Can Giving Birth Cause PTSD?

PTSD, or post-traumatic stress disorder, is most often associated with soldiers and survivors of war. The reality is anyone who lives through a traumatic experience can develop PTSD, whether it's childhood abuse, rape, or surviving a disaster like a plane crash. But can giving birth be considered a traumatic experience? And could the experience be so stressful that the new mother develops PTSD?

Defining PTSD

Post-traumatic stress disorder is an anxiety based psychiatric disorder that can develop in someone who lives through a stressful event which carried the threat of injury or death. It's not understood why some people develop PTSD, but we do know it changes how their bodies respond to stress. People with PTSD often have flashbacks that cause them to relive the stress of the traumatic event over and over. In an effort to reduce these flashbacks, a person with post-traumatic stress disorder may avoid situations that remind them of these damaging events. It is also common for people with PTSD to be hypersensitive and easily aroused.

How can childbirth be so traumatic?

Although we would like to think all women view their pregnancy and the day they give birth as an emotionally satisfying experience, the fact is this is not always the case. In 2008, a survey titled 'New Mothers Speak Out' found that nearly 1 in every 10 new mothers can meet the criteria for being diagnosed with post-traumatic stress disorder. This survey, published by The Wall Street Journal, found a correlation between the increased use of medical interventions during delivery (like Cesarean sections) and the development of PTSD in new mothers. Such interventions gave new mothers a feeling of powerlessness and a perception that their pregnancy was life threatening to either themselves or their babies. Some of the other conditions that were cited as potential causes for childbirth PTSD included unplanned pregnancies, lack of health insurance, and a history of sexual abuse.

Identifying PTSD in a new mother

Unlike postpartum depression (PPD), there is no specific screening tool to identify PTSD in a new mother. However, a PPD screening tool can still be helpful. The Edinburgh Postnatal Depression Scale asks new mothers such questions as how happy or anxious they feel and if they are able to laugh and enjoy themselves. A score above 10 warrants a further assessment and possibly a visit with a social services representative. To further assess for PTSD, ask specifically about nightmares and flashbacks about the childbirth experience, especially if it was a difficult birth. People with PTSD often try to avoid reminders of the traumatic experience, so ask the new mother how she feels about her childbirth and if she feels close to or isolated from her infant.

Sources:

Murray, Sharron Smith and McKinney, Emily Sloan, (2010) Foundations of Maternal-Newborn and Women's Health Nursing (5 ^th ed), Saunders-Elsevier, Maryland Heights, Missouri, pp 753, 755-756

US National Library of Medicine-PubMed Health, Post-traumatic stress disorder, March 2011

Clinical experience with PPD screenings