Introduction
Childbirth is one of the extremely intense and emotional experiences in a woman’s life. However, some women undergo traumatic childbirth, while some may develop stress following the traumatic birth experience. These can significantly affect the life of a woman, and cause psychological disorders. Most women feel that the sight and touch of the newborn may compensate for all the traumatic experiences and soon forget about the situation, however, it might have a negative effect on some mothers, affecting the relationship with the newborn, which in turn disturbs the breastfeeding process.
What Is Post-Traumatic Stress Disorder?
A response to a stressful event or a traumatic situation that is exceptionally threatening or considerably worse is referred to as post-traumatic stress disorder. It can be a self-experience or sensed in other persons and can cause deep distress to the individual. It occupies a special position in psychological disorders, as it is unlike other mental disorders with a specific cause, or a previous trauma that triggers the condition.
What Are the Causes of Postpartum Post Traumatic Stress Disorder?
Postpartum post-traumatic stress disorder (PTSD) is a type of anxiety disorder that develops in women due to the experience of traumatic events during labor or childbirth. It affects about three to six percent of women and about one percent of fathers. Approximately 30 percent of women perceive childbirth as a threat or trauma, especially during the initial stages following childbirth.
Some of the causes of postpartum PTSD include;
-
History of abortion.
-
Painful and long labor.
-
Significant bleeding or postpartum tearing of the tissues.
-
Painful delivery.
-
An unplanned cesarean section.
-
Shocking or traumatic unexpected experiences during childbirth.
What Are the Signs and Symptoms of Postpartum Post Traumatic Stress Disorder?
The symptoms of PTSD following childbirth are at their peak, especially during the first four to six weeks, which may reduce gradually in some patients at a later time. These include;
-
Persistent memories or thoughts about childbirth.
-
Dreams or nightmares affect sleep.
-
Unable to connect with the newborn or refusal to breastfeed.
-
Repetitive talks or expressions of the delivery process.
-
Negative feelings about motherhood.
-
A feeling of anger and aggressiveness towards self, healthcare professionals, and family members. In extreme cases, self-destructive or reckless behavior may be observed.
-
Physical symptoms include pain, sweating, trembling, panic, irritability, nausea, etc.
-
Difficulty in concentrating in daily activities.
-
Emotionally numb or trying to avoid or distancing from others when reminded of the trauma.
-
Loss of trust or safety among close people.
How Is Postpartum PTSD Diagnosed?
Postpartum PTSD requires an appropriate diagnosis and care by a doctor or a psychiatrist. A healthcare professional can diagnose by conversing with the patient and recognizing the symptoms of the condition. In some patients, though the childbirth process may not be traumatic it might be a situation wherein the child’s life was in danger, birth complications, the newborn requires a NICU (neonatal intensive care unit), premature birth, or an emergency cesarean section performed. A physical examination may be advised to check the underlying medical conditions causing the symptoms, or a psychological evaluation is performed by the doctor which includes a discussion of the signs and symptoms or the reasons or events that led to the development of the disorder.
How Does Postpartum PTSD Affect Breastfeeding?
-
Women after a traumatic childbirth may face difficulty in breastfeeding due to physical discomfort and emotional detachment towards the newborn, which can in turn lead to insufficient milk production. A large-scale study, which included data collected from eight weeks to two years indicated that postpartum PTSD was significantly related to the discontinuation of breastfeeding.
-
Traumatic events during pregnancy or delivery or postpartum can disrupt breastfeeding due to hormonal variations in the mother. Trauma leads to the activation of the stress system in the body which suppresses the hormones responsible for milk production such as prolactin and oxytocin. In many Western countries, breastfeeding rates have reduced when compared to that recommended by the WHO (World Health Organization).
-
Research on the association between PTSD and breastfeeding is sparse. An epidemiological study was conducted on eligible mothers after childbirth for one year to assess the development of PTSD. Around 12 percent of mothers developed postpartum PTSD at 42 days postpartum. It also indicated that exclusively breastfeeding mothers had a lower risk of postpartum PTSD, in comparison to partially breastfeeding mothers.
-
Studies have suggested that delayed or failed lactogenesis (the ability to secrete milk) may occur due to psychological stress and pain related to the childbirth process. It can be seen in mothers who experience stressful labor and delivery, psychological pain, or stress related to childbirth or unplanned cesarean births.
-
Depression and postpartum PTSD are known to influence breastfeeding outcomes in lactating mothers. Early screening and treatment of lactating mothers at risk of developing postpartum PTSD might be beneficial and help prevent further complications.
-
For many mothers with PTSD, breastfeeding can be challenging or intrusive and cause deeper pain. Traumatic memories can suddenly pop up affecting the efficiency of breastfeeding. A mother who has experienced a traumatic childbirth can have difficulties during breastfeeding due to problems in milk production, physical discomfort such as sitting, holding the baby, finding a comfortable position to breastfeed, etc. Breastfeeding frustrations can aggravate the feelings, especially in cases of insufficient milk, or rigid refusal by the baby for formula feed which can lead to irritability and weight loss of the infant.
How Can Postpartum PTSD Be Managed During Breastfeeding?
Living with the traumatic effects of childbirth can be challenging for most mothers, various treatment options are available to manage postpartum post-traumatic stress disorder, which include;
-
A behavioral therapy specially designed to manage PTSD known as trauma-focused cognitive behavioral therapy (TF-CBT) is recommended to improve the postnatal mental health of the mother. It works by encouraging the patients to identify the thought patterns that are negative and helps to establish coping responses, which in turn helps the patient develop new ways of thinking and overcome emotions.
-
Eye movement desensitization and reprocessing (EMDR) is recommended wherein a therapist guides the patient to make rapid eye movements which are helpful in stimulating the information processing system in the brain while recalling the traumatic event, which results in a quick recovery.
-
Medications may not actually treat the condition but may be helpful in reducing the symptoms such as anxiety or depression. It also facilitates the patient to be more stable in such episodes and helps to manage the infant.
-
A healthcare professional may also advise the patient to identify the situations or instances that trigger the thoughts in the mind about the trauma such as places, people, sounds, smells, words, films, etc, and in such circumstances, the individual can openly talk it out with friends and family or doctors, or practice breathing exercises, meditation, listening to soothing music, can be done which may be really beneficial.
-
Taking peer support by joining a support group or an online community can help the individual understand similar experiences, prevents self-judgment, and supports early recovery.
-
Mothers can express their thoughts and feelings to their near ones, doctors, or psychologists and validate their feelings. It is unfair to put pressure on the infant and the mothers must understand that breastfeeding is an effective way to develop a bonding with the baby which gradually helps to forget all the negative thoughts of the trauma faced during childbirth. It is also important to understand that breastfeeding helps to overcome sadness, and anger towards family members and society and develops peace of mind, and calmness, reduces anxiety, and promotes healing of thoughts.
-
Coping with postpartum PTSD can be exhausting to the individual and the family members, therefore following a healthy diet, frequently nursing the baby, spending time outside, regular walking, or other physical activities sharing household activities with the spouse can bring about a change in the lifestyle and helps overcome the disorder.
Conclusion
A stressful response to a traumatic event of childbirth can result in serious psychological impairment, especially in women, known as postpartum post-traumatic stress disorder. The consequences of this condition can affect breastfeeding and bonding with the infant. By analyzing the triggering factors and seeking care from family and healthcare professionals, this condition can be successfully managed, which can help the individual enjoy parenthood. While the potential for reversal of the causes of postpartum PTSD cannot be ruled out, strategies to improve the rate of exclusive breastfeeding can be achieved through support, education, and counseling which can benefit lactating mothers and infants.
