A Woman Afraid of Becoming Pregnant Again: Posttraumatic Stress Disorder Following Childbirth

• Published in: Bio-Psycho-Social Obstetrics and Gynecology pp. 33 - 49
• Main Authors: Stramrood, Claire, Slade, Pauline
• Format: Book Chapter
• Language: English
• Published: Cham Springer International Publishing
• Subjects: Childbirth; Delivery; Postnatal; Postpartum; Posttraumatic stress disorder; Pregnancy; PTSD; Trauma
• ISBN: 9783319404028; 3319404024
• DOI: 10.1007/978-3-319-40404-2_2

Labor and delivery are perceived as traumatic by a substantial percentage of women. Approximately 3 % develop a posttraumatic stress disorder (PTSD) following childbirth, and many report multiple symptoms without meeting all criteria for this diagnosis. Symptoms include intrusions, avoidance, negative cognitions and mood, and alterations in arousal and reactivity. Research has revealed many risk factors: psychological (history of psychiatric disorder, history of [sexual] trauma, depression during pregnancy, fear of childbirth); obstetric (emergency caesarean section, instrumental vaginal delivery, preterm birth, neonatal complications); social contextual (low perceived control [autonomy] during labor, low perceived support from staff and partner, and dissatisfaction with quality of care). PTSD does not only affect the well-being of the woman but may also negatively influence the intimate partner relationship and mother-child bonding. When pregnant again, which sometimes is avoided as a result of PTSD, women often report fear of childbirth, may avoid antenatal consultations, show signs of somatization, or request an elective caesarean section. In order to manage PTSD in clinical practice, (obstetric) healthcare staff may screen women for PTSD following childbirth using self-report questionnaires and should refer women with suspected PTSD to mental health professionals (e.g., psychologists, psychiatrists) experienced in treating trauma and postpartum psychopathology. The condition is usually not self-limiting but warrants treatment. Pilot studies confirm the benefit of interventions with proven effectiveness in non-postpartum populations, such as cognitive behavioral therapy (CBT) with exposure and eye movement desensitization and reprocessing (EMDR) therapy. Research on the prevention of PTSD following childbirth is ongoing and focuses on a multitude of causes and influencing factors. Awareness about the condition among those caring for women after childbirth, knowledge about screening options, and adequate referral possibilities are crucial for early detection and intervention. Lastly, obstetric staff (midwives, obstetricians, nurses) should be (made) aware of their crucial role, both positive and negative, in women’s appraisal of childbirth.