View Full Version : Help for PND and bonding
My SIL had a baby on 11th Dec. Lots of weird things happened with her labour, but that's another whole story in itself. She complained of bad back pain after her birth, and it hadn't improved by Christmas, in fact it was getting worse. She also had shocking fluid retention, a temperature and felt awful. Several midwives from the hospital did home visits, as did the Mat. Health Nurse. They all said it was part of recovery.
2 days ago she went to bend over, and couldn't move. She was in so much agony she called the doctor who had her admitted back to hospital. Apparantly her bladder had not emptied and was the size of a football. She also had fluid on the lungs, kidney damage, pancreas and liver damage.
After draining her fluids and doing tests, they discovered that during delivery the baby somehow injured a major nerve, and that has created all these problems. She has to stay in hospital for at least another two days.
However my biggest concern is this: she did not see her baby for nearly 3 days (saw him tonight) :eek: I don't know why my BIL didn't take him in earlier :confused: but my BIL left the baby at home with the inlaws while he went to see her in hospital. OMG - either she was on deaths door, or they don't understand the bonding concept.
Also, I spoke to her today, and she sounds like she is suffering from bad depression. She didn't mention to me, but I could tell from her voice. What can I do to assist her?
Can anyone who has suffered PND give me some advice - should I leave her alone, try and get her out and about soon, just be a shoulder to lean on? I'm very concerned that she hasn't bonded at all with her bub, she just holds everything inside. (During her labour she arrived at the hospital in transition, and the midwife said "You don't look like you're in labour, perhaps you should go home for a while".:eek:)
Chickadee
01-01-2006, 22:24
A shoulder to lean on may be all she needs. But if she's like most with depression, particularly relating to bonding issues with her bub, she will more than likely try to keep it all to herself. Especially if thats her nature anyways.
It's really hard to say what to do. Gentle support and being open with her about your experiences as a mum and about others you know might be enough to gain her trust and get her talking. But she might need more of a confrontational "shove" to get her to open up. Impossible to say without knowing her, sorry. I needed the "shove" :rolleyes:
It's a hard one. I kept suggesting that I go over to her place and we go for a small walk - even to the letterbox, but she kept saying she wasn't ready. She said she just opened the front door and it was all too much. I remember feeling a little overwhelmed the first time I went out after ds was born, but that was a few days after, not weeks later.
She said everyone was pestering her to get out and about, but she couldn't do it. Does that sound like a symptom of depression?
She may develop PTSD from this experience and not necessarily PND. But for either there are different supports. For mother/child bonding there are flower essences that are very gentle but effective.
The TABS site has very useful info on telling between PND and PTSD.
http://tabs.org.nz/
http://birthtraumaassociation.org.uk/
POST TRAUMATIC STRESS DISORDER
When we talk of birth trauma, we mean Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. We also include those women who may not meet the clinical criteria for PTSD but who have some of the symptoms of the disorder.
PTSD is the term for a set of normal reactions to a traumatic, scary or bad experience. It is a disorder that can occur following the experience or witnessing of life-threatening events. We usually recognize these as things like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. However, a traumatic experience can be any experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby) so it is now understood that Post Traumatic Stress Disorder can be a consequence of a traumatic birth.
Characteristic features of PTSD include:
An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
A response of intense fear, helplessness or horror to that experience.
The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time).
It is important to remember that PTSD is a normal response to a traumatic experience. The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are beyond the sufferer's control. They are the mind's way of trying to make sense of an extremely scary experience and are not a sign individual 'weakness' or inability to cope.
Chickadee
01-01-2006, 22:31
Yep, it does. Physically locking yourself in. Didn't you do the PND test with the health nurse or midwife after you had Max? There's a whole checklist. I'll try to find it or similar. Also check out www.beyondblue.org
Chickadee
01-01-2006, 22:38
Bubhub's info page on PND with links to support and information groups. http://www.bubhub.com.au/servicesdepression.shtml
You can't force her to go out, and having people pester at her to get out and about isn't going to help since it's just a symptom, not the cause. That's no practical help at all to you :( but all I can think of. She may have an underlying fear of something happening to her or her baby if she goes out, or it may be linked to not feeling adequate as a mum - ie, if you go out in public surely someone will notice you're not interacting properly with your baby.
No Martha - I saw a different health nurse every visit, and none of them ever did the test.:( Boo hiss. I wasn't very impressed with the care I received from them.
Thanks Janet interesting info. It's so hard to tell what's going on because she says so little about how she's really feeling. Maybe it's early days of PND rather than PTSD:confused:
Good point Martha. She said that because she has been in so much pain, that she picks him up to feed him, and that's about it. She hasn't held him other than that.
Is it possible that now she will be physically recovering that the bonding process will just begin naturally? Or do you think she might have put up too many barriers?
Sorry, I know it's hard when you don't know her.
Tea Lady
01-01-2006, 22:50
Sorry, not much help here Wattle, but I reckon it's great you're being proactive and getting info so you can help. I'm sure it will mean alot to her to know that you care about her and her family, and it sounds like you're already showing her that. If I were in her situation I'd be glad to have you to help!
Separation from your baby can cause a lack of bonding and we know that for some women that's a feature of PND although which came first is not always clear. A prolonged separation like that can definitely cause PTSD though which normally becomes apparent around the 4-6 month mark. Sometimes it's enough to just ask periodically how someone is and actually being interested in the answer will mark you out as different from most people! A pamphlet collection is always helpful :) "I'm here if you need anything" offers of physical support like cooking, washing or cleaning.
whatwasithinking
02-01-2006, 00:16
Once again I agree with JanetF on all aspects of advice.
Cathy you are a great SIL to show so much concern and compassion and worry.
Take care and hugs to you and the family.
Thanks girls, I hate feeling like I don't know how to help. I asked her if I could bring in some fresh fruit and something yummy to eat, but she said the hospital food was fine. It's not - it's disgusting. In her stay after delivering, I took her lots of yummy food, and she appreciated it so much because she said she couldn't stand the food there.:confused:
It's like she just doesn't care about anything. I doubt whether people have discussed depression with her. Is it something that sufferers put their head in the sand about?
Chickadee
02-01-2006, 13:45
I doubt whether people have discussed depression with her. Is it something that sufferers put their head in the sand about?
Yes yes yes!! It can be a very lonely thing, usually self-imposed. Although all women experience depression slightly differently, I think every single one recognises that something is wrong. The media and society bombards us with images of happy families, of tender care between mum and bub, of what a wonderful experience starting a family can be. And most of us have been looking forward to having our bub for a long time. So when a woman sits there holding her baby and doesn't feel the way she thinks she should, she internalises it. She reasons that there must be something wrong with her and that she's the only one who feels that way. It is so obviously wrong that it becomes something to hide from others. There can also be a lot of internal thoughts that cycle downwards into feelings of self-loathing: I am bad, I hate me, everyone else must hate me/I'm not worth liking or being around, I am a burden not worth other's time, I don't deserve help/gifts/fruit... If you ask what you can do to help she'll probably say nothing, but if you just jump in and do it anyways she may appreciate it.
Also knowing that she's not quite right with her bub may create a fear of having the baby taken away if anyone figures her out, so she may isolate herself further.
Talking to her about depression, finding some literature for her, or going through a depression test with her are probably good ideas. All the time with lots of love from you as her safe place.
Foxymoron
02-01-2006, 13:55
I suffered with pnd after my first and second birth and it was a terribly isloating experience :(
The advice already given re pnd is great so I won't add to that.
A great way for a mum to bond with her babe when there have been major traumas is for her to have the baby passed to her while she is having a deep relaxing bath ( when she is well and able to do so) with soft lighting and maybe her partner by her side. The skin to skin contact and the quiet can often bring on the wave of emotion that is supressed and in need of release.
Edited to add: I was given that wisdom by Joy Johnston, who I had as my private LC for breastfeeding troubles, and this approach also works a treat to help with breastfeeding that hasn't gotten off to a good start :)
Chickadee
02-01-2006, 14:20
Some links for you. None of these are full diagnostic tools - she needs to see a dr for full evaluation. But I think they can be a useful self-checklist of how a person is feeling, provided the person doesn't lie or try to minimise how they're feeling like I did :rolleyes: So possibly a good idea to allow her to do them on her own and let her choose whether to tell you the results or not.
The Edinburgh Postnatal Depression Scale (EPDS) is the test I was given to take while pregnant and at the 6 week check up. http://www.wellmother.com/articles/edinburgh.htm
The Beyondblue site provides three checklists or evaluation tools which are based more on general depression and anxiety and may not be as good for the immediate post-natal time period your sil is in. (I can't get the full link to work, grrrr).
Beyondblue also has a specific PND site: www.beyondblue.org.au/postnataldepression/
Oh dear, I spoke with her today, and she is in a bad bad way. She won't let me visit her, and just kept crying on the phone. She sounded so distraught, it was awful.
She will be spending at least another two days in hospital, and will have to have a catheter in for a month or so after she goes home. My heart just goes out to her so much. Her hubby and son visited her today, and she said she was hoping they wouldn't see how upset she was - she had already caused them enough stress.:( So she's still bottling it all up.
It's a recipe for disaster, and I feel so helpless.
The poor love. She's been in massive shock by the sounds of it. The hospital should be supplying her with counseling asap. As if! :rolleyes: Pamphlet collection, listening ear time. Good nutrition is a must! Encourage her to have as much skin on skin with the baby constantly to at least kickstart some of the hormonal load she's missing :( So sad!
This was written by the women in the birth trauma group I run, it may have some hints. I'll post another one under it that I wrote to give to traumatised women. You never know what might work for her.
What do I want from a birth partner who is supporting me through traumatic births and healing? By the women of Accessing *******.
A willingness to learn for himself: not to just go with the flow but to actively seek out information and discuss fears and interests.
A willingness to hear me without judging, even if I am treating him like one of my girlfriends and needing to talk over the same ground perpetually.
A willingness to be part of the entire process post-conception.
Truthfulness when he's feeling like he's not in a safe place before retreating to his cave.
An ability to bend like a willow as I rage about the invasion of my body.
A willingness to accept that sex after two dozen strangers have manhandled my vagina, my womanhood, my belly that sex is probably not going to be on the agenda for a very long time.
Believing me when I say that they are still sexy to me but I can't act on my feelings because of what has happened.
Trusting me that my body can/has healed and coming with me on the journey.
Cherishing me and hearing me when I say I need cherishing without expectations of reward (sex.....).
Trusting that my body can birth a baby despite what we've both been through and what he's seen in the hospital, the operating theatre and post birth.
Trusting in my parenting ability and seeing that I can separate the violations done to me from the baby.
Loving me and bringing me flowers for no reason other than he thinks I'm a goddess.
Being willing to look at how his actions contributed to what happened not just seeing me as the only one affected.
Being an equal partner in parenting and household maintenance not just while I am healing but all the time anyway!
To not be embarrassed about how distressed I am and try to cover it up or avoid it.
To become a stronger, more open partner and parent.
I hope you find something useful here.
Dealing with traumatic birth.
There are many things that women can do to begin healing from traumatic birth. Some of the avenues which have worked for us are:-
Seek out a support group. Consumer-driven support groups are usually free and run by women who have experienced trauma as well. You should feel safe and well supported in the group you choose. Or, start your own group! You will certainly attract other women as birth trauma is a vastly underestimated experience in Australia. Accessing ******* is both online and real life support. Check below for details.
Requesting a medical debriefing from your caregiver. If you were traumatised by birth in a hospital or birth centre they will probably have a midwife and doctor with whom you can discuss your experience. They should be able to explain to you, and your partner, exactly what happened and why. This can be particularly beneficial when something life threatening and unexpected has occurred and you feel shellshocked by it. It can also help your partner to understand why you are feeling as you are and how to support you. If you cannot go to the hospital because it is too distressing they can conduct this off site for you. If you do not wish to have anything to do with the hospital or BC, or your trauma occurred at home, a private midwife might be a good source of information for you. A general counsellor can sometimes help with the fallout but may not be able to give you medical information or explain your record to you.
Contacting the health service where the trauma occurred and requesting your medical record. Quite often during labour women will be unable to see all that happens around them. If you were in pain or had drugs such as gas or pethidine, you may not have a very clear idea of some of what occurred. Having a support person who was with you who can tell you what went on is also helpful in this way. We feel that to fully heal you need to look at everything that happened and your medical record is one way to fill in some of the gaps. Labour and birth notes are often not very clear and you may feel the staff’s notes have little or no relation to what happened from your point of view.
Write your experience down. Putting your story on paper can be very difficult. Some women write little bits of it and then string them together. This can help you feel that the experience is out of you and not sitting in your heart distressing you. It can help you find patterns in what emerged, work out your reactions and those of the people around you, and even find new ways to see some of it.
Keep a journal. You can record your emotional state and work out what distressed you the most as well as how you are healing yourself.
Talk about it to sympathetic listeners. Talking therapies such as counselling can be vital in giving us space and validating our experience. It is another way to get the pain out of you. People are often uncomfortable with emotions and you may find that even trusted friends or family members cannot comprehend what you are saying. They may try to comfort you by saying “You got a healthy baby, why don’t you concentrate on that?” This is not helpful. It goes without saying that we are happy that our baby and ourselves survive but there are many other factors which are important in a birth. Sometimes giving people a copy of your birth story to read will help them to really see why you are distressed.
Be good to yourself! You may find as you review your experience that you will start to feel that it was your fault. While it is always better to be an informed consumer, sometimes this would not have helped you improve your experience anyway. Hospitals and birth centres are institutions and can only be as good as the staff you get. Protocols are not necessarily useful or sensitive and some staff are not thoughtful about how they follow them. Having your medical record and understanding hospital/BC protocols will help you understand how much choice you actually had in the situation and what you might think of changing in subsequent births.
Alternative therapies can help. Maybe see your naturopath or GP. Not all caregivers, especially those in conventional medical fields, view traumatic birth as important or valid. If your caregiver is not supportive and understanding, get a new one! A naturopath or homeopath may offer you herbs, vitamins or flower essences to aid your recovery both physically and emotionally. Some of us have found this extremely helpful to use alongside talking therapies. Be wary of prescribed drugs such as antidepressants or sleeping pills which may help alleviate some of the symptoms but not help you with the root cause of your distress. They also may make it hard to care for your baby.
Try to get some physical support. Sometimes having a friend wash the dishes, do the washing or clean the kitchen can free up you and your partner to have time together. Some women find that a less chaotic home environment is beneficial. Sometimes even a little bit of scrubbing can be cathartic in itself! But we don’t recommend you get too bothered by housework at this point – healing is so much more important and, trust us, the dishes will be there tomorrow.
Read some books and articles about birth trauma and recovery but also about sexual assault. Many women feel that their experience was similar to sexual assault and find relief in approaching some aspects of their healing this way.
Some useful books, articles and web sites are:- Reclaiming the Spirituality of Birth: Healing for Mothers and Babies, Benig Mauger, Vermont, 2000. Rebounding from Childbirth: Toward Emotional Recovery, Lynn Madsen, London, 1994. Woman’s Experience of Sex: The Facts and Feelings of Female Sexuality at Every Stage of Life, Sheila Kitzinger, New York, 1985.
Birth Trauma and Stress Support, Brisbane We offer support through email and phone and a support group. Contact Ursula at Estramina House: phone: 07 3809 0196 or email us at birtrasup@yahoo.com.au
Support, Advocacy and Recovery on the internet http://health.groups.yahoo.com/group/accessingartemis
A group for women recovering from birth trauma.
www.birthrites.org
Loads of useful links. Includes info on recovering from traumatic birth. Very empowering. Encouraging of a consumer-type attitude to your health care.
http://www.victoriousbirth.com/index.html
Caesarean and Traumatic Birth Support. A site for women who want to truly heal spiritually and emotionally after a difficult birth experience
http://www.eheart.com/cesarean/index.html
A site by, for and about those born by c-sec.
http://www.tabs.org.nz/
New Zealand site on traumatic birth and recovery – PTSD and PND.
http://www.sheilakitzinger.com/Birth%20Crisis.htm
Kitzinger on birth trauma.
http://www.birthlove.com/petition/womens_rights.html
Petition and declaration on the rights of birthing women.
http://www.birthlove.com/
A US site devoted to improving women’s experience in birth. Excellent for birth trauma.
http://www.yoni.com/healerf/templedoor.shtml
Healing the Temple Door – a guided meditation on healing from rape which can also be excellently employed in recovering from birth trauma.
This pamphlet was written by
Janet Fraser for Accessing *******.©
Janet Fraser 2004.
My heart goes out to your SIL. I had a difficult delivery and some complications afterwards. Although nowhere near as bad as your SIL, the birth of my DS was so completely different to what I had expected that I felt quite traumatised for a few weeks afterwards. I remember telling a friend I felt like I'd been through a major car crash and was in shock.
Lots of excellent advice has been given here so I'll just add a few things that helped me.
I wouldn't let anyone visit me in the hospital, but one friend came anyway. I'm really glad she did. It depends on your SIL but you could visit anyway, just say you are popping in to drop off flowers or something and only stay if she seems to want company. I appreciated my friend acknowledging my feelings and not saying to look on the bright side. My parents are overseas and I told them not to come, but inside I was really sad they didn't.
It took me about 6 weeks to bond with my son. Although I looked after him well I didn't actually like him. It was really helpful when a few people told me this can happen (without me telling them how I was feeling) and it's ok and will pass. I was also feeling a bit angry at what he had done to me, accompanied my huge feelings of guilt because rationally of course it wasn't his fault.
I told anyone who wouldn't run away all about it (those poor people). Maybe asking a few questions may let her know you will listen if she feels ready to talk.
I still feel sad about my birth experience, disappointed in my body. But am fine and love DS now. I'm actually thinking about having a second, never thought that would happen!
Best wishes.
Hi there, thought I'd share thoughts re the bonding.
I had a caesarean in the evening (7.15pm) and I didn't really get to properly hold my baby before they took him away. My birth was very traumatic and then my little boy was in special care, so I finally got to hold him at 5.00am the next morning (for about 5 minutes before the nurse took him away again). I was so worried that I wouldn't get to bond with him properly and I was upset that I missed out on those first touches, but he adores me and I him and the bonding all happened so quickly. Just thinking about him makes me smile.
I have been diagnosed with PND and the biggest help I've found is a friend who phones me every couple of days 'just to say hi'.
Chickadee
14-01-2006, 09:55
Cathy,
Any good news yet? How is she doing?
Hi Martha, yes a little improvement.
To be honest, I've been so sick with morning (all day/night) sickness that I haven't spoken to her as much as I'd like and I haven't been able to go over to her place either. :(
We had Max's 1st birthday today, so it was her first outing! She did well, and I think it really cheered her up. We didn't get to talk much though with all the people here.
Hopefully I'll feel better soon and can be there more for her.
She is still quite sick, has to have the catheter in for a while longer etc. So it's all a real drag.
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