Although childbirth is often viewed as a uniformly happy event, it can also be a physically and psychologically stressful experience.

For some women, the postpartum period is a time of heightened vulnerability to developing a psychological disorder.

Postpartum depression is perhaps the best known and most studied of these disorders, however there is a growing field of research looking at lesser-known disorders as well.

Sharon Dekel, PhD, an Assistant Professor of Psychiatry at Harvard Medical School and a researcher and psychologist in the Department of Psychiatry at Massachusetts General Hospital, is studying childbirth-related post-traumatic stress disorder (CB-PTSD), a condition that may affect as many as 5 to 11% of postpartum women.

Post-Traumatic Stress Disorder in Mothers

PTSD is a psychological condition that can develop after an individual experiences a physically or psychologically traumatic event. It can result in symptoms such as flashbacks (reliving the trauma repeatedly), bad dreams, frightening thoughts and avoidance behaviors.

When it comes to new mothers, it is important to identify and treat PTSD symptoms as early as possible, as there is evidence that the psychological wellbeing of mothers can have a beneficial effect on the neurological development of their babies, particularly in the crucial weeks and months after birth.

"If we improve the wellbeing of the mother, we could improve the wellbeing of the child," Dekel says. "There is a lot of data to support that."

Scope and Risk Factors

Dekel's first goal has been to understand the scope of the problem and the factors that may put some women at risk for CB-PTSD.

This has included surveying more than 500 new mothers at repeated time points at Mass General to assess their mental health before birth, compare their stress levels immediately after birth (acute emotional response to the birth) and later in the postpartum period.

This work is supported by Anjali Kaimal, MD, Director of the Obstetric Research Program at Mass General.

Dr. Dekel also recently completed an international survey of 685 postpartum women, which found that mothers with CB-PTSD may have more difficulty bonding with their children, which can have a negative impact on child development.

In a related study, Dekel measured changes in heart rate, skin conductivity, facial muscles and other physiological processes that occur when mothers with CB-PTSD were reminded of their past childbirth.

The results helped her validate and compare the symptoms of CB-PTSD to the more well-characterized symptoms of combat-related PTSD. This work is conducted in collaboration with Roger Pitman, MD, and Scott Orr, PhD, from the Mass General Department of Psychiatry.

What Causes PTSD After Pregnancy?

While an objectively stressful birth experience that may involve medical complications for the mother and/or her child is a strong contributing factor to developing CB-PTSD, it is not the only one, Dekel says. "Research by ourselves and others show that CB-PTSD can develop in at-term deliveries with healthy baby outcomes."

She found that women who deliver via unplanned Cesarean section have a heightened risk for developing CB-PTSD, which may be a result of not delivering as planned (the expected vs. experienced delivery), and possibly abnormal and rapid changes in biological processes that occur when labor starts naturally but the baby is delivered surgically.

Other mothers may be at increased risk due to past traumatic experiences or a genetic predisposition to PTSD, although the latter is not clear. Dekel has found that younger and first-time mothers may also be at higher risk.

"People are very complex," she says. "There are possibly psychological and environmental stressors as well as biological factors that combine to create that risk."

"As we know from research on non-childbirth-related PTSD that outcomes are influenced by the objective magnitude of the stressor, but even more so by the subjective appraisal of the traumatic event and the person’s immediate emotional response."

How Early Screening and Intervention Could Help

Currently there is no routine screening for mothers who may be at risk for developing PTSD symptoms as the result of giving birth, and no routine interventions in postpartum units to help those who may be affected.

By learning more about the risk factors and the course of CB-PTSD, Dekel hopes to devise new strategies for early diagnosis and treatment.

"Even if the mother has a very traumatic birth experience and endorses acute stress symptoms, if we make can the right intervention in the immediate postpartum period, then these women are likely to have good chance of feeling OK and bouncing back," Dekel says.

She will also try to find the right balance between informing expectant mothers that CB-PTSD is a possibility after giving birth without causing them unnecessary worry.

"The take home message is that mothers are very resilient," Dekel says. "However, becoming a new mother brings many changes and stressors, and anything we can do to optimize the wellbeing of mothers—particularly those who might be predisposed to developing these conditions—could have an enduring impact on them and their children."

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