Childbirth-related posttraumatic stress disorder

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 sexual intercourse in order to prevent another pregnancy, and avoidance of birth and pregnancy related issues. Symptoms of increasing stress can be sweating, trembling, being irritated, and sleep disturbances.[4]

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.[5] 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.[6] 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.[7]

The following are correlated with PTSD:

• Medical complications before, during, or after childbirth:
  • Pregnancy complications[8][9]
  • Emergency C-section[8]
  • Instrumental delivery[8]
  • Episiotomy[8]
  • Severe pain during birth[8][9]
  • Postpartum complications[8][9]
  • Preterm labour[10][5]
  • History of infertility[10][11]
  • Inadequate care during labour[8]
• Social, psychological, and other factors:
  • Unwanted pregnancy[10][11][9]
  • Low socioeconomic status[10][11]
  • Primiparous (first labour)[10]
  • Parenting (infant caring) problems[10][9]
  • Social support following childbirth[12][13][14]
  • Cultural factors[12][13][14]
  • History of mental health issues[8]
  • Other life stressors[8]

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 misdiagnosed with postpartum depression or adjustment disorders. These diagnoses can lead to inadequate treatment.[15]

Prevalence of PTSD following normal childbirth (excluding stillbirth or major complications) is estimated to be between 2.8% and 5.6% at six weeks postpartum,[4] with rates dropping to 1.5% at six months postpartum.[4][15] Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1%[16] at six weeks, dropping to 13.6% at six months.[17]

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

• Beck CT (2009). "Birth trauma and its sequelae". J Trauma Dissociation. 10 (2): 189–203. doi:10.1080/15299730802624528. PMID 19333848.
• Elmir R, Schmied V, Wilkes L, Jackson D (October 2010). "Women's perceptions and experiences of a traumatic birth: a meta-ethnography". J Adv Nurs. 66 (10): 2142–53. doi:10.1111/j.1365-2648.2010.05391.x. PMID 20636467.
• Lev-Wiesel R, Daphna-Tekoah S (2010). "The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women". J Trauma Dissociation. 11 (3): 266–83. doi:10.1080/15299731003780887. PMID 20603762.
• Sawyer A, Ayers S, Smith H (June 2010). "Pre- and postnatal psychological wellbeing in Africa: a systematic review" (PDF). J Affect Disord. 123 (1–3): 17–29. doi:10.1016/j.jad.2009.06.027. PMID 19635636.
• Vythilingum B (February 2010). "Should childbirth be considered a stressor sufficient to meet the criteria for PTSD?". Arch Womens Ment Health. 13 (1): 49–50. doi:10.1007/s00737-009-0118-x. PMID 20127456.