A study has found that approximately one third of all post-partum women exhibit some symptoms of PTSD, and a smaller percentage develop full-blown PTSD following the ordeal of labour. The study further found that:
Of those women who developed post-traumatic symptoms, 80 percent opted for natural childbirth without pain relief.
The study interviewed only 89 post-partum women, and it did not define "natural" birth.
... one of the most influential factors was pain management during delivery. Of the women who experienced partial or full post-trauma symptoms, 80 percent had gone through a natural childbirth, without any form of pain relief. "The less pain relief there was, the higher the woman's chances of developing post-partum PTSD," he said. Of the women who did not develop any PTSD symptoms, only 48 percent experienced a natural childbirth.
... 80 percent of the PTSD group reported feeling discomfort with being unclothed, and 67 percent had previous pregnancies which they described as traumatic. Fear of the labor itself, both in terms of expected pain levels and danger to themselves and their children, was also influential. The researchers discovered to their surprise that support during labor, in the form of a midwife or doula, had no impact when it came to avoiding post-traumatic symptoms ...
I'm not sure that we can take too much away from this study.
The sorts of issues raised were:
- Women who do not have pain relief in labour are more likely to develop PTSD
- Women are more likely to develop PTSD if they are unclothed
- Women are more likely to experience PTSD if their previous birth was traumatic
- Fear is an influential factor
- Midwifery care made no difference.
Let's break this down.
Women who have no pain relief: were those women prepared for a natural (drug-free) labour and birth? Do we go through any other intense life experience without preparation? An empowering and drug-free labour and birth do not usually happen without intense preparation: mental, emotional and physical - for birth.
Women were more likely to develop PTSD when they were unclothed. Most people prefer to wear clothes ... this is about modesty, dignity and privacy. Disrespect these needs and anyone would feel uncomfortable ... add to it labour and birth, being in a strange environment and cared for by strangers, and it is no wonder women felt traumatised. Were the women given other options for modesty and privacy? Were they cared for by a midwife they knew and trusted? We know that these things make a difference.
Women are more likely to experience their current birth as traumatic of their previous birth was traumatic - this is logical. Without skilled and sensitive psychological intervention between births, the woman would carry the same issues, fears and anxiety from the first birth to her second birth. Were these women offered skills psychological care between births?
Fear is an influential factor: I think the authors hit the nail on the head with this one. It is well-known that fear correlated positively with a traumatic experience. What are we doing to classify and manage women's fear in pregnancy, before their labour starts?
Finally, the authors found that midwifery care made no difference. This is in direct contrast to many other studies that found that midwifery care made a huge difference to women's satisfaction with their birth experience. So my next question is: did these women know their midwife before labour? Were they cared for by the same midwifery right through pregnancy, birth and the postnatal period?
What can we learn from the study?
- Understand and respect a woman's need for privacy and dignity in labour.
- Early in pregnancy, ask the woman about her previous birth and work with her to identify things that she can do during her current pregnancy to maximise the possibility of her next birth being a positive experience. Spend time with the woman during her pregnancy debriefing her last birth. Understand what is important for her and work with her to implement this.
- Work with the woman during her pregnancy to address fears, doubts, concerns and anxiety about her pregnancy and upcoming birth.
- Provide each woman with one midwife to care for her through her pregnancy, birth and postnatal period.
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