Risk factors associated with development of PTSD (post-traumatic stress disorder) signs post-delivery are categorized into vulnerability-related, trauma-related as well as postpartum factors. PTSD prevalence rates indicated between 3 and 12 months post-delivery range beginning from 0.9 to 14.9%. Recently, childbirth was recognized as an event perceived as traumatic and that consequently trigger post-traumatic Stress Disorder. Studies indicate that between 0 to 6.9% of women meet criteria for PTSD between 4 and 10 weeks of post-delivery, whereas 1.5 to 33.1% of women may partially show symptoms in this time period. Several neonatal and obstetrical variables relate to symptoms of PTSD in postpartum (Eelco et al, 2006). Among variables available at delivery like low socioeconomic status, null parity, history of psychiatric problems, perception of poor social support in pregnancy, high anxiety sensitivity, postpartum depression, sexual trauma and sever fear of childbirth get associated with development of PTSD.
Regarding childbirth experience the fear for one's life or infant's life, feeling of loss of control, rating of birth experience as a negative experience and perception of insufficient intrapartum care from partner or staff are associated with PTSD. Few studies show that postpartum depression and poor social support postpartum are associated with the progress of PTSD. Labor and child birth challenges life event with potential for both positive and negative experiences. In recent years, there has been an establishment that labor and child birth to be an event perceived as traumatic (Nancyet al, 2012). Undesirable childbirth experiences like unexpected medical intervention, threat of death and severe pain may result in post-traumatic stress reaction in women. Childbirth is a complex event capable of resulting in various psychological responses either positive or negative. Thus, it can result in mental disorders specifically postpartum depression and postpartum psychosis (Sawyer & Ayers, 2009).
Recent studies focused on PTSD associated with childbirth and symptoms of PTSD categorized into 3 clusters within DSM-IV re-experiencing, persistent avoidance and increased arousal. PTSD was listed in DSM-III as anxiety disorder that encompassed symptoms similar to exposure to extreme events outside the range of usual human experience like witnessing someone being killed. Thus, this definition suggests that childbirth cannot be classified as potential traumatic stressor, since it is in the range of usual experience for about half of the population. In DSM-IV the stressor criteria was adjusted to stressful situations where a person experienced or confronted an event that entailed actual or threatened death or severe injury or threatened physical integrity of others or self (Diana, 2012).
Studies show that even regular childbirth may lead to the development of PTSD symptoms even to full-blown PTSD. Women were found to nurture intrusive symptoms like flashbacks and nightmares. Signs of avoidance were common by avoiding talking or reading about pregnancy or birth related issues. Signs of increased arousal include sweating, being irritated, trembling and sleep disturbances. Labor and childbirth is a challenging and significant life event and changes adults in numerous ways. PTSD is an anxiety disorder that develops when confronted by traumatic stressor. Most characteristic signs are re-experiencing the event and hyper-arousal. In last decade, increased attention got devoted to childbirth as possible traumatic event (Alexandra, Susan & Helen, 2010). Studies carried out between 1 and 6 months postpartum estimate prevalence of PTSD after childbirth to range from 0.0 to 5.9. Nevertheless, experts consider 1-2% to be a realistic estimate for developed countries. Previous studies identified various obstetric, personality, and psychosocial factors to contribute to PTSD after childbirth ( Ayers et al 2009).
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