Valerie Gommon Midwife’s Blog

Archive for the ‘Post Traumatic Stress’ Category

I am very grateful for this Guest Blog about Hyperemesis Gravidarum or Pregnancy Sickness written by Amanda.  Amanda’s contact details are at the end of the article.

Hyperemesis Gravidarum

So, what is Hyperemesis Gravidarum?

Most people accept that Nausea and Vomiting in Pregnancy (NVP) or “Morning Sickness” is just part and parcel of pregnancy. However very few people are aware of just how bad this can be and that Hyperemesis Gravidarum (HG) even exists.

HG is an extreme form of NVP and is more like having a stomach flu or food poisoning for months on end rather than the occasional moments of nausea and odd vomiting session experienced by most expectant mothers. 

There are many different levels of HG and sufferers range from those who consider it to be “mild”, perhaps battling nausea and vomiting at home right through to those with “severe” HG which has them in and out of hospital throughout their entire pregnancy. Thankfully HG is not the killer that it once could be here in the UK but awareness and compassion from both society and the medical profession is extremely limited. This means that not only does a woman with HG suffer through the worst sickness imaginable, but she does so while having to fight just for the support she needs.

It is often difficult to get a diagnosis and treatment for HG and many doctors are reluctant to prescribe medication until a woman is dehydrated enough to require hospitalisation. And yet many HG survivors who have gone on to have subsequent pregnancies have found that early and aggressive treatment with anti-emetics and IV hydration can limit the severity of their symptoms and make HG much more tolerable, if not necessarily easy.

There are so many symptoms that may suggest a woman has HG, and a whole list of them can be found on the HelpHer website here. However, it is most women’s experience that there has to be a significant loss of body weight and ketones in the urine before their GP or midwife will realise how severe the sickness is.

It is all too common for HG sufferers to be told everything from, “have you tried ginger?” to “this is normal, just get on with it”. A woman suffering from that level of sickness may be too weak to fight for what she needs and often needs an advocate. Yet when facing HG, especially the first time round, it can be all too easy to feel there is nothing you can do and that you just have to accept what the doctor says. In fact it can be far too easy to believe that it really is normal and you are just weak, leading to depression and isolation at how ill you feel and how unable you are to cope with what you believe every other pregnant woman deals with easily.

Which leads to the fact that many HG sufferers not only deal with the physical effects of the condition but can also become very isolated, depressed and even go on to develop Post Traumatic Stress Disorder (PTSD). And the emotional effects of HG can last far beyond the pregnancy itself, even affecting the woman’s decision of whether to face further pregnancies or not. 

Finally, we must not forget the extremely stressful and painful experience that the woman’s partner, parents, siblings and other children go through every single day that she is sick. They can become as isolated and vulnerable as the pregnant woman herself and yet they are so often overlooked even if the woman herself manages to get the treatment she needs.

This is just a very basic overview of what is a complicated and extremely traumatic condition that can ruin what should be one of the most wonderful times in a mother’s life. I cannot possibly do the topic justice on just one page of my blog and so I would like to now draw your attention to some of the most resourceful sites on the web dedicated to this condition before sharing my own personal experience of HG with you and what it has inspired me to work on now my pregnancy is over.

Hyperemesis Gravidarum Resources on the Web

HelpHer – Hyperemesis Education and Research Foundation

The HelpHer website is full of fantastic information for mothers, partners, medical professionals, and the media. It was the most helpful resource I found during my pregnancy and the forums are particularly helpful and supportive both whilst in the midst of HG and afterwards.  

Pregnancy Sickness Support UK

Pregnancy Sickness Support UK is a charity that hopes to offer a support network for HG sufferers and raise awareness of the condition here in the UK. I only found the site after my pregnancy was over but I would sincerely recommend checking it out.

Motherisk

Motherisk is based in Canada and has huge amounts of research available to read online into many different facets of pregnancy that HG sufferers will find interesting, include research into the effectiveness and safety of drugs during pregnancy.

http://amandaclairedesigns.typepad.com/amanda-claire-designs/hperemesis-gravidarum.html

Twitter: @amandaspatch

Following my recent posting when I mentioned that some women choose unassisted birth as a result of previous trauma, I have recently read that  American actor and talk-show host Rikki Lake has revealed that she was sexually abused as a young child.

Ricki Lake bravely discusses her past in her new book “Your Best Birth”.  Lake discusses her past battles with her weight and body image but goes on to describe the healing that she has experienced through her own birthing experiences, and I have to say that this concurs with my experiences as a midwife – I absolutely believe that a positive birth experience can be healing and empowering for women whether their past trauma was sexual abuse or a traumatic birth experience and am very happy to speak to women about this subject www.3shiresmidwife.co.uk.   It is well recognised by midwives that pregnancy and birth are significant times for women who have experienced sexual abuse – memories may well come to the fore, or a woman may remember events that she had previously buried and forgotten.

The documentary “The Business of Being Born”, www.thebusinessofbeingborn.com, which Lake made with filmmaker Abby Epstein, has touched many people and was championed by both the Independent Midwives Association (IMA) www.independentmidwives.org and the National Childbirth Trust (NCT) www.nct-org.uk and has been shown to packed audiences around this country and abroad.

Help is available for survivors of child sexual abuse from a number of sources including:

www.thesurvivorstrust.org

www.childline.org.uk

www.sheilakitzinger.com

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.


Twitter