• Postpartum PTS/PTSD (or) PTSD secondary to childbirth -PSTD/CB.

The diagnosis of PSTD secondary to childbirth, while cited in research for several years, is not currently recognized in the DSM.

Trauma exists on a spectrum from uncomfortable feelings> pts > ptsd

Ayers (2009) reports 1/3 of the women in the western world consider their birth to be traumatic, ten percent report severe symptom of traumatic stress, however, most self-resolve. 1% – 2% develop clinical post-traumatic stress symptoms which should be treated.

Ayers (2009) reports that trauma depends on the interaction of the severity of birth, interpersonal factors, personal strengths and vulnerabilities.

Ayers (2009) says that the issues of the relationship between PTSD and childbrith is in its infancy, yet we are broadening our understanding of postnatal mental health.

The Listening to Mothers (2006) research indicates there is an increasing pressure to improve maternity services.

Regarding uncomfortable feelings:

Research such as Cheryl Beck’s In the Eye of the Beholder (2004) mentions feelings that women have while birthing. A predominate theme indentified in the research:

“Why couldn’t they have cared for me?”

Beck (2004) culled four themes describing the essence of women’s experiences of birth trauma:

“To care for me: Was that too much too ask? To communicate with me: Why was this neglected? To provide safe care: You betrayed my trust and I felt powerless, and The end justifies the means: At whose expense? At what price? Beck’s conclusion was that birth trauma lies in the eye of the beholder. Mothers perceived their traumatic births were viewed as routine by clinicians.”

Regarding Post-traumatic stress (PTS):

Post-traumatic stress is a normal response to stress. Behaviors used to cope, to a certain degree, such as dissociation (to a certain extent), putting it out of your mind, numbing to the experience, flashbacks, hypervigilance, are types of psychological defenses that help keep the psyche healthy. In some research, these survival behaviors/mechanisms are described as “coping ugly.” Some people have PTS or acute stress symptoms for a few weeks, and then they pass.

For a good portion of people, this normal response to trauma, or “coping ugly,” is a healthy survival response. It is classified as normal. People can evolve from trauma. Difficult birth experiences can affect psychological health, but for majority it is self-resolved. Other’s conditons do not self-resolve, but continue on for more than a few weeks or so.

Regarding Post-tramatic Stress Disorder (PTSD):

Symptoms:

Post-traumatic stress disorder is the result of the body and mind’s response to a stressful event, such as natural or man-made disasters (hurricanes, bombings, assault, crime, medical interventions, etc.). Symptoms are flashbacks, hypervigilance, triggers, anxiety, depression, b/c of overlap, can be blanketed as PPD, differential diagnosis can affect tx

Treatments for PTSD: Immediate professional treatment to process the event. Eye Movement Desensitization and Rreprocessing (EMDR) is an evidence -based treatment for trauma and PTSD. EMDR is recommended by the Substance Abuse and Mental Health Services Adminstration (SAMHSA), best practices / Irish & Israeli govts

Research Reference Specific to EMDR for PTSD Secondary to Childbirth – published in Birth March 2012

Stramrood, C. A., van der Velde, J., Doornbos, B., Marieke Paarlberg, K., Weijmar Schultz, W. C. and van Pampus, M. G. (2012), The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth. Birth, 39:70–76. doi:10.1111/j.1523-536X.2011.00517.x

Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group. (BIRTH 39:1 March 2012)

Listening to Mothers II Survey (2006)

Listening to Mothers II (2005) is a research study developed by the Childbirth Connection, Boston University, and Harris Interactive® in partnership with Lamaze International. Second study explored core issues in more depth and alos postpartum issues. It is a study of 1573 women aged 18- 45, who had given brith to a single baby, in one hospital.

The study remidns us that there are 4 million births in America each year and that a percentage point is 40,000 people.

The study concludes that the US is on track with prenatal care.

However, with birthing practices, it was found that large segments of the health population were given clearly inappropriate care during birthing, that support for normal birth was limited; and there were large amounts of interventions, invasion and risk.

The majority of women reported feeling overwhelmed and frightened at the pivotal point of their life, childbrith. They reported suffering indignities and unaked for treatment. It was reported that clear informed consent was not followed, that side effdects of medical treatments were not fully understood. The researcers found that women suffered emotional and physical side effects at the same time they are beginning to care for newborns.

Further, the study found that in the healthy population, four in ten births were started artifically, one in three women had a c-section, and most did not experience spontaneous physiologic birthing. In addition, most women interested in VBAC were denied that option. Of these 1500 women, only a small fraction used low-risk, highly rated, drug-free measures for pain relief, such as tubs, showers, birth balls.

The study found that even though large scale prospective studies indicate healthy women require low intervention during birth, most experience birth as a technological event, with wires, tubes, machines, immobilization, high levels of surgery, and come out of the experienec burdened with health concerns while caring for a newborn.

This study also found that US to have reproductive health policies which fail to minimize unplanned pregnancies.

 

References

Ayers, S. and Ford, E. (2009). Birth trauma: Widening our knowledge of postnatal mental health. European Health Psychologist, June, 2009, (11), p. 16 – 20.

Beck, C. T. (2004) Birth Trauma – In the Eye of The Beholder. Nursing Research. 53(1): 28 – 35

Declercq E, Sakala C, Corry M, Applebaum S. 2006. Listening to mothers II: Report of the second national U.S. survey of women’s childbearing experiences. New York: Childbirth Connection.

Driscoll, D. and Sichel, J. (1999). Women’s moods: What every woman must know about hormones, the brain, and emotional health. New York: HarperCollins

Kendall-Tackett, K. (2005). Depression in new mothers. New York: Haworth Press.

Kleiman, K. (2009). Therapy and the postpartum woman. New York: Routledge Press.

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Postpartum Support International (2009). Components of care. Seattle: PSI

Puryear, L. J. (2007). Understanding your moods when you’re expecting. New York: Houghton Mifflin Company.

Stramrood, C. A., van der Velde, J., Doornbos, B., Marieke Paarlberg, K., Weijmar Schultz, W. C. and van Pampus, M. G. (2012), The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth. Birth, 39:70–76. doi:10.1111/j.1523-536X.2011.00517.x

Twomey, T.M. (2009). Understanding postpartum psychosis: A temporary madness. Westport, Ct.: Praeger Publishers.

 

 

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