What is postpartum post-traumatic stress disorder (P-PTSD)

The time of delivery is a glorious time for the family but it can sometimes be overwhelming for the new mom and the whole family by extension. It can be such an unaccustomed experience that it is not uncommon for the new mom to feel overwhelmed, anxious, sad, stressed and sometimes out rightly depressed.

Postpartum stress disorder also commonly referred to as postpartum post-traumatic stress disorder (P-PTSD) or birth trauma is a form of anxiety disorder that is fueled by the feeling, either real or perceived of frightening, distressful or traumatic birthing or postpartum experience.

Postpartum stress disorder is a well-established postpartum event but it is not as common a condition as the other postpartum mood or depressive illnesses but it nevertheless affects around 6 to 15 % of women transiting to motherhood from delivery.

Causes

The causes can be either real or perceived and it can develop from days to months following delivery so should always be suspected if the patient starts showing symptoms. The causes are numerous but the following list will serve as a guide:

• Instrumental delivery with forceps or use of vacuum extractor

• Unplanned cesarean section, unplanned hysterectomy, severe preeclampsia/eclampsia

• Baby being referred to neonatal intensive care unit

• Prolonged labor that may or may not be associated with postpartum hemorrhage

• Delivery of a malformed baby or having a previous complication from delivery or being malformed from a previous delivery like foot drop following delivery, severe perineal trauma (3rd or 4th degree tear)

• Previous traumatic birth experience, rape, or sexual abuse

• Feeling of lack of support and communication from both the family and caregivers and feelings of powerlessness over your condition.

Symptoms

The symptoms patients present with are related to the traumatic experience either real or perceived. They include:

• Nightmares

• Flashbacks to the experience

• Reliving the experience, constant negative feelings and thoughts

• Avoidance of places, persons, discussions or events related to the precipitating experience, emotional numbness(trying to feel empty or nothing),

• Physical sensations like pain, nausea, vomiting anytime the trauma is discussed

• Anxiety, sudden angry outbursts and panic attacks

• Irritability

• Difficulty concentrating, headaches. Difficulty sleeping

Who are those at risk of P-PTSD?

P-PTSD is most commonly associated with mothers who have a past history of anxiety disorders or depressive illness. It is also common in individuals with a family history of mental health disorders or people who are easily agitated in common situations. Women who have experienced prior trauma like sexual abuse or rape are at increased risk. Patients who have a phobia about delivery in general either vaginal delivery or cesarean section also have increased risk of developing postpartum stress disorder. These events are then exacerbated by a traumatic experience in pregnancy, labor, delivery and postpartum.

Differences between P-PTSD and PPD

Though symptoms of P-PTSD and postpartum depression (PPD) can look alike and sometimes may coalesce they are not the same disorder. Postpartum depression can sometimes exacerbate P-PTSD. Postpartum post-traumatic stress disorder is a result of a traumatic event in a woman during pregnancy up to the time of delivery and postpartum while postpartum depression is as a result of the hormonal changes in a woman following delivery. This distinction is important for the proper diagnosis and treatment of P-PTSD.

Treatment

The good news is that this is a treatable condition and with proper assessment and care you can go back to taking good care of yourself and your baby while you recover from post-traumatic stress disorder

The mainstay of treatment lies with therapy with medication having a minimal role in the treatment of postpartum stress disorder. Therapy can be in combination or single therapy.

Cognitive behavioral therapy (CBT) – A trauma focused CBT is a special form of CBT directed at people with PTSD and it helps you to reprocess the trauma in the light of proper evaluation of the situation you were faced with so you can come to a more realistic recognition that it was never your fault.

Eye movement desensitization and reprocessing (EMDR) – In this therapy, you are guided by a therapist while you make rhythmic eye movements while you recall the traumatic events. The eye movements help the information processing center in the brain to guide you as you process the trauma speeding up recovery and readjustment to reality.

Group therapy – This also helps in speeding up recovery as you verbalize your experience in the presence of others with similar problems and you learn coping and recovery measures from people who have gone through the same experience.

Hypnosis and other alternative medicine techniques like acupuncture and yoga are also of immense assistance in the treatment of PTSD.

Medication

Not commonly used for PTSD but it can be offered

• If there are anxiety or depressive aspects to the PTSD

• As an intermediary measure if therapy is inaccessible or the therapy waiting list is long

These are usually given on a short term basis.

Self help measure you can take

• Talk to a friend, your spouse and family members about how you feel and what actually happened to you. This is the first step to healing and they are your main network of support in the long road to recovery.

• Avoid feeling guilty about your thoughts and feelings – They are not your fault.

• Engage in relaxation routines and exercises

• Seek out peer support groups and engage them in your recovery.

• Give yourself time to heal – This is not a race and each person has her own rate of response and recovery

• Eat well and exercise regularly – A well-balanced diet with enough rest is good for your recovery just like exercise and do not indulge in smoking and alcohol as a way of coping. It harms you and your baby and prolongs recovery times.

Abiding Grace and Joy

Bringing a baby into the world is a marvelous thing that gives abiding joy and grace unlimited that it should never be associated with any form of grief or sadness but in the unfortunate event that any aspect of it from pregnancy to labor and delivery up to the postpartum period is traumatic, you have the right to feel hurt and express it but you should never feel ashamed or disillusioned by that experience

You should make every effort to seek help, counsel and advice and seek out and use the family support network you have fully and to maximum advantage to take care of yourself and your baby so the post-partum experience remains joyful in spite of that pain and trauma you had.

Postpartum stress disorder is a treatable condition. Do not let it spoil your fun and happiness postpartum.

Dr Mawa

To your postnatal health and freedom

mypostnatalmanagement.com