Penny’s PSI Address 2011

Most recently, Penny Simkin was asked to present on PATTCh at the Postpartum Support International (PSI) Conference in Seattle, WA, on Sunday, September 18th, 2011. She gave the following address:

Story of Laura (3 month old)

Laura is the mother of a 3 month old daughter. Her birth was traumatic and humiliating, and she felt terribly unsupported, disrespected, and discounted and cannot accept that her cesarean was necessary. Her partner was overwhelmed by events and worry for Laura and his child, and unable to function in the advocacy role.

A task for new mothers is to put their birth experience in to words – to make sense of it, to figure out what happened. It’s often a painful struggle, comes out “in pieces”, and they feel frustrated that they keep talking in circles. The more they talk about it, the more mired they are in the confusion and emotions. It doesn’t do any good to talk about it. With Laura, that’s what we are working on. She can’t write the story or answer a questionnaire asking about good and bad things about her experience. She is working very hard. She keeps apologizing for being unable to stay on track. Our first task is to give the story a chronology, to match feelings with events and make the story “tellable.”

Laura is one of thousands of women who come out of their birth experience emotionally and physically wounded. Ironically, their caregivers either have no idea of how the women are suffering, or they dismiss them as angry, unreasonable, and ignorant — of putting a higher priority on their experience than on the well-being of their babies, or they fear the women will sue them. Only rarely do caregivers show empathy and a desire to clarify what happened, and to help the woman heal.

We’re just beginning to discover the magnitude of traumatic birth as an outcome AROUND THE WORLD! Many studies report that 25% of women describe their births as traumatic, and about 1 in 10 meet the criteria for PTSD. This is the rather desperate milieu from which the concept of PATTCh has grown. PATTCh stands for Prevention and Treatment of Traumatic Childbirth.

We know that PTSD after childbirth is under-recognized, under-diagnosed, and undertreated by the people most intimately involved in women’s maternity care. It’s time to recognize that one’s experience of childbirth — that one day during which she gives birth — plays a key role in not only her physical health, but her mental health. In many countries around the world – England, the Scandinavian countries, Israel, Australia, New Zealand, Canada, and the US, to name some – sensitive and talented researchers are studying and publishing about all facets of traumatic birth and its impact on mothers, babies, partners, and others. Most studies are small and qualitative (Kathleen Kendall-Tackett’s, Cheryl Beck’s, and Listening to Mothers Surveys, being exceptions).

As I read about the wonderful work being done in this fledgling field, I often think how wonderful it would be to bring all these researchers and leading clinicians together. Who knows what would come of it? Nothing less than transforming maternity care around the world to embrace psychosocial outcomes of childbirth. This should come out as a priority right after coming out of it alive.

Realistically, without big money backing such an effort, a face to face meeting (which I have dreamed about!) is not going to happen. However, it might be possible using the internet to communicate and become acquainted, share resources (annotated bibliographies, service programs, etc.), identify gaps in knowledge and services, and identify barriers to the goal of prioritizing psychosocial outcomes in maternity care.

Three years ago, right before the big economic crisis, I had made an attempt to get something like this going, but life intervened. Annie Kennedy, Teri Shilling, Sharon Storton, Phyllis Klaus, Kathy McGrath, were enthusiastic participants.

The vision statement we came up with was:

We envision maternity care that enhances the emotional well-being of mothers and families during the perinatal period.

I guess that my purpose in addressing you is to raise awareness and introduce this idea of PATTCh, to get you talking about it, thinking about the need to modify maternity care to incorporate good mental health as a described outcome of maternity care. If any of you want to explore this further, let me know – I’m around today but you can send any thoughts about PATTCh to [info@pattch.org].