Women's experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: a review and critical appraisal.

Stella James

doi:10.1007/s00737-015-0560-x

Abstract

This paper critically analyses nine studies on postnatal posttraumatic stress disorder (PTSD) following traumatic childbirth, in order to find common themes of PTSD symptoms, using the cognitive model of PTSD as a guide; it critically appraised one of the studies in depth and it attempted to explain the lived experience of women suffering from postnatal PTSD following traumatic childbirth and the suitability of cognitive behavioural therapy (CBT) for postnatal PTSD. This paper found that women following traumatic childbirth do experience postnatal PTSD; postnatal PTSD symptoms are similar to PTSD symptoms of other events and that CBT for PTSD of other events is just as effective for postnatal PTSD. Future recommendations include more qualitative studies with interpretative phenomenological approach in order to establish evidence-based CBT treatment for this client group, and more referrals need to be sent to the psychological services for CBT intervention.

Highlights

Elhers and Clark (2000) suggest posttraumatic stress disorder (PTSD) to be a common reaction to traumatic events
This paper focuses on cognitive behavioural therapy (CBT) for postnatal posttraumatic stress disorder
Highlights included influence of previous events and beliefs on the women’s perceptions and emotional response to pregnancy, birth and expectations of birth, sensitivity to management of events during birth impacting on the woman’s experience and appraisal of events, the need to be more sensitive to vulnerability during traumatic childbirth, issues around recognising and diagnosing both postnatal PTSD (PNPTSD) and postnatal depression (Kessler et al 1995) and issues around women being avoidant of reminders of trauma memories of the birth

Summary

Introduction

Elhers and Clark (2000) suggest posttraumatic stress disorder (PTSD) to be a common reaction to traumatic events. Researchers report a common theme of women’s description of current threat as emotional numbing and hyperarousal, anxiety, panic, depression, suicidal, dissociation of the mind and body, vulnerability, confusion, helplessness, low self-esteem, intense burst of anger, shame, fear, disturbed sleep, feeling threatened, stress and feeling disconnected This supports the proposal of the cognitive model of PTSD (Elhers and Clark 2000) which proposes that both the nature of trauma memory and the negative appraisal of trauma and its sequelae (as can be seen in above themes) are contributing factors to the current threats. Ruiter and Bosschot (1994) in Dale-Hewitt et al (2012) report the Bstrategic cognitive avoidance^ of attention bias away from labour words This supports the proposal of Elhers and Clark (2000) who propose that current threats contribute towards strategies intended to control threats/symptoms, which in turn prevents the change of the trauma memory and the negative appraisal (which maintains the problem)

Findings

Discussion

Conclusion