervision? The study gives no details, but if the latter is true for some of the women, I don't envy them. It is excruciating to be kept from natural relief of movement and change of positions during contractions.

What I would like to see is a study which compares the occurrence of PTSD between women who gave birth in a hospital and received an epidural or other method of medical pain relief, women who gave birth in a hospital with no medication, and women who had natural home births. If someone conducts such a study in Israel, I would be very interested to know its results.


Magnolia Tea said...

I'm fairly certain there will be no such study as you suggest. Why? The result might severely choke the big medical money machine in place in a lot of hospitals. Thank you for bringing such as this to light as so many women have no idea what's behind those "alarming" diagnoses.
Have a great day!

Laura Jeanne said...

A poorly conducted and skewed study, indeed. To be accurate, they should have studied women who gave birth in a variety of settings, or at the very least a variety of hospitals!

I have had 4 children. The first 3 were in hospital with an epidural. The fourth was at home, with a midwife (which thank goodness the government does pay for here in my province of Canada). My hospital births were much more stressful and traumatic, although I had pain relief. It was hard not to be able to move around, to eat or drink, and the nurses were sometimes quite rude and bossy. I felt like I had no control over the situation.

My home birth however, was amazing. Being able to walk around, my labour only lasted 1.5 hours, and the actual birth was so easy, and guess what, almost pain-free. Healing was so quick too - the whole process was much easier on me and my body. I would recommend an unmedicated birth, and a home birth, to anyone.

Liora S. said...

Why does it matter how you get the kid out? Shouldn't it matter more what you do to mother your kids after it is out of your body? If an epidural provides pain relief, what should a woman be made to feel guilty for alleviating pain?

Anonymous said...

Labor doesn't even hurt that much for all women, it really depends. It wasn't very painful for me at all. People don't mention that, maybe because they don't want women who DO suffer immensely to be taken seriously. But it doesn't have to be gruesome for everyone (and that's without meds).

Ellie Rae said...

I had natural childbirth in a hospital. That was 25 years ago, and Lamaze natural childbirth was in style then, so just about everybody did it. I don't know why they went to epidurals, but many of the young ladies I talk to now have epidurals.

As far as childbirth without medication goes, we had Lamaze childbirth classes which focused on breathing to relax and things like that.

Births in a tub of water was considered a fad and many doctors would have nothing to do with it. I was never attracted to that.

I'm wondering, myself, why Lamaze natural childbirth was abandoned.

As far as the PTSD goes, well, I suppose it would depend upon how bad the birth actually was. I have a friend who had natural childbirth and I would say she had PTSD from it, and never would consider having another child. She never did. It sounded like the nurses were impatient, the doctor didn't care, a bad scene all around. I could see where pain and fear and nobody caring about you would give you PTSD, especially if you genuinely felt your very life was in danger (and in the olden days, women did die in childbirth). So, yes, I can see where it would be possible, in bad circumstances like my friend had.

Mrs. Anna T said...

Liora, no mother should be made to feel guilty about having an epidural, but the fact is, epidurals come with a set of risks, as do other unnecessary medical interventions, like inductions. Many women who want to have a natural birth and are physically capable of it end up succumbing to unnecessary interventions just because of unsupportive hospital staff. Example: my first birth didn't progress as fast as it was "supposed" to, and they offered an induction. I refused and went home to wait out. Someone else might have conceded to have an induction, which makes contractions much more painful, which brings on the need for epidural, which slows down contraction, which makes further induction needed... hence a cycle of interventions that can lead to traumatic birth, fetal stress and even an unnecessary C-section, all because doctors in hospitals don't have time and patience and humility to distinguish when they aren't needed, and stand aside for nature to work its course.

Jen said...

I, for one, don't agree with the study. First of all, I questions their "science." To be more accurate they should minimally study more hospitals. Completing the study in one hospital will lead to a definite bias, which should be minimalized in a sound study.

I had my first child 9 months ago through natural, non-medicated childbirth. My husband and I took steps to prepare and educate ourselves so that we would be able to make sound decisions in the event of complications and he was wonderfully supportive and helpful through the process. I had a very intense and quick labor, but had intense back contractions due to our little one facing the wrong way. I arrived at the hospital too late for any medication, and my husband and I are hoping to conceive number 2 soon. No PTSD here!

I also had the privilege of attending the births of the children of two of my close friends. They both had lengthy hospital labors (11 and 12 hours) attended by nurse midwife and a obstetrician. Happily, our hospital has adopted a natural birth/breastfeeding friendly policy and the care providers only intruded on the process when necessary. They mostly observed the women in labor. One friend did have a traumatic labor and delivery experience. She had 40+ hours of back labor (23 hours contracting 5 minutes apart or less), tore badly (big baby), and her son broke her tailbone as he was born (still "sunny side up"). She did have a tramatic labor, but looks back on it as her story. A woman traumatized by her labor? Yes. Would all of those things have been "fixed" by an epidural? No, and she admits that. Her tailbone would have still broken and she would have still torn, and she says recovering from those injuries was worse than labor itself.

Anonymous said...

Though it's not communally talked about, the epi drugs do go into the baby. I understand that drugged babies are simply not as alert as babies born with no meds. this makes eating harder for them and may delay breastfeeding, causing more problems. I would think it caused more breathing problems too. If you are birthing in the hospital, flat on your back, hooked up to machines that keep you from moving, with induction drugs, then, yea, you will probably need the epi. Just know that it does increase risks to baby and mommy.

There have been a few studies that are largely ignored that showed that the MORE medical interventions in a birth the greater the PTSD. Quite the opposite of the study you are talking about (which sounds suspiciously like propaganda to me).

Why do hospitals want moms on epi's? Women are easier to control if they are numbed from the naval down. They can't walk around and get in the way. they can't leave. They don't yell. They don't demand things to help with the pain such as showers, tubs, balls, stools. They just lie there and do what they are told.

Does it matter how you get the baby out? Yes. Avoiding MAJOR ABDOMINAL SURGERY while birthing (otherwise known as c-sections) is a good thing. the western worlds systems of birth dont tell us how many complications can happen with a c-section, even years latter. It is really NOT as safe for mom or baby. C-section babies are way more likely to have respiratory problems, among other things, breastfeeding is delayed, and mom? Can you really say "At least you and baby are healthy" if baby spent so long in NICU that you can't nurse him and you now have a scared abdomen, uterus, and are now subject to all the future potential problems of having had a c-section, besides increased risk of infection now? Better than a dead baby and mommy? Of course. When that is REALLY the only other option, Praise the Lord we have c-sections! But that should only be 10% (or less) of all births, not 32% (US)! Women are being talked/forced into surgery because it is easier for the doctors and hospitals as well as more profitable.

harper said...

Having had a (brief) unmedicated birth in a hospital in the US, I really felt battered afterward. It had nothing to do with the birth itself, which went beautifully. And the doctors and nurses were kind, thoughtful people. The problem was the hospital culture. Everything had an underlying message of "You can't handle this", "Let the experts take care of this", "You know, you really aren't qualified." There was explicit pressure to go on government assistance and an implicit understanding that, since this was #2, I WOULD be talking to my doctor about birth control.

I also know far too many women who, on attempting a natural birth in the hospital, spent most of their labor trying to ward off doctors and nurses who wanted to bully them into intervention, or coping with doctors who chose to intervene without first gaining consent.

As a student of psychology, I think it is worth noting that a significant part of PTSD is the feeling of absolute disempowerent during the trauma. A complete lack of control was definitely the name of the game for me at the hospital. We weren't even allowed to choose how we carried the baby out of the hospital!

With regards to the study, I have to wonder how many women in the sample actually intended to have an unmedicated birth. Plenty of women wind up unintentionally in an unmedicated labor, simply because their labor progressed fasted than planned.

Since the study is an Israeli one, I'm also curious whether there was a difference in experience between secular and religious mothers, since the religious mothers would have a more positive view of fertility and motherhood in general.

harper said...


I don't think that unmedicated birth is for everyone. And I don't think their should be a stigma against women who do have interventions or medication.

What I want is the abandonment of the stigma against unmedicated birth. I especially want that stigma to go away in medical environments, where it can be psychologically toxic for expectant mothers.

I also want the medical industry to crack down on doctors who unnecessarily defy the wishes and decisions of laboring mothers. And many such doctors use pain medications as an excuse not to communicate with their patient.

Sammy said...

I have two children, both of whom were born at home. Both were also textbook births--no complications, no interventions, not particularly long. My first son's birth was about 10 hours, including about an hour of pushing. As I understand it, this is considered a relatively short birth for a first birth. In contrast, my second son's birth was less than 3 hours from start to finish.

That said, I do believe I had PTSD after the birth of my first son. Yes, it was a peaceful, calm, amazing experience. We had candles lit, the only people present were my amazing midwife and my loving husband. Nothing at all went wrong! However, it hurt. It hurt a lot, as birth does. I was mentally prepared for it, I chose to have a homebirth, and I never, ever doubted that choice. But still, for several weeks after the birth I felt traumatized by the experience. I was fearful and I had flashbacks.

And then I had another homebirth! Of course I did. I believe in homebirth and if I have another child, which I hope to do, I hope to be lucky enough to birth that baby in my own home as well.

I never regretted my decisions and I was always extremely thankful that I had such amazing experiences. But I really do think the extreme pain of that first birth gave me a touch of PTSD.

Mrs. Anna T said...

"A complete lack of control was definitely the name of the game for me at the hospital."

Same here.

Sasha said...

Yeah, my friend who has given birth recently told me that the birth became really unbearable only after they made an induction.... And then the epidural was needed. You are right.

Renee said...

I thought you might like to see these two articles from the website "Science and Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond
from Lamaze International" that address how poorly done the research is.

It might be preaching to the choir to post them here, but I like how they address two different topics. The first of how the media coverage was a problem, the second of how the research was a problem.

The intro to the two articles reads:
In a two part series examining the recent research that stated that natural childbirth is a major cause of Posttraumatic Stress Disorder, our guest bloggers, Penny Simkin and Dr. David White, look at how the media may be sensationalizing the topic and reviews the published article to help understand more about what the research revealed.

Liora S. said...

How someone chooses to give birth, feed their kids, and raise their kids is THEIR choice, and what works for one family may not work for another family. I am sick of people who give birth naturally and breastfeed arrogantly claim that they are superior mothers and superior human beings for it. Nowhere in the Torah does it claim that a woman MUST give birth naturally or that she MUST breastfeed. I remember one woman who was bragging about how superior she is because she breastfeeds her baby and what a good thing she is doing for her baby, while the baby's older sibling, a toddler, was eating fried food garbage from burger king. So...formula=poison for baby but Burger King fries=ok for toddler...ok, got it...NOT! I was formula fed however, my mother would NEVER let me eat fast food garbage growing up. Parenthetically, during the times when my mother worked full time, she also ALWAYS prepared three fresh, healthy, organic meals a day for me, and we always ate a healthy home cooked meal as a family.

Lea said...

Wow. This is a pretty intense "debate" here.

I had an induction and an epidural. I loved my birth experience.

I was overdue (past my due date) with twins and they were starting to show signs of stress from being in utero too long. I was at a point where I could not move without help. I was SO ready to go into labor and my body did not - probably because of a severe bladder infection I had had 8 weeks prior (there's a connection there).

The hospital I was at was known for non-invasive birth - aromatherapy, mostly mid-wife assisted, water birth, etc. They were so kind and compassionate. My perinatalogist was great - someone who really listened and put my own thoughts about my body first (you know your body better than I do, he'd say).

My twins were born vaginally and without any major complications (my son had mild jaudice, which is fairlly common). We went home on time and without incident and I was "up and about" that day.

There was no laying on my back ever and yes, after the epidural, I wasn't able to walk but since I couldn't walk without assistance at that point anyway, that was fine with me.

I think Liora's point is that everyone needs to do birth the best way they can - not the way anyone else thinks they should - and they should not be made to feel bad about their choice or need.

I am delighted with my birth experience and would definitely do it again. I am also very pleased that my mother-in-law was able to have most of her nine children at home with a mid-wife and was able to leave the hospital within 3 hours of her other births.

I am so grateful that I live in a place and time where such choices and options are available


Mrs. Anna T said...

Liora, again, this isn't about someone being more virtuous than another; along the same venue, we could say "if someone goes to McDonald's every day, it's THEIR choice" - well, of course it is, but it doesn't cancel the health implications! Natural birth is the healthiest, lowest-risk way to bring children into the world, and women should not be cheated out of it because hospitals have a different agenda.

Elana K said...

This "scientific" study is ridiculous - while I'm a fan of the epidural (had for my first birth, will hopefully have for my second), the hospital setting itself was awful - the nurses took my baby away from me for hours after my first birth and I had no idea what was flying. Definitely thinn it's the setting that causes PTSD, not the epidurals. Of course, everyone experiences something else.

I just can't agree with Anonymous who said, "Labor doesn't even hurt that much for all women." Seriously??

Carol said...

Anna, thank-you for responding to this study. The discussion here is great. As a nurse that works in the hospital setting-- and has also worked in home birth settings-- I believe that the environment and emotional support are key factors for healthy birth experiences.

Anonymous said...

To me the problem here is more the over-psychiatricization of everything than an issue of births. EVERYTHING gives somebody PTSD somehow, every one of us has some kind of "disorder" of things which used to be simple personality characteristics. I think many women from the beginning of time have been getting "PTSD" from childbirth - it is painful, scary, and intense, with fears and uncertain outcomes! To me, this is simply LIFE and not some psychological disorder.

Mrs. Anna T said...

Anon, in a way I agree with you. Whereas a person used to be "inattentive", "unsociable" or "lazy", now they have "attention disorders", etc, and need Ritalin. A person used to be sad, or mourning; now they have "clinical depression" and get anti-depressants, rather than friendship and support, given out to them. I'm not saying there's no such thing as PTSD or depression or anxiety disorder, but many times symptoms are being treated, rather than humans.