Childbirth-related posttraumatic stress disorder

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

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

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]). This is rape according to the FBI's definition, since the vagina is penetrated by an object without consent.[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 diagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.[9]

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]

Management

"Several interventions can prevent the development of clinically relevant PTSD, however there is a lack of evaluated treatment strategies: provide opportunity to talk about the birth experience, promotion of expression of feelings, responding to patient's questions about the course of birth, connect events with emotions, psychoeducation about post-traumatic stress symptoms and assessment of self-perceived severity and ability to cope, concrete suggestions like writing down her own birth narrative, and enhancement of stabilizing steps focusing on intra- and interpersonal resources. More specifically, the strengthening of partner support and of the emotional relationship between the spouses. [sic] In addition, a network of psychosocial support should be activated to avoid exhaustion of the partners' resources, and consequently of the couple."[9]

Epidemiology

Alder et al. (2006) say that most studies show about 1.5% of women develop PTSD after childbirth;[9] Olde et al. (2006) say the range is between 2.8 and 5.6%.[3]

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 Gynaecol. 31 (3): 113–22. doi:10.3109/0167482X.2010.503330. PMID 20653342.
  2. 1 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. 1 2 3 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. ↑ "Attorney General Eric Holder Announces Revisions to the Uniform Crime Report's Definition of Rape". press release. FBI. 2012. Retrieved 2014. Check date values in: |access-date= (help)
  9. 1 2 3 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

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