Posttraumatic stress following childbirth: Diagnosis, treatment and prevention

Background: What to do with women who experienced childbirth as so traumatic that they keep having nightmares, flashbacks and problems concentrating, who do not want to become pregnant again or demand a cesarean section at the next delivery? One to two percent of women suffers from posttraumatic stress disorder (PTSD) following childbirth, which may affect mother-child bonding as well as future pregnancies. Methods: Based on current knowledge from literature, including own research, an overview will be presented of the prevalence, risk factors, diagnosis and treatment of PTSD following childbirth. Results: PTSD is an anxiety disorder affecting 1-2 percent of women after childbirth. Risk factors include [a] obstetric complications and interventions (emergency cesarean section, preterm birth), [b] history of psychiatric problems or depression/anxiety during pregnancy, [c] psychosocial factors (low coping skills, low social support). Furthermore, 50 percent of women with PTSD following childbirth also suffers from postpartum depression. When PTSD is suspected, clinicians can use the self-report measure Traumatic Event Scale-B to quantify symptoms, and refer to a psychiatrist/psychologist if necessary. Several studies indicate that spontaneous remission of PTSD following childbirth is uncommon. Possible negative consequences of the condition include insecure attachment of the infant, impaired partner relationship, avoiding future pregnancies and demanding a cesarean section in a subsequent pregnancy. Although these possible adverse outcomes justify treatment and prevention, effective interventions and prevention strategies have not been adequately researched in this patient group. International guidelines regarding PTSD in other (non-pregnant) populations point to eye-movement desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT) as the most promising treatments. Identification of women at risk, both during pregnancy and postpartum, is key to early intervention and possible prevention. Conclusions: Posttraumatic stress disorder following childbirth is a serious condition affecting 1-2 percent of postpartum women, with higher prevalence rates among women with complicated pregnancies/deliveries and those with a history of mental health issues. Adequate identification of women at risk and those with clinical symptoms is key to early intervention and eventually prevention.

Conference

English

Claire Stramrood
K. Marieke Paarlberg
Ad J. Vingerhoets
P. P. van den Berg
Maria G. van Pampus

Stramrood, C., Paarlberg, K. M., Vingerhoets, A. J., van den Berg, P. P., & van Pampus, M. G. (2012, March). Posttraumatic stress following childbirth: Diagnosis, treatment and prevention. Poster presented at the 70th annual scientific meeting of the American Psychomatic Society, Athens, Greece