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What is Birth Trauma?
When a woman looks forward to giving birth to a baby, she may not know exactly how the birth will go, but she has a basic expectation of respectful and protective treatment from her partner and from maternity care providers. This expectation includes the right to understand and to participate in health care decisions, and a confidence in her own and her infants’ safety. When these things are not present, the results can be severe.
Cheryl Beck, who researches the subject of birth trauma, observed:“Mothers with post-traumatic stress disorder attributable to childbirth struggle to survive each day while battling terrifying nightmares and flashbacks of the birth, anger, anxiety, depression, and painful isolation from the world of motherhood…”
In another study, Thomson stated:
“...for women in this study, their self-defined traumatic birth was experienced as violent and abusive. Some described their experiences as torture, resulting in a profound sense of being disassociated from the childbirth experience, and alienated from societal regard”
In our culture, when a baby is born, a woman is expected to be grateful and joyful. However, when a woman has a birth experience that leaves her feeling traumatized, she is not only unhappy, but can experience severe emotions.
Postpartum Posttraumatic Stress Disorder (PTSD) was once estimated to only affect 1.5% to 6% of women. Many researchers and clinicians now feel that the number of women experiencing trauma following childbirth may actually be much higher.
Actual rates of trauma following childbirth may be higher than previously predicted because of the way PTSD is diagnosed by mental health providers. Trauma is generally recognized and diagnosed when all 9 of the criteria for PTSD, as described in the Diagnostic and Statistical Manual of Mental Disorders IV-TR (American Psychological Association 2000), are observed.
Further, if a mother who has experienced birth trauma is good at “avoiding”, the hypervigilence and perhaps the intrusive symptoms may be kept at levels that are not detectable by a clinician. Mothers with postpartum trauma may minimize discussions about their experiences with health care providers and even avoid health care providers themselves, particularly those associated with the birth. For so many reasons, a woman suffering from traumatic stress is often left unheard and untreated by professionals.
Some women may not fit the DSM criteria for PTSD. However, research that is centered on the woman’s definition and experience of trauma suggests that debilitating traumatic stress following childbirth is extremely common. Some studies suggest that over 30% of women have experienced multiple symptoms of trauma. Also, research has shown that women who have a “normal” vaginal delivery also can experience PTSD or traumatic symptoms.
Trauma is not currently included in the standard screening for mood disturbances after the birth of a new baby. Frequently, very competent providers staying within the current standards of care, will misdiagnose any disorder as “Postpartum Depression” (PPD) since that is what their screening questionnaires diagnose. The likelihood is high, therefore, that some women currently diagnosed with postpartum depression may actually be exhibiting a traumatic response to their childbearing experience.
When should a woman suspect that she is suffering from a trauma-based anxiety disorder and not postpartum depression? Click here to read through information that will help you identify whether you may be suffering from PTSD or traumatic stress.
References:
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders IV- Text Revision. Washington, D.C.: American Psychiatric Association.
Beck, C. (2004a). Birth trauma: In the eye of the beholder. Nursing Research 53(1): 28-35.
Beck, C. (2004b). Post-traumatic stress due to childbirth. Nursing Research 53(4): 216-224.Briere, J., Elliot, D. (1994). Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model. In The APSAC handbook on child maltreatment (2nd ed.)(2002). Newbury Park, CA: Sage Publications.
Creedy, D., Sochet, I., Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth 27(2): 104-111.
Jukelevics, N. Understanding the Dangers of Cesarean Birth: Making Informed Decisions. Westport, CT: Praeger Publishing.Loveland Cook, C., Flick, L., Homan, S., et al (2004). Post-traumatic stress disorder in pregnancy: Prevalence, risk factors, and treatment. Obstetrics Gynaecology 103(4): 710-717.
Maggioni, C., Margola, D., Filippi, F. (2006). PTSD, risk factors, and expectations among women having a baby: A two-wave longitudinal study. J Psychosomatic Obstetrics and Gynaecology, 27(2): 81-90.
Swickert, R., DeRoma, V., Saylor, C. (2004). The relationship between gender and trauma symptoms: A proposed mediational model. Individual Djfferences Research, 2(3): 203-213.
Thomson, G., Downe, S. (2008). Widening the trauma discourse: the link between childbirth and experiences of abuse. Journal of Psychosomatic Obstetrics & Gynaecology, Vol. 29 (4): 268-273.
Wijma, K., Soderquist, J., Wijma B. (1997). Post-traumatic stress disorder after childbirth: a cross-sectional study. Journal of Anxiety Disorders, 11(6): 587-597