Post Traumatic Stress Disorder (PTSD) symptoms sometimes appear in pregnancy and following the birth of the baby. They may be connected with:
- A previously experienced traumatic event which might have happened some years ago in childhood or adulthood.
- An event that occurred in a previous pregnancy.
- An event that occurred during current pregnancy or during the birth.
Any woman who is concerned about the effect of traumatic events on her mental or emotional health should discuss her feelings or symptoms with her healthcare provider.
What is PTSD?
PTSD is characterized by the development of recognizable symptoms following exposure to one or more traumatic events. These symptoms are persistent and are connected to how the woman experienced or witness the traumatic event at the time it occurred. Usually, PTSD occurs where there was a risk of death or serious injury to the woman in the original event and intense fear was felt at the time.
What are the signs and symptoms of PTSD?
Symptoms include features from 4 clusters:
- Re-experiencing the traumatic event, perhaps through intrusive memories or nightmares, or intense reactions to reminders of the event.
- Thoughts or behaviours that help the woman avoid reminders of the trauma.
- Feelings of general numbing and detachment.
- Symptoms of increased arousal, such as difficulty with sleep, irritability, poor concentration, easily startled, and sensitivity to environmental stimuli
How often does PTSD occur during pregnancy and the postpartum period?
Women who are pregnant or in the postpartum period have an increased risk of PTSD. Exact rates are hard to determine but up to 7% of women may develop PTSD in the perinatal period.
PTSD often occurs alongside Post-Partum Depression and other Anxiety Disorders.
What are the risk factors for PTSD?
Women are at greater risk of experiencing PTSD in the perinatal period if there is:
- history of abuse
- women with a history of childhood abuse may have complex feelings and worsening anxiety when preparing to be a parent
- women with a history of sexual abuse may be triggered by the physical changes in pregnancy or by routine prenatal care
- history of infertility
- increased anxiety late in pregnancy
- traumatic events from a previous pregnancy
- unanticipated outcomes, such as miscarriage or loss, or birth defects
- a more negative childbirth experience than expected, or if the mother feels the labour was complicated, e.g. emergency Cesarean Section (even if the medical team does not feel there were complications)
Women with a history of PTSD who stop their medications for pregnancy are at a higher risk of relapse both in pregnancy and the postpartum period.
Why should women with PTSD seek treatment in pregnancy or postpartum?
Treatment can help decrease symptoms and decrease distress from the disorder. As with other forms of mental health challenges and disorders women with untreated PTSD in pregnancy or following the birth may:
- become involved in risky health behaviours, such as substance use
- have a baby with low birth weight
- be less likely to seek follow-up medical care
- be more likely to have conflict in their relationship
- be more likely to have a sexual dysfunction
- be more likely to have difficulty bonding with the baby
- be less likely to breastfeed
- be less likely to have subsequent births (or may request elective c-section)
- be at higher risk of developing Post-Partum Depression
Discussion symptoms or concerns with a healthcare provider is important so that early treatment can be provided, lessening some of the risks outlined above.
What are the treatment options for women with PTSD?
- To learn more about the effect of PTSD on mental health.
- To teach coping strategies and how to build social networks and supports.
- Can involve partners, friends and family supports.
- Offers support, reassurance and education for the woman to continue coping with the PTSD.
- Focuses on establishing a sense of safety and managing active symptoms.
- Therapy focused on exploring past trauma is not recommended when in crisis as this has the potential for worsening symptoms.
Antidepressants are often used to treat symptoms of PTSD. The most common type of antidepressant used is a Selective Serotonin Reuptake Inhibitors (SSRIs). Generally, SSRIs are considered safe in pregnancy and for breastfeeding:
- There does not appear to be an increased risk of birth defects to the developing fetus during pregnancy.
- There is no evidence of difficulties for the baby with IQ, behaviour, or development in childhood.
- There may be mild symptoms in the baby after birth, including difficulty feeding or sleeping, harder to soothe, jitteriness, that usually resolve without the need for treatment.
SSRIs are present in small amounts in breast milk. There are no or very minimal adverse effects on the baby. Early benefits of treatment with medication can be seen within a few days, but often several weeks are needed to see the full effect of SSRIs and so it is important to keep taking medications and discuss with your healthcare provider should you think about stopping.
Your doctor will prescribe medications at the lowest dose that it is most effective to deal with symptoms
Medications are often recommended in combination with one or more of the non-medication treatment options (education, psychotherapy) described above as this may have higher levels of improvement than each of the treatments alone.
Seeking advice about PTSD symptoms and treatment not only helps a woman during pregnancy but also her and her relationship with her baby following the birth as well as her baby’s longer term development. Early treatment is advised and any woman in the perinatal period with concerns about her mental health should talk to her healthcare provider.
More information is available on PTSD is available on the Here to Help Website.