Please be advised that the story below is an honest and powerful, though traumatic, story of childbirth.
Anna Haring is a mother of two girls and has a deep appreciation for research with her profession as a board-certified clinical specialist in neurologic physical therapy. Her second daughter's birth was a traumatic experience, leading Anna to discover the work of Sharon Dekel, PhD, MS, MPhil, whose lab researches post-traumatic stress disorder (PTSD) related to childbirth in the Department of Psychiatry at Massachusetts General Hospital. Anna's experience has given her valuable insight into the importance of mental health during the postpartum period.
“As a medical professional, I highly value research and how this can impact clinical care,” Anna says. “When I heard about the work that Dr. Dekel was doing [on women’s mental health following traumatic childbirth experiences] I decided there were several benefits for participating to me personally, to medical providers, and to the community.”
Ensuring the well-being of people after they give birth from the very early postpartum period is important for parent and child health. Unfortunately, some people can have a traumatic birth. They may have a hard time coping psychologically and can develop PTSD. This maternal condition is underdiagnosed and under-treated. The Dekel Lab is among the leading labs in the world that conducts large-scale clinical and translation studies focused on characterizing childbirth-related PTSD (CB-PTSD) and co-occurring conditions. Dr. Dekel’s research team is developing novel tools for the early detection of parents at risk for CB-PTSD and testing preventive treatments that are effective and safe. Funded by the National Institute of Health (NIH), they have been conducting the first neuroimaging (brain) study of patients following childbirth trauma to reveal the disorder biomarkers.
The Birth Story
Anna recalls her second pregnancy being fairly smooth and going as expected; she even went into labor on her due date. Her labor was straightforward, and while it was 16 hours, that was shorter than with her first pregnancy, so she was pleasantly surprised.
“When it was time to start pushing, I remember feeling really proud of my body for getting to that point,” she recalls. “This thought was fleeting, and unfortunately, everything changed very rapidly.”
The doctors and nurses noted that the baby’s heart rate was dropping on the monitor, and Anna had started bleeding. She was rushed to the operating room in case a cesarean section (c-section) was needed. The doctors gave her a couple of minutes opportunity to try to push the baby out, but because the baby’s heart rate was continuing to drop, an emergency cesarean section was necessary. Her daughter was delivered quickly and was healthy, but then Anna began hemorrhaging. “I remember seeing my baby far across the room but feeling so terrible and weak that I did not even want to hold her,” Anna remembers.
The doctors could not immediately find the source of her bleeding. Her body went into hemorrhagic shock and required massive blood resuscitation. A surgical specialist helped identify the source of the bleeding and eventually discovered that my uterus had ruptured. “My medical team and my family had to make the difficult decision to perform a hysterectomy to stop the bleeding and save my life,” Anna says. “I remember waking up in the ICU [intensive care unit], my husband and parents were at my bedside, and I immediately began asking about what had happened. Even though I knew that my life had been in danger during the delivery of my baby, it was still devastating to learn that I would never be able to carry another child or not be able to make that decision for myself,” Anna recalls.
Searching for Rest & Healing
About 14 hours after her daughter was born and her necessary but life-changing surgeries, Anna held her baby girl for the first time. She remembers feeling very drowsy and weak and being barely able to support her or keep my eyes open. She recalls having flashbacks to her delivery experience during those first couple of days when she was in the ICU, re-experiencing some of the physical sensations she had during her delivery. Eventually, when she was stable, she was transferred to the recovery floor and remembers feeling like she finally got to spend quality time with her new baby. A few days later, she was discharged home with her husband and baby girl.
When she returned home, Anna remembered feeling many conflicting feelings. “I was very happy that my baby and I were alive and home, but I felt sad about missing the first days of my daughter’s life and shocked about how the delivery went. I was in a lot of pain and utterly exhausted, but proud of what my body had endured and its ability to recover,” she recalls.
Findings from Dr. Dekel’s research show that objective stressors in birth such as mode of delivery and obstetrical complications, like the ones Anna experienced, can predict the development of subsequent CB-PTSD. In fact, her research finds that patients who have an unscheduled c-section are three times more likely to suffer from CB-PTSD.
“The experience of childbirth and subsequent negative and positive psychological responses vary greatly person-to-person,” Dr. Dekel explains. “My research aims to better capture the various postpartum mental health trajectories. Unfortunately, a significant portion of women will experience clinically significant distress and develop a mental illness in the form of depression, anxiety, or CB-PTSD. We want to understand what puts a person at risk to experience birth trauma as well as what helps people recover psychologically following traumatic childbirth and even experience posttraumatic psychological growth (PTG). This will ultimately help clinicians more fully understand postpartum mental health conditions which will translate to better, more comprehensive mental health care for mothers and their children”
Because of her major surgeries, she experienced an initial loss of independence and an inability to hold her older daughter. She was very motivated to recover so she could regain her independence. “I knew my life was redefined by what I had survived, and yet felt like so many people could not really understand what I had gone through,” Anna remembers. “Those first several months were challenging with caring for two young children and recognizing I needed to try to take care of myself physically and psychologically.”
She was able to be present for her kids but kept experiencing recurrent vivid memories of her traumatic delivery, especially when she was alone. She recalls her birth experience replaying in her head like it was on a video or audio loop. While these memories are less intrusive and frequent now, they still occur to this day, and she acknowledges her road to recovery will take some time. She returned to work after five months and remembered feeling like she got part of her old self back because of how much joy and fulfillment she finds at work.
I know the team I had at Mass General saved my life. While my experience was terrifying at times, I consistently felt confident in the care I was receiving from the multidisciplinary team.
Compassionate Care & Validation
Sarah Bernstein, MD, delivered Anna’s baby and helped manage her postpartum hemorrhage with other surgical specialists. Dr. Bernstein visited her in the ICU and offered to explain everything that had happened if she was ready and wanted to hear everything. “While I didn’t fully realize what was happening at the time, I now understand how important this medical debrief and validation of my traumatic experience was for me,” she recalls. Dr. Dekel notes that for some patients debriefing is positive but for others it can have a negative effect.
One interaction with a doctor continues to stick out for Anna. One of her goals before the delivery was to breastfeed her daughter, which couldn’t happen right away given the circumstances of her delivery. “I remember one doctor telling me that it was more than ok if I no longer wanted to breastfeed given what I went through,” she remembers. “In general, I have found a lot of pressure in the community to breastfeed. This doctor removed the pressure and stress surrounding breastfeeding and gave me a choice. Their approach helped me successfully transition my baby to breastfeeding when I was able.”
Healing Through Storytelling
Anna credits her family, close friends, and the OBGYN outpatient social worker she met with in the months following her ordeal with helping her to heal. The social worker helped her process her experience, brainstorm coping strategies, and find resources in case she needed them.
“Increasing awareness and knowledge of conditions of childbirth-related traumatic stress and associated postpartum post-traumatic stress disorder, which is different and distinct from postpartum depression, after giving birth can help destigmatize postpartum PTSD, promote healing and a sense of ‘you’re not alone,’” says Dr. Dekel. “We have studied hundreds of people in our lab who had birth trauma. Many never disclosed their birth experience or symptoms of CB-PTSD to anyone until they spoke about it in the study. This is often the case for victims of trauma. People know something is wrong, that they are not coping well but at the same time feel that they are not experiencing postpartum depression. We hope that our research will inform revising the formal classification of mental disorders to include PTSD with postpartum onset”.
Anna’s advice for new parents is to talk about what they’re experiencing to help everyone feel less isolated and alone. “Before having kids, I had this false impression that birth and the postpartum time was this magical experience,” Anna says. She acknowledges that while not all birth experiences are traumatic, they are intense and can be stressful. “The postpartum experience can feel very isolating, and I think we need to allow the space for mothers to talk about it so that we can help each other, and so providers know how to best support us.”
Have You Had a Stressful Childbirth Experience?
We are interested in studying people who are pregnant or recently gave birth at Mass General or another Harvard-affiliated hospital. If this applies to you and you are interested in participating in research, please reach out to the Dekel Lab.