All posts by Boukje Eerkens, Psy.D.

Boukje Eerkens, Psy.D., QME, has worked as a clinical psychologist in both intensive inpatient and outpatient settings for 16 years addressing depression, anxiety, PTSD, work disability, immigration hardship, and postpartum life transitions. Her current research interests include the experience of psychological trauma during labor and delivery. She serves as Consulting Psychologist for the California Department of Health Care Services and lives with her husband and daughter in San Rafael, California.
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On Pacifiers

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From The Informed Parent:

“The bottom line is pacifiers are NOT bad. The literature shows overwhelmingly that their use is protective against SIDS. Pacifier use should be on an individual basis. Quite frankly, it should be a decision that is made between the mom and the child. The official stance by the American Academy of Pediatrics, published in October of 2005 in updated guidelines for the reduction of SIDS, was a recommendation that parents consider offering a pacifier at bedtime for infants up to twelve months of age.”

On PTSD and Traumatic Birth

What is traumatic birth?

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What is traumatic birth and postpartum PTSD?

“Traumatic births may vary greatly. As explained by Baby Center, a traumatic birth involves distress for the mother, whether this is due to difficulties with physical or emotional problems. The physical aspects of childbirth cannot be overstated. If a woman has to cope with tearing or an emergency C-section, for instance, then she may experience feelings of trauma, as further explained by Baby Center. Furthermore, emotional distress can also lead to a traumatic birth. As noted in Psychology Today, anything from unrealistic expectations of the birth experience to feeling neglected by the hospital’s medical staff may contribute to the experience of a traumatic birth…

“If you do experience a traumatic birth, keep in mind that, for better or worse, you are far from alone. According to Postpartum Support International (PSI), around nine percent of women cope with some form of PTSD following the birth of their child. And as further explained by PSI, the symptoms of postpartum PTSD may include flashbacks to the traumatic birth, an aversion to things that remind you of the event, and even a sense of unreality. If any of these symptoms describe your own birth experience, then don’t hesitate to reach out to doctors, counselors, or loved ones for support. Both you and your child deserve to move on and be happy.”

Guest post: when birth is trauma

“Research in this field is at an early stage and more needs to be done before making policy recommendations. However, the body of evidence points towards several considerations. Firstly, some women enter pregnancy and birth with existing risk factors for PTSD, and these women may need particular care. Health professionals should be aware that women with a history of trauma, abuse (particularly sexual abuse) and psychiatric problems are at higher risk of PTSD following birth. There is some evidence that a lack of support during the birth may put these women at particular risk (5).

Secondly, interactions with other people have a strong effect on trauma reactions. For example, PTSD is more likely following events which are perceived to have been intentionally perpetrated rather than following accidents (15). This effect of personal relationships and care is particularly relevant to childbirth (16). There is substantial research showing support during labour and birth improves both physical and psychological outcomes (17), and that perceptions of inadequate support and care are predictive of traumatic stress responses. Women who are traumatised often describe negative interactions with staff such as feeling rushed, bullied, judged, ignored or put off when asking for pain relief.

Understanding the importance of support helps explain why, for example, level of pain is not consistently associated with PTSD symptoms. It may not be the level of pain per se which is traumatising for women, but the experience of unbearable pain in combination with the perception of being denied pain-relief by an uncooperative caregiver. Women also report caregivers proceeding with interventions, such as forceps deliveries or episiotomies, without consent, and sometimes even when the woman has clearly expressed her wish not to have the intervention. Negligent care such as leaving women naked in stirrups with the door open can be intensely degrading and stressful. Many of the traumatising aspects of childbirth could be reduced with consistent and considerate care from maternity staff.”

On PTSD and Traumatic Birth

On Postpartum PTSD

Excellent information can be found at The Birth Trauma Association (click here), which addresses the need to respect a women’s basic human rights throughout the birth process and to acknowledge that birth has a psychological outcome as well as a physical one.

From MGH Center for Women’s Mental Health:

Postpartum PTSD is Probably More Common Than You Think

Also, from Postpartum Support International:

Postpartum Post-Traumatic Stress Disorder

On C-section Choice

On C-section choice

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Elective C-sections are the women’s health issue abandoned by feminists, says Alberta doctor:

“Murphy concedes C-sections have surgical risks, but says they need to be contrasted against the risks of vaginal delivery so that pregnant women can make a choice based on informed consent… ‘The pelvic floor outcomes are completely ignored and that is a huge impact on a woman’s quality of life over time,’ he says…

“Murphy now focuses exclusively on pelvic floor dysfunction — a range of symptoms which include bladder and bowel problems as well as pelvic pain — and he says he often hears patients voicing regret…

“‘It’s not uncommon to hear ‘if I had only known, I would have made this choice or that choice’ and the point I’m trying to make is not that women should choose caesareans or that’s the way it should be done, but that women deserve to have proper information… There are a lot of women who do feel that the feminist movement has dropped the ball on this,” he says…

“Murphy says he thinks part of the problem is that generally the feminist movement has hitched itself to what he calls the ‘natural movement’ and as a result have abandoned women who might opt for a C-section…

“It’s become a situation where you are not a real woman unless you go through as normal or natural a birth as possible — less of everything. That’s a valid position. But the opposite position should be respected as well. I’m not sure why these women are denigrated as ‘too posh to push.’ That’s a very denigrating slogan and it’s used to humiliate and I think that’s completely unnecessary and unfair.”…

“‘We don’t accept diseases that can be prevented with vaccines. We don’t accept diseases that can be treated with antibiotics, or conditions that can be corrected with surgeries. They are all normal. It’s also normal to have a 1 in 7 chance of dying during childbirth — [but] we don’t accept that.'”

Recommended reading: Choosing Cesarean: A Natural Birth Plan.

Obstetrician and gynecologist Magnus Murphy, MD, and journalist/advocate Pauline McDonagh Hull offer a compelling case for surgical delivery as a legitimate birth choice for informed women. By offering a wealth of medical evidence from around the world and thoughtfully countering the many objections detractors have lodged against it, the authors convincingly demonstrate that a planned cesarean birth at thirty-nine- plus weeks is a safe and often preferred alternative to a planned vaginal delivery. An indispensable guide for women, their families, and medical professionals.

 

Read: Caesarean rates don’t indicate quality of care and targets are dangerous

 

On the Psychological Impact of Pain

Pain Puts Women at Risk

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“According to Prof. Strous, one of the most influential factors [as to whether a woman would develop PTSD was pain management during delivery. Of the women who experienced partial or full post-trauma symptoms, 80 percent had gone through a natural childbirth, without any form of pain relief. ‘The less pain relief there was, the higher the woman’s chances of developing post-partum PTSD,’ he said. Of the women who did not develop any PTSD symptoms, only 48 percent experienced a natural childbirth.” https://www.sciencedaily.com/releases/2012/08/120808121949.htm.

In another study, emergency cesarean section, severe labor pain, and poor coping skills were associated with more posttraumatic stress symptoms and risk of PTSD.

A study of the risk of psychological complications with prolonged physical pain after childbirth also uncovered a possible correlation between postpartum depression and the duration of pain after childbirth: “Presenting recently at the World Congress of Anaesthesiologists in Hong Kong, the team from Duke-NUS Medical School described their followup on 138 healthy women who received an epidural while delivering their first baby. The new mothers reported their pain levels in the weeks after childbirth; meanwhile, readings on the Edinburgh Postnatal Depression Scale (EPDS) signaled which women were suffering from the condition. With EPDS scores of 12 or higher, the investigators determined that 5.8% of the new moms had in fact developed postpartum depression by week 4 or later. The women with the highest scores were those who also reported being in pain for longer than 4 weeks, and the lowest scores were for mothers who experienced no pain at all following childbirth. ‘The research findings support the need to address pain comprehensively to lessen the risk of developing PND [postnatal depression], and a larger study is being conducted to evaluate the impact of pain and PND in pregnant women,’ remarked medical student and study coauthor Wei Du.”  http://www.pharmacist.com/childbirth-pain-linked-risk-postpartum-depression

“New mothers who reported higher stress levels, greater pain vulnerability during labor or delivery, and greater anxiety at 6-8 weeks after childbirth also had higher [risk of postpartum depression], the researchers report… The research findings support the need to address pain comprehensively to lessen the risk of developing PND [postnatal depression], and a larger study is being conducted to evaluate the impact of pain and PND in pregnant women.”

 http://www.medicalnewstoday.com/articles/312647.php

On Breastfeeding

On Breastfeeding

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Breast milk vs. formula: What do the studies really tell us?

“Nine percent of breastfed infants had at least one illness with diarrhea vs. 13 percent in formula fed infants… Three percent of breastfed infants had eczema vs. 6 percent formula fed… There were no differences in the number of common colds… This tells us that breastfed babies do suffer less often from diarrhea and eczema, but by a relatively small difference.  And…that’s it… ”

“What we know today about breast feeding is based on many studies, but almost all those studies suffer from significant flaws. That is not, in any way, an “anti-breastfeeding” statement. Rather, it’s a statement about supporting those women who choose not to, or can’t breastfeed. Every pediatric practitioner can tell you that nursing can take an emotional and physical toll on some women. When those women forgo nursing, they should be reassured that their babies’ health outcomes and IQ’s will likely be just as positive.”

Everybody Calm Down About Breastfeeding

“[T]he evidence suggests that breastfeeding may slightly decrease your infant’s chance of diarrhea and eczema but will not change the rate at which he gets colds or ear infections and will not prevent death.”

“Many women find breastfeeding to be an enjoyable way to bond with their babies. There is certainly no evidence that breastfeeding is any worse for a baby than formula. And maybe there are some early-life benefits in terms of digestion and rashes, which you may or may not think are important. But what the evidence says is that the popular perception that breast milk is some kind of magical substance that will lead your child to be healthy and brilliant is simply not correct.”

Research On Infant Feeding Favours Having Options: Breast and Bottle

“[The study showed that in the developed world,] the group with significantly more breastfed babies had slightly lower rates of gastrointestinal infections and eczema. Avoiding such conditions during the first year is certainly a boon for any mother, and it’s a benefit which is good for mothers to know about. However, it is hardly something that would give us reason to ostracise mothers less inclined to breastfeed… However, benefits for pre-term infants are profound…”

“It is important to realise, that mother’s circumstances, anything from medical (such as medications, infectious diseases) and mental health (like post-partum depression) issues, to societal circumstances (needing to return to work) and personal preferences (wish to be able to spend time away from childcare, difficulty or inability to use a breast pump), are also important factors that weigh in on the feeding choice and can influence the baby’s health and development. In the developed world, where the evidence-based benefits of breastfeeding are small, a mother’s happiness is easily a larger factor for the child’s overall wellbeing than feeding source, whereas having a choice between feeding options can be highly beneficial for the mother and her personal life situation.”

“It should not be too difficult to find a way of keeping both options open, arriving at a win-win situation for the mental and physical health of both, the parents and their babies…”

Why Choosing to Formula Feed is One of the Best Decisions I’ve Ever Made

“Choosing to stop breastfeeding has allowed both myself, and my husband to bond with our baby. I’m not in constant pain from clogged ducts. My son has gone from being in the 23rd percentile for weight to the 53rd percentile. We no longer have to battle with pumping, supplemental nursing systems, breastfeeding pillows and mastitis. He’s happier, I’m happier and we’re both healthier – physically and mentally.

It’s been 2 months since I made that decision to formula feed my son, and I don’t regret it for one second – it’s one of the best decisions I’ve ever made.”

On Natural Parenting

On Natural Parenting

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3 Ways The Natural Parenting Movement Dehumanizes Women

 

“That the suffering of childbirth is all in a woman’s head, not real but a consequence of conditioning against our natural instincts, is a popular meme in the natural parenting community. It has no basis in reality or in an equal society. When’s the last time we asked a man to pass a kidney stone or endure a migraine without pain relief because it’s ‘natural’?”

“I choose not to take advice on what’s most natural and therefore best for me and my children from a movement that prefers me barefoot making an all-natural from-scratch meal, strapped to a nursing baby that I birthed in agony so I can prove my all-natural worth. As long as my children know their parents love them, and see that a woman and mother is more than her most base instincts and valued for more than the functions of her reproductive organs? The kids will be alright.”

On Natural Birth

On Natural Birth

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Read: No Gain from Childbirth Pain

 

Why are we still trying to talk women out of epidurals?

“Culturally, we’re obsessed with women suffering as much as possible during childbirth. I’ve lost count how many times I’ve been asked if I had an epidural. Nobody has ever asked me about pain relief for any other medical procedure.”

“It now strikes me as absurd that I actually wanted to endure totally unnecessary pain, let alone felt disappointed and ashamed that I didn’t. But that goes to show just how much pressure women face to give birth ‘the right way.'”

“If women want to have a ‘natural’ birth, then all the power to them. But we should all be free to make that choice without the burden of ideology and moralising.”

On the risks of vaginal tearing

“Surgeons repaired the tear, but Debbie was left with a small hole between the wall of her vagina and her bowel, eventually requiring her to be fitted with a colostomy bag.”

Has childbirth pain outlived its evolutionary purpose?