Post-traumatic (childbirth) stress disorder

Kalina Christoff’s harrowing postpartum experience began days after delivering a healthy son. She was anxious, worried and jolted repeatedly from sleep when flashbacks of the birth—a tough delivery that involved forceps—reeled through her mind.

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“I was in a room of 15 people. I had no idea who was sticking what inside of me because I couldn’t see,” says Christoff of the dream. “Thoughts of this gang of people in front of me, doing things to my body…I would wake up, and I wouldn’t be able to get back to sleep.”

Two months later, she was still on edge and crying all the time. “I had a constant sense of danger around me. But I had no signs of depression. I was overactive—I needed to do things,” she says. An associate professor of psychology at the University of British Columbia in Vancouver, Christoff turned to her collection of medical textbooks to make sense of what she was experiencing. She came across a list of symptoms connected to Post-Traumatic Stress Disorder (PTSD). “I realized I was having almost all of them,” she says.

Among those who study postpartum afflictions, the profile of women exhibiting signs of PTSD—the same illness linked to soldiers in wartime—is on the rise. Two recent studies on the topic, one published by researchers at Montreal’s McGill University and another produced at the University of Tel Aviv in Israel, found that approximately one-third of all postpartum women suffer some elements of PTSD, and three to seven percent suffer full-blown PTSD.

“During childbirth, many women experience real threats regarding physical harm or death to themselves or their baby,” says Inbal Shlomi-Polchek, a psychiatrist and co-author of the Tel Aviv study. “During a painful birth, many women believe that their bodies are torn or destroyed irreversibly.”

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Women who suffer the more commonly recognized postpartum depression (PPD) experience depressive moods, fatigue, insomnia and indecisiveness, while those with PTSD symptoms are battling a completely different beast. The doctors who diagnose them have a checklist of key elements that differentiate PTSD sufferers from moms going through anxiety or depression. These include experiencing one or several events that involve the threat of serious injury or death (to themselves or their baby) and subsequent feelings of fear, helplessness or horror. Sufferers may have flashbacks and hallucinations. Many also suffer from what psychologists call “hyper-arousal”—irritability and difficulty sleeping and concentrating.

Because awareness of the postpartum PTSD link has only just begun to build, women with these symptoms are at risk of slipping through the diagnostic cracks. The implications of having untreated PTSD are broad, says Shlomi-Polchek. “There are women who avoid subsequent childbirth or vaginal childbirth or—worse—avoid the baby because he reminds them of the trauma.”

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Helen Dunn, a Vancouver mother who experienced PTSD, remembers having a distinct feeling of aversion upon seeing her newborn son in 2003. She had a tough birth—a long, induced labour that resulted in an emergency Caesarean section—which she endured alone because her husband had left the hospital to care for the couple’s dogs, not anticipating an emergency. She began suffering symptoms of PTSD immediately, including panic attacks and terrifying visions.

“I’d be eating next to my son and holding a fork, and I’d imagine what would happen if I lost control and stabbed him,” she said. “I felt completely out of control.”

Her marriage became strained due to her mental state, and Dunn moved to Ontario with her one-month-old son to stay with her mother. After recognizing her symptoms on a poster at the doctor’s office, she dialled a help line and was soon enrolled in a postpartum support group. When her son was about five months old, Dunn realized she was no longer afraid to be alone with him and the two moved back to Vancouver.

“I believe this happened to me because of a lack of support,” she says. “If I had felt comfortable telling someone without fearing I’d be institutionalized, or that my child would be removed, it would have been OK,” she says. “If you say ‘I’ve been in a bus accident or a hostage situation and now I’m traumatized,’ everybody would understand that. But when you say ‘I was traumatized while giving birth to my child,’ there’s a lot less support.”

Among researchers who study postpartum PTSD, hopes are high that new studies will create awareness, so trauma is recognized and treatment is offered. While there is no one predictor of whether a women is likely to experience PTSD, studies have shown increased incidences of symptoms among those who deliver vaginally, have a history of PTSD, sexual abuse, anxiety, a prior negative birth experience, or a perceived lack of support or control during labour.

For those working to recover from it, connecting with other moms is key in helping to reduce the stigma and isolation, according to Maura O’Keefe, a social worker who specializes in reproductive issues at Women’s College Hospital in Toronto. Christoff agrees: “The advice I give to women is that the most important thing for them is to get in touch with other survivors of birth trauma who are able to hear, acknowledge and understand your experiences at a visceral level, because many times your closest friends and relatives are unable to do that.”

Regular psychotherapy is another important piece of the treatment puzzle. O’Keefe says the sessions include developing relaxation skills, finding coping strategies to manage anxiety and difficult moods, and mobilizing a support system. Eventually, patients work on behavioural plans to help them become more comfortable and involved with their babies. Medication, O’Keefe says, is usually a last resort.

For pregnant women who worry that they may be at risk of developing postpartum PTSD, O’Keefe recommends connecting with a hospital social worker to set up a support system before the baby arrives. She also encourages women who are anxious about giving birth to prepare for labour with an open mind. “Ask yourself what kinds of strategies you can use to manage the lack of control and vulnerability you might feel,” she says. “It’s important when you go into a birth not to have fixed plans.”

Dunn, who waited six years to conceive again because she feared having another C-section and experiencing “intrusive thoughts,” had a home birth with a midwife. Instead of lying in bed to deliver, she took control, squatting to birth her son. “I didn’t have any tubes in me or monitors on me,” she says, and she did not experience any repeat PTSD symptoms.

Christoff, who is expecting her second baby later this year, said she is also planning a home birth. This time, she is more mentally prepared for labour. “One of the few good things about what happened to me is that I’m much more confident about what I can do with my body than I was the first time,” she says.

A version of this article appeared in our October 2013 issue with the headline "Post-traumatic (childbirth) stress disorder," p. 38.