Childbirth-related post-traumatic stress disorder

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

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth.^[1] This disorder can also affect men or partners who have observed a difficult birth.^[2] Its symptoms are not distinct from post-traumatic stress disorder (PTSD).^[3]^[4] It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).^[5]

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), uncomfortable sexual intimacy, discomfort being touched, abstinence, fear of pregnancy, and avoidance of birth- and pregnancy-related issues. Symptoms of increasing stress can be sweating, trembling, being irritated, and sleep disturbances.^[6]

Other examples of symptoms of paternal childbirth-related post-traumatic stress disorder include anxiety, or intense fear of losing either the child or their partner who is giving birth to it. This can lead to difficulties in the father-child connection.^[2]

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.^[7] 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.^[8] 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.^[8]

The following are correlated with PTSD:

Medical complications before, during, or after childbirth:
- Pregnancy complications^[9]
- Emergency C-section^[9]
- Instrumental delivery^[9]
- Episiotomy^[9]
- Severe pain during birth^[9]
- Postpartum complications^[9]
- Preterm labour^[10]^[7]
- History of infertility^[10]^[11]
- Inadequate care during labour^[9]
Social, psychological, and other factors:
- Unwanted pregnancy^[10]^[11]
- Low socioeconomic status^[10]^[11]
- Primiparous (first labour)^[10]
- Parenting (infant caring) problems^[10]
- Social support following childbirth^[12]^[13]^[14]
- Cultural factors^[12]^[13]^[14]
- History of mental health issues^[9]
- Other life stressors^[9]

Diagnosis

Childbirth-related PTSD is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.^[3] Many women presenting with symptoms of PTSD after childbirth are misdiagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.^[15]

Treatment

In order to treat postpartum PTSD, it is essential to normalize the feelings that arise and alleviate anxiety. In some cases, medication such as antidepressants or anti-anxiety drugs might be prescribed to manage symptoms. Seeking emotional support from support systems is crucial. Mental health professionals can conduct comprehensive assessments and provide evidence-based therapies tailored to individual needs. These therapies include Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure Therapy (PE), and Narrative Exposure Therapy (NET). These trauma-focused therapies can assist in reshaping thought patterns, processing memories, and reducing anxiety and avoidance behaviors.^[16]

Epidemiology

Prevalence of PTSD following normal childbirth in women (excluding stillbirth or major complications) is estimated to be between 2.8% and 5.6% at six weeks postpartum,^[6] with rates dropping to 1.5% at six months postpartum.^[6]^[15] Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1%^[6] at six weeks, dropping to 13.6% at six months.^[17]

References

^ Lapp LK, Agbokou C, Peretti CS, Ferreri F (September 2010). "Management of post traumatic stress disorder after childbirth: a review". Journal of Psychosomatic Obstetrics and Gynaecology. 31 (3): 113–122. doi:10.3109/0167482X.2010.503330. PMID 20653342. S2CID 23594561.
^ ^a ^b Fisher SD (May 2017). "Paternal Mental Health: Why Is It Relevant?". American Journal of Lifestyle Medicine. 11 (3): 200–211. doi:10.1177/1559827616629895. PMC 6125083. PMID 30202331.
^ ^a ^b Condon J (February 2010). "Women's mental health: a "wish-list" for the DSM V". Archives of Women's Mental Health. 13 (1): 5–10. doi:10.1007/s00737-009-0114-1. PMID 20127444. S2CID 1102994.
^ Martin C (2012). Perinatal Mental Health : a Clinical Guide. Cumbria England: M & K Pub. p. 26. ISBN 9781907830495.
^ Ertan D, Hingray C, Burlacu E, Sterlé A, El-Hage W (March 2021). "Post-traumatic stress disorder following childbirth". BMC Psychiatry. 21 (1): 155. doi:10.1186/s12888-021-03158-6. PMC 7962315. PMID 33726703.
^ ^a ^b ^c ^d Olde E, van der Hart O, Kleber R, van Son M (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. PMID 16176853. S2CID 22137961.
^ ^a ^b Goutaudier N, Lopez A, Séjourné N, Denis A, Chabrol H (September 2011). "Premature birth: subjective and psychological experiences in the first weeks following childbirth, a mixed-methods study". Journal of Reproductive and Infant Psychology. 29 (4): 364–373. doi:10.1080/02646838.2011.623227. S2CID 71379594.
^ ^a ^b 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. S2CID 35279461.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Andersen LB, Melvaer LB, Videbech P, Lamont RF, Joergensen JS (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. PMID 22670573. S2CID 205802183.
^ ^a ^b ^c ^d ^e ^f Beck CT, Gable RK, Sakala C, Declercq ER (September 2011). "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. PMID 21884230.
^ ^a ^b ^c 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. PMID 12061035. S2CID 7762819.
^ ^a ^b 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. PMID 9225370. S2CID 25412801.
^ ^a ^b Creedy DK, Shochet IM, Horsfall J (June 2000). "Childbirth and the development of acute trauma symptoms: incidence and contributing factors". Birth. 27 (2): 104–111. doi:10.1046/j.1523-536x.2000.00104.x. PMID 11251488.
^ ^a ^b Ford E, Ayers S (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. PMID 21598181. S2CID 14015059.
^ ^a ^b Alder J, Stadlmayr W, Tschudin S, Bitzer J (June 2006). "Post-traumatic symptoms after childbirth: what should we offer?". Journal of Psychosomatic Obstetrics and Gynaecology. 27 (2): 107–112. doi:10.1080/01674820600714632. PMID 16808085. S2CID 21859634.
^ Ahsan, Areeba; Nadeem, Abdullah; Habib, Ashna; Basaria, Areeba Aamir Ali; Tariq, Rabeea; Raufi, Nahid (2023-12-07). "Post-traumatic stress disorder following childbirth: a neglected cause". Frontiers in Global Women's Health. 4. doi:10.3389/fgwh.2023.1273519. ISSN 2673-5059. PMC 10733854. PMID 38130709.
^ Montmasson H, Bertrand P, Perrotin F, El-Hage W (October 2012). "[Predictors of postpartum post-traumatic stress disorder in primiparous mothers]". Journal de Gynécologie, Obstétrique et Biologie de la Reproduction. 41 (6): 553–560. doi:10.1016/j.jgyn.2012.04.010. PMID 22622194. S2CID 196363612.