Childbirth-related post-traumatic stress disorder

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

Childbirth-related post-traumatic stress disorder

Specialty| OB/GYN, psychiatry

Template:Pregnancy and mental health

Childbirth-related post-traumatic stress disorder (PTSD) is a psychological disorder that can develop in women who have recently given birth.[1] There are over 140 million births that occur in the world annually. Up to 50% of women describe their childbirth experiences as "traumatic." [2] This disorder can also affect men or partners who have observed a difficult birth.[3] Its symptoms are not distinct from post-traumatic stress disorder (PTSD).[4][5] It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).[6] Symptoms of childbirth-related PTSD include anxiety, flashbacks, and fear of losing one's child. [3]

## Contents

* 1 Signs and symptoms
* 2 Cause
* 3 Diagnosis
* 4 Treatment
* 5 Epidemiology
* 6 See also
* 7 References
* 8 Further reading

## Signs and symptoms

About 4.7% of mothers develop childbirth-related PTSD.[7] 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 irritatable, and sleep disturbances.[8]

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.[3]

Although there is much information about childbirth related PTSD within mothers, the data is representative of white mothers. Many Black, Latina, and Asian mothers described to experience obstetric racism following their traumatic birth experiences.[9] The racism faced by POC mothers has led to an increase in medical mistrust and fear of undergo racism for future children. The mistrust and stress experienced further intensifies maternal disparities, leading to poorer health outcomes and discouragement from receiving prenatal and postnatal care.

## Cause

Giving birth can be traumatic in many 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.[10] 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. For some mothers, giving birth is a profound and monumental moment in their lives. Therefore, having complications and a painful experience can be discerned negatively.[11] 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.[12] 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.[12] These examinations can directly impact the patient's overall emotional and physical well-being, thus contributing to symptoms of childbirth-related PTSD.

The following are correlated with PTSD:

* Medical complications before, during, or after childbirth:
* Pregnancy complications[13]
* Emergency C-section[13]
* Instrumental delivery[13]
* Episiotomy[13]
* Severe pain during birth[13]
* Postpartum complications[13]
* Preterm labour[14][10]
* History of infertility[14][15]
* Inadequate care during labour[13]
* Social, psychological, and other factors:
* Unwanted pregnancy[14][15]
* Low socioeconomic status[14][15]
* Primiparous (first labour)[14]
* Parenting (infant caring) problems[14]
* Social support following childbirth[16][17][18]
* Cultural factors[16][17][18]
* History of mental health issues[13]
* Other life stressors[13]

## Diagnosis

Childbirth-related PTSD is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.[4] Many women presenting with symptoms of PTSD after childbirth are misdiagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.[19] Having a traumatic childbirth experience is unrecognized amongst maternity services, due to a lack of knowledge regarding the well-being of women who are freshly postpartum.[2]

## Treatment

Treatments for postpartum PTSD can include methods to normalize the feelings that can arise and alleviate anxiety. In some cases, medication such as antidepressants or anti-anxiety drugs can be prescribed to manage symptoms. Seeking emotional support from support systems can contribute to improvements in well-being as well. 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.[20] Upholding screening practices for risk factors that negatively impact mothers in their pregnancy and postpartum stages can improve support and welfare.[11]

## 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,[8] with rates dropping to 1.5% at six months postpartum.[8][19] Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1%[8] at six weeks, dropping to 13.6% at six months.[21]

## See also

* Miscarriage
* Pain management during childbirth
* Miscarriage and mental illness

## References

1. ↑ "Management of post traumatic stress disorder after childbirth: a review". Journal of Psychosomatic Obstetrics and Gynaecology 31 (3): 113–122. September 2010. doi:10.3109/0167482X.2010.503330. PMID 20653342.
2. ↑ 2.0 2.1 Horsch, Antje; Garthus-Niegel, Susan; Ayers, Susan; Chandra, Prabha; Hartmann, Katharina; Vaisbuch, Edi; Lalor, Joan (2024-03-01). "Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment" (in English). American Journal of Obstetrics & Gynecology 230 (3): S1116–S1127. doi:10.1016/j.ajog.2023.09.089. ISSN 0002-9378. PMID 38233316. https://www.ajog.org/article/S0002-9378(23)00713-5/fulltext.
3. ↑ 3.0 3.1 3.2 "Paternal Mental Health: Why Is It Relevant?". American Journal of Lifestyle Medicine 11 (3): 200–211. May 2017. doi:10.1177/1559827616629895. PMID 30202331.
4. ↑ 4.0 4.1 "Women's mental health: a "wish-list" for the DSM V". Archives of Women's Mental Health 13 (1): 5–10. February 2010. doi:10.1007/s00737-009-0114-1. PMID 20127444.
5. ↑ Perinatal Mental Health: a Clinical Guide. Cumbria England: M & K Pub. 2012. p. 26. ISBN 978-1-907830-49-5.
6. ↑ "Post-traumatic stress disorder following childbirth". BMC Psychiatry 21 (1): 155. March 2021. doi:10.1186/s12888-021-03158-6. PMID 33726703.
7. ↑ Heyne, Clara-Sophie; Kazmierczak, Maria; Souday, Ronnie; Horesh, Danny; Lambregtse-van den Berg, Mijke; Weigl, Tobias; Horsch, Antje; Oosterman, Mirjam et al. (June 2022). "Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis". Clinical Psychology Review 94. doi:10.1016/j.cpr.2022.102157. ISSN 0272-7358. https://www.sciencedirect.com/science/article/pii/S0272735822000423.
8. ↑ 8.0 8.1 8.2 8.3 "Posttraumatic stress following childbirth: a review". Clinical Psychology Review 26 (1): 1–16. January 2006. doi:10.1016/j.cpr.2005.07.002. PMID 16176853.
9. ↑ Dmowska, Amelia; Fielding-Singh, Priya; Halpern, Jodi; Prata, Ndola (March 2024). "The intersection of traumatic childbirth and obstetric racism: A qualitative study". Birth (Berkeley, Calif.) 51 (1): 209–217. doi:10.1111/birt.12774. ISSN 1523-536X. PMID 37849421. PMC 10922554. https://pmc.ncbi.nlm.nih.gov/articles/PMC10922554/.
10. ↑ 10.0 10.1 "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. September 2011. doi:10.1080/02646838.2011.623227.
11. ↑ 11.0 11.1 Kranenburg, Leonieke; Lambregtse-van den Berg, Mijke; Stramrood, Claire (2023-02-04). "Traumatic Childbirth Experience and Childbirth-Related Post-Traumatic Stress Disorder (PTSD): A Contemporary Overview". International Journal of Environmental Research and Public Health 20 (4): 2775. doi:10.3390/ijerph20042775. ISSN 1660-4601. PMID 36833472. PMC 9957091. https://pmc.ncbi.nlm.nih.gov/articles/PMC9957091/.
12. ↑ 12.0 12.1 "Birth trauma: in the eye of the beholder". Nursing Research 53 (1): 28–35. January–February 2004. doi:10.1097/00006199-200401000-00005. PMID 14726774.
13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 "Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review". Acta Obstetricia et Gynecologica Scandinavica 91 (11): 1261–1272. November 2012. doi:10.1111/j.1600-0412.2012.01476.x. PMID 22670573.
14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 "Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey". Birth 38 (3): 216–227. September 2011. doi:10.1111/j.1523-536X.2011.00475.x. PMID 21884230.
15. ↑ 15.0 15.1 15.2 "Traumatic stress after childbirth: the role of obstetric variables". Journal of Psychosomatic Obstetrics and Gynaecology 23 (1): 31–39. March 2002. doi:10.3109/01674820209093413. PMID 12061035.
16. ↑ 16.0 16.1 "Risk factors for postpartum depression in Japan". Psychiatry and Clinical Neurosciences 51 (3): 93–98. June 1997. doi:10.1111/j.1440-1819.1997.tb02368.x. PMID 9225370.
17. ↑ 17.0 17.1 "Childbirth and the development of acute trauma symptoms: incidence and contributing factors". Birth 27 (2): 104–111. June 2000. doi:10.1046/j.1523-536x.2000.00104.x. PMID 11251488.
18. ↑ 18.0 18.1 "Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms". Psychology & Health 26 (12): 1553–1570. December 2011. doi:10.1080/08870446.2010.533770. PMID 21598181. https://openaccess.city.ac.uk/id/eprint/2080/6/Support_during_birth_interacts_with_prior_trauma_and_birth_intervention_to_predict_postnatal_post-traumatic_stress_symptoms.pdf.
19. ↑ 19.0 19.1 "Post-traumatic symptoms after childbirth: what should we offer?". Journal of Psychosomatic Obstetrics and Gynaecology 27 (2): 107–112. June 2006. doi:10.1080/01674820600714632. PMID 16808085.
20. ↑ 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. PMID 38130709.
21. ↑ "[Predictors of postpartum post-traumatic stress disorder in primiparous mothers]". Journal de Gynécologie, Obstétrique et Biologie de la Reproduction 41 (6): 553–560. October 2012. doi:10.1016/j.jgyn.2012.04.010. PMID 22622194.

## Further reading

* "Birth trauma and its sequelae". Journal of Trauma & Dissociation 10 (2): 189–203. 2009. doi:10.1080/15299730802624528. PMID 19333848.
* "Women's perceptions and experiences of a traumatic birth: a meta-ethnography". Journal of Advanced Nursing 66 (10): 2142–2153. October 2010. doi:10.1111/j.1365-2648.2010.05391.x. PMID 20636467.
* "The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women". Journal of Trauma & Dissociation 11 (3): 266–283. 2010. doi:10.1080/15299731003780887. PMID 20603762.
* "Pre- and postnatal psychological wellbeing in Africa: a systematic review". Journal of Affective Disorders 123 (1–3): 17–29. June 2010. doi:10.1016/j.jad.2009.06.027. PMID 19635636. https://openaccess.city.ac.uk/id/eprint/1994/1/Sawyer_Ayers_Field_2010_text_copy.pdf.
* "Should childbirth be considered a stressor sufficient to meet the criteria for PTSD?". Archives of Women's Mental Health 13 (1): 49–50. February 2010. doi:10.1007/s00737-009-0118-x. PMID 20127456.

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