Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren't exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

• Your inherited mental health risks, such as an increased risk of anxiety and depression
• Your life experiences, including the amount and severity of trauma you've gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
• The inherited aspects of your personality often called your temperament
• The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

• Being female women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
• Experiencing intense or long-lasting trauma
• Having experienced other trauma earlier in life
• Having other mental health problems, such as anxiety or depression
• Lacking a good support system of family and friends
• Having first-degree relatives with mental health problems, including PTSD and depression
• History of abuse (such as childhood abuse, sexual abuse, rape)
• Combat exposure
• Physical attack
• Being threatened with a weapon
• Car accident, plane or train crash
• Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

• Flashbacks of the event vivid and sudden memories
• Nightmares
• Insomnia
• Fears of recurrence
• Emotional numbing
• Panic attacks
• Inability to recall important aspects of the event psychogenic amnesia
• Exaggerated startle response, hyper-arousal, always on guard
• Hyper-vigilance, constantly looking around for trouble or stressors
• Avoidance of reminders of the traumatic event
• Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it's hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

• Postpartum Mood and Anxiety Disorders, A Clinician's Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
• Beyond the Birth, A Family's Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
• When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

• The Birth Trauma Association: www.birthtraumaassociation.org.uk
• Trauma and Birth Stress (TABS): www.tabs.org.nz
• PTSD After Childbirth: www.ptsdafterchildbirth.org
• Postpartum Support International: www.postpartum.net

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

• prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
• educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
• encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
• promote healthy birth practices for all women and families;
• promote evidence-based research regarding PTSD secondary to childbirth;
• increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
• support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.