London - For Lucy Lord and her husband Alex, the birth of their healthy son, Oliver, should have been the joyful start of parenthood. There had been no hints of any potential problems during the 23-year-old’s pregnancy.
“It was my first child, but there were no issues until I went in for the delivery. I was two weeks overdue, but that’s not unusual for a first child,” says Lucy.
Her waters broke at 9am, but her son was not delivered for a day and a half. During that time, Lucy suddenly developed the dangerous high-blood pressure condition, pre-eclampsia.
“I started to feel strange. I told my husband I could see silver worms. I don’t know whether they were a hallucination or the result of a problem with my vision,” she says.
“One of the hospital team overheard me saying this and became concerned. They checked my blood pressure and found it was in the bad stages of pre-eclampsia. They filled me with beta blockers to slow my heart rate. But I was feeling unwell and disorientated. Suddenly, it was like the room just flooded with people. I did not understand what was going on. It was an utter nightmare.”
She could not be given extra pain medication because of the high blood pressure. Eventually, the care team decided to give her an episiotomy - without extra anaesthesia - slicing into her to get the baby out speedily.
“I immediately lost more than a litre of blood,” says Lucy. “Then a couple of hours after having my son, they found the placenta hadn’t been fully expelled. They gave me abdominal massage to get it out. That was the most painful thing - even more agonising than childbirth.”
Lucy’s ordeal was not over because she then suffered two haemorrhages. In total, she lost nearly two litres of blood.
Oliver was born a healthy 8lb, but Lucy doesn’t remember delivering her son or almost anything about the next three days. “I have only fragmented bits of memory. For example, I’ve had a flashback of the paediatric doctor coming in to the room just after the birth.”
Lucy was in hospital for a week, at one point losing more blood and having a panic attack on the floor.
“I’d never had a panic attack before in my life. I felt I was about to die,” she says.
“I’m from a family that just takes things on the chin. I thought it would all just be OK. But when they said they were going to discharge me from hospital, I panicked.
“My husband didn’t understand what was going on. Everyone was being kind to me, but it just made me feel more sure I was dying.
“After leaving hospital, I was weepy and anxious. I thought it might just be a bad case of baby blues.
“But looking back, I was out of control. I would pace up and down the garden in a constant state of fear. I could not even make a sandwich out of terror I might somehow harm myself with the knife.”
Three weeks after the birth, Lucy went to her GP and asked if she was suffering with post-natal depression.
“The doctor said he thought it was something else,” she says.
“He read my birth notes and then asked me a list of questions about panic symptoms and trauma. He diagnosed post-traumatic stress disorder following childbirth.”
Post-traumatic stress disorder (PTSD) is generally associated with the survivors of wars and major disasters, but the childbirth form of the condition is hardly rare.
Estimates vary, but up to 50,000 women a year may be affected, with many going undiagnosed and untreated.
New studies suggest it is becoming more common: research has found that a third of new mothers found childbirth to be “horrific” or “terrifying”.
“They feared for their life or that of their baby,” says Professor Debra Creedy, an Australian psychologist and nurse, who surveyed 1,000 new mothers with no previous history of mental problems.
“Unless these sort of emotions are dealt with, they can have lasting effects on women.”
While post-traumatic stress following childbirth might seem similar to postnatal depression, there are significant differences. The symptoms of postnatal depression are the same as those for clinical depression; in severe cases, they include thoughts of harming the baby or obsessive fears about the baby’s health.
With post-traumatic stress, however, there may be panic attacks, flashbacks, nightmares, sadness and a sense of detachment.
Maureen Treadwell, co-founder of the Birth Trauma Association, believes the number of women suffering with the condition is growing, thanks to an increase in physical and social pressures on mothers.
“Research shows that babies are getting bigger. This has resulted in more women having difficult labours,” she says.
“Women are also getting fatter, which adds to the risk of them suffering birth complications, as well as the danger of them having diabetes, which makes them more at risk of falling ill during childbearing.”
And many women are older when they become mothers. “More women are having IVF and giving birth later in life, which is causing more birth traumas.”
On top of that there is the general belief that giving birth should be simple and even glamorous. When this clashes with the reality of a difficult birth, it can make matters even more shocking.
“You have the whole obsession with celebrity births and instantly thin new mothers,” says Treadwell.
“To expect that birth will be easy is simply not fair to most women. With unrealistic expectations, you are far more likely to suffer postnatal emotional problems.”
Such damage can endure for years, as Dr Susan Ayers, a Sussex University psychologist and leading researcher in the field, has discovered.
“I had one woman contact me who was 70. Decades ago, she had suffered a traumatic birth, but it was still very much an issue for her,” she says. “She was significantly anxious and upset. If it is not treated, it can go on and be devastating for the woman.”
PTSD significantly increases the risk of a mother suffering anxiety in subsequent pregnancies. The mother’s relationships with their children can also be affected.
“Some can become over-protective and over-anxious about their child,” says Dr Ayers. “Other women report not having any feelings for the baby.”
There may also be a lasting physical impact on the children, if they have been exposed to high levels of stress hormones in the womb.
“We see more anxiety and developmental problems among these offspring,” says Dr Ayers. “It may be that the mother’s heightened levels of the stress hormone cortisol prime the foetus to be anxious when it is born.”
Research Dr Ayers has published in the journal Psychological Health shows women who receive little support from health practitioners during and after childbirth are at significantly higher risk, particularly if they had troublesome births.
“Doctors and midwives can make such a difference during birth, making the difference between mothers thinking their baby is going to die and understanding that they are being looked after.
“It is the meaning that the women make of a difficult birth afterwards that can determine the difference. If they become negative or try to cope by pushing it to one side, they are more likely to develop PTSD.”
Soon after her diagnosis, Lucy Lord was offered anti-anxiety medication, but decided not to take it.
“I had my pride,” she says. “But then last year I got pregnant again and miscarried at five months. Five weeks later, I was made redundant. The anxiety came back and I began to have panic attacks again - feeling shaky, being sick and not wanting to be around people.”
She was prescribed a six-week course of anti-anxiety pills.
“I have to say the tablets worked,” she says. “They helped me to move ahead with my life.” Now Oliver has just turned two, Lucy has far fewer panic attacks.
Many women with this type of PTSD find their problems get better by themselves, says Dr Ayers.
“Often they manage it in chunks, reliving bits of the trauma.”
This can help mothers to process their emotions, which is similar to how therapy for the condition works. By remembering the event, going over it and making sense of it, the mind can do its normal job of storing away the memories and moving on to other things.
But other mothers do not recover spontaneously.
“The worst-case scenario is when it becomes chronic,” says Dr Ayers. “Marriages break down and mothers don’t have a good relationship with their child. Women have even requested sterilisation, so they don’t have to face the experience again.”
The sad fact is that all of these problems could be prevented effectively and cheaply if the NHS introduced a national system of routine screening and support for new mothers, says Dr Ayers.
“If we could screen women and catch them early enough, the majority of cases could be treated successfully.”
One thing that may make a big difference is post-birth support from midwives who have been trained to help mothers who have had difficult births.
In Australia, Professor Creedy trained a team of midwives in counselling skills to work with women showing early signs of the condition.
After 12 months, eight percent of the mothers reported moderate to severe problems, compared with almost 20 percent of an uncounselled group of women.
“Ideally, women who show symptoms should be referred to psychotherapy or counselling,” says Dr Ayers.
“This does happen in some places, but not many. “Thankfully, there is increasing awareness and a big push by the British Psychological Society to increase perinatal psychology services by experts.”
Such support would have been welcomed by Lucy, who is still haunted by doubts and fears about her son’s birth.
“I don’t understand what really happened to me during the birth or why I bled so much,” she says.
“If a nurse or anaesthetist had come to me after the birth to explain what had gone wrong, that would have been a big help.
“If we have another child, I will ensure I have more control over my care.”
Remarkably, Lucy has retrained as an NHS phlebotomist - a nurse who takes blood.
“I have even worked on the antenatal ward where I gave birth,” she says.
“That is something I really had to get over - going back to the scene of the trauma. I thought it was going to be too tough, but I really surprised myself. It has been a great therapeutic help.” - Daily Mail