Post Traumatic Stress Disorder (PTSD) 

Evidence

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03158-6

Deniz Ertan, Coraline Hingray, Elena Burlacu, Aude Sterlé & Wissam El-Hage

Childbirth could be experienced as distressing or even traumatic for some women, which might produce undesirable marks on their lives. A traumatic childbirth could cause psychological distress, intense fear, or helplessness for the parturient and increases the risk of anxiety, depression and even post-traumatic stress disorder (PTSD) One  study showed that about 45% of women experienced traumatic childbirth and up to 4–6% of women developed PTSD following childbirth (PTSD-FC)  Women who experience PTSD-FC might feel abandonment, guilt and helplessness. These feelings have direct impact on mother-child interactions and could cause important social isolation  Moreover, couples relationships could be negatively affected by a traumatic childbirth experience and PTSD-FC symptoms. During the postpartum, women could suffer from mental health disorders related to birth experience. The risk of postpartum depression, postpartum psychosis, and anxiety are increased after a complicated childbirth.

Education 

Post-traumatic stress disorder (PTSD) refers to a range of symptoms or reactions that you can develop if you have personally experienced or witnessed a traumatic event.

For some people, childbirth can also fit into this category.

A traumatic event is one in which you, or others around you, may have felt threatened or unsafe and leads you to feel intense fear, helplessness or horror. Both men and women can experience PTSD after experiencing or watching a birth.

If you have PTSD following the birth, you may find yourself experiencing the following types of difficulties:

• Re-living the birth/traumatic event
• Through unwanted and recurring memories, including vivid images and/or nightmares. This may cause you to experience intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of or discussing the birth or events.
• Being overly alert or wound up
• Being overly alert or wound up can lead you to experience sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.

Avoiding reminders of the event

Some parents find themselves wanting to deliberately avoid activities, places, people, thoughts or feelings associated with the birth or aftercare event because it brings back painful memories.

Feeling emotionally numb

You may find yourself losing interest in day-to-day activities, feeling cut off and detached from friends and family, or feeling emotionally flat and numb.

PTSD in parents of NICU babies

Research has also shown that parents of premature and sick babies who spend time in the NICU or SCN may be at higher risk of PTSD in the first few weeks after the birth. The constant stress, anxiety and worry about a sick baby, trying to understand complex medical terminology and juggling other children can all take their toll.

One study found that PTSD was more common among women who reported anxiety symptoms prior to pregnancy and in first time mothers.

https://womensmentalhealth.org/posts/mothers-of-nicu-infants-at-high-risk-of-ptsd/

“The experience of the neonatal intensive-care unit, the birth of a premature baby—it’s a very different kind of trauma from what we call single-incident trauma, like someone in a car accident or even a sexual assault,” Dr Richard Shaw

https://link.springer.com/article/10.1007/s10880-010-9202-7

Who is at risk?

Post traumatic stress disorder following birth can happen to anyone, particularly those who have experienced:

A previous traumatic or difficult birth, (for example a premature birth, or your baby was born with medical complications.)

For these reasons it is important to discuss this with your obstetrician, midwife or birthing professional prior to the birth, or those involved in your delivery at the time of birth – so they can be extra sensitive to your experience and supportive.

If you can identify with these symptoms, there are effective treatments available to help you recover from PTSD and allow you to move forward from the traumatic experience.

Trauma-focused cognitive behavioural therapy (CBT)

This treatment can help you to identify distressing thoughts, painful memories and feelings that you may hold from the birth, and give you tools and strategies to confront and come to terms with what has happened so that you don’t feel as distressed by them.

Treatment also generally involves giving you strategies to help you to relax, and stop the anxious feelings that you may be experiencing, as well as helping you identify and address situations that you may be avoiding.  This can include for example, avoiding intimacy, talking about the birth or delaying a future pregnancy.

Eye movement desensitisation and reprocessing (EMDR)

This is a technique used specifically to treat PTSD by getting you to recall distressing images while using an external stimulus, such as eye movement or tapping. As with CBT, this treatment works by helping you to process distressing memories, reduce their lingering effects and allow you to develop effective coping strategies.

Medical treatment for PTSD following birth

Antidepressant medication, particularly selective serotonin re-uptake inhibitors (SSRIs) are helpful for the treatment of PTSD.  This type of antidepressant can be safely used whilst breast-feeding.

Even if you don’t have depression, antidepressants can help make feelings associated with trauma more manageable.

Peer support

To speak with a peer support person or health professional call the PANDA helpline on 1300 726 306 (Monday to Friday 9.00am – 7.30pm AEST/AEDT).

Or to speak to another mother who has experienced PTSD following your babies stay in the NICU/SCN call Miracle Babies Foundation 24hrs family support helpline 1300 622 243

Empowerment 

Whilst your hopes and plans for the birth may not have worked out, this is no reflection on you as a person or as a parent. Be proud of yourself for getting through the experience.

It is completely natural to experience distress after such an event such as your baby has spent time in a NICU or SCN, so it is important to accept and acknowledge that you are likely to be in need of support at this time.

Tips from those who’ve been there:

• Make sure you take care of yourself as well as your baby and get yourself the help you need too.
• Go easy on yourself, especially if you have other children at home. Surround yourself with people who will support you.
• It’s OK to cry.
• Don’t be afraid to ask lots of questions or ask doctors to explain terms you don’t understand. And take notes if you need to.
• Consider keeping a journal of your experience to record your own feelings and your baby’s milestones and achievements.
• It’s OK if you and your partner process the situation differently – try to keep communicating and looking after one another.
• Spend time reading to your baby while in the NICU.
• If you feel comfortable and open to it, get to the know the other parents in the NICU. Many parents form ongoing friendships with others who’ve been through the same experience.
• Try to eat well, drink enough water and rest where you can.
• Say yes to offers of help – and be specific about what you need.

Useful Links

Special thanks for Cope – Centre for Perinatal Excellence for content sharing and providing support for families.

COPE – Centre for Perinatal Excellence

https://www.cope.org.au/getting-help/e-cope-directory/

Through the Unexpected – Perinatal Diagnosis

https://throughtheunexpected.org.au/

Panda - Perinatal Mental Health

https://panda.org.au/

Beyond Blue - Mental Health Support

https://www.beyondblue.org.au/

For When – Perinatal Mental Health and Wellbeing 

https://forwhenhelpline.org.au/