Childbirth-related posttraumatic stress disorder

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

Childbirth-related posttraumatic stress disorder is well-described in the medical literature,[1] but is not recognized as a condition distinct from posttraumatic stress disorder (PTSD).[2]

Signs and symptoms[edit]

Examples of symptoms of childbirth-related posttraumatic 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 sex in order to prevent another pregnancy, and avoidance of birth and pregnancy related issues. Symptoms of increased arousal involve sweating, trembling, being irritated, and sleep disturbances.[3]

Cause[edit]

Birth can be traumatic in different ways. First, 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. For example, Goutaudier et al. (2011) recently reported that premature birth may be traumatic.[4] Second, 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. Even if others perceive the birth as normal, if the mother perceives it as traumatic, it was traumatic. Childbirth related PTSD can be caused even by a normal birth and should be diagnosed based on symptoms of the mother, not by the events.[5] Third, in the process of a medically-managed birth, doctors and nurses who are there to aid the birthing mother may touch or insert things into her genitals without or even against her consent (women are sometimes held down if they protest, verbally berated into submitting, or coerced with false reports that if they don't submit the baby will be endangered[6][7]).

Diagnosis[edit]

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 diagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.[8]

Several studies have focused on the impact of emergency caesarean sections (EmCs). "Women who underwent EmCs reported the most negative cognitions and emotions regarding delivery overall. Women who underwent EmCs or instrumental vaginal delivery (IVD) reported more symptoms of posttraumatic stress compared to women who had an elective caesarean section (EIC) or a normal vaginal delivery (NVD)." [3]

Epidemiology[edit]

Alder et al. (2006) say that most studies show about 1.5% of women develop PTSD after childbirth;[8] Olde et al. (2006) say the range is between 2.8 and 5.6%.[3]

References[edit]

  1. ^ Lapp LK, Agbokou C, Peretti CS, Ferreri F (September 2010). "Management of post traumatic stress disorder after childbirth: a review". J Psychosom Obstet Gynaecol. 31 (3): 113–22. doi:10.3109/0167482X.2010.503330. PMID 20653342. 
  2. ^ a b 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. ^ a b c 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. PMID 16176853. 
  4. ^ 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.
  5. ^ 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. 
  6. ^ Chicago, Tribune (2008). "Lawsuit details painful delivery". Retrieved 2014.  Check date values in: |access-date= (help)
  7. ^ court documents. "CATHERINE SKOL, Plaintiff, v. SCOTT PIERCE, M.D., RUSH UNIVERSITY MEDICAL CENTER d/b/a RUSH-PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER, and DRS. PILDES and PIERCE, S.C, Defendants". theunnecesarean.com. Retrieved 2014. At one point during the delivery, Plaintiff was in the middle of a very strong contraction when Defendant Pierce decided to perform a vaginal exam. Plaintiff specifically stated, “No. Stop!” Defendant Pierce refused and performed a very rough vaginal exam causing Plaintiff extreme pain. [...] despite Plaintiff begging him to wait for the contraction to end, stating, “I’m in the middle of a contraction,” Defendant Pierce inserted a catheter during one of Plaintiff’s contractions, which was extremely painful for Plaintiff.  Check date values in: |access-date= (help)
  8. ^ a b Alder J, Stadlmayr W, Tschudin S, Bitzer J (June 2006). "Post-traumatic symptoms after childbirth: what should we offer?". J Psychosom Obstet Gynaecol. 27 (2): 107–12. doi:10.1080/01674820600714632. PMID 16808085. 

Further reading[edit]

  • 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". 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.