Psychiatric disorders of childbirth
||It has been suggested that Organic prepartum and postpartum psychoses be merged into this article. (Discuss) Proposed since March 2014.|
Psychiatric disorders of childbirth are mental disorders developed by the mother related to the delivery process itself, not those of pregnancy or the postpartum period. Complications occasionally occur during childbirth or immediately after that can lead to psychiatric problems. Some examples are delirium, posttraumatic stress disorder, rage, or in rare cases, neonaticide.
The word comes from the Greek tokos, meaning parturition. Early authors like Ideler wrote about this fear, and, in 1937, Binder drew attention to a group of women who sought sterilization because of tocophobia. In the last 40 years there have been a series of papers published mainly from Scandinavia. Tocophobia can be primary (before the first child is born) or secondary (typically after extremely traumatic deliveries). Elective Caesarean section is one solution, but psychotherapy can also help these women to give birth vaginally.
Post-traumatic stress disorder (PTSD)
Postpartum PTSD was first described in 1978. Since then over 60 papers have been published. After excessively painful labours, or those with a disturbing loss of control, fear of stillbirth or complications requiring emergency Caesarean section, some mothers suffer nightmares, and intrusive images and memories ('flashbacks'), similar to those occurring after other harrowing experiences. They can last for months. Some avoid further pregnancy (secondary tocophobia), and those who become pregnant again may experience a return of symptoms, especially in the last trimester. Rates up to 5.9% of deliveries have been reported. There is some evidence that early counseling reduces these symptoms. Enduring symptoms require specific psychological treatment.
- Brockington I F (2006), Eileithyia’s Mischief: the Organic Psychoses of Pregnancy, Parturition and the Puerperium. Bredenbury, Eyry Press, chapter 3.
- Ideler K W (1856) Über den Wahnsinn der Schwangeren. Charité-Annalen 7: 28-47.
- Binder H (1937) Psychiatrische Untersuchungen über die Folgen der operativen Sterilisierung der Frau durch partielle Tubenresektion. Schweizer Archiv für Neurologie und Psychiatrie 40: 1-49.
- Nerum H, Halvorsen L, Sørile T, Øian P (2006) Maternal request for Cesarean section due to fear of birth: can it be changed through crisis-orientated counseling? Birth 33: 221-228.
- Bydlowski M, Raoul-Duval A (1978) Un avatar psychique méconnu de la puerperalité: la névrose traumatique post obstétricale. Perspectives Psychiatriques 4: 321-328.
- Söderquist J, Wijma B, Wijma K (2006) The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynaecology 27: 113-119.
- Adewuya A O, Ologun Y A, Ibigbami O S (2006) Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors. British Journal of Obstetrics and Gynaecology 113: 284-288.