Support for Birth Trauma

Postnatal birth trauma or post-traumatic stress disorder (PTSD) is now being recognized as an important cause of severe mental health issues following childbirth. It has been estimated to affect 1 – 21% of women at this time.

Childbirth is not perceived uniformly by all laboring and delivering women as a time of joy, but instead may be a time of great threat and danger to the unborn child and/or the mother, coupled with intense fear and lack of control.

The labor pain may reawaken memories of early trauma associated with feelings of intense vulnerability. This may then become associated with the birthing process, making it a fresh and horrifying repetition of the earlier pain. Other women may perceive this time negatively, being conditioned to expect high levels of pain and feelings of helplessness. This again results in the experience of fear in the absence of any specifically abnormal event during delivery or afterwards.

Risk Factors

Several factors are associated with a higher incidence of birth trauma, such as:

• Female gender
• Age
• Ethnic origin
• Disadvantaged social status
• History of mental health issues
• Dysfunctional family situation
• Lack of coping skills
• Past history of 2 or more traumas, abuse, or violence
• General hyper-reactivity
• Lack or presence of adequate social support following trauma
• Presence of depression or panic attacks during or following pregnancy

Support Measures

In view of the above, support for women with PTSD begins with assessment of the mental health of all expectant and new mothers at each postnatal visit, with sensitivity and a willingness to understand their frame of mind without prejudice.

Careful questioning should indicate the availability of help for the woman who is struggling with past or present issues. These may include those such as  domestic violence, sexual abuse, or female genital mutilation, or any other situation in which she feels powerless and threatened.

Trained professional assessment is preferable to relying solely on the woman’s own evaluation and honesty, as the mere fact of seeing a health professional is itself a threat to shy or reserved women, or women who are embarrassed to admit their neediness to a stranger.

Secondly, other psychiatric conditions should be ruled out by mental health professionals. This is especially important because depression and PTSD overlap in many features.

A woman with PTSD should be offered the opportunity to debrief i.e., to tell her birth story to a friendly, empathetic health professional so that she can discover hidden aspects of it and thus resolve some of the story. This provides mental strength to overcome the fear associated with the memory of the experience. Benefits also include:

• Feeling that her emotions of pain, anger, anxiety, and depression, are acknowledged
• Better understanding of what happened
• Bringing out expectations about childbirth which were unfulfilled
• Relieving some of the pain
• Exposing hidden emotions for resolution
• Support in the postpartum period
• Providing practical and emotional support
• Suggestions of appropriate support groups
• Watching for signs of trauma or distress

Support of Women With PTSD in Following Pregnancies

• Make sure to ask for history of PTSD
• Look for symptoms of depression, avoidance, or panic
• Ask for and record the mother’s wishes as to the mode of delivery, pain relief and informed care
• Counseling and referral for psychological support if required

Support During Labor

• Inform the woman about all procedures and get verbal consent before proceeding
• Discuss all decisions with adequate information and make sure she is on board before proceeding to allow her to feel in control
• Stop any procedure on her request unless to do so would be life-threatening
• Be alert to any perception of danger or threat to avoid traumatization
• Pain relief should be suggested if the intensity of pain is felt to be pushing her over the edge
• Make sure the experience is as fulfilling and empathetic as possible, because it has immense value for healing the past birth trauma

References

• http://www.nhs.uk/Conditions/Post-traumatic-stress-disorder/Pages/Treatment.aspx
• https://nj.gov/health/fhs/maternalchild/mentalhealth/about-disorders/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168363/  
• Clinical Guideline, South Australian Perinatal Practice Guidelines – Managing women in distress after traumatic birth experience. Policy developed by: SA Maternal & Neonatal Clinical Network.  
• http://ebn.bmj.com/content/8/2/59.full

Further Reading

• All Post-Traumatic Stress Disorder (PTSD) Content
• What is Post-Traumatic Stress Disorder (PTSD)?
• Post-Traumatic Stress Disorder (PTSD) Symptoms
• Post-Traumatic Stress Disorder (PTSD) Causes
• Post-Traumatic Stress Disorder (PTSD) Diagnosis

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.