Childbirth-related posttraumatic stress disorder

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

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.

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. However, 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.

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

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)."

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."

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