Motherhood can be one of the most joyous times in a woman’s life. However, a small, somewhat controversial 2012 study from Tel Aviv University published in the June issue of the Israel Medical Association Journal found that nearly one-third of the 89 post-partum women who volunteered for the study reported having varying levels of Post-Traumatic Stress Disorder one month after their delivery. Many of those women chose natural childbirth with no pain medication during their delivery.
The lead researcher, Prof. Rael Strous of the Sackler Faculty of Medicine at TAU, and his team, Dr. Inbal Shlomi Polachek of the Beer Yaakov Mental Health Center and Liat Harari and Micha Baum of the Sheba Medical Center surveyed the new mothers, who were between the ages of 20 and 40 years old, looking for clues that might provide insight into whether some women have a higher risk of developing the stress disorder during pregnancy and delivery and whether others bring a predisposition into their pregnancy.
“The less pain relief there was, the higher the woman’s chances of developing post-partum PTSD,” said Strous. “Of the women who did not develop any PTSD symptoms, only 48 percent experienced a natural childbirth.”
Within the group that reported having all of the symptoms of PTSD, 67 percent said that prior pregnancies had been “traumatic,” and 80 percent said they were uncomfortable “being unclothed.” Many said they feared the intense pain, and the potential “danger to themselves and their children.”
“Expectant mothers worry for not just their own safety but also for the health and well-being of their babies,” Strous said.
According to the research, 80 percent of the women who had a natural delivery reported some or all of the symptoms of PTSD, nearly 8 percent suffered from partial PTSD, and 3.4 percent had fully developed PTSD, including flashbacks of a previous labor, an unwillingness to bear another child, avoiding the topic, and having heart palpitations while talking about it.
PTSD was first identified in war veterans who had been in extreme combat situations. The disorder is identified by three categories of symptoms: Those who continually relived the event, those who shunned the subject by “numbing” or staying away from people and places that reminded them of it, and those who displayed arousal symptoms, where a sufferer is always “on guard,” alert, or startled when reminded of the event.
Researchers also looked at the relationship between the PTSD-prone women and whether they had assistance from a midwife or doula. They reportedly found none, but cited no statistics. Also, they wrote that education, religion, socio-economic position and marital status did not affect the results.
However critics of the PTSD–childbirth connection challenged the study’s findings.
Writing on the Lamaze International’s research blog Science & Sensibility, Penny Simkin, co-founder of DONA, an international doula organization, and PATTCh, the Prevention and Treatment of Traumatic Childbirth, a member of the editorial board of the journal “Birth,” a childbirth educator, doula, birth counselor, and author of books and published research on maternity, found this study to be flawed, sensational, without enough detail, and bordering on fear-mongering by both researchers and the media.
“It has happened again,” Simkin wrote. “Yet another study of a hot topic in maternity care — this time, ‘natural childbirth,”” which the authors define as ‘childbirth without an analgesia or without an epidural’ — has been picked up by online and print media, and passed on to their audiences, with twists sensationalizing the material and adding fuel to the belief that natural childbirth is traumatic….most of which do not accurately present the study findings.”
Simkin criticized the small sample size, the fact that the women self-selected, and the use by researchers of “vague” terminology and inconsistent numbers as reasons to doubt the applicability of the results to women outside of the study sample.
“For example,” added Simkin, “80 percent of the women with PTSD also had discomfort with being undressed, previous mental health problems in previous pregnancy or postpartum, and complications, emotional crises, and high fear of childbirth in their current pregnancy. All these factors have been reported in many studies to be instrumental in the development of PTSD.”
Strous and his team concluded that women should be more closely profiled for PTSD tendencies during pregnancy, identified as at-risk for the disorder, and monitored for its onset after their delivery.
Simkin agreed with this assessment, writing that the recommendation to screen women for the syndrome is “on target, as has been confirmed over and over again in the literature on traumatic birth.”