by Penny Simkin, PT, PATTCh Founder
Between 25 and 34 per cent of women report that their births were traumatic(1-7). A birth is said to be traumatic when the individual (mother, father, or other witness (8)) believes the mother’s or her baby’s life was in danger, or that a serious threat to the mother’s or her baby’s physical or emotional integrity existed.
Following the birth, some of these people go on to develop Post-Traumatic Stress Disorder (PTSD), which is a severe and long-lasting reaction to the trauma. The diagnosis is based on the following criteria that have been paraphrased from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (9): at least nine symptoms, from the following categories, lasting for at least one month:
- Intrusive recollections, such as:
- Nightmares; flashbacks; feeling the traumatic event is recurring; intense psychological or physiological reactions when reminded of the event
- Avoidance/numbing reactions, such as:
- Avoiding thoughts feelings, location or people associated with the trauma; Avoiding situations in which it can recur; amnesia of parts of the event; diminished interest in significant activities; detachment from others; inability to feel loving feelings; sense of foreshortened future.
- Hyperarousal, for example:
- Difficulty sleeping; irritability or angry outbursts; difficulty concentrating; hyper-vigilance; exaggerated startle response; panic attacks or symptoms
- Functional impairment, such as:
- Significant distress in social, occupational or other areas of functioning
Qualitative studies of women’s experiences of traumatic birth put women’s personal descriptions to the phenomena listed above. Their poignant words bring to life the meaning of this debilitating burden these women carry (10-12).
Most women who have had a traumatic birth do not develop PTSD. Studies report rates of PTSD after childbirth, as varying between 1.5 and 9 percent of all births (1-7). The differences among study findings are partly explained by differences in study designs, assessment tools, study populations (13), usual maternity care practices and caregiver attitudes (14-16).
Those who have traumatic births but are not diagnosed with PTSD have fewer symptoms of the disorder or a duration of symptoms of less than a month. These women are referred to variously as having Post-Traumatic Stress Symptoms (PTSS), Post-Traumatic Stress Effects, (PTSE), or Partial Post-Traumatic Stress Disorder (PPTSD) (17). .All these terms refer to a less severe manifestation of birth trauma, meaning they had some symptoms of PTSD, but not enough to qualify for the diagnosis.
Recovery from PTSE, etc. occurs with time, support, and can be facilitated by empathic discussion with a knowledgeable caregiver, and various nonpharmacological treatments, such as:
- Adequate sleep;
- Exercise, yoga;
- Support groups;
- Body work, massage;
- Psychotherapy; counseling; and social work (18-21).
- Downloadable app for a smartphone –PTSD COACH. It contains self-help tips (some to use is a stressful moment) and information in a very user-friendly format:
- Self-Help guides to trauma recovery. Online and walk-in bookstores offer a variety of titles (22-24). It is preferable that the woman check these before selecting the ones that appeal to her.
Helpful Websites include:
1. Beck CT, Indman P. 2005. The many faces of postpartum depression. J Obstet Gynecol Neonatal Nurs 34(5):569-76
2. Cigoli V, Gilli G, Saita E. 2006. Relational factors in psychopathological responses to childbirth. J Psychosom Obstet Gynaecol 27(2):91-7.
3. Czarnocka J, Slade P. 2000. Br J Clin Psychol 39 (Pt 1):35-51.Prevalence and predictors of post-traumatic stress symptoms following childbirth.
4. Declercq E, Sakala C, Corry M, Applebaum S. 2008. New Mothers Speak Out: National Survey Results Highlight Women’s Postoartum Experiences. Childbirth Connection: New York
5. Gross MM, Hecker H, Keirse MJ. 2005. An evaluation of pain and “fitness” during labor and its acceptability to women. Birth 32(2):122-8.
6. Soet JE, Brack GA, DiIorio C. 2003.Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 30(1):36-46.
7. Szalay S, 2011. Post-Traumatic Stress Disorder after Childbirth in an Out-of-Hospital Birth Population. Presentation at Annual Conference of Midwives Association of Washington State, Seattle, Washington (unpublished).
8. Nicholls K, Ayers S. 2007. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol. 12(Pt 4):491-509.
9. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: APA.
10. Ayers S. 2007. Thoughts and emotions during traumatic birth: a qualitative study. Birth 34(3):253-63.
11. Beck C. 2004. Post-traumatic stress disorder due to childbirth: the aftermath. Nursing Research 53(4): 216-24.
12. Elmir R, Schmied V, Wilkes L, Jackson D. 2010. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing 66(10): 2142-53.
13. Stramrood C, Huis C, Van Pampus M, Leonard W, et al. 2010. Measuring posttraumatic stress following childbirth: a critical evaluation of instruments. Journal of Psychosomatics in Obstetrics and Gynecology 31(1): 40-49.
14. Goer H. 2010. Cruelty in maternity wards: Fifty years later. Journal of Perinatal Education 19(3): 33-42.
15. Johnston-Robledo I, Barnack J. 2004. Psychological issues in Childbirth. Women & Therapy 27(3-4):133-150.
16. Simkin P. 2011. Pain, suffering and trauma in labor and prevention of subsequent posttraumatic stress disorder. Journal of Perinatal Education 20 (3): 166-176.
17. Breslau N, Lucia V, Davis G. 2004. Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychological Medicine 34(7): 1205-1214.
18. Creedy DK, Horsfall J, Gamble J. 2002. Developing critical appraisal skills using a review of the evidence for postpartum debriefing. Aust J Midwifery 15(4):3-9.
19. Gamble JA, Creedy DK, Webster J, Moyle W. 2002. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 8(1):72-9.
20. Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P. 2005. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Birth. 32(1):11-19.
21. Skibniewski-Woods D. 2011. A review of postnatal debriefing of mothers following traumatic birth. Community Practice 84(12): 29-32.
22. Rothschild B. 2010. 8 Keys to Safe Trauma Recovery: Take Charge Strategies for Reclaiming Your Life. W.W. Norton & Co. Inc.: New York.
23. Cori JL. 2007. Healing from Trauma: A Survivor’s Guide to Understanding Your Symptoms and Reclaiming Your Life. Marlowe & Company: Cambridge, MA
24. Shapiro F. 2012. Getting Past Your Past: Tale Control of Your Life with Self-Help Techniques from EMDR Therapy. Rodale: New York
25. PATTCh (Prevention and Treatment of Traumatic Birth). 2012. PATTCh Resource Guide on PTSD After Childbirth. Available at PATTCh.org.