Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.

These studies have reported a wide range of PTSD symptoms, including flashbacks, nightmares, hypervigilance, and avoidance of reminders of the trauma.  Women with PTSD also may experience feelings of numbness, anger, depression, social isolation, and chronic sleep problems.

While earlier reports suggested that PTSD after childbirth appeared to be precipitated by delivery trauma, a recent study by Zaers and colleagues suggests that there are certain predisposing factors which raise the likelihood that a woman will develop PTSD after childbirth.  In this study, 6% of 60 postpartum women reported clinically significant PTSD symptoms at six weeks postpartum. At six months postpartum, 14.9% reported PTSD symptoms. The strongest predictor for post-traumatic stress symptoms was anxiety late in pregnancy. Other predictors included psychiatric symptoms in late pregnancy, stressful life events, and the delivery experience. Nearly one quarter of the women in this study also reported depressive symptoms at 6 weeks and 6 months postpartum.

The long-term consequences of PTSD after childbirth can be devastating for the mother and/or her family.  Women who have experienced PTSD may experience nightmares resulting in conditioned insomnia, difficulties with breastfeeding, impaired bonding with the child, difficult sexual relations with their partner, and poor sense of self-worth.  Women with PTSD may avoid childbearing in the future or may opt for an elective Cesarean section in subsequent pregnancies in order to avoid recurrent trauma.

Careful screening for PTSD symptoms in postpartum women by healthcare professionals is warranted, with special attention being paid to depressive symptoms and anxiety, particularly in cases where the woman presented with anxiety or other psychiatric symptoms during pregnancy or experienced a complicated delivery or an unexpected pregnancy outcome.

Laura Petrillo, MD

Read more:

llard CG, Stanley AK, Brockington IF. Post-traumatic stress disorder (PTSD) after childbirth. Br J Psychiatry. 1995;166(4):525-8.

Reynolds JL. Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. CMAJ. 1997; 156(6):831-5.

Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008; 29(1):61-71.

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