Pregnancy and childbirth bring feelings of joy, excitement and anticipation. They also can complicate existing mental health issues and can create new mental health problems during the pregnancy, at the time of the birth and afterward. Mother and baby both can be affected long-term.
I have noticed in my own practice a number of clients who meet criteria for both acute stress disorder or post-traumatic stress disorder (PTSD) and postpartum depression. The correlation between PTSD and depression has been documented. One study conducted by Shalev et al. (1998) found that 44.4 percent of traumatized participants suffered from comorbid depression one month after the trauma occurred, and 43.2 percent continued experiencing symptoms four months following the trauma.
In addition, the Diagnostic and Statistical Manual, fifth edition (DSM-5) — used by mental health professionals to help make diagnoses — states that people with a PTSD diagnosis are 80 percent more likely also to meet criteria for another mental health disorder than people without PTSD.
A study conducted by Soderquist et al. (2009) assessed the risk factors for postpartum depression and PTSD during pregnancy. They found that 1.3 percent of the women who participated in their study met DSM-IV criteria for a diagnosis of PTSD. A total of 5.6 percent of the women who participated in this study had postpartum depression one month after their delivery.
Soderquist et al. (2009) estimate that between 1 and 7 percent of women of develop post-traumatic stress reactions after giving birth. The study found that women with PTSD or postpartum depression have risk factors that are very similar. Women at greater risk for PTSD and postpartum depression tend to have a fear of childbirth and high anxiety in early pregnancy (also a predictor of postpartum depression).
Another study by Ayers and Pickering (2001) found that 6.9 percent of women met criteria for PTSD or postpartum depression. Nearly three percent of those women had not met criteria for PTSD or depression prior to delivery.
Postpartum depression can affect the way a mother bonds with her child. It also can affect how the child develops, putting him or her at risk for attachment, cognitive, behavioral and emotional problems (Lefkowitz et al., 2010). In my observations, acute stress disorder and PTSD can compound and complicate the postpartum depression, making it that much more difficult for a mother to bond with her child.
So what can a new mother and her loved ones do to address and overcome postpartum depression and trauma?
- Be aware.
Know the signs of postpartum depression and the difference between postpartum depression and the “baby blues.” According to the Mayo Clinic, signs of the two can be similar. Symptoms of both include loss of appetite, fatigue, trouble sleeping, mood swings, irritability, crying and decreased concentration.
“Baby blues” should only last a few days to two weeks at the most. Postpartum depression is longer-lasting and more intense and also can include loss of interest in once-pleasurable activities, withdrawal from loved ones, irritability, mood swings, and thoughts self-harm or of harming the baby.
Too often, I have noticed that women are hesitant about talking about the symptoms of postpartum depression for fear of being judged by others and feeling shame. Loved ones can help by validating that these symptoms are difficult and nothing to be ashamed of. They can happen to even the most prepared women. Being aware and acknowledging these symptoms is the first step in getting help. In my experience, the sooner a woman and her loved ones can get help, the better.
- Know the symptoms of acute stress disorder and PTSD.
Symptoms of acute stress disorder and PTSD include:
- exposure to a traumatic event
- distressing memories about the event
- psychological distress
- negative mood
- altered sense of reality
- inability to remember important aspects of the event
- attempting to avoid symptoms and reminders of the event
- problems with concentration
- sleep disturbance and
The difference between the two is that acute stress disorder occurs three days up to one month after the event. It becomes PTSD when it lasts more than a month.
- Get professional help.
A good place to start is with the physician. OB/GYNs are becoming more educated and informed about postpartum mental health issues. They can make referrals to appropriate professionals such as psychiatrists and therapists. Whether you notice one or all of the above symptoms, professional help is extremely important and is very effective in helping to overcome postpartum depression and trauma.
- Make sure you have adequate support, particularly in caring for the baby.
Sleep deprivation and stress can aggravate PTSD and postpartum depression symptoms. Ensuring that you are getting regular breaks and support can make a significant difference in your functioning and recovery. This means it is extremely important for your well-being and the well-being of your child to ask others for help and to accept their help.
- As a loved one, make sure you are getting your own support.
Postpartum depression and trauma are extremely difficult and taxing. They also can cause stress in loved ones. Talking about this experience can lessen the stress and help a person to feel more supported, which will help them to be more available to the mother.It is important to keep in mind that recovery is very realistic whether you are dealing with one or both of these issues. I have seen my own clients get back to themselves and move forward, symptom-free, through hard work and willingness to ask for and accept help.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Edition). Arlington, VA: American Psychiatric Publishing.
Ayers, S., Pickering, A.D. (2001). Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth, 28(2), pp. 111-118.
Lefkowitz, D.S., Baxt, C., Evans, J.R (2010). Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). Journal of Clinical Psychology in Medical Settings, 17(3), pp. 230-237.
Mayo Clinic (2012). Postpartum depression. Retrieved December 10, 2013 from http://www.mayoclinic.com/health/postpartum-depression/DS00546/DSECTION=symptoms.
Shalev, A.Y., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S., Pitman, R. (1998). Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry, 155, pp. 630-637.
Soderquist, J., Wijma, B., Thorbert, G., Wijma, K. (2009). Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 16(5), pp. 672-680.