A Case For Post-natal Trauma Among African Women

In their book titled “Post-Traumatic Stress Disorder after Childbirth in (African) Women: Prevalence and Risk Factors”, Adewuya , Ologun and Ibigbami did a fine job enlightening the public on a situation in childbirth among African women that the media in Africa ought to have taken great interest in long before now, but have glossed over it all these years.

I was forced to join issues here when my trusted contractor of 20 years standing defrauded me of a huge sum of money and absconded from the housing project I had contracted him to oversee. I was to learn later that his wife who gave birth to a bouncing baby boy had suffered “madness” after the birth. My contractor took her to a native doctor. This native doctor tied her up, hands and feet, and kept flogging her up to 12 strokes of the cane every morning in a bid to exorcise “the devil” which he claimed had possessed her. And to think that her ignorant husband had actually stolen my money to pay the spiritualist!

On learning what happened, I was moved with pity at first, and then fury, knowing that like my contractor, many pregnant African women and their husbands, especially in the rural areas, have little or no knowledge whatsoever of post-natal trauma. To think that a mother who just gave birth to a child should be subjected to such dehumanizing condition as my contractor's wife had experienced was very distressing for me.

Everyone knows that childbirth is a stressful and, sometimes, traumatic process. In most cases, women experience feelings of helplessness and fear when they are pregnant. Strange as it may seem, the fact is that when deliveries are difficult or when medical personnel are not duly respectful to most pregnant women, negative memories can eclipse their post-natal period. This is often the case with many African women.

For instance, research has shown that women who experience upsetting conditions during delivery are certain to develop symptoms of post traumatic stress disorder (PTSD). These include flashbacks, anxiety and nightmares. A recent study of 289 pregnant women in the UK showed that 2.8% met the criteria for PSTD at 6 weeks post-partum. Other studies conducted in Sweden, Germany and Italy also confirmed a rate of PTSD of around 2-3%. In Africa, the rate is about 5.9%.

These rates can be said to represent the worst cases. But research has also shown that many women who have never experienced full-blown PTSD can develop several symptoms of the disorder. In some countries of the West, sub-syndromal PTSD among women has been reported to be as high as 30%.

Women who experience symptoms of post traumatic stress disorder are literally tortured by reflective thoughts and memories. The “flashbacks” of periods of discomfort during childbirth can instigate feelings of fear, horror or helplessness in these women. Mothers, especially those whose babies were prematurely born, could live in constant fear that their babies could die. Sufferers could also feel an overwhelming sense of being socially isolated, lonely, angry or depressed.

Such symptoms are capable of making it more difficult for nursing mothers to bond with their babies. To avert this possibility, sufferers can avoid activities that remind them of giving birth, such as gynaecological examinations. They have also been known to fear subsequent pregnancies. To avoid becoming pregnant, they reject sex with their husbands. In some cases, this has led to serious misunderstandings between husband and wife, and even been the cause of broken relationships and broken homes.

Because people differ about what they perceive as traumatic, it is impossible to institute hard and fast guidelines about what sort of experiences can trigger post traumatic stress. What research studies have done is to point to several risk factors which can facilitate its development during the post-partum period. Researchers in the United Kingdom and the Netherlands found that women are more likely to develop symptoms if they have one or more of these experiences: premature births or miscarriages; difficult deliveries that require such instrumental interventions as the use of forceps; emergency caesarean sections; feelings of fear for the well-being of their babies or for themselves; feelings of helplessness or a lack of control during labour; a history of other traumatic experiences, such as sexual abuse; a history of psychological problems or trait anxiety or insufficient social support from partners or medical staff.

Other studies show links between prior obstetric procedures and post-partum distress. For instance, a study of some African women found that post-partum women with a history of illegal or induced abortions experienced higher levels of post-partum anxiety and depression.

Naturally, childbirth is stressful and no level of adequacy in preparation can remove all the risks of trauma. There is, however, an old application that can reduce the stress, and that is social support.

Again, research shows that a woman in labour benefits more from a supportive companion – a person who is continuously present, who praises and touches her, and who explains what is going on. When women receive such social support, they have better childbirth experiences. They have shorter labours and fewer medical interventions. They also report less pain and feel they have a greater control over the process. Put in a nutshell, they generally have more dignified post-partum experiences.

There have been recent studies where women admitted to maternity wards were assigned to receive either enhanced social support or routine hospital procedures only. Women who received enhanced social support had easier childbirths. Six weeks later, they also showed lower anxiety levels; lower rates of depression; higher self-esteem; increased rates of breastfeeding; more time spent with their infants and more positive feelings about their families.

If a woman is pregnant, the implications seem clear and African media must champion the campaign to bring this home to all expectant mothers in every nook and cranny of the continent. To make birth less difficult and reduce post-partum stress symptoms, an expectant mother must get someone to stand by and support her during labour.

For some women, the designated supporter is the father of the child. Generally, women who are attended to by their husbands are known to have less anxiety than women who are not.

However, other studies suggest that the presence of the husband can also intensify the would-be mother's level of stress. It may be that some fathers, because of their own anxieties during the process of their wives' childbirth are unable to offer them the right kind of support. If that is the case, expectant parents should consider finding a relative, a trusted friend, or a professional childbirth coach to attend to the childbirth. In most cultures, women give birth with such helpers, and in fact evolve a psychological need for such social support.

Another factor that can play a vital role in post-partum stress is the environment. Advocates of natural childbirth believe that hospital births are more likely to cause post-natal stress than home births. This claim can only be validated by the fact that most people find the hospital environment more stressful than their own homes. However, it will be wrong to assume that hospitalization causes trauma because, at the end of the day, women who experience birth complications are more likely to end up in a hospital, even if they started labour with the intention of delivering at home. Women who gave birth at home could experience less stress because they were fortunate not to have suffered medical complications. But even at that, no one can be sure that home birth protects women more from childbirth trauma and post-partum stress than hospital birth.

So, what should a woman do if her childbirth experience is haunting her?

If she has already given birth, and her experience was disappointing or traumatic, she should look for and get sympathetic people who can understand and deal with her situation. Many experts believe that assuring talks can help women through the memory lane of their disappointments and anxiety during childbirth.

A recent study of women who experienced post-partum trauma found that psychological counselling helped reduce symptoms of psychological trauma. Women at risk of developing post-partum trauma symptoms were randomly assigned to either control or test groups. Test groups received brief counselling from midwives within 72 hours after birth and again by telephone 4-6 weeks later. The counselling did not prevent everyone from developing post traumatic stress disorder. However, women who received counselling had fewer symptoms than those assigned to the control group. They also had fewer feelings of self-blame, and were more confident about future pregnancies.

If a woman has a sympathetic listener in her life, she must be advised to utilize the opportunity to discuss her feelings with him or her. She must not hesitate to find counselling if she thinks it would benefit her. She must seek out professional help if her symptoms are intense – such as suicidal feeling – or if they prevent her from what she considers as normal functioning. This may be difficult. Not everyone is sensitive to this problem. Medical personnel could dismiss a nursing mother's complaint or give the impression of being too busy to listen. Perhaps experienced mothers would be the ideal confidants.

In some cases, some women have been known to view childbirth as a competitive sport, and could make sufferers of PTSD feel that their problems are a synopsis of their personal failure. These problems and the need to educate rural women inspired a group of mothers in the United Kingdom to establish the Birth Trauma Association - a website for people who have been traumatized by childbirth. The site offers diagnostic information and advice. It also includes life stories of real women who have experienced trauma after childbirth. Some of these women are interested in being contacted by fellow sufferers. If you are haunted by your childbirth experience, this website may be a helpful place to begin the healing process.

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Articles by Emeka Asinugo