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发帖数: 234 | 1 Healing the Trauma: Entering Motherhood with Posttraumatic Stress Disorder (
PTSD)
by Jennifer Jamison Griebenow
© 2006 Midwifery Today, Inc. All rights reserved.
[Editor's note: This article first appeared in Midwifery Today Issue 80,
Winter 2006.]
Making the leap to parenthood is a challenging transition even at the best
of times. For some mothers that transition is made even more difficult by
additional challenges in the postpartum period. Most people know about the
baby blues, and the media has given a good deal of attention to postpartum
depression (PPD) and postpartum psychosis. They have given less attention to
the unique problems suffered by mothers who experience symptoms that seem
like postpartum depression, but don't completely fit that profile. PTSD may
be the culprit.
How is such a situation possible? Can childbirth—something so common—
create a physiological reaction in a mother, complete with insomnia,
nightmares or flashbacks? For some, it does.
Denise was one of those women. At nine centimeters dilation, her doctor told
her that her baby girl was too big and she needed a cesarean. The physician
told her about a large baby getting stuck and being decapitated, with the
mother undergoing a cesarean to remove the rest of the infant's body. Denise
says, "[The doctor] was obviously angry with me…because then he flung his
glove (which was covered with blood) all over me…. He even wrote in my
chart that I told him I felt forced to have a c-section and that I called
him mean."
Too many times women must give birth unsupported, while being poked and
prodded in a depersonalizing and sometimes literally violent process, as
Denise did. Is it any wonder that we react to the things that happen to us
during our children's births? Being treated in a patronizing manner,
receiving interventions without knowing why they are needed and being
refused food and drink all are common in current birth settings. Women are
also pressured to get the baby out within a certain amount of time. A vacuum
extraction, an episiotomy, and of course, the ultimate intervention, a
cesarean, are all common today, at least for the hospital staff who perform
them.
The problem is, these experiences are not common for the mother who is
living them.(1) Labor alone is an incredibly powerful and overwhelming
experience. When you add in an unexpected situation—the baby being in
danger or an emergency surgery—the drama of birth can become overwhelming.
What Does PTSD Look Like?
When seeking help, you may be told that you are experiencing the baby blues
or PPD, either of which may be present with PTSD. However, along with the
typical weepiness, anxiety and depression of PPD, key symptoms of PTSD
include insomnia, irritability and angry outbursts, panic attacks,
nightmares about the birth, a desire to avoid the baby or anything relating
to the birth, feelings of detachment from loved ones, and a sense that some
other disaster is imminent.(2) This sense that something bad may happen can
also manifest as suicidal thoughts.
Many women experience physiological and psychological reactions to reminders
of the birth, including seeing the birthplace and anniversaries of the
event. Susan was unable to celebrate her son's first birthday on the actual
date of his birth, as she wept all day. She also avoided the hospital where
her son was born due to the physical and emotional reactions she experienced
on seeing it. She went so far as to refuse to go to the emergency room of
that hospital when she later became ill, although her family doctor strongly
recommended that she go.
In some cases, the birth trauma is so severe that it includes the flashbacks
with which PTSD is commonly associated. Linda [name changed for privacy]
experienced this after her child's birth, in every part of her life,
including lovemaking: "I couldn't have sex at first because I saw the [
hospital staff's] faces whenever I had my legs apart."
Revealing PTSD
Psychologist Lynn Madsen works extensively with women who are experiencing
PTSD due to their births. Her book Rebounding from Childbirth, published in
1994, is an excellent resource for working through birth trauma and
currently the only book specifically devoted to the subject. (Editor's Note:
Motherbaby Press, an imprint of Midwifery Today, has published a book
entitled Survivor Moms: Women's Stories of Birthing, Mothering and Healing
after Sexual Abuse.) The attention she has brought to PTSD has opened doors
for further study, as interest in the subject has increased since 1995.
Going beyond the simple acknowledgment that trauma can occur with childbirth
, researchers and professionals are beginning to evaluate what can be done
to assist women with PTSD. Therapists are using short-term, cognitive group
therapy "to reduce or resolve ongoing psychological disruption and/or trauma
" to assist women who have had traumatizing interactions with their care
providers during childbirth.(3)
Nonetheless, media and public understanding of PTSD's relation to birth
experiences lags behind, and Madsen's book remains a unique and essential
guide for professionals and laypeople alike. Throughout the book, Madsen
addresses the factors that can lead to a traumatic stress reaction, among
them the trauma experienced during the birth itself, a previous traumatic
situation, childhood abuse and a loss experienced around the time of the
birth or in tandem with the birth.
Other risk factors have been identified in medical studies, as well. Women
who have had a prior stillbirth are at increased risk for PTSD (4), as are
those who have had psychological counseling prior to a first birth.(5)
Another predisposing factor is anxiety as a personality trait.(6)
Understandably, women who are extremely fearful about childbirth have a
greater risk of psychological difficulties post-birth, especially if the
birth does not go as hoped or expected.(7)
A medical study of 500 women that evaluated the effects of obstetric
intervention concluded that in a first childbirth experience such
interventions have psychological risks "rendering those who experience these
procedures vulnerable to a grief reaction or to posttraumatic distress and
depression."(8) While the PTSD rate varied from study to study, in this case
up to 5.6% of women were found to have PTSD.(9)
Several other studies found that when mothers felt that they had no control
over the birth experience and their partners and staff were not supportive,
the risk of PTSD increased.(10) These studies mesh with the statements of
the women I interviewed in that they identified unwanted procedures and
interventions as one of the primary causes of their PTSD reactions.
Madsen advocates respecting the mother's interpretation of events and her
reactions to the birth. The first step to healing is acknowledgement, which
sometimes does not come easily. As Madsen notes, our culture denies pain and
trauma. "The most common and blatant denial of the pain of a traumatic
birth is the phrase, 'What is important is that your baby is…healthy…. Put
the past behind you.'"(11) Madsen turns this on its head with the truth
that a mother must determine for herself whether a birth was traumatic: "One
essential guideline is that if she feels traumatized, she was."(12)
Whether a birth will cause PTSD is specific to each individual.(13) Linda
had planned a homebirth but as her pregnancy reached 42 weeks her midwife
began to question her readiness for labor. The midwife issued an ultimatum
that if Linda did not start labor within two days she would no longer
provide care. Linda spent the final hours of her pregnancy agonizing over
what she might be doing "wrong."
"They told me that I had to 'get mad and decide that I am going to have this
baby,' but I couldn't figure out how to do it. I think they expected me to
do it with mind control—just by willing labor to start."
When Linda went into labor, the doula told her she was not surrendering to
it. Without the necessary emotional support, she felt she had failed and
eventually was transported to the hospital. Linda says, "Turning birth into
a medical delivery (without…true complications to justify medical
involvement) is against all of my beliefs and there was no health reason to
justify being there. I simply failed to stand up for myself…and [gave in to
the pressure to use] drugs out of self-destructiveness and total
demoralization." The mental stress involved in having to abandon one's
deepest beliefs can be quite violating.
To add insult to injury, the midwife and doula told Linda that "…this was
the best hospital birth we have ever seen!" Linda felt that such a response
invalidated her perceptions and feelings. Her child was more than a year old
at the time she discussed her experience with me, yet she was unable to
call his arrival a birth; it was, she said, "a removal."
Many women experience this kind of trauma as a rape. Birth can include the
threat of violence against them (for example, "if you don't dilate soon we'
ll have to use Pitocin") and the threat of harm to the baby. Women are
vulnerable at this time as never before, and childbirth, obviously, is a
profoundly intimate and sexual act. The loss of control can be very
frightening in an emergency situation or when being coerced into unwanted
procedures. Labor alone can create a feeling of losing control that is
difficult to assimilate. Thinking and compassionate people are now taking
rape seriously, and the incredibly challenging experience of a traumatic
birth should be taken seriously too.
What Can Women Do?
First, be aware that you are not alone and that the symptoms you are
experiencing, however disturbing, are not unusual for someone who has gone
through a traumatic or life-threatening situation. Do not judge yourself.
You are deserving of support and respect for having survived this experience
and for being a feeling human who is upset by what happened.
Second, surround yourself with supportive, loving people who are able to
care for and nurture you. Tell people who need to know that you are having a
hard time and ask for support. Get extra help with the baby, if possible.
Caring for an infant who indirectly was responsible for the ordeal you have
been through can be difficult. You may have no feelings or have very
negative feelings about your baby. Do not blame yourself. Know that
gradually your feelings about your baby will change and become more positive
. Give yourself time to recover. Becoming a mother is a wonderful but
unsettling transformation at the best of times; you've come through what,
for you, was one of the worst of times. You need nurturing and care too.
Some women feel that they are to blame for the interventions or trauma that
occurred. They think, "If only I had eaten better…" "If I had just tried
for one more hour…." This internal bargaining is a normal part of working
through what has happened. Most likely you could not have done anything "
better" given the information you had at the time you went into your labor
and birth. As both Madsen and Nancy Wainer, author of Silent Knife, point
out, you have acted with love, allowing yourself to be injured, doing all
you could to give your baby life. You are to be admired. All of these
feelings, the guilt and the difficulties connecting with your baby are
understandable given what you have experienced. Let yourself feel what you
feel and know that you have done what you could.
Lynn Madsen states that healing means eventually coming to the place where
you can accept the reality of what has happened to you.(14) "Trauma is
trauma, and its identification is one more way of acknowledging the power
and importance of the birth experience."(15)
In some situations, a woman also knows or suspects that the problems within
the birth were iatrogenic and feels betrayed and angry. Forty-eight hours
after the surgery, nearly 10% of women in one survey believed that they had
been treated badly by the hospital staff when undergoing a cesarean.(16)
Madsen comments that one of the benefits of a diagnosis of PTSD is that it
lets a woman know she is not crazy.(17) The symptoms are unpleasant but they
are a normal part of trauma recovery. While this emotional work is
undoubtedly very difficult, as Madsen points out, it doesn't die if
repressed; it will simply come forth later demanding to be dealt with. "
Feelings and memories seem to have lives of their own; they emerge when a
person is ready to experience them. The job is to meet them halfway."(18)
What Can You Do to Feel Okay Again?
When working through PTSD after a birth, any activity or process that brings
healing to you can be helpful. Many women draw, paint or sculpt, bringing
out the images that are bothering them. When physically possible, exercise
can help relieve the pain. Journaling is always a good choice. Writing
letters to the people who were involved in your birth can be very
therapeutic, whether you choose to send them or not. I wrote letters
expressing my anger to the hospital staff: most I didn't send, the last few
I did, letting them know how I felt about my care and what they could have
done differently.
Therapies that promote whole body wellness are likely to help recovery from
trauma. Massage, hot soaks and aromatherapy are comforting, supportive and
healing to the mind, body and spirit. Cranial sacral therapy to release the
physical trauma has proven quite helpful to many women.
Walking yourself and your baby through the birth experience again and
creating a more positive outcome in your mind may be helpful; for example, I
wrote out my birth story in detail as I wished it had happened.
An option suggested by Nancy Wainer is to wrap yourself and your child (you
can do this with older children too) in your robe or a warm blanket and walk
/talk yourself and your child through your birth experience. When it's time
for your baby to be "born," open the robe and say to your child just what
you would like to have said to him or her at the birth. I have found as the
years go by, when cuddling with my cesarean-born son, that we sometimes
lapse into baby talk and "mother talk" almost unintentionally. I hold him
close and comment on how beautiful and sweet he is. It sounds a bit funny
when explained, but each incident, I find, draws us closer, perhaps bringing
us another step toward what should have been from the beginning.
Learning all the details of what happened, what interventions were used and
why, although painful, can be cathartic and provide a sense of closure. You
may need to obtain your medical records and review them with a knowledgeable
third party to gain a complete understanding of what happened.
Many women find that experiencing a subsequent birth in a different setting
is quite healing; however, recovery is always possible, whether or not one
has another child. For me, what helped the most was finding other women who
were supportive and talking, talking, talking. Most of these contacts were
made online, where finding a sympathetic listening ear can be easier than
among personal acquaintances.
Find a counselor who is knowledgeable about PTSD, supportive about women's
issues, or both. If no such person is in your area, look for someone who has
a reputation for being open-minded. A rape recovery counselor may be
helpful. Be wary when interviewing counselors; someone who urges you to just
be thankful for the baby and put the past behind you will not be helpful.
If a supportive counselor is not available, several Internet-based support
groups may be of help.
A relatively new, but somewhat controversial, therapy that is used in
healing trauma is eye movement desensitization and reprocessing (EMDR). In
sessions with a trained professional, individuals work through specific
traumatic memories, while using an external stimulus, such as eye movement
or tapping, to facilitate processing the traumatic memories. Studies
appear to show that this is a very effective way to move through healing.(19)
Other recommended therapies for processing trauma are relaxation
training (20) and prolonged exposure therapy.(21) A competent counselor will
be able to help you to use these, or refer you to someone who can.
Another option is the judicious use of medication. Madsen comments, "
Medication for emotional pain can give a woman a break from the intensity of
her situation and free her to look at her situation more clearly. [However]
, for some, medication prolongs denial and suppression of images and
emotions that need to emerge."(22) Each woman's needs are different, and her
decisions about medication use should be honored.
Your Family's Reactions
Those closest to someone experiencing PTSD, whether husband, partner, parent
or close friend, can be a part of the healing process as well. Partners may
react with anger, frustration, sadness, withdrawal or sympathy when you are
struggling with PTSD. These reactions are understandable. However, those
who care need to know that mothers need support most of all. A traumatic
birth is an event from which recovery is possible, but time-consuming; thus
patience on a day-to-day basis is essential. A partner may not understand
fully why you feel as strongly as you do or why you are acting in the ways
you are. You can explain that although he or she may not understand you, you
need full acceptance of your feelings in order to move forward.
Feeling angry that your partner did not do more to protect you from unwanted
interventions or abusive care providers is also not unusual. Talk such
feelings through at length with another person before bringing them up with
your partner.
Partners also can experience some PTSD symptoms as well, depending on their
individual reactions to the traumatic birth. They too deserve a supportive
response and help from extended family and friends. Their close connection
to the experience also highlights why you will likely benefit from finding
other people with whom to share your feelings and thoughts; sometimes a
partner may not be able initially to fully understand your feelings and
process what you've gone through, as well as what he's gone through. My
husband and I got through this by scheduling selected specific times during
which I could talk all I wanted about what had happened, so that he didn't
feel completely overwhelmed with my need to process the birth.
What about the Baby?
Babies are affected by their birth experiences and the way they come into
the world. A variety of research addresses their experiences, and some care
providers—most of them in alternative therapies—are gradually
acknowledging the reality of infant trauma.
Mothers can balance their concerns that the experience traumatized the baby
with the knowledge that their love, the passage of time and their care can
bring healing. Holding the baby closely, looking into her eyes and
expressing your sorrow over the birth situation can help both of you. One
primary recommendation for babies who've experienced a traumatic birth is to
take them to see a children's cranial sacral therapist. This non-invasive,
holistic therapy can work wonders for many subtle problems that traditional
medical care providers can't solve, including physical and emotional birth
trauma.
Avoiding PTSD
Obviously, the best solution is to avoid PTSD if at all possible. Birth can
come with surprises, and interventions including surgery may be necessary.
You cannot plan what to do in all scenarios. If the unexpected happens, get
the help you need as you recover from the birth, or have your partner get
you the help you need.
You can avoid many unpleasant outcomes by carefully choosing a care provider
for the birth. Interview providers thoroughly, picking a birth setting that
fits your views on how birth should be supported. Avoid a setting in which
most births are handled differently than you prefer; avoiding the procedures
that are applied to everyone else will be difficult, even if the provider
says that you will be able to waive the standard procedures or interventions
. Homebirth is a good option for this reason. You will have much more
control over the setting, the people present and the tone of the birth, and
a homebirth midwife is more likely to be respectful of your autonomy than a
hospital-based care provider.
Regardless of the best-laid plans, you will need to anticipate and talk
through some of the possible outcomes with your partner, doula and other
helpers. Be sure they fully understand what you would like and how they can
support and advocate for you. During labor, if something doesn't seem right
to you or is being forced on you, ask for alternatives and help from your
partner and doula, if at all possible. Selecting a care provider carefully
in the beginning will help you to avoid situations in which you don't have
the power to make free choices or in which your partner or doula do not have
enough information or influence to help you. You also want a care provider
who will do all she can to assist you emotionally, as well as physically, in
the event of an unexpected or emergency situation.
Pregnant Again: How to Minimize a Recurrence
When planning for another birth, start researching childbirth attendants
before you even conceive. Finding someone you believe is both qualified and
compassionate may take time and will be easier when you are not dealing with
the fatigue and other challenges of pregnancy. Of course, if you are
halfway through your pregnancy and are still looking for the best care
provider for you, all is not lost. Your effort will be worthwhile when you
find someone whose philosophy of birth is a good match. That type of person
is much more likely to handle your birth experience gently and with respect.
Prevention of PTSD is more likely if the care provided during labor "
enhances perceptions of control and support."(23)
Questions to ask a provider might include the following:
* How do you help support a laboring woman?
* What type of situation is of concern to you but is not an emergency?
* What constitutes an emergency situation, in your opinion?
* How would you handle such a situation?
* What kind of choices are parents likely to have in this type of
situation?
* Can you be with me throughout a transport and/or in case of an
emergency?
You also will want to request references from each potential provider and
question those mothers about how they were treated. Get two references for
each provider in whom you are interested, including at least one woman who
had either an emergency or a complication in her labor, and be sure to ask
that woman how the care provider handled the situation and treated her.
If you will be delivering in a hospital or birth center you may want to
visit and talk with the nursing staff and the anesthesiologist. If you are
planning a homebirth, visit the hospital you would be transported to in an
emergency. Having a face and a name that you already know if transport
becomes necessary can be reassuring. Obviously you will need to make the
decisions that are right for you.
Many women with previous trauma find the strength to face an upcoming birth
through religious or spiritual beliefs. Life brings rough roads to everyone;
trust in a higher power can help to make some sense of past experiences and
to provide comfort as you journey forward into new life territory.
Making the Difference
Compassionate professionals are out there. They can be hard to find but the
effort is worthwhile, whether you are seeking postpartum counseling or a
birth care provider for a subsequent pregnancy. People are available to help
you as you move along the path toward healing. You can also find valuable
information in much greater depth than what is presented here in books and
on the Internet.
Care providers are more aware of the possibility of birth trauma than ever
before. They may implement a number of strategies to assist you, among them
"careful prenatal screening of past trauma history, social support and
expectations about the birth; improved communication and pain management
during the birth; and opportunities to discuss the birth postpartum."(24)
Also, the severity of posttraumatic stress due to an emergency c-section can
be decreased by early postpartum counseling.(25) One study notes that "…
women reported that an opportunity to talk with someone about the birth was
helpful in facilitating recovery."(26) A long-term approach to talking
things through is more beneficial than just one counseling session in the
hospital.
After her horrible hospital experience, Susan made very different plans for
her second son's birth. "I made the decision to have a natural birth and
then…to have a homebirth with a midwife. While initially the decision was
based on fear of the hospital, the more I learned the more I decided that
homebirth with a midwife is smarter and safer."
Susan felt an immense difference. "I was treated respectfully and with true
care for me as a person. The first time I was treated rudely and abusively
and my role as Mother was not acknowledged. Even if the outcome of the birth
had been another cesarean, it would have been a much more positive
experience."
As in Susan's case, my homebirth after cesarean was a good choice. The
outcome of this birth was different from my first—a vaginal birth instead
of a cesarean. The way I was treated was different. My midwife acknowledged
my concerns and supported and respected me. I gave birth, not the midwife, a
surgeon or anyone else. The difference for me during the postpartum period
was stunning. I did experience anxiety for several weeks that I would have a
PTSD reaction again. That didn't happen, and the rest of postpartum was
uneventful.
Although my first birth was horribly traumatic, I have had the opportunity
to grow and change. As Madsen comments, "I do not wish this opportunity to
learn from trauma or pain for anyone, yet here is the paradox: if such
things do happen, then I hope there are gifts from having learned the hard
way. These gifts are powerful, and they will continue to keep on giving
throughout one's life."(27) Suffering is painful, but help is available;
healing, recovery and new growth are absolutely possible.
Jennifer Jamison Griebenow, MA, Phi Beta Kappa, is a psychology minor and
mother of three—one born by cesarean, two at home. A former chapter leader
and board member of ICAN, she is currently homeschooling her children.
References:
1. Beck, C.T. 2004. Birth trauma: in the eye of the beholder. Nurs Res 53
(1): 28–35.
2. PTSD symptoms from DSM-IV as experienced by postpartum women.
Diagnostic Criteria for PTSD. Online Psychological Services. www.
psychologynet.org/ptsd.html. Accessed 1 Oct 2002.
3. Sorenson, D.S. 2003. Healing traumatizing provider interactions among
women through short-term group therapy. Arch Psychiatr Nurs 17(6): 259–69.
4. Ryding, E.L., et al. 2003. An evaluation of midwives' counseling of
pregnant women in fear of childbirth. Acta Obstet Gynecol Scand 82(1):10–17.
5. Turton, P., et al. 2001. Incidence, correlates and predictors of post-
traumatic stress disorder in the pregnancy after stillbirth. Br J Psychiatry
178: 556–60.
6. Wijma, K., J. Soderquist and B. Wijma. 1997. Posttraumatic stress
disorder after childbirth: a cross sectional study. J Anxiety Disord 11(6):
587–97.
7. Hofberg, K., and I. Brockington. 2000. Tokophobia: an unreasoning
dread of childbirth. A series of 26 cases. Br J Psychiatry 176: 83–85.
8. Fisher, J., J. Astbury and A. Smith. 1997. Adverse psychological
impact of operative obstetric interventions: a prospective longitudinal
study. Aust N Z J Psychiatry 31(5): 728–38.
9. Creedy, D.K., I.M. Shochet and J. Horsfall. 2000. Childbirth and the
development of acute trauma symptoms: incidence and contributing factors.
Birth 27(2): 104–11.
10. See note 9 above; Czarnocka, J., and P. Slade. 2000. Prevalence and
predictors of post-traumatic stress symptoms following childbirth. Br J Clin
Psychol 39(Pt 1): 35–51.
11. Madsen, Lynn. 1994. Rebounding from Childbirth. Westport, Connecticut:
Bergin and Garvey.
12. Ibid. 19.
13. Soderquist, J., K. Wijma and B. Wijma. 2002. Traumatic stress after
childbirth: the role of obstetric variables. J Psychosom Obstet Gynaecol 3(1
): 31–39.
14. See note 11 above.
15. Ibid.
16. Ryding, E.L., K. Wijma and B. Wijma. 1998. Experiences of emergency
cesarean section: A phenomenological study of 53 women. Birth 25(4): 246–51.
17. See note 11 above.
18. Ibid.
19. Carlson, J., et al. 1998. Eye movement desensitization and
reprocessing (EMDR): Treatment for combat-related post-traumatic stress
disorder. Journal of Traumatic Stress 1: 3–24; Ironson, G.I., et al. 2002.
Comparison of two treatments for traumatic stress: A community-based study
of EMDR and prolonged exposure. J Clin Psychol 58(1): 113–28.
20. Stapleton, J.A., S. Taylor and G.J. Asmundson. 2006. Effects of three
PTSD treatments on anger and guilt: exposure therapy, eye movement
desensitization and reprocessing, and relaxation training. J Trauma Stress
19(1): 19–28.
21. Rothbaum, B.O., M.C. Astin and F. Marstellar. 2005. Prolonged Exposure
versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape
victims. J Trauma Stress 18(6): 607–16.
22. See note 11 above.
23. Czarnocka and Slade.
24. Soet, J.E., G.A. Brack and C. DiIorio. 2003. Prevalence and predictors
of women's experience of psychological trauma during childbirth. Birth 30(1
): 36–46.
25. Ryding, E.L., K. Wijma and B. Wijma. 1998. Postpartum counselling
after an emergency cesarean. Clin Psychol & Psychother 5(4): 231–37.
26. Gamble, J.A., et al. 2002. A review of the literature on debriefing or
non-directive counselling to prevent postpartum emotional distress.
Midwifery 18(1): 72–79.
27. See note 11 above.
Related Resources
* International Cesarean Awareness Network (ICAN) Web site—mailing list
, support group available, information: www.ican-online.org
* Post Traumatic Stress Disorder After Childbirth: www.
ptsdafterchildbirth.org
* Midwife Archives Maternal Birth Trauma Page: www.gentlebirth.org/
archives/ppdepres.html
* Emotional Recovery from Cesarean: www.plus-size-pregnancy.org/
CSANDVBAC/csemotionalrecov.htm
* Upledger Institute for information about cranial sacral therapy: www.
iahe.com/html/therapies/cstfaq.jsp
* Eye Movement Desensitization and Reprocessing (EMDR): www.emdr.com
* Birth Psychology site, useful for mothers and babies: www.
birthpsychology.com/birthscene/index.html
* Birth as an American Rite of Passage, an online chapter: www.
birthpsychology.com/messages/contents.html
* Making peace with your Birth: www.lalecheleague.org/NB/NBMarApr02p44.
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