Childbirth-related post-traumatic stress disorder

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Childbirth-related post-traumatic stress disorder
Specialty OB/GYN, psychiatry

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. [1] This disorder can also affect men or partners who have observed a difficult birth. [2] Its symptoms are not distinct from post-traumatic stress disorder (PTSD). [3] [4] It may also be called post-traumatic stress disorder following childbirth (PTSD-FC). [5]

Contents

Signs and symptoms

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 irritated, and sleep disturbances. [6]

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. [2]

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. Premature birth may be traumatic. [7] 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. [8] 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. [8]

The following are correlated with PTSD:

Diagnosis

Childbirth-related PTSD is not a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders . [3] 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]

Treatment

In order to treat postpartum PTSD, it is essential to normalize the feelings that arise and alleviate anxiety. In some cases, medication such as antidepressants or anti-anxiety drugs might be prescribed to manage symptoms. Seeking emotional support from support systems is crucial. 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. [16]

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, [6] with rates dropping to 1.5% at six months postpartum. [6] [15] Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1% [6] at six weeks, dropping to 13.6% at six months. [17]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a mood disorder experienced after childbirth, which can affect women. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

<span class="mw-page-title-main">Postpartum period</span> Time period beginning after the birth of a child and extending for about one month

The postpartum period begins after childbirth and is typically considered to last for six weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the subacute phase, lasting six weeks; and the delayed phase, lasting up to six months. During the delayed phase, some changes to the genitourinary system take much longer to resolve and may result in conditions such as urinary incontinence. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during this period.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder, but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems are reported by 31% of women.

Psychiatric disorders of childbirth, as opposed to those of pregnancy or the postpartum period, are psychiatric complications that develop during or immediately following childbirth. Despite modern obstetrics and pain control, these disorders are still observed. Most often, psychiatric disorders of childbirth present as delirium, stupor, rage, acts of desperation, or neonaticide. These psychiatric complications are rarely seen in patients under modern medical supervision. However, care disparities between Europe, North America, Australia, Japan, and other countries with advanced medical care and the rest of the world persist. The wealthiest nations represent 10 million births each year out of the world's total of 135 million. These nations have a maternal mortality rate (MMR) of 6–20/100,000. Poorer nations with high birth rates can have an MMR more than 100 times higher. In Africa, India & South East Asia, as well as Latin America, these complications of parturition may still be as prevalent as they have been throughout human history.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.

<span class="mw-page-title-main">Post-traumatic stress disorder among athletes</span> Prevalence of PTSD among athletes

Posttraumatic stress disorder (PTSD) is a cognitive disorder, which may occur after a traumatic event. It is a psychiatric disorder, which may occur across athletes at all levels of sport participation.

Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

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  7. 1 2 Goutaudier N, Lopez A, Séjourné N, Denis A, Chabrol H (September 2011). "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. doi:10.1080/02646838.2011.623227. S2CID   71379594.
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