Note: If you just want to know the risk factors for developing PTSD after giving birth, and what you can do to possibly prevent childbirth causing PTSD, scroll down to the end.
As you may know, I taught natural childbirth classes for many years, and had both of my children naturally, without any pain medication. So when I found this article in Skygrid that mentioned natural childbirth causing PTSD in some women, I was very curious.
Can childbirth cause PTSD? YES, but why?
I have no doubt that, in some cases, giving birth can be a traumatic experience that can lead to PTSD (post-traumatic stress disorder). I have been at a couple of births as a doula that I would definitely call traumatic for the mom, and possibly for other family in the room, too. What was intriguing to me about this article, however, was the claim that a much higher percentage of women who had natural births went on to show signs of PTSD than those who had epidurals.
Now, you might be thinking, “of COURSE natural births are going to cause more PTSD, don’t they hurt more?” But you have to remember my background. As a natural childbirth educator and doula, I know a LOT of women who have given birth without medication. Very few, if any, of them described their birth as anything approaching traumatic, so I do not imagine natural births causing PTSD more often than medicated ones. I have, however, spoken with many women who were looking for classes for their second or subsequent baby and had experienced a traumatic natural birth previously. In general, they either had a normal (unmedicated) birth by accident – there was just no time for the anesthesiologist to arrive and place the epidural – or they were not trained to cope well with labor contractions, did not have enough support, or were confined to bed and unable to labor as they needed to. Many of these women came to my classes and had an untraumatic, even empowering, natural birth the second time, after having prepared.
So, in trying to figure out why this study found that more women having unmedicated births were developing PTSD symptoms, I traced the news story back to the press release about 1/3 of postpartum women developing PTSD symptoms, and the original study on Postpartum Post-Traumatic Stress Disorder symptoms.
The study was completed with 89 women who had given birth in Israel. Of these, 3 were determined to have developed full PTSD, 7 partial PTSD, and an additional 15 had some PTSD symptoms, but could not be considered a true diagnosis. The study does not make it clear how many mothers gave birth without pain medication. They do state that “A significantly smaller number of women who developed PTSD symptoms received analgesia during delivery
compared to the control group,” but that precise percentage is not revealed. The authors have a chart that splits all of the study participants into categories: “Natural,” “Elective Cesarean,” “Emergency Cesarean, and “Instrumental.” since this chart does not include a category for “vaginal with anagesia” or “epidural,” we can not assume that all of the women either had a cesarean, an instrumental delivery, or had no medication at all. It seems that the study authors use “natural” to mean “vaginal, without vacuum or forceps, ” not a normal vaginal birth without pain medication. Ah, now I think I understand.
If you combine the information in this study with what we already know about PTSD, and about PTSD and childbirth, from other studies, we can conclude that there are a number of risk factors. Here are the factors that were more often associated with the development of PTSD after giving birth:
- “Very uncomfortable” with being unclothed during labor (80% of those who developed PTSD, vs. 27.7% of non-PTSD group).
- Previous birth was considered “traumatic” (60% of PTSD group, vs. 15.5% of control group.
- History of depressive symptoms or seeking mental help. 50% of the PTSD group had sought out help from a mental health care practitioner after a previous birth, while only 8.3% of the control group did. Also, 80% of the PTSD group reported sadness or anxiety during or after the previous pregnancy, vs. 33% of the control group. In the current pregnancy, 80% of the PTSD group felt that they had at least one emotional crisis, vs. 23.8% of the control group.
- Pregnancy complications were reported by 80% of the PTSD group, but only 28.6% of the controls.
- A high fear of birth itself was reported by 80% of those women who developed PTSD, but only 30% of those who did not develop PTSD.
- 71.4% of the women who developed PTSD reported feeling like their life or health was in danger during labor, vs. 20.7% of the controls. Additionally, 40% of the PTSD group felt as if their baby was in danger at some point during labor, while only 3.6% of the controls felt this way.
- The PTSD group used significantly fewer birth methods to prepare for labor than did the control group (0.4 methods vs. 1.5). The PTSD group also had less confidence in their ability to ability to cope with labor.
Strangely, having a doula or other support person did not influence the development of PTSD in this study, but that may be due to the small size of this study. The control group did more reading and birth preparation, but this was not considered significant. Again, this value could reach significance in a larger study.
Overall, this study has some problems. It has a very small sample size and some of the terms are used in confusing or non-conventional ways. In addition, the press release and media articles make a questionable conclusion the headline.
Does this mean that childbirth does NOT cause PTSD? No, childbirth can cause PTSD. Let’s look more closely at the circumstances under which women have developed PTSD after giving birth in the past.
In a 2008 study by Zaers, et. al. on depressive symptoms and PTSD after childbirth 6-15% of women reported clinically significant PTSD symptoms 6 weeks and 6 months, respectively, following labor. In the Zaers study, they found the factor most strongly associated with developing PTSD symptoms was women experiencing anxiety in late pregnancy.
According to the Mayo Clinic, the risk factors for anyone for developing PTSD include:
- Being female
- Experiencing intense or long-lasting trauma
- Having experienced other trauma earlier in life
- Having other mental health problems, such as anxiety or depression
- Lacking a good support system of family and friends
- Having first-degree relatives with mental health problems, including PTSD
- Having first-degree relatives with depression
- Having been abused or neglected as a child
This may seem to doom certain women to developing PTSD after giving birth no matter what, especially those who have or have had anxiety or depression. However, I think there are some trends that may point to preventive measures women can take to reduce their risk of developing PTSD as a result of giving birth. My thoughts are below.
What to do when pregnant that may help reduce the risk of PTSD after giving birth:
- Seek help from a mental health professional to help process any previous traumas. You may have experienced a Trauma (a single traumatic event), such as a car accident, rape, natural disaster, previous traumatic birth, etc., or it may have been trauma (a series of smaller events that created an atmosphere of fear and danger), such as an abusive parent, school bullying, being in combat, a chronic illness, etc. An especially effective form of treatment for processing trauma of any kind is Eye Movement Desensitization and Reprocessing (EMDR). This treatment is approved by the VA for use in helping veterans process combat trauma and improve symptoms of PTSD. Logically, it can help with other types of trauma, too. You can find a certified EMDR practitioner at www.emdr.com or www.emdria.org
- Get support for you during this pregnancy. Talk with friends, family, other pregnant moms, and professionals, if necessary, about how you are doing during your pregnancy. Make sure you take time to pamper yourself. Enlist your partner and friends to help make sure you take time out for yourself, and to check in to see how you are feeling.
- Work on reducing any pregnancy fears that you have. Sometimes just talking about them helps, sometimes making preparations to help in case something did go wrong is a good answer, and sometimes you need to put some focused effort into just processing the fear. There are many ways to uncover and process birth fears in the classes and book Birthing from Within, by Pam England.
- Get plenty of sleep. Everything is harder when you are not well rested. There is a list of many ways to get better sleep during pregnancy in the Pocket Pregnancy Guide to Feeling Great While Pregnant, available in early September, 2012 where e-books are sold.
- Eat omega-3 essential fatty acids. Essential fatty acids are needed by the body to create hormones and enzymes. These hormones help your body keep baby in until the right time, know when to start labor, help your baby develop, help you sleep, and even help determine your mood.
- Get enough protein. Like essential fatty acids, your body needs the amino acids in protein to create hormones, including those we need to feel happy and sleep well. Many experts recommend that pregnant women eat at least 80 grams of protein a day, or over 100 grams daily if carrying twins or triplets.
- Exercise at least 4 days a week, preferably daily. Exercise releases endorphins (feel-good hormones), and has been shown to reduce symptoms of depression. Depression symptoms are a risk factor for developing PTSD.
- Learn and practice meditation and other stress-reducing techniques. Reducing overall stress can help with coping with events better so they are less likely to create the negative mental loops that exist in anxiety and depression and breaking up negative loops already in process.
- Decide how you would prefer your labor and birth to go, and prepare for it. Understanding how your body works during labor, the procedures to expect, and how your birth attendant would deal with possible problems that come up can help reduce any fear about birth so you are more comfortable letting nature take its course. Whether you decide that you want to have a normal (unmedicated, low-intervention) birth or that you want an epidural as soon as you can get one, learn about the possible interventions that might be needed, and how to work with labor contractions to feel more comfortable. Just knowing that you and your support team can handle just about anything that comes up will help you have a much better, more emotionally relaxed birth experience overall, no matter what happens.
- If you think you will be uncomfortable with wearing a hospital gown or being unclothed during labor, ask if you can bring a nightgown. Many birth attendants and hospitals are fine with you wearing your own clothes, as long as it opens completely in the front. They do need to have access to checking the baby’s heart rate and catching him or her, after all. Make sure whatever you bring is something you don’t mind throwing away afterwards, because it will probably get rather stained.
One in Three Postpartum Women Suffers PTSD symptoms After Giving Birth, American Friends of Tel-Aviv University, Wed. Aug 8. 2012. http://www.aftau.org/site/News2?page=NewsArticle&id=17059
Inbal Shlomi Polachek MD, Liat Huller Harari MD, Micha Baum MD and Rael D. Strous MD. Postpartum Post-Traumatic Stress Disorder symptoms: The Uninvited Birth Companion. IMAJ, VOL 14: June 2012, pp. 347-353.
Post-Traumatic Stress Disorder (PTSD) Following Childbirth, MGH Center for Women’s Mental Health, Harvard Medical School, Posted October 8, 2008. http://www.womensmentalhealth.org/posts/post-traumatic-stress-disorder-ptsd-following-childbirth/ Accessed August 13, 2012.
Post-Traumatic Stress Disorder: Risk Factors. Mayo Clinic website. Accessed Aug. 13, 2012. http://www.mayoclinic.com/health/post-traumatic-stress-disorder/ds00246/dsection=risk-factors
Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol. 2008 Mar;29(1):61-71.