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Grieving Though Grateful: 
Reconciling the Traumatic and Disappointing Birth Experience 
Jaclyn Engelsher DNP, APRN 
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Grieving Through Grateful: Reconciling the Traumatic Birth Experience

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When a woman experiences a traumatic or disappointing birth, there often exists an emotional dichotomy between gratefulness for the child and grief toward the experience. This presentation describes characteristics that contribute to traumatic birth and resources for the PMH nurse to aid in prevention, diagnosis, treatment, and collaboration.

Published in: Health & Medicine
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Grieving Through Grateful: Reconciling the Traumatic Birth Experience

  1. 1. Grieving Though Grateful: Reconciling the Traumatic and Disappointing Birth Experience Jaclyn Engelsher DNP, APRN Effects of Traumatic Birth Community & Peer Support Resources Clinical Considerations Background When a woman experiences a traumatic or disappointing birth, there often exists an emotional dichotomy between gratefulness for the child and grief toward the experience. Between 25-34% of women world-wide experience traumatic birth and incidence of PTSD after childbirth ranges from 1-6%, yet the DSM-5 lacks specific discussion in the sections on perinatal mood disorders, trauma and stress-related disorders, or bereavement. Postpartum trauma may be missed or mistaken for other postpartum mood disorders by clinicians, and under-reported by mothers. Platitudes such as "all that matters is a healthy baby" and recommendations to “just move on” minimize and invalidate the mother's grief toward the experience and contribute to feelings of guilt, anger, helplessness, failure, or diminished self-esteem. This presentation describes risk factors that contribute to traumatic birth and resources for the PMH nurse to aid in prevention, diagnosis, treatment, and collaboration. Risk Factors Implications References Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010) Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing, 66(10), 2142–2153. Foley, S., Crawley, R., & Wilkie, S. (2014). The birth memories and recall questionnaire (BirthMARQ): Development and Evaluation. BCM Pregnancy and Childbirth, 14(211). Retrieved from http://www.biomedcentral.com/1471-2393/14/211 Harris, R. & Ayers, S. (2012). What makes labour and birth traumatic? A survey of intrapartum ‘hotspots.’ Psychology & Health, 27(10), 1166-1177. Please visit www.onednp.com for a list of complete references LOSS OF CONTROL • Unplanned C-section • Life-threatening obstetric complications • Emergent obstetric interventions including forceps and ventouse • Precipitous birth • Prolonged birth • Significant pain or inadequate pain relief • Feelings or fear and powerlessness • Birth plan not realized • Intrapartum dissociation • Stillbirth • Infant complications or disability • Not provided opportunity to make educated choices • Unnecessary medical interventions LACK OF SUPPORT • Interpersonal difficulties with birth partner • Health providers unsupportive or not empathetic • Feeling mistreated by healthcare team • Inadequate education and preparation for birth and postpartum period • Poor postnatal care or continuity PERSONAL HISTORY • Psychiatric history • Previous traumatic birth • Previous trauma Birth is not a merely a means to an end, but an experience independent of the outcome. A comprehensive understanding of traumatic birth provides the PMH nurse a foundation for enhanced assessment, intervention, integrative strategies, and interdisciplinary collaboration to help women at risk for or experienced traumatic birth. Knowledge of the risk factors, characteristics, and supportive resources results in refined diagnosis, effective treatment planning, and the opportunity to build connections with peer obstetric clinicians. Physical Lactation insufficiency Psychosomatic complaints Gynecological and sexual problems Disturbed sleep, appetite, and energy Psychosocial Ineffective maternal role attainment & bonding Disrupted relationships Avoidance/isolation Fear of future birth Lack of self-esteem and confidence as a mother Psychological Postpartum depression Postpartum anxiety PTSD Bereavement Compulsions Baby Center Community: Disappointing Birth Experience http://community.babycenter.com/groups/a1198275/disappointing_birth_e xperience Pinterest www.pinterest.com/onednp/traumatic-birth-resources Facebook • Unplanned CBAC and Birth Trauma Support Group https://www.facebook.com/groups/111066659056348/ • Birth Trauma Association https://www.facebook.com/groups/TheBTA/ Solace for Mothers • Website http://www.solaceformothers.org • Forum http://mothers.solaceformothers.org Twitter • @BirthTraumaHelp • @PostpartumHelp International Cesarean Awareness Network • http://www.ican-online.org In addition to evidence-based assessment, diagnosis and treatment strategies for depression, anxiety, and PTSD, there are special considerations when considering birth trauma Assessment Birth Memories and Recall Questionnaire (BirthMARQ) Differential Diagnosis Postpartum mood and anxiety disorders, thyroid disorders, insulin resistance Psychotherapy • Grief and trauma focused therapy • Review medical records from the birth • Encourage to write birth story Pharmacology Determine breastfeeding status Collaboration Opportunities for Continuity of Care • Primary care • Women’s Health/OBGYN Defining Traumatic Birth The individual perceives or experiences the birth and/or postpartum period as threating to the physical or emotional integrity of the mother or the baby. Birth Matters

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