Post-Traumatic Stress After Childbirth Is Underrecognized by Clinicians

Post-traumatic stress after childbirth is underrecognized among the public and mental health professionals, relative to post-traumatic stress disorder (PTSD) associated with other events. These findings were published in the Journal of Anxiety Disorders.

Approximately 30% of individuals who give birth describe the childbirth experience as traumatic, with 12.3% of mothers and 1.3% of fathers exhibiting childbirth-related PTSD symptoms after delivery. However, the typical characteristics associated with the postpartum period (ie, disturbed sleep, perceived positivity of childbirth, low tendency to report symptoms) can potentially contribute to the under-recognition of this form of PTSD – further exacerbating disparities in women’s health.

To assess public and professional perception of post-traumatic stress after childbirth, investigators from Bar-Ilan University and Tel-Aviv Yafo Academic College in Israel conducted 2 experiments. For Study 1, individuals (n=498) living in the United States were recruited online and randomly assigned to read 1 of 5 vignettes about a woman experiencing an event, all 5 of which included all the criteria needed for a diagnosis of PTSD. The 5 traumatic events were a complicated birth, a severe car accident, a terrorist attack, sexual assault, or severe earthquake. Then, participants were asked if the woman in the vignette should be diagnosed with PTSD. Study 2 had the same methods as Study 1, but the study sample consisted of mental health professionals (n=285).

In Study 1, the participants had a mean (SD) age of 37.98 (12.77), 256 were women, 206 had children, and 61 indicated that they had PTSD. In Study 2, the participants had a mean (SD) age of 44.64 (11.34) years, and 218 were women. Of these mental health professionals, 216 were psychologists, 37 were social workers, 18 were psychiatrists, and 14 were classified as “other”. Almost half (44.2%) of these mental health professionals reported that they had specific expertise in trauma.

In Study 1, the rate of diagnosing PTSD (F_4,493=11.51; P <.001), the perceived severity of trauma (F_4,493=2.68; P <.031), and the legitimacy of PTSD (F_4,493=3.34; P <.010) significantly differed based on the traumatic event described in the vignette.

Study 1 participants were less likely to think the woman should be diagnosed with PTSD after trauma from childbirth than after trauma from a terror attack (t₄₉₃=6.47; P <.001), sexual assault (t₄₉₃=4.40; P <.001), car accident (t₄₉₃=3.02; P =.003), or earthquake (t₄₉₃=2.44; P =.015). The severity of childbirth-associated trauma was perceived as lower than trauma from sexual assault (t₄₉₃=2.23; P =.026) and terror attack (t₄₉₃=2.15; P =.032). The legitimacy of post-traumatic stress after childbirth was also thought to be less than that of a sexual assault (t₄₉₃=2.26; P =.025).

In Study 2, the rate of diagnosing PTSD (F_4,282=2.93; P =.021) and certainty of diagnosis (F_4,283=3.06; P =.017) among mental health professionals also significantly differed based on the traumatic event described.

The mental health professionals were less likely to diagnose PTSD from the childbirth-related trauma than PTSD due to terror attack (t₉₃=2.67; P =.009), earthquake (t₉₅=2.40; P =.019), and sexual assault (t₈₀=2.22; P =.030) scenarios. The clinicians were more confident in a PTSD diagnosis following an earthquake than post-traumatic stress after childbirth (t₂₇₈=2.18; P =.030).

 “The present experimental research suggests that women who suffer from childbirth PTSD symptoms are less likely to be recognized or diagnosed with PTSD compared to women who suffer from the same symptoms due to other index events,” the investigators concluded. “This failure in recognition, which was evident among both lay people and mental health professionals, is alarming as research suggests that social support and acknowledgment are key factors in coping with PTSD.”

This study was limited by its sample size and the low reliability observed in experiment one.

This article originally appeared on Psychiatry Advisor