Childbirth-related post-traumatic stress disorder

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth.[1] Its symptoms are not distinct from post-traumatic stress disorder (PTSD).[2][3]

For broader coverage of this topic, see Psychiatric disorders of childbirth.

Childbirth-related post-traumatic stress disorder
Specialty	OB/GYN, psychiatry

Signs and symptoms

Examples of symptoms of childbirth-related post-traumatic stress disorder include intrusive symptoms such as flashbacks and nightmares, as well as symptoms of avoidance (including amnesia for the whole or parts of the event), problems in developing a mother-child attachment, not having sexual intercourse in order to prevent another pregnancy, and avoidance of birth- and pregnancy-related issues. Symptoms of increasing stress can be sweating, trembling, being irritated, and sleep disturbances.[4]

Cause

Birth can be traumatic in different ways. Medical problems can result in interventions that can be frightening. The near death of a mother or baby, heavy bleeding, and emergency operations are examples of situations that can cause psychological trauma. Premature birth may be traumatic.[5] Emotional difficulties in coping with the pain of childbirth can also cause psychological trauma. Lack of support, or insufficient coping strategies to deal with the pain are examples of situations that can cause psychological trauma. However, even normal birth can be traumatic, and thus PTSD is diagnosed based on symptoms of the mother and not whether or not there were complications.[6] Additionally, in the process of birth, medical professionals who are there to aid the birthing mother may need to examine and perform procedures in the genital regions.[7]

The following are correlated with PTSD:

• Medical complications before, during, or after childbirth:
  • Pregnancy complications[8]
  • Emergency C-section[8]
  • Instrumental delivery[8]
  • Episiotomy[8]
  • Severe pain during birth[8]
  • Postpartum complications[8]
  • Preterm labour[9][5]
  • History of infertility[9][10]
  • Inadequate care during labour[8]
• Social, psychological, and other factors:
  • Unwanted pregnancy[9][10]
  • Low socioeconomic status[9][10]
  • Primiparous (first labour)[9]
  • Parenting (infant caring) problems[9]
  • Social support following childbirth[11][12][13]
  • Cultural factors[11][12][13]
  • History of mental health issues[8]
  • Other life stressors[8]

Diagnosis

Childbirth-related PTSD is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.[2] Many women presenting with symptoms of PTSD after childbirth are misdiagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.[14]

Epidemiology

Prevalence of PTSD following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8% and 5.6% at six weeks postpartum,[4] with rates dropping to 1.5% at six months postpartum.[4][14] Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1%[15] at six weeks, dropping to 13.6% at six months.[16]

See also

• Miscarriage
• Pain management during childbirth
• Miscarriage and mental illness

References

1. Lapp LK, Agbokou C, Peretti CS, Ferreri F (September 2010). "Management of post traumatic stress disorder after childbirth: a review". J Psychosom Obstet Gynecol. 31 (3): 113–22. doi:10.3109/0167482X.2010.503330. PMID 20653342.
2. Condon J (February 2010). "Women's mental health: a "wish-list" for the DSM V". Arch Womens Ment Health. 13 (1): 5–10. doi:10.1007/s00737-009-0114-1. PMID 20127444.
3. Martin, Colin (2012). Perinatal Mental Health : a Clinical Guide. Cumbria England: M & K Pub. p. 26. ISBN 9781907830495.
4. Olde E, van der Hart O, Kleber R, van Son M (January 2006). "Post-traumatic stress following childbirth: a review". Clin Psychol Rev. 26 (1): 1–16. doi:10.1016/j.cpr.2005.07.002. hdl:1874/16760. PMID 16176853.
5. Goutaudier, N, Lopez, A, Séjourné, N et al. (2011). Premature birth: subjective and psychological experiences in the first weeks following childbirth, a mixed-methods study. Journal of Reproductive and Infant Psychology, 29, 364-373.
6. Beck CT (January–February 2004). "Birth Trauma: In the Eye of the Beholder". Nursing Research. 53 (1): 28–35. doi:10.1097/00006199-200401000-00005. PMID 14726774.
7. Beck, Cheryl Tatano (January 2004). "Birth trauma: in the eye of the beholder". Nursing Research. 53 (1): 28–35. doi:10.1097/00006199-200401000-00005. ISSN 0029-6562. PMID 14726774.
8. Andersen, Louise B.; Melvaer, Lisa B.; Videbech, Poul; Lamont, Ronald F.; Joergensen, Jan S. (November 2012). "Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review". Acta Obstetricia et Gynecologica Scandinavica. 91 (11): 1261–1272. doi:10.1111/j.1600-0412.2012.01476.x. ISSN 1600-0412. PMID 22670573.
9. Beck, Cheryl Tatano; Gable, Robert K.; Sakala, Carol; Declercq, Eugene R. (2011-09-01). "Posttraumatic Stress Disorder in New Mothers: Results from a Two-Stage U.S. National Survey". Birth. 38 (3): 216–227. doi:10.1111/j.1523-536X.2011.00475.x. ISSN 1523-536X. PMID 21884230.
10. Söderquist, J.; Wijma, K.; Wijma, B. (March 2002). "Traumatic stress after childbirth: the role of obstetric variables". Journal of Psychosomatic Obstetrics and Gynaecology. 23 (1): 31–39. doi:10.3109/01674820209093413. ISSN 0167-482X. PMID 12061035.
11. Tamaki, R.; Murata, M.; Okano, T. (June 1997). "Risk factors for postpartum depression in Japan". Psychiatry and Clinical Neurosciences. 51 (3): 93–98. doi:10.1111/j.1440-1819.1997.tb02368.x. ISSN 1323-1316. PMID 9225370.
12. Creedy, D. K.; Shochet, I. M.; Horsfall, J. (June 2000). "Childbirth and the development of acute trauma symptoms: incidence and contributing factors". Birth (Berkeley, Calif.). 27 (2): 104–111. doi:10.1046/j.1523-536x.2000.00104.x. ISSN 0730-7659. PMID 11251488.
13. Ford, Elizabeth; Ayers, Susan (December 2011). "Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms" (PDF). Psychology & Health. 26 (12): 1553–1570. doi:10.1080/08870446.2010.533770. ISSN 1476-8321. PMID 21598181.
14. Alder J, Stadlmayr W, Tschudin S, Bitzer J (June 2006). "Post-traumatic symptoms after childbirth: what should we offer?". J Psychosom Obstet Gynecol. 27 (2): 107–12. doi:10.1080/01674820600714632. PMID 16808085.
15. Olde, Eelco; van der Hart, Onno; Kleber, Rolf; van Son, Maarten (January 2006). "Posttraumatic stress following childbirth: a review". Clinical Psychology Review. 26 (1): 1–16. doi:10.1016/j.cpr.2005.07.002. hdl:1874/16760. ISSN 0272-7358. PMID 16176853.
16. Montmasson H.; Bertrand P.; Perrotin F.; El-Hage W. (2012). "[Predictors of postpartum post-traumatic stress disorder in primiparous mothers]". Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 41 (6): 553–560. doi:10.1016/j.jgyn.2012.04.010. PMID 22622194.

Further reading

• Beck CT (2009). "Birth trauma and its sequelae". J Trauma Dissociation. 10 (2): 189–203. doi:10.1080/15299730802624528. PMID 19333848.
• Elmir R, Schmied V, Wilkes L, Jackson D (October 2010). "Women's perceptions and experiences of a traumatic birth: a meta-ethnography". J Adv Nurs. 66 (10): 2142–53. doi:10.1111/j.1365-2648.2010.05391.x. PMID 20636467.
• Lev-Wiesel R, Daphna-Tekoah S (2010). "The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women". J Trauma Dissociation. 11 (3): 266–83. doi:10.1080/15299731003780887. PMID 20603762.
• Sawyer A, Ayers S, Smith H (June 2010). "Pre- and postnatal psychological wellbeing in Africa: a systematic review" (PDF). J Affect Disord. 123 (1–3): 17–29. doi:10.1016/j.jad.2009.06.027. PMID 19635636.
• Vythilingum B (February 2010). "Should childbirth be considered a stressor sufficient to meet the criteria for PTSD?". Arch Womens Ment Health. 13 (1): 49–50. doi:10.1007/s00737-009-0118-x. PMID 20127456.