Birth Trauma Part 3

According to Cheryl Tatano Beck, traumatic birth is defined as “an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother  or her infant. The birthing woman experiences intense fear, helplessness, loss of control, and horror” she had later revised that statement to include the woman feeling stripped of her dignity.

What is the cause of women perceiving their birth experience as traumatic? It is the systemic elimination of protective care during the birthing process.

In Beck’s study of 40 women she says that there were four themes that emerged. Theme #1 was to care for the women and treating them as human beings. Theme #2: Lack of Communication.  Theme #3 was safety. Theme #4: The ends will justify the means.

With theme One: #1 women feeling they were objectified, and treated arrogantly and with a lack of empathy. The women were #2 left alone, and abandoned. The #3 birthing mother’s needs were not met by the hospital staff. An example given was of a woman from Puerto Rico who was on all fours, when a nurse brought in 20 students to observe…without her consent.

In theme Two: #1 no one communicated with the woman in labor. They were described as having conversations with one another within earshot but not directly talking with or to the laboring mother. As if she were non-existent.

In the third theme:  the #1 laboring mothers felt that the staff (nurses and doctors) did not adequately deliver safe care. #2 The mothers were not being allowed input into the care being given for their own selves and actually fearing for their own and / or the infant’s life!

In theme Four:  entailed #1 the sense that what was endured and experienced by the mothers was the sense of being “pushed to the background” as everyone around them were celebrating the baby’s healthy birth. These women #2 felt invisible, only the infant mattered.

The experiences mothers have had led to severe post-partum trauma and depression.  Beck, Driscoll, and Watson’s book Traumatic Birth goes into detail about feedback loops [pp. 10-12] that describe the interaction of the mother and child after a traumatic birth, with a listing of the causes and consequences of the cause. Sometimes even breastfeeding is difficult, creating “…intruding flashbacks, disturbing detachments with their infants, feeling violated, enduring physical pain, and insufficient milk supply…” Often the anniversary of a traumatic birth amplifies the feedback loop.

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My own reaction to the shared experiences the women in this book had illustrated the barbarism of western medical professionals, a barbarism that is completely contrary to those principles I listed from the ACOG website in part #2.

The women who tell their story of childbirth weave an astounding sense of personal alienation.  It is no wonder that there is PTSD, depression, self-destructive behaviors, socially isolationistic behaviors and pelvic floor injuries as a result of the improper calloused form of care received. Many of the women feel as though they were raped, yet most had no “history of physical, emotional, and/or sexual abuse” so birth precipitated  a sense of having “the loss of the soul”.

I only touched on a small portion of the book in these three posts. In the next few blogs, I would like to address how we can alter the outcome for women in these circumstances and possibly change childbirth for women.

Sexually Transmitted Infections – Part 3

Syphilis

Transmission “is thought to be by entry in the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse (Lowdermilk & Perry, 182)”. It also can be transmitted through kissing, biting, and oral-genital sex.

The rate of transmission declined from 1995-2004. Syphilis continues to be at a high rate in the southern states.

Primary syphilis appears 5-90 days after as a lesion or chancre, usually painless. Then it erodes into an ulcer appearing sore.

Secondary syphilis occurs 6 weeks to 6 months after transmission. Its appearance is a widespread, symmetric rash on the palms and soles of the feet; with affected lymph nodes. Some individuals also have a fever, headache, and generalized malaise (under-the-weather sensation).

In the vulva, perineum, or anal area Condylomata lata may develop. If left untreated the female may enter a latent phase. If still left untreated, tertiary syphilis will develop, in approximently 1/3 of these women. In this third stage, neurologic, cardiovascular, musculoskeletal, or multi-organ system complications can develop.

Screening and Diagnosis

All women who are diagnosed with another STI or with HIV should have a screen form syphilis. All pregnant women should be screened at the first prenatal visit.

Diagnosis is dependent upon the microscopic exam of primary and/or secondary lesion tissues during the latent or late infection. Serologic tests of antibodies may not be reactive, in early tests.

There may be false-positives with VDRL or RPR screenings. This is not unusual for several reasons, such as: drug addiction or acute infection. To confirm the positive results the use of treponemal tests, fluorescent treponemal antibody absorbed (FTA-ABS) and microheagglutination assays of antibody to T. palidum (MHA-TP) are used to confirm positive results.

Testing should be repeated at 1 to 2 months when genital lesions exist. This is due to early exposure not showing results until 6 to 8 weeks after exposure.

Other STI tests should be done at this juncture, for chlamydia, gonorrhea, et al. HIV should be also offered as a test if indicated.

Management

Penicillin is the preferred drug for treatment. Doxycycline, tetracycline, and erythromycin are alternative treatments. Tetracycline and Doxycycline are contraindicated in pregnancy.

Some pregnant women may get what is known as “Jarisch Herxheimer ” reaction, that may be accompanied with headaches, myalgias, and arthalgias . If the treatment occurs at the second half of pregnancy, it may cause early labor and birth. Their doctor should be contacted if fetal movement stops or if contractions occur.

Women should abstain from sexual activity during treatment and all evidence of primary or secondary syphilis is gone. She should also tell all partners that have been exposed, and that this disease is to be reported.