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SELF-HELP
READING YOUR NOTES
PROFESSIONAL HELP
READING YOUR NOTES
HAVING YOUR SAY

A person with PTSD does not have to look forward to a life-time of unrelieved suffering and maintenance therapy.

Unlike many mental illnesses, most people can gain permanent, significant, if not substantial relief and freedom from PTSD through a variety of non-chemical options. What follows covers some of these options - how you can help yourself, and what sort of professional help has been found to be of assistance. Even as a scar will seldom completely disappear, neither will the effects of your trauma, however, you can enjoy life again in a meaningful and fulfilling way.

SELF-HELP

These measures are not an alternative to professional treatment but they will assist with how well you are able to cope before, during and after treatment.

Create your own support network of friends, family and professionals. Use people to help you in the way that they can eg. a family member may not understand your illness but is only too willing to offer babysitting whenever it's needed. Avoid spending time with people who are critical or unsympathetic or those who have a negative outlook on life.

Be aware of your limitations: Don't try to do too much and don't blame yourself for not coping. Accept help when it is offered no matter how small. If you don?t like to ask for help try leaving a list of ?jobs? on the fridge that you can refer to when someone asks if there?s anything they can do to help. Prioritise tasks and on bad days stick to only what must happen on the day eg. caring for baby, preparing meals. Leave any non-urgent tasks such as vacuuming the hall or folding the laundry, for your keen volunteers, or for another day.

Take care of yourself. Tend to your own needs and don?t feel guilty for doing so. Making use of a volunteer to mind a grizzly baby so you can shower in peace or eat a meal while it?s hot can make a huge difference to your day. Make time for some ?time-out.? Use aromatherapy, homoeopathy, yoga, exercise, relaxation techniques; anything that works for you to soothe the mind, body and soul. And don?t neglect your spiritual needs either.

Establish some normal routines. Sometimes, sticking to a routine involves less thought and planning. Along with the routine of feeding and bathing baby in the morning, include time for brushing your teeth, combing your hair, getting dressed and eating a nutritious breakfast. These may seem like obvious and insignificant tasks when we are well but during the bad times they can seem like insurmountable chores to add to an already overloaded day and yet they will help you greatly in your sense of well-being.

Good nutrition is vital. You need to eat well in order to care for others, especially if you are breastfeeding too. Adjust your shopping list to include healthy, easy snacks like fresh fruit and vegetables, dried fruit, nuts and cheese and simple to prepare meals including tinned and frozen foods. If you cook a dish that can be easily frozen, cook it in bulk and freeze it in meal-size portions for tougher days. Fill a thermos with a hot drink and set it aside with a snack to have in the early hours when you are breastfeeding. Also have a water bottle on hand to keep you hydrated, as breastfeeding is thirsty work.

Eat a well balanced diet. Eat to maintain your optimum energy, which means keeping your blood sugar levels constant. A low blood sugar level leaves you feeling tired, listless and shaky while a high blood sugar level gives you a short-lived buzz. Avoid simple carbohydrates like sugar and refined white flour which are easily digested and metabolised rapidly, giving an almost immediate energy high, followed later by a significant energy slump. Avoid also caffeine, which is found in tea, coffee, chocolate and some fizzy drinks; also avoid smoking, alcohol and added salt.

B vitamins are essential for effective sugar metabolism and energy release. Alcohol, caffeine, smoking, oral contraceptives and stress can all deplete your body of them. As B vitamins are not stored in the body it will probably be necessary to use a supplement during these times of stress especially vitamins B9 and Bl2. Feelings of depression, irritability and tiredness can be symptoms of a B vitamin deficiency. Fresh fruit and vegetables, wholegrain cereals, wholemeal bread, yeast extract, liver, beans, lentils and tofu are all excellent sources.

An iron deficient diet will also leave you feeling tired. Good sources are cereals, liver, kidneys, dried apricots, eggs, watercress, beef, lamb and wholemeal bread. Vitamin C improves the way your body absorbs iron so combine this in your meals.

Consult your GP, pharmacist, health shop rep, a nutritionist or dietician, etc. for specific advice concerning your particular nutritional needs.

Allow yourself some simple pleasures. Try to do at least one thing each day that isn?t a ?should?; something that you get some enjoyment from such as reading a magazine in the morning sunshine for 10 undisturbed minutes or going for a leisurely walk around the block while listening to your favourite music. If necessary, plan it into your day but don?t berate yourself if it doesn?t happen. Try not to feel that the minute that you put the baby down for a sleep, you need to race around catching up on all the jobs that need doing. Prioritise and be willing to let some things go.

Be adaptable. New babies invariably mean a lack of sleep and sleep deprivation can make you feel like your going crazy some days. When the going gets tough, accept that it?s not forever and ease up on your expectations of what ?needs? to be done each day. Conserve your energy, sleep when and where you can and put off anything that?s not essential.

Be unsociable when you need to be. Don?t feel that you have to always answer the door or the phone. Put a note on the door that says ?Mother and baby sleeping, please do not disturb? and put the answer phone on or leave the phone off the hook if the ringing will wake you. Chances are that the minute you get your unsettled baby to sleep and you dive for your pillow, the phone will ring!

Exercise. Forget trying to keep up to your previous schedule at the gym or worrying about if you are ?pushing play? for the required time each day. Simply, a little fresh air, sunshine and gentle exercise, no matter how small will do wonders for your stress levels and to help you to feel connected to the world outside your four walls. Include your exercise as one of your simple pleasures.

Find a trusted person(s) to talk to about the trauma. They need to be empathetic, non-judgmental, and attentive listeners. Your partner may be this person. Be aware, however, that he is likely to be affected by the trauma too and may feel blamed or at fault for things that happened. He may also need to have his feelings heard. Speaking with someone who isn't emotionally involved may be a better option.

The need to debrief. After any highly emotional event, good or bad, there is a strong need to share the experience and to have one's emotions acknowledged. Having a baby is a monumental experience in any woman's life.

Every woman needs to debrief; even after the most normal of births. Those who had a stressful experience will need to talk it through many times. Friends and family may be initially sympathetic but may not understand the continuing need to talk.

Debriefing has been shown to reduce the occurrence of PND. It is also effective in reducing the severity of PTSD.

We believe all women should have the chance to talk over their birth experience in the early postnatal days, preferably with a health professional who was present for the labour and the birth.

Get writing. Record your birth story. Putting your experiences into words can be a way of beginning to make some sort of sense of what you have been through. As you write your story and compile the events in the order that they happened, you may begin to discover more clearly which events are particularly hard for you to deal with, or to clarify exactly what your emotions are in regards to particular situations. Many sufferers have told us that they found it very helpful to write their story or to write a letter to the people involved in their birth. They were able to express how they were feeling and what they were going through, what they would have liked to have happened, or what they want to do now to make sure it doesn't happen again. Even if the letter is never sent it can be a very empowering and therapeutic exercise.

If writing your story is too difficult, a TABS member has suggested another way of recording the events that worked well for her: she drew the events in cartoon form. She found that then she didn't get caught up in trying to find the right words to express how she felt. Instead a picture said it simply and quickly.

Another suggestion is to start a journal to record how you are feeling, the emotions you are dealing with and what you think may be upsetting you. Putting your thoughts into words may help you to understand your feelings better rather than bottling them up especially if you don't have someone that you can talk openly to.

"When you come to the end of your tether, tie a knot and hang on."

Some further avenues that can give some relief are:

• Naturo Pharm: Introducing homoeopathic remedies.
Naturo Pharm have contributed an introduction to homoeopathy.
• Bach Remedy Flowers: Bach Remedy Flowers in your recovery - for an overview.
• Homoeopathy: an introduction to homoeopathy.

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HOW YOUR PARTNER, FAMILY AND FRIENDS CAN HELP:

Childbirth-related PTSD affects more than just the mothers. Apart from partners and support people possibly being traumatized in their own right, we have to recognize that the experience of PTSD has an impact on the people around the mother, whether those people recognize it or not.

Little research and study has been done on this area, and no specific programmes of help and support are available. Be aware, though, that thought-leaders in PTSD treatment are becoming more and more aware of the situation of those supporting mothers with PTSD, and are starting to investigate and explore options.

In the mean-time, know that you are not forgotten in the rush of attention of the mother. Stick with her. What you are doing is great, and you are a very important person!

A PARTNER'S PERSPECTIVE

This has been written by the partner of a PTSD survivor.

"PTSD affects partners too. Women experience it directly, men see and try to deal with its effects. Men have to understand that the women's experiences have affected them. Women have to know that their men have been affected too.

Men sometimes struggle to cope with the changes they see in their women. Some previously important things might no longer count. Other thoughts and reactions have appeared. Women might be always "on" about the birth or something to do with it. Against all apparent logic, they won't "let it go" and "get on with it."

They might seem to be "going round in circles" "like a stunned guppy," as if they have been knocked over by a steam-roller. They might go right over the top in reaction to harmless things. A well-meaning comment might put them into spin, and set them back untold - men will not appreciate the well-wisher's comment.

But the women have not "gone nutty." The women's reactions are par for the course, given what has happened to them. They have been steam-rollered, they cannot help being in a "daze." A war veteran might dive for cover when a car backfires - other "backfiring" might panic women as dramatically. But the women are still there. They know they are not well. They want to be better. For that, they need help. Their men will probably not have the skills. But their men can hold them. Their men can work to shelter them from what is not helpful. And their men can listen. Listening, not chemicals, underlies the available treatments for PTSD. In this way men can help, as their women "ride out the storm."

Ralph

A HELPFUL SITE

Postpartum Dads: this website is intended to help other dads by providing firsthand information and guidance through the experience of PPD. Their message is one of hope, that "your wife can overcome PPD and you can have a happy, love filled family." While this site relates to Postpartum Depression, a lot of it is equally relevant to those close to PTSD sufferers and survivors.

Ways in which your partner can help are:

• Offer to go with her to the doctor or health professional.
• Take the initiative with housework. Try to do things without being asked.
• Bring the baby to her in the night for breastfeeding and settle the baby afterwards. Or share the feeding by including some bottle feeds too.
• Try to screen her from unwanted visitors or phone calls.
• Try to keep any unnecessary tasks to a minimum.
• Try to just listen to how she is feeling without feeling the need to fix the problem.
• Understand that emotions will run high on some days for both of you and try to make time to talk about things together when things are more settled.
• Understand that sexual feelings will probably not be very high on her list with all the demands of the baby. Be patient and offer non-sexual touching and affection.
• Arrange some time together without the children. Organize a babysitter and make the necessary arrangements to enable you both to go for a meal, to see a movie or to simply go for a walk together.
• Remember to look after yourself too and get support if you need it. You may also be affected by the trauma so don?t try to do too much and don?t expect to be able to fix everything.
• Here is a list that you can print out and attach to your fridge to refer to as and when help is offered by family and friends:

PROFESSIONAL HELP

These therapies have been proven to be successful in the treatment of PTSD. It is essential that they are carried out by a therapist who has been specially trained in the use of the treatment.

COGNITIVE BEHAVIOUR THERAPY

Cognitions are the way we interpret what happens to us, as well as our images, thoughts, and attitudes, ie a person's mood reflects the way he/she thinks. Challenging self-defeating beliefs is a skill that can be learnt. CBT is structured programme of self-help with the therapist acting as the guide.

The "Behaviour" component involves helping the client to change the way they act by repeatedly facing up to their fears on their own until anxiety fades - a strategy called self exposure. Clients are usually taught how to alternate their coping strategies to enable them to face up to their fears and to reinterpret their symptoms of anxiety.

CBT differs from psychoanalysis by being problem oriented. It deals with the "here and now" and not with unconscious conflicts derived from childhood. The number of sessions does not usually need to exceed 15.

EXPOSURE AND IMAGERY REPROCESSING

The therapy consists of helping the client to think about and imagine the traumatic event without getting too upset.

To achieve this the patient has to expose herself in imagination to the actual trauma. The client also learns to change the traumatic event into a more 'mastery' event. Instead of being a helpless victim the client regains control over the situation.

EYE MOVEMENT DESENSITISATION AND REPROCESSING

EMDR is a complex method of psychotherapy that integrates many of the successful elements of a range of therapeutic approaches in combination with eye movements or other forms of rhythmical stimulation in ways that stimulate the brain's information processing system.

With EMDR therapy it is unnecessary to delve into old psychological material. People can achieve their therapeutic goals at a rapid rate with recognisable changes that don't disappear over time.

"Daylight will peep through a very small hole." (Japanese proverb)

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Penny Simkin and Phyllis Klaus have compiled a Self-Assessment form: Self-Assessment for Maternal Distress after Difficult Childbirth. Reprinted with permission from When Survivors Give Birth, by Penny Simkin and Phyllis Klaus, 2004, www.pennysimkin.com.

READING YOUR NOTES

Glenda Stimpson, friend of TABS, Convenor of Childbirth Education at Aucklands National Womens Hospital provided the following information at the TABS Study Day in March 2004.

1. You can get a copy of your hospital notes any time. Time frames to obtain them differ from hospital to hospital. They do not cost you any money. The writing can be difficult to read and the photocopies may not be of good quality.

2. To gain the maxium information from your notes you would be advised to have an impartial health professional present to provide explanations if required and to assist you.

3. It is important to deal with your concerns/queries after the event, because misconceptions/misunderstandings or a feeling that your care has been less than adequate can leave you feeling very angry, disempowered, desparing and depressed, especially if the outcome has not met our expectations.

To make us "whole people" again, we must face the situation, and sometimes working through the notes can be very healing.

If there is anything I can do to assist you with intrepretation of your notes, I am willing to help.

Glenda E Stimpson
Email glendas@slingshot.co.nz

HAVING YOUR SAY

DO YOU KNOW HOW TO GET ACCESS TO YOUR NOTES?

You have the right to:

• Read your notes
• To have a copy of all of your notes
• To write your version of your birth story, to be added to your notes, if you don't agree that your notes accurately describe all that happened.

To request a copy of your notes you will need to contact your hospital or health provider and find out what steps you need to follow. It is likely that you will need to make a request in writing. Include your full name, date of birth, address and phone number, the information you require, your signature and a copy of personal identification. It is usual to allow 20 working days for your request to be completed so let them know if you need your copies urgently and why. Your notes are kept for up to 10 years, as a rule, before being destroyed.

DO YOU WANT TO HAVE YOUR SAY ABOUT HOW YOU WERE TREATED?

Feedback is an important way of gauging how well we have done something. We all know that we can learn from our mistakes; these are perhaps the best lessons learnt. To know that we have done something well and why is also helpful for improvement and growth.

One option that may be helpful to you in dealing with your bad birth experience is to comment on the service you received during your care. Contact your health provider to find out the correct procedure to do this in order to get the desired response as quickly as possible. Alternatively, contact the Health and Disability Consumer Advocacy Service to enlist their help. There are various approaches you may wish to choose from:

• There may be forms or a questionnaire available that you can fill in to comment on what you "Liked" or what you would like them to "Do Differently."
• You may want to discuss your care in person.
• You may want to make a formal complaint about any aspect of your care.

Being able to have your say may be helpful in beginning to deal with what has happened to you. It may also mean that hopefully, errors will be picked up and acted upon so that the same thing won't happen to another woman under the same care.

HEALTH & DISABILITY CONSUMER ADVOCACY SERVICE

To directly approach the health provider responsible for your care is likely to seem like an impossible and insurmountably scary proposition when you are feeling vulnerable / frightened / overwhelmed and /or traumatised by your experience. This is where the HEALTH & DISABILITY CONSUMER ADVOCACY SERVICE may be beneficial to you. This service is free to everyone and is available nationwide.

Advocacy services operate independently. One of their primary goals is to assist the consumer to resolve complaints about the quality of a health or disability service directly with the service provider. This gives the opportunity for both parties to discuss the matter and to hopefully come to a resolution. It also enables both parties to understand the issues that led to the complaint and to assist in ensuring these are not repeated.

Advocates are not investigators. Nor are they mediators. Instead their role is to support the consumer in reaching clear decisions and taking action as a result of those decisions.

To contact the advocacy service phone the 0800 numbers listed at the end of this article. You will be put in touch with an advocate in your area. You are able to discuss your concerns over the phone or meet with the advocate in person. They will discuss the options available to you to resolve your issues. You may want to use the advocate to facilitate communications with your provider, to help you to get a full explanation about what went wrong, to request an apology, to have charges reversed, to have any further treatment arranged that may be necessary because of what has happened to you, etc. The advocate is "on your side" to assist you to find a resolution.

The health provider is encouraged to minute any meetings, however you may wish to do so yourself or you may wish to request to use a dictaphone to record the meeting. Again, the advocate can help you to achieve the result you want.

If a resolution can not be reached or you want to make a formal complaint about the quality of the treatment you received eg. you feel there was negligence or mismanagement involved, you should make a direct complaint to the Commissioner. The advocacy service is able to advise you on how to do this.

For further information about the Health & Disability Commissioner, Ph 0800 11 22 33
Website: www.hdc.org.nz

ACC and other Victims - state insurance for personal injury in New Zealand

If your child suffers a disability relating to your obsetric care and you have previously applied for and been declined ACC . . .
An invitation to take part in representations to Government on this issue.

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