Experience of Child Birth
None of us can stay without being amazed by the transformative power of pregnancy and childbirth. The childbirth typically is considered to be the most joyful, spiritual and beautiful experience for all humans. Typically the standard practice for childbirth and pregnancy will involve sharing the joy of the pregnancy news, prenatal visits, and ultrasounds, shopping and decorating the room for baby, when the labour starts going to the hospital, delivering the baby, taking endless pictures, visits and wishes from family and friends, booking for ceremonies and so on…..here comes the joy. Ideally life would have been so perfect with the harmony and joy all around us. How can one forget the beautiful lines by Hahnemann in aphorism 9 of Organon “In the healthy condition of man, the spiritual vital force, the dynamis that animates the material body, rules with unbounded sways and retain all the parts of the organism in admirable, harmonious, vital operation, as regards both sensation and functions so that our indwelling reason-gifted mind can freely employ this living, healthy instrument for the higher purpose of our existence.”
When the conditions surrounding us are internally and externally healthy, we engage to our highest purpose of existence and enjoy our natural tendency of producing babies and continuing generations. The environment both internal and external does not remain same for all women who bear a child.
Childbirth even though which sounds to be the most welcoming experience can be a complex event that may lead to both positive and negative psychological responses in couples having a child, especially in the women. Frequently it leads to postnatal depression in women particularly when the experience of labour is a traumatic. Trauma as defined in Oxford Dictionary is “a powerful shock that may have long- lasting consequences”. Such injuries even though not visible can perfectly be perceived by means of senses (as describe in aphorism 6 of Organon) as they leave massive effect of stress on the mothers.
Post Traumatic Stress Disorder (PTSD) is usually recognized as set of normal reactions to a bad traumatic experience which can be violence or terror attack, natural catastrophe, or an accident. The traumatic experience can be any experience involving danger of death or injury to an individual or anyone close to them and in such cases usually their baby and therefore a Birth Trauma.
How to Diagnose Post natal PTSD?
Such patients come with the history of experiencing a threat of serious injury or threat of death to themselves or someone close especially their babies. This result in an immense fear and helplessness within them, they feel out of control. The patient usually complaints of nightmares and flashbacks which makes them feel very anxious and distressed. They enter the state of panic and try to avoid anything that reminds them about their traumatic experiences and would avoid talking about it; however some women like to speak about their experience a lot, even to a stage that they are obsessed with it at times. The way they express their experiences is a characteristic personality trait and aid in remedy selection at later stage. The train of bad memories and struggle to avoid such reminders often leads to concentration and sleep disorders. The patient may also feel angry and irritable at most times.
Risk Factors for Post Natal PTSD
The research on this is limited, however Post Natal PTSD is considered to be excited by various factors. Some women are known to be traumatized by group of Objective factors which includes delivery methods and yet others are known to be traumatized by Subjective factors which are more related to emotions and feelings.
- The risk factors include:
- H/O stillbirth
- H/O giving birth to a disabled baby
- H/O baby at risk of life
- H/O trauma in mother e.g. in her childhood, domestic violence etc.
- Short or lengthy or very painful labour
- Inefficient Pain relief
- Intense medical interventions
- Obstetric complication such as Instrumental medical delivery and emergency deliveries
- Harsh and impersonal treatment by staff members
- Being neglected and Poor postnatal care
- Lack of information and informed consent to medical procedures
Many men who see the partners traumatized by the experience of childbirth also feel being traumatized.
Research by Beck suggests that ‘Birth Trauma lies in the eye of the beholder’. Another research revealed that the mothers perceived their birth trauma was observed as a routine by the clinicians. This reveals that experiencing Birth Trauma is an individual perception and is associated with the personality of an individual, which I can now call as “constitution”. This is how different individuals will perceive the same thing differently and therefore some are sensitive to trauma, while others are not.
Some of the risk factors that cause trauma like- emergency delivery, risk of death to mother or her baby, can traumatize any normal person. However risk factors like-ineffective pain relief, intense medical interventions, lack of information about pregnancy and attitude of staff members towards the mother etc, can be the ones that are perceived differently by different individuals and depends on the susceptibility of the mother.
Anis Mikhail, defines the holistic definition of stress as “Stress is the state which arises from an actual or perceived demand-capability imbalance in the organism’s vital adjustment actions, and which is partially manifested by nonspecific response.” This again suggests that response to a certain condition will not be specific for all individuals and are we again mentioning about the individual susceptibility?
It is worthwhile to mention aphorism 11 of Organon “ When a person falls ill, it is only this spiritual, self-acting vital force, everywhere present in his organism, that is primarily deranged by the dynamic influence upon it of a morbific agent inimical to life, it is only the vital force, deranged to such an abnormal state, that can furnish the organism with its disagreeable sensations, and incline it to the irregular processes which we call disease; for as a power invisible in itself, and only cognizable by its effects on the organism, its morbid derangement only makes itself known by the manifestation of disease in the sensation and functions of the observer and physician, that is, by morbid symptoms, and in no other way can it make itself known.”
This invisible injury of birth trauma, would have certainly affected at the level as deep as in the vital force, that it expresses itself as a derangement which is expressed by mothers as a terrifying experience of anxiety, panic attacks, nightmares, flashes of past bad experiences and so on.
Selecting a Remedy
The Cause: The cause of Birth Trauma is so intense and deep that it has affected the patient straight to the level of mind and produced acute symptoms like panic attacks, anxiety, nightmares etc. The intensity of cause must have been so strong and powerful to produces such kind of symptoms in a very short time. Looking at the aphorism 5 of Organon “Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease…………………..”, we cannot ignore considering the cause in case of Birth Trauma which has caused invisible injury to the mother. It will be the most important characteristic symptom of the case.
Way of expression to a particular condition: Expression of dealing with a condition is different in all individuals. Childbirth has been welcoming for many women, yet it causes invisible injury to others. Among those who have been vulnerable and sensitive to the injury will express it in so many different ways, some becoming irritable, others becoming violent, and yet some of them weepy and others quiet within themselves. The way of expression of the patient to the trauma will aid a physician to select a similimum in a very comfortable and confident manner.
Rubrics: We can consider looking into some of these rubrics especially from the ‘Mind’ chapter like Anxiety, Anger, Brooding, Death: thoughts of, Delusions, Dwells, Fear-sudden, Helplessness- feeling of, Indifference, Irritability, Sadness, Sensitive, Sentimental, Weeping etc.
Ailments from abused: physically/marriage in/ sexually (children/rape), bad news, death of loved ones, neglected being, rudeness of others etc.
Actual selection of rubrics will depend on the individual case and help in guiding the selection of remedy.
What more can be done?
Besides taking the homeopathic remedy support; good antenatal education, informed consent of the patient in any kind of labour complications or procedure, postnatal hospital care with properly trained and compassionate staff, post natal support from specialist can help the mothers avoid the occurrence of the disorder or atleast reduce its intensity. In settings like India with strong family networks; emotional support from the family and friends will play a strong role in combating such conditions.
Getting to the nerve of the case and understanding what needs to be dealt is important for a physician. The thorough case analysis will aid the physician to hit on the exact characteristic symptoms and form a totality to find the similimum. These are the basics which we all know, yet help as grounding aid to many budding homeopaths who many times feel unsure when dealing with cases.
- Ayer, S 2004, Delivery as a traumatic event: Prevalence, risk factors, and treatment for posttraumatic stress disorder. Clinical Obstetrics and Gynecology, 47(3), 552-567.
- Beck, CT 2004, Birth trauma: in the eye of the beholder, Nursing Research, Jan- Feb; 53 (1): 28-35.
- Beinart, H, Kennedy, P and Llewelyn, S (eds) 2009, Clinical Psychology in Practice, BPS Blackwell, UK.
- Brockingston, IF 1996, Motherhood and Mental Health, Oxford University Press, Oxford.
- Hahnemann, S 2011, Organon of Medicine, 5th & 6th edn., BJain Publishers, New Delhi.
- Hornby, AS 2005, Oxford Advanced Learner’s Dictionary, Oxford University Press, India.
- Humphrey, J H 2005, Women and Stress Research, Nova Science Publishers, New York.
- Humphrey, JH 2003, Stress Education for College Students, Nova Science Publishers, New York.
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- The Birth Trauma Association, accessed on http://www.birthtraumaassociation.org.uk
- Tomb, DA 1999, Psychiatry, 6th edn., Lippincott William & William, USA.
- Wiegartz, P, Gyoerkoe, K 2009, The Pregnancy & Postpartum Anxiety Workbook, USA.