I appreciated Cheryl Tatano Beck's "Postpartum Depression" (May), which also described disorders such as postpartum panic disorder and postpartum posttraumatic stress disorder. It's taken me nearly a year to recover emotionally, mentally, and physically from my hospital birth experience.

My daughter's birth included an unnecessary amniotomy, administration of oxytocin (Pitocin), and an episiotomy. The amniotomy caused my daughter to turn sideways, which later resulted in damage to my coccyx; the episiotomy caused a third-degree tear. These treatments were given without my permission being sought; my daughter was not in danger, and there was no need to speed up the process.

No mother should have to feel as scared or out of control as I did while giving birth. Afterward, I never thought about harming my baby or myself, but I couldn't stop replaying in my mind the physical and emotional victimization I had endured.

Postpartum posttraumatic stress disorder would be greatly reduced by adopting the midwifery model for delivery of normal pregnancies. Our hospital birthing classes mentioned, but did not advocate, doulas and midwives. It was implied that they were unnecessary because the nurses were "fabulous" and our coaches would know how to act.

But I found their support to be inadequate-a common circumstance that often leads to the need for expensive interventions. A 2003 review of 15 trials in the Cochrane database found that women who received continuous support by doulas during labor were 26% less likely to undergo cesarean section, 41% less likely to give birth with the use of forceps or a vacuum extractor, 28% less likely to require analgesia or anesthesia, and 33% less likely to be dissatisfied with or negatively rate the birth experience.1

Obstetricians and nurses should be strong advocates of the support doulas and midwives provide during labor and delivery.

Melissa Moehrl

Minneapolis

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