Archive for November, 2008

PTSD after childbirth

Women can experience Post-traumatic Stress Disorder after childbirth. Most women go into their births with plans of a beautiful, wonderful birth where she sees the baby afterwards and they immediately bond. But it doesn’t always go that way. A lot of births end up less than ideal but some births end up actually traumatic. I’m going to review the DSM-IV-TR criteria for PTSD and comment on how they can apply to birth.
According to the DSM-IV-TR, the following criteria must be met to be diagnosed with Post Traumatic Stress Disorder (PTSD):

A. The person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND the person’s response involved fear, helplessness or horror.

Has the mother felt like she or her baby was in danger of death or injury? And how did she react to that during the event? Panicking? Dissociating? Cooperating, resisting, crying, doesn’t remember? All of these can be stress reactions to an event.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

  • Recurrent and intrusive distressing recollections of the event.
  • Recurrent distressing dreams of the event.
  • Acting or feeling as though the event were recurring (including flashbacks when waking or intoxicated).
  • Intense psychological stress at exposure to events that symbolize or resemble an aspect of the event.

The mother can have nightmares about her birth, images and flashbacks can come to her during the day at random moments or when she looks at her baby.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the event) as indicated by at least three of the following:

  • Effort to avoid thoughts or feelings associated with the event.
  • Efforts to avoid activities or situations which arouse recollections of the event.
  • Inability to recall an important aspect of the event (psychogenic amnesia.)
  • Markedly diminished interest in significant activities, such as hobby or leisure time activity.
  • Feeling of detachment or estrangement from others.
  • Restricted range of affect; eg, inability to experience emotions such as feelings of love.
  • Sense of a foreshortened future such as not expecting to have a career, more children or a long life.

This can present several way. Moms may skip their postpartum checkup in an effort to avoid the doctor or midwife. If asked about her birth, she may not want to talk about it. She avoids parenting groups or birth class reunions. She avoids the hospital or birth center.

D. Persistent symptoms of increased arousal (not present before the event) as indicated by at least two of the following:

  • Difficulty in falling or staying asleep.
  • Irritability or outbursts of anger.
  • Difficulty concentrating.
  • Hyper-vigilance.
  • Exaggerated startle response.
  • Physiological reactivity on exposure to events that resemble an aspect of the event, eg breaking into a sweat or palpitations.

Moms may have an anxiety reaction when driving past their birth centers or hospitals. They may get anxious when discussing the birth or when birth stories come up in conversation.  They may also feel detached from their baby, partner, family, or friends.

E. B, C, and D must be present for at least one month after the traumatic event.

F. The traumatic event caused clinically significant distress or dysfunction in the individual’s social, occupational, and family functioning or in other important areas of functioning.

Like postpartum depression, PTSD is highly treatable, meaning the woman can get better, sometimes very quickly. Treatment options include

  • talk therapies such as cognitive-behavioral therapy
  • medications and herbs
  • acupuncture
  • body therapies such as Eye Movement Desensitization and Reprocessing (EMDR), biofeedback, and hypnosis

The important part is recognizing what is going on and then getting some help. Many women feel like they’re saying they don’t love their babies if they admit that their births were less than ideal. After all, numerous people probably said to her, “a healthy baby is the most important thing.” Yes, but the two issues are completely separate. It doesn’t negate how her birth went or what she’s going through now.

To learn more about PTSD after childbirth, check out the site PTSD Childbirth.