The psychological effects of childbirth stress

© 2008 Gwen Dewar, Ph.D., all rights reserved

In Western countries, parents are expected to respond to childbirth with happiness and joy. This may seem like a natural reaction.

But when anthropologist Wenda Trevathan reviewed childbirth in other cultures, she discovered that joy is not very common (Trevathan 1987).

In many cultures, birth is recognized as a potentially dangerous event. Women don’t respond to newborns with immediate euphoria. After delivery, parents and attendants may seem emotionally neutral or indifferent. Celebrations—-if they come—-wait until mother and child are judged to be safe and well (Jordan 1993; Trevathan 1987).

For some Western parents, the expectation of a joyful childbirth may be disappointed. Childbirth is a stressful, and sometimes traumatic, process. Mothers—-and fathers, too-—may experience feelings of helplessness and fear. When deliveries are difficult or medical staff disrespectful, negative memories of birth can cast a shadow over the postnatal period.

Symptoms of postpartum trauma

These rates represent the worst cases. Many women who don’t develop full-blown PTSD nevertheless develop several symptoms of the disorder. In Western countries, reported rates of “subsyndromal” PTSD are around 30% (Maggioni et al 2006; Soet et al 2003; Creedy et al 2000).

Women who experience symptoms of post traumatic stress disorder are bothered by intrusive thoughts and memories. These “playbacks” may inspire feelings of fear, horror, or helplessness. Mothers—-particularly those with premature infants—-may live in constant fear that their babies could die (Affleck et al 1991). Sufferers may also feel socially isolated, lonely, angry, or depressed. Such symptoms may make it more difficult for women to bond with their babies (Reynolds 1997). Sufferers may avoid activities that remind them of giving birth (such as gynecological exams). They may also fear subsequent pregnancies. To avoid becoming pregnant, they may reject sex (Bailham and Joseph 2003).

Other women are free of these symptoms, yet nonetheless ruminate over aspects of the birthing experience that were upsetting or disappointing. A woman may feel haunted by memories of disrespectful behavior from hospital staff. Medical interventions may replay in her mind. Were these procedures really necessary? Did she make the right decisions? Or does she feel violated because she wasn’t allowed to make the decisions?

Risk factors

However, studies have identified several risk factors for developing PTSD in the postpartum period. Researchers in the United Kingdom (Bailham and Joseph 2003) and the Netherlands (Olde et al 2006) have reviewed published studies on postpartum PTSD and looked for risk factors. They found that women are more likely to develop symptoms if they have

• Premature births or miscarriages

• Difficult deliveries that require instrumental interventions (e.g., forceps)

• Emergency caesarean sections

• Feelings of fear for well-being of their babies or for themselves

• Feelings of helplessness or a lack of control during labor

• A history of other traumatic experiences, such as sexual abuse

• A history of psychological problems or trait anxiety

• Insufficient social support from partners and/or staff

Other studies have shown links between prior obstetric procedures and postpartum distress. For instance, a study of Nigerian women found that postpartum women with a history of illegal, induced abortion experienced higher levels of postpartum anxiety and depression (Fatoye et al 2006).

Prevention: Social support

Research shows that women in labor benefit from a supportive companion-—a person who is continuously present, who praises and touches the women, and who explains what is going on (Trevathan 1999). When women receive such social support, they have better childbirth experiences. They have shorter labors and fewer medical interventions (Scott et al 1999). These women also report less pain and feel they have more control over the process (Langer et al 1998).

They also have better postpartum experiences.

In several controlled studies (summarized in Klaus et al 1992), women admitted to maternity wards were assigned to receive either (1) enhanced social support or (2) routine hospital procedures only. Women who received enhanced social support had easier childbirths. Six weeks later, they also showed

• Lower anxiety levels

• Lower rates of depression

• Higher self-esteem

• Increased rates of breastfeeding

• More time spent with their infants

• More positive feelings about their families

If you’re pregnant, the implications seem clear. To make birth less difficult and reduce postpartum stress symptoms, get someone to stand by and support you during labor.

For some women, this designated supporter is the father of the child. In a Hungarian study, women who were attended by the father had less anxiety than women who were not (Szeverenyi et al 1989).

But other studies suggest that the presence of the father can intensify the mother’s stress (Ketz 1993; Kennell et al 1991; Nolan 1995). Perhaps some fathers—-dealing with their own anxieties during the childbirth process-—aren’t able to offer women the right kind of support. For this reason, expectant parents might consider finding a relative, friend, or doula (professional childbirth coach) to attend childbirth. In most cultures, women give birth with such helpers, and it is possible that women have evolved a psychological need for such social support (Trevathan 1999).

The childbirth environment may also play a role in postpartum stress.

Advocates of natural childbirth claim hospital births are more likely to cause postnatal stress than are home births. This claim has intuitive appeal, since most people find hospitals more stressful than their own homes.

However, we can’t assume that hospitalization causes trauma, since women who experience birth complications are more likely to end up in a hospital—even if they began labor with the intention of delivering at home. It might be that women who gave birth at home experienced less stress because they were the fortunate ones who didn’t suffer medical complications. Until these factors are teased apart, we can’t be sure that home birth protects women from childbirth trauma and postpartum stress.

What to do if your childbirth experience is haunting you

Many experts believe that talking can help women work through their disappointments and anxiety. A recent study of postpartum women found that psychological counseling helped reduce symptoms of psychological trauma (Gamble et al 2005). Women at risk for developing postpartum trauma symptoms were randomly assigned to either control or test groups. Test groups received brief counseling from midwives within 72 hours after birth and again (by telephone) 4-6 weeks later. The counseling did not prevent everyone from developing post traumatic stress disorder. However, women who received counseling had fewer symptoms than did controls. They also had fewer feelings of self-blame, and were more confident about future pregnancies (Gamble et al 2005).

If you have a sympathetic listener in your life, take the opportunity to discuss your feelings with him or her. Don’t hesitate to find counseling if you think it would benefit you. In particular, seek out professional help if your symptoms are intense (e.g., feeling suicidal) or if they prevent you from functioning normally.

Of course, this may be easier said than done. Not everyone is sensitive to the problem. Medical staff may be dismissive or too busy to listen. Experienced mothers might seem like ideal confidants. But some women view birth as a competitive sport, and may make sufferers of PTSD feel that their problems are signs of personal failure.

These problems inspired a group of mothers in the United Kingdom to establish the Birth Trauma Association, a website for people who have been traumatized by childbirth. The site offers diagnostic information and advice. It also includes the birth stories of real women who have experienced trauma. Some of these women are interested in being contacted by fellow sufferers. If you are haunted by your childbirth experience, this website may be a helpful place to begin the healing process.

References

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