During childbirth we often feel intense pain which can cause us to feel out of control and vulnerable. Like most animals, humans have the “Fight or Flight” response. In the face of danger, adrenaline is released in the brain to assist in this response. When one is unable to fight or flee, a feeling of helplessness sets in. Extreme trauma can cause abnormally high levels of adrenaline to be released in to the blood, which appear to inhibit the normal processing of memories. (Turnbull, 1994) In time, any sensation of an adrenaline surge can trigger the individual to relive the original trauma as a flashback.

PTSD is not widely recognized as a postpartum disorder. Women who have been sexually abused or raped in the past or who have a history of PTSD are much more susceptible to developing the disorder than women who have not. Trauma is different for everyone. Two women may go through the exact same experience. One may develop PTSD and one may not. PTSD can occur at any time after the traumatic event.

According to the DSM IV, one must meet the following criteria to be diagnosed with Post Traumatic Stress Disorder (PTSD):

A. The person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND the person's response involved fear, helplessness or horror.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1. Recurrent and intrusive distressing recollections of the event.
   
2. Recurrent distressing dreams of the event.
   
3. Acting or feeling as though the event were recurring (including flashbacks when waking or intoxicated).
   
4. Intense psychological stress at exposure to events that symbolize or resemble an aspect of the event.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the event) as indicated by at least three of the following:

1. Effort to avoid thoughts or feelings associated with the event.
   
2. Efforts to avoid activities or situations which arouse recollections of the event.
   
3. Inability to recall an important aspect of the event (psychogenic amnesia.)
   
4. Markedly diminished interest in significant activities, such as hobby or leisure time activity.
   
5. Feeling of detachment or estrangement from others.
   
6. Restricted range of affect; eg, inability to experience emotions such as feelings of love.
   
7. Sense of a foreshortened future such as not expecting to have a career, more children or a long life.

D. Persistent symptoms of increased arousal (not present before the event) as indicated by at least two of the following:

1. Difficulty in falling or staying asleep.
   
2. Irritability or outbursts of anger.
   
3. Difficulty concentrating.
   
4. Hyper-vigilance.
   
5. Exaggerated startle response.
   
6. Physiological reactivity on exposure to events that resemble an aspect of the event, eg breaking into a sweat or palpitations.

E. B, C, and D must be present for at least one month after the traumatic event.

F. The traumatic event caused clinically significant distress or dysfunction in the individual’s social, occupational, and family functioning or in other important areas of functioning.

Some Risk Factors for developing PTSD include, but are not limited to:

• Managed labour
• Induction
• Poor pain relief
• Feelings of loss of control
• Unnecessary trauma
• Traumatic delivery
• Impersonal treatment, overly professional, stand-offish or judgemental attitude of staff
• Multi handling
• Shift changes
• Lack of explanations
• Feelings of loss of control
• Not being believed or listened to
• Lack of attention to dignity, e.g. no coverings
• True obstetric emergencies
• Invasive procedures without explanations or consent
• Forceps, suturing without adequate analgesia
• Prolonged latent phase - resulting in demoralisation
• Conflicting advice
• Having baby(ies) admitted to SCBU (Special Care Baby or Unit) or NICU (Neonatal Intensive Care Unit)
• Severe postnatal anaemia
• Post Partum Haemorrhage
• Poor postnatal care
• Old trauma
• Unmet need to debrief, review, or to understand what happened
• Emergency Caesarean Section
• Shoulder dystocia
• Poor Postnatal Care
• Postnatal problems

Accurate diagnosis of PTSD is often difficult due to the number of characteristics of the illness. The sufferer may not want to think or talk about the trauma because this means reliving it. Sometimes the mother may not know that her negative feelings, thoughts, and problematic behaviour are linked to the trauma. The longer the person has suffered from untreated PTSD, and the more severe the trauma, the more likely the PTSD will be hidden by Cover-Up Symptoms. This is especially so in the numbing stages of PTSD.

Cover-Up Symptoms:

• Alcohol and drug abuse
• Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
• Compulsive gambling or compulsive spending
• Psychosomatic problems
• Homicidal, suicidal or self-mutilating behaviour
• Phobias
• Panic disorders
• Depression or depressive symptoms
• Dissociation symptoms
• Fainting spells

I encourage each every one of you to see your doctor and a counselor after having a baby, and to tell him/her how you are feeling. Be specific! Something you may think is unimportant may be very important for your doctor to know. You know your body.

This condition improves with treatment. Visit Heal my PTSD for the latest treatment options for battling PTSD.

More Information about PTSD After Childbirth: