Perinatal Trauma

Birth-Related PTSD

Labor and delivery are often the context for trauma symptoms that can cause PTSD. In one study, as reported in a 2001 study in the journal Birth (Ayers & Pickering, 2001), 289 women were assessed at 36 weeks gestation, and 6 weeks and 6 months post-partum. Women with preexisting PTSD or depression were excluded. At 6 weeks, 2.8% of women met full criteria for PTSD and 1.5% still met criteria at 6 months. Similarly, another study assessed 264 women with unassisted vaginal births (no forceps or vacuum extraction) at 72 hours and 6 weeks postpartum, as reported by Jo Czarnocka and Pauline Slade. Three percent of the women met full criteria for PTSD and had clinically significant levels of intrusion, avoidance, and hyperarousal. And 24% had at least one symptom. A low level of partner or staff support and low perceived control during labor predicted traumatic stress symptoms.

In another study of 64 couples 9 weeks after giving birth, Susan Ayers and Alan D. Pickering reported that 5% of men as well as women had severe symptoms of PTSD (avoidance and intrusion). The couples who experienced PTSD symptoms had complications, but both groups had normal vaginal deliveries. The researchers concluded that men and women have comparable levels of PTSD after birth. But short-term PTSD symptoms had little impact on the couple's relationship and parent-infant bonding. The long-term effects are unknown.

Infant Health Issues and Trauma

In 2006 in Psychosomatics, Richard J. Shaw and colleagues reported that mothers of premature or seriously ill infants have high rates of trauma symptoms. [Page 421]A study of 40 parents of babies in the neonatal intensive care nursery (NICU) found that 44% of the mothers met full criteria for acute stress disorder, but none of the fathers did. Acute stress disorder was associated with alterations in the parental role, which included not being able to help, hold, or care for the infant; protect the infant from pain; or share the infant with other family members. Mothers' subjective appraisals of the seriousness of the illness were better predictors of their reactions than were the objective disease characteristics. Family environment and parental coping style were significantly associated with trauma symptoms. The authors recommended that care providers help with parental feelings of helplessness and inadequacy, even with severely ill infants.

Prior Infant Loss

Prior infant loss can also increase the risk of trauma symptoms and PTSD. In a study published in the Journal of Loss and Trauma in 2005, Joann O'Leary explored mothers' and fathers' experiences of ultrasound following loss of an earlier pregnancy. Most of the parents indicated that the current ultrasound reminded them of seeing their babies die on the previous ultrasound. Many aspects of the experience reminded them of that event: the smells, sights, feelings, and sounds of the ultrasound room. During the ultrasound, some mothers experienced flashbacks to when they lost their previous babies—even when the current baby was healthy. Both the fathers and the mothers showed equal levels of trauma following the ultrasound. O'Leary recommended recognizing that parents may be remembering their previous babies when undergoing testing for a current pregnancy. She also recommends preparing parents for possible flashbacks during ultrasound. Acknowledge and validate the parents' concerns while assuring them that the current baby is healthy. And finally, recognize that fathers may be as traumatized as the mothers.

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