Childbirth and post-traumatic stress

Visit my website to learn more about my services. Link

It's more often associated with survivors of torture or war, but post-traumatic stress disorder (PTSD) can also affect women who have had an unexpectedly difficult childbirth.

Reliable figures are hard to come by as the condition often goes undiagnosed, but studies suggest up to a third of women find labour traumatic, with as many as 6 per cent of new mothers going on to develop symptoms of PTSD.

Symptoms of PTSD in the postnatal period are often confused with post-natal depression. But PTSD is different in that the focus is on the traumatic birth itself, with sufferers typically experiencing flashbacks and seeking to avoid anything that will remind them of the trauma.

"If it's PTSD, they usually get the classic things such as flashbacks and the fear, a feeling of powerlessness and loss of control," says obstetrician Ted Weaver, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Affected women often feel they did not get the support they needed during a difficult labour, he says.

"A lot of it seems to be related to how a woman is cared for in labour: the support she receives, or the feeling of being ignored perhaps, the care from all the professionals and others, the environment, the calmness or otherwise around the birth…"

Most of which can be prevented by having continuity of midwifery care for pregnancy, labour and the postnatal period. Homebirth or hospital birth, the value of continutiy of midwifery care cannot be understated.

Triggers of future trauma symptoms will vary for individual women but might include an unexpected emergency caesarean, especially if ordered by an unfamiliar clinician, or a request for an epidural when a woman is "in great pain but is told she doesn't 'need' one".

Two groups of women seem to be at particularly high risk of developing PTSD if their labour does not go according to plan, according to Weaver.

Women who are very anxious and fearful beforehand are at greater risk, as are those who have very high expectations of themselves and of the way they want their labour to go.

For both groups, a key to preventing trauma symptoms is to establish a solid and trusting relationship with care providers before the birth, Weaver believes.

The more anxious women need to be reassured that they will be looked after and health care professionals then need to make sure they deliver on those promises during the actual labour.

The second group are often women who have a "really idealised view of what birth will be", which leaves them at risk of trauma if things don't work out the way they expect.

It is important for these women to have the "what if" conversations with caregivers before they go into labour so that they are prepared for the possibility that all might not go according to plan.

In my experience, these "what if" conversations take time - time in each consultation over a period of months. Hence, another good reason why continuity of midwifery care is perfect for women who are fearful of their birth experience. Women who have a "really idealised view of what birth will be" are also fearful in a way, because their idealised view protects them from gently exploring "what if". This exploration can be done with a trusted midwife over the course of the pregnancy.

Having a trusted support person who understands their wishes present during the birth can help to prevent the feelings of abandonment, or of not being listened to, that are common in many women who later develop trauma symptoms, Weaver says.

For new mothers who develop PTSD, cognitive behaviour therapy has been shown to help, as have opportunities to "debrief" about the birth experience, but too many miss out because their condition is never diagnosed, Weaver says ...

Melissa Maimann, Essential Birth Consulting 0400 418 448