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Post Traumatic Stress Disorder suffered as a result of a traumatic birth experience has only recently been recognized.

Becoming a mother can put women under considerable psychological pressure. Post-natal (or post-partum) depression (PND or PPD) is a well-known and very common experience. Potentially much longer lasting and insidious, however, is Post Traumatic Stress Disorder (PTSD) arising from events before, during, after or throughout the whole of the birth experience.

What is PTSD?

Post Traumatic Stress Disorder (PTSD) is the psychological term for a set of reactions anyone may experience when something traumatic, scary or bad happens.

It is a normal reaction to an event that involves the threat of death or injury to self or others. Only recently has it been recognized that PTSD may be suffered as a result of a traumatic birth experience.

First identified in soldiers during the Vietnam War, and previously known as Shell Shock during World War I, it is common for rape or road accident victims. Frequently we hear of events likely to result in people possibly suffering PTSD, eg bombings, hostage taking, shipwrecks, armed hold-ups, disasters like the Hillsborough Stadium crush, as well as natural disasters . . . . Having a baby, also, can be such an event.

Could this be PTSD?

Note: The following information is not intended to serve as a basis for a comprehensive diagnosis of PTSD replacing the need for consultation with an appropriately qualified health professional or other caregiver. While we have made every effort to be as accurate as possible, the diagnosis of PTSD is the responsibility of an appropriately qualified practitioner. Accordingly, we recommend in the strongest possible terms that people seeking advice on whether they are affected by PTSD should consult an appropriately qualified practitioner.

These symptoms should alert you to possible PTSD:

• Experienced an event perceived by the person experiencing it as traumatic
• Flashbacks of the event, vivid & sudden memories
• Nightmares of the event
• Inability to recall an important aspect of the event - psychogenic amnesia
• Exaggerated startle response, constantly living on edge
• Hyper-arousal, always on guard
• Hyper-vigilant, constantly looking around for trouble or stressors
• Avoidance of all reminders of the traumatic event
• Intense psychological stress at exposure to events that resemble the traumatic event
• Physiological reactivity on exposure to events resembling the traumatic event- panic attacks, sweating, palpitations
• Fantasies of retaliation
• Cynicism and distrust of authority figures and public institutions
• Hypersensitivity to injustice

How is PTSD different from PND/PPD?

Cover-up Symptoms

The longer the person has suffered from untreated PTSD, and the more severe the trauma, the more likely the PTSD will be hidden by one or more of these or other cover-up symptoms.

• Alcohol and drug abuse
• Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
• Compulsive gambling or compulsive spending
• Psychosomatic problems
• Homicidal, suicidal or self-mutilating behaviour
• Phobias
• Panic disorders
• Depression or depressive symptoms
• Dissociation symptoms
• Fainting spells

Risk Factors

A Risk Factor is an event(s) that can contribute to PTSD occurring. It might happen any time during the pregnancy, labour, delivery and/or postnatal periods. The number of Risk Factors present may vary greatly. Some Risk Factors affect some women, but not others.

Each risk factor can increase the chances of PTSD occurring. Most can be avoided or lessened considerably by those looking after the woman, by simple measures such as giving the woman respect, treating her with dignity, acknowledging her needs and communicating effectively at all times.

Common Risk Factors

• Managed labour
• Induction
• Poor pain relief
• Feelings of loss of control
• Unnecessary trauma
• Traumatic delivery
• Impersonal treatment, overly professional, stand-offish or judgemental attitude of the staff
• Multi handling
• Shift changes
• Staff related problems
• Feelings of loss of control
• Not being believed or listened to
• Lack of attention to dignity, eg no coverings
• True obstetric emergencies
• Invasive procedures without explanations or consent
• Forceps, suturing without adequate analgesia
• Prolonged latent phase - resulting in demoralisation
• Conflicting advice
• Having baby/ies admitted to SCBU (Special Care Baby or Unit) or NICU (Neonatal Intensive Care Unit)
• Severe postnatal anaemia
• Post Partum Haemorrhage
• Poor postnatal care
• Old trauma
• Unmet need to debrief, review or to understand what happened
• Emergency Caesarean Section
• Shoulder dystocia,
• Poor Post Natal Care
• Post Natal problems

UNRESOLVED TRAUMA LEADS TO DEPRESSION

Note: for more information on PTSD after childbirth, please visit the TABS web site by following this link.