Post-traumatic stress disorder (PTSD) is common among women of child-bearing age.  While we are increasingly attentive to screening for depressive symptoms after delivery, we may not always ask about PTSD symptoms.  Importantly, PTSD symptoms that go undetected and unaddressed may complicate the treatment of postpartum depression.  A recent study has looked at the prevalence of PTSD symptoms in women who experience complications at delivery.

The objective of this prospective cohort study was to assess the relationship between severe maternal morbidity (i.e. major hemorrhage, severe hypertensive disorders or intensive care unit admission) and postnatal psychological symptoms, focusing on post-traumatic at PTSD symptoms at 6-8 weeks postpartum (assessed using a mailed questionnaire).  Data on the incidence of severe maternal morbidity were extracted from maternity records.

Of women eligible to participate (n=3509), 52% responded.  Clinically significant levels of intrusive thoughts in 6.4% (n=114) of all women. 8.4% (n=150) of the women endorsed avoidant behaviors. There was a higher risk for PTSD symptoms among women who experienced severe maternal morbidity compared with women who did not (adjusted OR = 2.11 for intrusion; adjusted OR = 3.28 for avoidance).

This is one of the largest studies to date of PTSD symptoms among women who had recently given birth. The finding is probably not that surprising: the experience of severe maternal morbidity was associated with symptoms of PTSD.  Experiencing a complication at delivery clearly increases the risk of postpartum PTSD, but there are other factors at work here.  Other studies highlight the importance of the mother’s perception of her childbirth.  The number of hours in labor is less important than whether or not the mother felt that her labor was prolonged.  Similarly, the mother’s experience of whether or not complications occurred carries more weight than the obstetrician’s perceptions of whether or not complications occurred.

The study described here noted that higher ratings of reported sense of control during labor and delivery appeared to partially mediate the risk of PTSD symptoms. Given this finding, the researchers call for Individually tailored obstetric care, hypothesizing that by increasing women’s sense of control during labor and delivery, we may help to protect them from PTSD symptoms later on. 

Ruta Nonacs, MD PhD

Furuta M, Sandall J, Cooper D, Bick D.  The relationship between severe maternal morbidity and psychological health symptoms at 6-8 weeks postpartum: a prospective cohort study in one English maternity unit.  BMC Pregnancy Childbirth. 2014; 14(1):133. [Epub ahead of print]

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