Sydney Pelvic Floor Health

Post-traumatic Stress Disorder

Postpartum PTSD : Post-traumatic Stress Disorder

Posttraumatic stress disorder is a reaction to severe stress, for example in childbirth, and it can be a major long- term health problem.

Psychological Symptoms

* Feelings of intense fear, helplessness or horror to reminders of that experience e.g. words, smells, rooms, clinicians

* Withdrawal from normal activities

* Fear and anxiety of going outside

* Poor self image

* Flashbacks of your traumatic vaginal delivery during sexual relations.

* Trying to push your feelings away and getting on with looking after baby.

* Nightmares regarding the delivery of baby causing insomnia

 * Claustrophobia – a feeling of panic in railway tunnels or lifts or enclosed spaces

* Jumping, startling or on guard at the sound of loud noises

 * Feelings of isolation

* Irritability and guilt

* Anxiety or panic where you are unaware of the origin.

* Need to avoid reminders of your traumatic birth and spending time changing environments

* Difficulty sleeping due to bad memories or reminders of the birth

 * Feeling emotionally numb or detached from others, activities, or your surroundings

 * Sweating, shaking, headaches, dizziness, gastro intestinal upsets and chest pains not connected to medical conditions

* Alcohol and drug misuse

* Poor bonding with your baby

* Inability to explain these disabilities to spouses, family, friends or bosses.

The psychological consequences in the above list can be characteristic features of postpartum PTSD after the birth of your baby – especially if the birth was traumatic.

PTSD is caused by exposure to an event or ordeal involving the occurrence or threat of physical harm.

The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are beyond the sufferer's control. This is the mind's way of trying to make sense of the experience and is not a sign individual 'weakness' or inability to cope.

Many sufferers feel uncomfortable talking about their previous traumatic delivery especially if they are not asked about the trauma in a sensitive manner.

Some women who experience postpartum PTSD do not realize what is happening to them and they may be misdiagnosed as having PND – Postnatal Depression.

Often women blame themselves instead and think they are weak – after all they have just had a baby like countless other women. So they remain silent and try to cope with physical and psychological symptoms believing that health professionals or family and friends will not believe them.

Issues that may exacerbate symptoms of Postpartum PTSD:

* Inadequate antenatal education about rapidly changing situations during the birth process involving lack of control, inadequate anesthesia, forceps use

* Absent of ‘informed consent’ causing poor preparedness for birth

* Nil antenatal information on potential physical injuries during birth

* Conflicting advice from clinicians before, during and after birth

* Partners also traumatized by unexpected events and unable to assist

* Nil postnatal assessment of birth injuries

* Multiple symptoms of pelvic floor dysfunction apparent after birth including: urinary and/or faecal incontinence, feeling that pelvic organs are falling out, pain having sex (see above)

* Denying or putting up with injuries

 * Dismissive or offensive reactions from unsympathetic clinicians regarding birth injuries/PTSD

http://www.ics.org/Abstracts/Publish/241/000214.pdf

The effects of a traumatic birth vary from woman to woman. The feelings about it and ability to cope with what has happened will be unique to each individual.

Lack of interest in sex and relationship struggles are fairly normal for most new parents. But if these persist for months after the birth, and include symptoms listed above, it may be postnatal PTSD. 

Coming to terms with the experience of childbirth may take longer than the mother, or those close to her, expected. If, as the weeks and months go by, the above signs and symptoms appear it is important to seek support from a clinician. 

Hoping that the feelings will go away, or assuming that they are not important will inevitably be unhelpful. There is support available. Sharing experiences with others may help to make sense of what has happened. Being believed about this is also vital in dealing with PTSD. 

Postpartum PTSD can also affect partners after traumatic deliveries 

Partners play a vital role in the lives of women affected by postnatal PTSD and endeavour to shield the effects of mothers’ compromised psychological state from their baby and other children. However, fathers often need support themselves. Many who experience their partners’ PTSD are possibly suffering from PTSD also, especially if they were present at the birth. 

They have often had to witness someone they love go through a traumatic delivery and been fearful that their partner could have died. Subsequently they may despair that there was nothing they could do to alleviate their partner’s trauma or they may feel guilty for making her pregnant. Unfortunately, at present, this condition is not readily diagnosable and effected couples should seek expert advice. 

Treatment for Postpartum PTSD

* Counselling and cognitive behavioural therapy. 

 

Elizabeth Skinner
RN RM CFHN Master of Health Science (Ed.) The University of Sydney
PhD Candidate
McKern Scholar
Sydney Medical School Nepean
Department of Obstetric & Gynaecology
The University of Sydney
Email: eskinner@uni.sydney.edu.au