Running head: PTSD AFTER CHILDBIRTH

Post-Traumatic Stress Disorder Brought on by Childbirth Jessica Hart Loras College

PTSD AFTER CHILDBIRTH Post-Traumatic Stress Disorder (PTSD) Brought on by Childbirth Labor and the birth of a child is a challenging life event for both women and men with

the potential for positive and negative experiences, and in recent years has been established as an event that can be perceived as traumatic (Sawyer & Ayers, 2009). Post-Traumatic Stress Disorder (PTSD) shares commonalities with Post-partum depression, so there has been little realization of PTSD symptoms. PTSD needs a specialized treatment other than what is used to treat depression because it will not go away on its own. More research needs to be done in determining the cause of PTSD in childbirth, the effect it has on the mothers, fathers, and relationships within the family, and finally the best course of action to treat it. Childbirth is now classified as an event that can cause PTSD which affects the individual and their relationships following the birth. Posttraumatic Stress Disorder has only been recognized following childbirth in the more recent years, there has been some research done to determine what causes PTSD following childbirth. PTSD symptoms were significantly higher in women that had a caesarean section when compared to women who underwent a normal delivery during childbirth; it was seen that woman who feel they have little control over their self and their environment during childbirth are more likely to experience PTSD symptoms following birth (Sawyer & Ayers, 2009). Women who do not breastfeed as long as they want or were unable to breastfeed after birth, had a significantly higher post traumatic stress symptom scores. The strongest predictor of elevated posttraumatic stress symptoms was elevated postpartum depressive symptoms (Beck, Gable, Sakala, & Declercq, 2011). The best predictor of post-traumatic stress symptoms was the onset of anxiety during late pregnancy (Zaers, Waschke & Ehlert, 2008). On study looked at how the emergency caesarean section is associated with postnatal PTSD, but it found that the majority of

PTSD AFTER CHILDBIRTH women who develop postnatal PTSD have normal vaginal deliveries (Nicholls & Ayers, 2007). Birth factors that were most commonly mentioned by mothers with PTSD symptoms were pain, negative emotions in labor, perceived lack of control, lack of choice or involvement in decision making, and restricted movement or physical restraint (Nicholls & Ayers, 2007). The causes of PTSD are still being explored and studied, but the research that has been conducted has given new light into how childbirth can cause PTSD. PTSD can be caused by witnessing a traumatic event; research has been done to determine if a father witnessing the birth of a child is traumatic enough to cause PTSD. The sample from Parfitt and Ayers (2009) study found 22% of the women and 12% of the men met the criteria for PTSD. Men who attend births may experience intrusive thoughts and images especially if they feel they did not support their partner during labor or conversely if they felt pressured to attend the birth (Bradley & Slade, 2011). Bradley and Slade (2011) predicted that men who reported having fewer children, unplanned pregnancy, being present at the actual

delivery, or feeling less prepared were more likely to develop PTSD symptoms. From the current research it is observed that men are able to develop PTSD symptoms from witnessing or attending childbirth. PTSD does not only effect the individual but also every relationship that person has, especially in intimate relationships. Case studies and qualitative research indicate there are good reasons to expect that postnatal PTSD has implications for womens ability to maintain and develop meaningful relationships there is also an avoidance of sex (Nicholls & Ayers, 2007). Women mentioned avoiding sex either because it served as a reminder of the event, triggering flashbacks or traumatic memories, or through fear of becoming pregnant again (Nicholls & Ayers, 2007). In the same study by Nicholls and Ayers (2007) women commented on feeling

PTSD AFTER CHILDBIRTH abandoned by their partner when men went back to work, and men commented on feeling rejected by their partner as a result of lack of sexual contact and loss of intimacy. PTSD hinders and affects the bonding ability between the parent and child. In a study by

Beck et al. (2011), mothers who were traumatized by childbirth shared that the following factors that hindered their breastfeeding attempts: flashbacks, disturbing detachment, enduring physical pain, feelings of violation, and an insufficient milk supply. Post-traumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother-infant relationship (Davies, Slade, Wright & Stewart, 2008). Events such as daily contact with their baby can either intensify symptoms or reduce avoidance by giving the mother exposure to the child (Ayers, Joseph, McKenzie-McHarg, Slade & Wijma, 2008). A child, for example, may function as a trigger for the re-experiencing of a traumatic birth (Davies, Slade, Wright & Stewart, 2008). The study by Davies et al. (2008) found that mothers who met both full and partial criteria for PTSD following childbirth report a lower quality of attachment to their infants than mothers with no PTSD symptoms. The co-morbidity between posttraumatic stress disorder and depression is especially difficult to diagnose because of overlapping symptoms. In Beck et al. (2011) they found the possibility of a shared underlying vulnerability to disorders of both PTSD and major depression. The study done by Gamble, Creedy, Moyle, Webster, McAllister, and Dickson (2005) found that brief counseling intervention after a traumatic birth reduced trauma symptoms, depressive symptoms, stress and feeling of self-blame. Secondary prevention can be initiated by screening mothers after birth for posttraumatic stress symptoms and then providing treatment if necessary (Beck et al., 2011). A longitudinal study is recommended to determine whether postpartum

PTSD AFTER CHILDBIRTH PTSD has any long-term negative outcomes in terms of womens psychological well-being and later child development (Davies, Slade, Wright & Stewart, 2008). In the study conducted by Zaers, Waschke and Ehlert (2008) post-traumatic stress symptoms were assessed six weeks and six months postpartum and no decline of the symptom levels was found. PTSD is difficult to diagnose due to the co-morbidity with depression symptoms, but unlike depression, PTSD will not go away without some form of treatment. Childbirth is only beginning to be looked at as an event that can cause Post Traumatic Stress Disorder in both men and women. PTSD shares a lot of similar symptoms with depression, so there has been little realization of PTSD symptoms in the past. More research needs to be conducted in order to prevent and treat the PTSD, but more importantly research needs to be done to see the long term effects it has on the child parent bond and if there are any developmental differences caused by a family member having PTSD caused by the birth.

PTSD AFTER CHILDBIRTH References Ayers, S., Joseph, S., McKenzie-McHarg, K., Slade, P., & Wijma, K. (2008). Post-traumatic stress disorder following childbirth: Current issues and recommendations for future research. Journal Of Psychosomatic Obstetrics & Gynecology, 29 (4), 240-250. doi:10.1080/01674820802034631 Beck, C., Gable, R. K., Sakala, C., & Declercq, E. R. (2011). Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey. Birth: Issues In Perinatal Care, 38(3), 216-227. doi:10.1111/j.1523-536X.2011.00475.x Bradley, R., & Slade, P. (2011). A review of mental health problems in fathers following the birth of a child. Journal Of Reproductive And Infant Psychology, 29 (1), 19-42. doi:10.1080/02646838.2010.513047

Bradley, R., Slade, P., & Leviston, A. (2008). Low rates of PTSD in men attending childbirth: A preliminary study. British Journal Of Clinical Psychology 47(3), 295-302. doi:10.1348/014466508X279495 Davies, J., Slade, P., Wright, I., & Stewart, P. (2008) Posttraumatic stress symptoms following childbirth and mothers perceptions of their infants. Infant Mental Health Journal, 29(6), 537-554. doi:10.1002/imhj.20197 Gamble, J., Creedy, D., Moyle, W., Webster, J., McAllister, M., & Dickson, P. (2005).

PTSD AFTER CHILDBIRTH Effectiveness of counseling intervention after a traumatic childbirth: A randomized controlled trial. Birth: Issues In Perinatal Care, 32(1), 11-19. doi:10.1111/j.07307659.2005.00340.x Nicholls, K., & Ayers, S. (2007). Childbirth-related post-traumatic stress disorder in couples: A qualitative study. British Journal Of Health Psychology, 12(4), 491-509. doi:10.1348/135910706X120627 Parfitt, Y. M., Ayers, S., (2009). The effect of post-natal symptoms of post-traumatic stress and depression on the couples relationship and parent-baby bond. Journal Of Reproductive And Infant Psychology, 27(2), 127-142. doi:10.1080/02646830802350831

Sawyer, A., & Ayers, S. (2009). Post-traumatic growth in women after childbirth. Psychology & Health, 24(4), 457-471. doi:10.1080/08870440701864520 Zaers, S., Waschke, M., & Ehlert, U. (2008). Depressive symptoms and symptoms of posttraumatic stress disorder in women after child birth. Journal of Psychosomatic Obstetrics & Gynecology, 29(1), 61-71. doi:10.1080/01674820701804324

PTSD AFTER CHILDBIRTH Bonding- DV mother-child bonding survey out there on mother child bond? 30 pregnancy that went according to plan 30 that didnt go according to plan follow mothers to see how the bond -6 month measure of bonding and 1 year measure of bonding -6 month also test or survey for PTSD symptomsBetween groups -survey for indication of bonding -measure of PTSD t-test for PSTD could look at frequency of PTSD in the two groups (according to or not according to) bonding survey -according to or not -bonding scale

Likert scale or interview

PTSD AFTER CHILDBIRTH Mothers opinions on relationships according to plan or not according to plan frequency of ptsd (6 months checking bonding and at 6 month period ) (1 month post child birth- survey (diagnostic) for PTSD) (acute if less than 3 months and chronic if more than 3 months) 3 questions -easy understand child -enjoy doing things with child -do you spend a lot of time together