Childbirth is a significant event in a woman’s life. Awareness of postnatal depression and anxiety is increasing, however PTSD is an often overlooked mental health condition effecting women in the perinatal period. PTSD may arise as a result of experiences associated directly with the birth, or the experience of pregnancy and birth may exacerbate pre-existing PTSD. For example, a woman with a history of sexual assault may be triggered by examinations during pregnancy and delivery, she may also find breast feeding triggering. Prevalence estimates of the rates of PTSD directly related to the birth are between 2% to 4.7%. However when PTSD that existed before or during pregnancy is included, estimates of prevalence range between 2.3% and 24%. There are also high rates of PTSD (up to 25% ) amongst mother with infants admitted to the Neonatal Intensive Care Unit after birth.
Untreated, PTSD can lead to difficulties with the transition to motherhood, postnatal depression and difficulties with the mother-infant relationship. Sensitive responsiveness to baby signals is at the heart of secure attachment for infants, it follows that mothers with PTSD who are hyperaroused, experiencing intrusive symptoms or dissociating, are less able to be emotionally available to respond to their baby.
Comprehensive assessment and treatment in the antenatal and early postpartum periods is important. It is also important to differentiate postnatal depression from posttraumatic stress disorder.
Can it happen to fathers?
Yes. PTSD diagnostic criteria includes witnessing events, and a birth with serious medical intervention and a distressed partner could meet criteria for PTSD. This could even happen if the partner did not perceive the event in the same way.
RISK factors – Identifying those at risk
One study noted that bad memories of deliveries at day 2 were strongly associated with PTSD diagnosis and profile a year after vaginal delivery. The authors suggest this question might be a useful tool that could be routinely used to detect women at high risk of PTSD. As mentioned earlier, admission of a baby to NICU may be an indicator of risk factors. In a 2014 meta analysis labor experiences such as interactions with medical staff were identified as a factor in PTSD in the perinatal period.
Other risk factors for PTSD in the broader PTSD literature include
- Lower education levels
- Low socio-economic status
- Adverse childhood environment
- Prior trauma
- Pre-trauma psychopathology
- Pre-trauma life stress
- Personality disorder
