Post Traumatic Stress Disorder (PTSD)
When we talk of birth trauma, we mean Post Traumatic Stress Disorder
(PTSD) that occurs after childbirth. We also include those women who
may not meet the clinical criteria for PTSD but who have some of the
symptoms of the disorder.
PTSD is the term for a set of normal reactions to a traumatic, scary
or bad experience. It is a disorder that can occur following the experience
or witnessing of life-threatening events. We usually recognize these
as things like military combat, natural disasters, terrorist incidents,
serious accidents, or violent personal assaults like rape. However,
a traumatic experience can be any experience involving the threat of
death or serious injury to an individual or another person close to
them (e.g. their baby) so it is now understood that Post Traumatic
Stress Disorder can be a consequence of a traumatic birth.
Characteristic features of PTSD include:
- An experience involving the threat of death or serious injury to
an individual or another person close to them (e.g. their baby).
- A response of intense fear, helplessness or horror to that experience.
- The persistent re-experiencing of the event by way of recurrent
intrusive memories, flashbacks and nightmares. The individual will
usually feel distressed, anxious or panicky when exposed to things
which remind them of the event.
- Avoidance of anything that reminds them of the trauma. This can
include talking about it, although sometimes women may go through
a stage of talking of their traumatic experience a lot so that it
obsesses them at times.
- Bad memories and the need to avoid any reminders of the trauma,
will often result in difficulties with sleeping and concentrating.
Sufferers may also feel angry, irritable and be hyper vigilant (feel
jumpy or on their guard all the time).
It is important to remember that PTSD is a normal response to a traumatic
experience. The re-experiencing of the event with flashbacks accompanied
by genuine anxiety and fear are beyond the sufferer's control. They
are the mind's way of trying to make sense of an extremely scary experience
and are not a sign individual 'weakness' or inability to cope.
Who gets Birth Trauma?
Birth trauma is in the eye of the beholder’
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)
It is clear that some women experience events during childbirth (as
well as in pregnancy or immediately after birth) that would traumatise
any normal person.
For other women, it is not always the sensational or dramatic events that trigger
childbirth trauma but other factors such as loss of control, loss of dignity,
the hostile or difficult attitudes of the people around them, feelings of not
being heard or the absence of informed consent to medical procedures.
Research into the area is limited and, to date, it has largely focused
on the importance of the type of delivery. It is clear however, that
there are risk factors for Post Natal PTSD which include a very complicated
mix of objective (e.g. the type of delivery) and subjective (e.g. feelings
of loss of control) factors. They include:
- Lengthy labour or short and very painful labour
- Induction
- Poor pain relief
- Feelings of loss of control
- High levels of medical intervention
- Traumatic or emergency deliveries, e.g. emergency caesarean section
- Impersonal treatment or problems with the staff attitudes
- Not being listened to
- Lack of information or explanation
- Lack of privacy and dignity
- Fear for baby's safety
- Baby’s stay in SCBU/NICU
- Poor postnatal care
- Previous trauma (for example, in childhood, with a previous birth
or domestic violence)
In addition, many women who do not have PTSD, suffer from some of
the symptoms of PTSD after undergoing difficult birth experiences and
this can cause them genuine and long-lasting distress. These women
are also in need of support.
Finally, men who witness their partner’s traumatic childbirth
experience may also feel traumatised as a result. Please
see our ‘partners’ section
What is different about Post Natal PTSD?
It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as
childbirth can be traumatising but it has been clear for many years
that women can suffer extreme psychological distress as a consequence
of their childbirth experience for a complex variety of reasons which
are frequently related to the nature of delivery. Unfortunately, the
difference between the common perception of childbirth and some women’s
experience of it means that women who suffer Post Natal PTSD symptoms
frequently find themselves very isolated and detached from other mothers.
They also find themselves without a voice in a society which fails
to understand the psychology of childbirth and which therefore expects
mothers to get over their birth experience very quickly.
Consequently, women affected by Postnatal PTSD often find that there
is nowhere to turn for support because even other mothers, who have
not had traumatising births, can find it hard to understand how affecting
a bad birth can be. This can make sufferers lonely and depressed as
they often feel they are somehow ‘weaker’ than other women
because they are unable to forget their birth experience, despite being
told by others to ‘put it behind them’. They may feel incredibly
guilty as a result.
This is a terrible burden for women to shoulder and one which profoundly
affects their lives. The nature of PTSD means that constant ruminating
on the birth experience is beyond the sufferer's control but this is
constantly misunderstood, even by health care professionals. Unfortunately,
for women suffering from Postnatal PTSD, their detachment from others
and the lack of support provided to them can mean that relationships
with friends and family may deteriorate. For example, many women end
up feeling torn between their desire for more children and their determination
to avoid another pregnancy. They may also lose interest in sex and
these problems can place a great strain on relationships.
Worryingly, it is suggested that women may also try and avoid medical
treatments like smear tests.
For many women, their greatest concern is the day to day difficulties
they encounter bonding with their baby who may be viewed as a constant
reminder of the trauma they have experienced.
The BTA aims to tackle this isolation by offering women much needed
support and showing them that they are far from alone. By working together
and providing women with a voice, we hope that we can help change those
practices which contribute to Postnatal PTSD.
Isn't this just Post Natal Depression?
No. PTSD can overlap with Post Natal Depression (PND) as some of the
symptoms are the same, but, the two illnesses are distinct and need
to be treated individually.
Unfortunately, because awareness of this issue is generally poor,
many women are wrongly diagnosed with Post Natal Depression and are
prescribed medication that may do little, or nothing, to help their
situation. Women tell us that they are frequently told by their health
care professionals that they should try and 'move on' with their lives
or that they should just be grateful that they have a healthy baby.
Unfortunately, this type of reaction shows a gross misunderstanding
of the nature of Post Natal PTSD and may actually exacerbate the feelings
of guilt and isolation that women already feel. Women may then end
up with prescriptions for anti-depressants, simply because doctors
do not understand the disorder.
However, it is important to note that depression can go hand in hand
with Postnatal PTSD, so not everyone is misdiagnosed and if you have
been prescribed anti-depressants, this may well be an appropriate course
of action for your particular circumstances. If you are concerned about
this issue in any way, you must speak to your health professional (e.g.
GP or Health Visitor) for further advice. Please show them a copy of
our leaflet if they appear to be unaware of Post Natal PTSD or the
fact that it requires specialised treatment.
http://www.birthtraumaassociation.org.uk/index.htm