Different from depression, postpartum PTSD traps new mothers in “trauma time”.
It was her first baby. The labor lasted 21 hours and the epidural only kind of worked. She was so exhausted — and worn out emotionally — when her daughter finally arrived, she couldn’t really hold the baby.
“It’s really not the story I wanted to tell,” the 23-year-old new mom from Philadelphia said.
She’s willing to talk about the birth, but also wants her privacy; so we’re calling her Sierra.
She and her four-month-old daughter are like a matched set: golden skin, dark hair and easy smiles.
“She’s amazing. Doesn’t cry much. She’s so playful, it’s amazing how much love you can feel for somebody you just met,” Sierra said.
And still, thinking about the delivery is tough. At one point, a nurse rushed into Sierra’s hospital room and strapped an oxygen mask on her face.
“That really freaked me out, because I was like: Am I not breathing? I couldn’t even think why they would be putting it on me. Is something about to happen that’s going to stop me breathing?” she said. “What is going on? Am I OK, is my baby OK?”
That fear stuck and weeks after, Sierra had obsessive thoughts that something horrible was going to happen to her daughter. She felt out of control—and she’d cry–unless the baby was right by her side.
Sierra is getting counseling at a Philadelphia treatment program called Mother-Baby Connections at Drexel University. The pilot is testing different therapies to help new mothers. Some women in the group have postpartum depression; some have an anxiety informally called ‘birth PTSD’ – for post-traumatic stress disorder.
Program director Bobbie Posmontier says birth PTSD can make a woman vulnerable for depression. But the two conditions are not the same.
Different from the sadness and loss of energy that often come with depression, flashbacks are the hallmark sign of birth PTSD, Posmontier said.
In the big bible of mental illnesses, birth PTSD isn’t recognized as an event that causes post-traumatic stress disorder but Posmontier has clients who relive the scariest parts of their delivery over and over.
“They wake up in the middle of the night and they remember, or even during the daytime, maybe driving their car and suddenly this video almost goes in front of her face,” Posmontier said. “We don’t want her to be paralyzed by that, where that’s all she can think of.”
Posmontier became a psychiatric nurse practitioner after 20 years working as a midwife.
“We talk about machismo among men, and being macho, but there’s this thing about being a woman. I am woman, and I’m going to get through this and I’m going to be really proud of myself. And when they actually get to the experience and they are not living up to the ideal of being woman. It can be really disappointing,” she said.
Moving past that disappointment is particularly hard if a mother has a tight attachment to who her baby will be or the dream of how a birth will go.
For one client, it was the terror she felt when her son was born limp and lifeless. She watched as the baby was being resuscitated, and then the staff took the baby away.
That mom imagined her son was dead or brain damaged. It was four hours later—four hours — before she found out her baby was fine.
“Things happen when babies are born. I know this as a midwife that sometimes people get busy,” said Posmontier, an associate professor at Drexel.
The doctors and nurses moved on to the next thing, while the woman was left in that moment of helplessness.
The Mother-Baby Connections program was designed to help women move on—and their babies are welcomed to come to therapy too. Right now the program is free and babysitters are available to watch the infants.
Identifying tensions through movement
On Wednesdays, there’s dance movement therapy. For 23-year-old Sierra it’s a chance to practice being away from her daughter without worrying—and without having to talk about your fears.
“Having your body move to what it wants to at that moment,” she said. “it’s fun.”
Therapist Elizabeth Templeton opened her studio for a tour but not during the mothers’ session.
“At this particular juncture in a woman’s life they are feeling especially vulnerable. They are not feeling themselves, they are not their old self,” Templeton said. “I just feel very protective of the women who are here.”
It’s therapy, she said and that’s private. So Templeton talked about how dance movement therapy works and gave a demonstration.
The studio floor is a soft grey–and rubber-y. Huge windows look out over a park, and there’s a ballet bar. One wall is covered in mirrors. First thing each week, the women find their way unprompted and stand in front of those mirrors, Templeton says. They turn to the side, push back their shoulders and pooch out their post-baby bellies.
“It’s a good check in, and that can also be a place where we begin to talk,” said Templeton, who also teaches a course in Drexel’s Creative Arts Therapies department.
Sometimes the guided movements are wild and playful, other times the moms lie quietly, stretched-out on blankets.
Templeton is trained in kinesthetic empathy. The theory is that emotional problems are held in the body–in the muscles–and those tensions show up in the movements of the body. A therapist can see that and help bring it out, she said. Or she can introduce movement to help people experience positive emotions.
Her tools include music, a small drum and sheer scarves in different lengths.
“It extends the movement, it brings color and energy,” Templeton said.
Lots of people go home after a bad day at work, turn up the music and dance alone in the living room to get frustrations out, but with a therapist there to witness that dance and guide it, Templeton says dance movement therapy goes further.
She believes people get better.
Several studies show it helps people with depression or patients coping with a chronic disease, but reviewers say many of those studies were poorly designed or netted low-quality evidence. Health investigators are calling for gold-standard research.
Reprocessing memories through EMDR
Posmontier offers her clients with birth PTSD a therapy that is widely used, but also somewhat controversial, called EMDR, eye movement desensitization and reprocessing.
It’s a kind of talk therapy in which the counselor uses sounds, lights and vibrations to stimulate first one side of the brain then the other to work on the memory of trauma.
“You take the dream and you put it in a different part of the brain, like in a different file, so now it can go into a past file,” Posmontier said.
No one knows for sure how it works, but it may be related to the re-processing that happens during REM sleep—that’s the stage where your eyes move rapidly back and forth behind your eyelids.
“If you think about soldiers that have been in combat, often there’s a debriefing afterwards, so they can process what’s happened,” Posmontier said. EMDR gives new mothers with trauma a chance to debrief, she said.
During EMDR, a patient puts on headphones. Then the patient watches a horizontal bar of moving lights, and holds two small vibrating tappers—one in each hand. The vibrations and sounds all synch up with the moving lights.
“First the left, then the right, left, right, left, right,” Posmontier said.
“It’s kinda wacky,” said Virginia O’Hayer. She’s a psychologist and one of Posmontier’s colleagues from work.
“I was not a believer,” she said.
O’Hayer says there’s a divide among psychology professionals about EMDR.
“Part of that is because the theories as to why EMDR works haven’t been corroborated by scientific evidence,” she said.
O’Hayer didn’t have postpartum PTSD but her son’s delivery was a series of things that did not go as planned. That time was an anxious memory, so she basically said what that heck and tried EMDR when Posmontier offered to mentally take her mind back to the delivery room.
You think about the trauma, watch the lights, listen to the tones – and after each round of brain stimulation, the therapist asks you to rate the level of emotional disturbance you feel.
At first, O’Hayer was at an 8, a few rounds later she went down to a 3. The experience felt like a ‘zero’ emotionally after several sessions.
During EMDR, as she replayed the scene, she started to notice other things —funny things.
“There was a student who just looked completely horrified,” she said.
She remembered her husband kept repeating the same silly phrase: “Well, that just happened.”
Instead of returning to the feeling that “this baby might die,” O’Hayer says maybe EMDR therapy pushed her brain to make new connections and take her thinking in new directions.
“The idea was that neuroplasticity was increased,” she said.
For mothers who do have birth PTSD, that’s the goal to move from living “in trauma time” to living in the present.
Women with a past history of child- or sexual abuse may be most at risk for birth PTSD, Posmontier said.
For example when you’re in labor, arrive at the hospital, have your clothes taken away—and discover there are no locks on the door, that can be deeply distressing. A different new mom might just feel inconvenienced or annoyed.
A baby’s birth is a joy for most women, but not always. Posmontier let’s women define for themselves whether or not an event is traumatic.
“There’s something about childbirth that we’re supposed to be happy and grateful, and when you have to be happy and grateful there’s no room to talk about the reality,” she said.