“I am dying,” Stacy* said to her husband half an hour after giving birth to their first child in 2016. Realizing that she was bleeding internally from a placenta that would not deliver, Stacy’s blood pressure dangerously dropped, nearly giving way to hemorrhagic shock. Her life was saved via an excruciating procedure: A team of medical professionals manually removed her placenta from her uterus, and then later gave her a blood transfusion as well as blood pressure medication. As traumatic as her first birth story was, Stacy was appalled when she re-experienced the same nightmare scenario again with the birth of her second child six months ago.
Society celebrates the birth of a child as a uniformly joyful event, but what if the delivery of a child results in a traumatic experience for the mother?
While postpartum depression or the “baby blues” has widely entered the public lexicon, psychologist Sharon Dekel, Ph.D., has focused her research on a different aspect of the childbirth experience: postpartum posttraumatic stress disorder (PP-PTSD). Dekel, an assistant professor of psychology at Harvard Medical School and a principal investigator at Massachusetts General Hospital in the Department of Psychiatry has taken the lead in the study of PP-PTSD by surveying over 1,500 women so far, using clinical, physiological, and brain imaging tools. She was fascinated to find that PP-PTSD rates are between 4.6 and 6.3% following full-term successful birth, while 16.8% of mothers were found to have clinically significant symptoms. Given that in 2018 there were close to four million births in the United States alone, 200,000 American women could potentially be impacted by PTSD after birth each year. And given that globally there are close to 140 million births each year, PP-PTSD could potentially impact millions of mothers and their babies around the world.
While Dekel, with her background in trauma research, was aware of factors that can contribute to PP-PTSD, such as pre-existing maternal psychiatric problems, or a lack of social support, she was expecting that a hard childbirth experience such as Stacy’s could result in PP-PTSD even without having prior symptoms for some women. Given her background in trauma and her focus on the birth experience, Dekel knew that a lot happens to the mother throughout the birth experience: changes to her hormones, weight and blood loss, intense bodily pain during and after delivery, and sleep deprivation.
Dekel gathered a sample of close to 800 women about three months after childbirth to ask about their experiences. Dekel and her team found that women who had unplanned cesarean sections or experienced the use of instruments (like forceps) during delivery had more PP-PTSD compared to peers. If the mother had a history of mental health problems, sexual assault, trauma, a longer duration of childbirth and less sleep before birth, or higher levels of emotional distress during birth, she was more at risk for PTSD after birth. The researchers found that women who were experiencing PTSD as a result of childbirth had lower levels of attachment to the infant in the first months after birth.
Dekel and her team found that much of the woman’s experience had to do with objective factors – such as having obstetrical complications and nearly dying during birth – as well as subjective factors: How did the woman perceive her childbirth experience? How was her immediate emotional reaction? If she recounts it as a traumatic experience, her negative appraisal could also impede further healing.
As Dekel explained, “A woman feels a sense of shame in not enjoying the birth experience” and believes she should manage a traumatic response by “‘just getting over it’, a strategy that often does not promote her coping. Her feelings are often compounded by lack of sleep, stress, and responsibility, leading to a vicious cycle.” Dekel encourages doctors and clinicians to ask each woman, “How was your childbirth experience?” Depending on how the mother responds, she can then be screened for PP-PTSD, and referred for psychological or psychiatric care. Partners, family members, and friends are recommended to “let the mother share her experience. Let her seek consultation if she needs support. It is important to chip in and help the mother engage with her baby. Give her time to focus on herself.”
Dekel and her lab have many goals in mind to assist women in the aftermath of birth. They are currently working on creating a screening tool based on a machine learning mode to predict the risks of a woman to developing PP-PTSD, identify women who are at-risk and then offer them appropriate interventions early on. Funded by NIH, they have been testing a nasal spray of oxytocin – the hormone that can promote mother-child bonding – for easy use as an immediate postpartum treatment. Dekel hopes to develop a simple blood test that can be used to examine bio-markers – the blood test can be used to assess levels of hormones related to the HPA axis which can then help to understand if the birth was stressful for the mother. With additional government or private donor funding, Dekel aims to open a center inside the hospital for mothers who experienced traumatic births via combining clinical research and care, and to offer the parents a holistic, comprehensive treatment immediately and long-term using advanced cutting-edge, novel ideas and interventions.
Mothers like Stacy could undoubtedly benefit from Dekel’s research advancements. Months later, Stacy still “cannot believe I almost died.” Given that she experienced a healthy, easy pregnancy and a relatively calm delivery initially, Stacy remains stunned by how “the most natural thing in the world can be so dangerous. I thought everyone just has a baby… I never thought childbirth could be like this."
Dekel, S., Stuebe, C. & Dishy, G. (2017). Childbirth induced posttraumatic stress syndrome: A systematic review of prevalence and risk factors. Frontiers in Psychology, 8(560). https://doi.org/10.3389/fpsyg.2017.00560.
Dekel, S., Ein-Dor, T., Berman, Z., Barsoumian, I.S., Agarwal, S., Pitman, R.K. (2019). Delivery mode is associated with maternal mental health following childbirth. Archives of Women's Mental Health, 22(6), 817-824. doi: 10.1007/s00737-019-00968-2.
Dekel, S., Thiel, F., Dishy G., Ashenfarb, A.L. (2019). Is childbirth-induced PTSD associated with low maternal attachment? Archives of Women's Mental Health, 22(1), 119-122. doi: 10.1007/s00737-018-0853-y.