Thursday, September 6, 2012

Postpartum PTSD

For numerous reasons both personal and professional, my attention was grabbed by an article stating that one in three women suffers symptoms of Post-Traumatic Stress Disorder (PTSD) postpartum.  The article then goes on to say that 80% of those suffering these symptoms had "natural" childbirths (I roll my eyes at that term, but that's a story for another day) with no pain medication. Another risk factor appears to be not being adequately covered while giving birth.

There are so many issues with this article that I'm not even sure to begin. But because I a) believe that parents and parents-to-be should be well-informed and should make their own choices regarding their babies, their bodies, and their health (including mental), and b) I can see this sort of thing being cited without further discussion, I will just start at the beginning and see where I end up.

So, first off, how postpartum are these women?  According to the DSM-IV-TR (the American Psychiatric Association's diagnostic manual for mental disorders), PTSD cannot even be diagnosed until symptoms have been present for a month or more.  In this study, mothers were interviewed at 2 to 5 days postpartum and again at one month.  There is no mention of any follow-up beyond a month.

Second, (and I admit this should have been my first question!) what is the sample size?  A meager 89 women.  It's a start - and I am truly interested to know how prevalent this is cross-culturally, and also how long these symptoms persist.

Next, what is the birth culture like where these women gave birth?  Are there numerous people coming in and out of the birthing space, making it particularly uncomfortable for these women to be disrobed?  Are the births usually attended by men?  Is there a tacit (or even explicit) expectation that the women will remain clothed/covered while giving birth?  Were these all hospital births?  Were there homebirths?  Birth centers?  Was there a difference between those groups, and was it as pronounced as the unmedicated/medicated split?

I'm glad to see this investigation on the impact that childbirth has on the emotional well-being of mothers.  It's a good start.  And I appreciated the last sentence (a quote from the lead researcher):  “Dignity is a factor that should be taken into account. It’s an issue of ethics and professionalism, and now we can see that it does have physical and psychological ramifications."

I have no doubt that a lot of new mothers feel traumatized by various aspects of the experience of becoming a mother (whether the physical, the emotional, or the spiritual).  I also have no doubt that women experience traumatic births and resulting anxiety, depression, and PTSD.  But I am concerned that stating the statistics within this study  - without context or discussion - could cause more anxiety, and less dignity. 

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