The latest issue of Midwifery, containing an editorial by Professor Susan Ayers and articles from several of our collaborators, focuses on fear of childbirth and post-traumatic stress disorder.
The importance of addressing maternal mental health needs has been increasingly recognised in recent years. The commentaries published on this web-site have cited the evidence relating to the impact of maternal psychological distress upon gestational age, infant outcomes and cognitive, behavioural and emotional development of young children, and upon the wellbeing and relationships of the woman and child. The World Health Organisation has underlined the importance of ensuring adequate perinatal care for women experiencing psychological difficulties, but also recognises the lack of empirically evaluated care pathways.
There is a need to increase our knowledge of the mechanisms involved in perinatal mental health, not least to inform our understanding of the wider issue and to facilitate intervention aimed at prevention and treatment. This special issue of Midwifery makes a contribution to this process through its focus upon fear of childbirth and postnatal PTSD. It includes articles specifically on perinatal PTSD together with original research relating to fear of childbirth, women’s perceptions of morbidity, parental stress, the role of support, the impact on women midwives’ views on antenatal care, and treatment. Contributions have been included from around the globe.
This special issue is published online on the Midwifery website and is fully accessible until the end of March 2014.
Thank you so much for this comprehensive editorial on PTSD following childbirth and fear of childbirth.
The Birth Trauma Association gets a large number of support requests on these themes and as ‘distributor’ of the requests to our support volunteers, I read nearly all of them.
You are so right in saying that good midwifery care can prevent so much trauma and distress. I wonder too, whether health care systems also have a role in prevention and whether this might be a pointer for future research.
The following anecdote may illustrate this. We recently had some support requests that were so utterly desperate that I did not send them on to the volunteers. They were women with such incredibly severe tokophobia that I was worried about their immediate mental health; both wanted elective caesareans and both had had their requests denied. They were suffering extreme anxiety; one was having nightmares, palpitations, constant ‘dark’ thoughts that she faced a terrible and traumatic birth and would be physically injured by the birth. The other had ceased to function on any level at all and was vomiting with fear, talking about preferring to die than face vaginal birth etc. In both cases, I asked whether they would be happy if we contacted the hospital on their behalf which we did. This seemed to flag them up as needy cases sufficiently for both to eventually be offered an elective caesarean which both got.
As soon as the first woman got her c/s agreed, she emailed to say she was over the moon and could at last ‘enjoy’ her pregnancy. Both babies have since been born and the outcome in both cases was incredibly positive. The change point came at the moment they got their elective caesarean agreed.
It made me reflect on whether they were tokophobic at all. The problem was a health system that wasn’t sympathetic to their needs. As soon as it became sympathetic, their problems evaporated.
Looking at the research, it is notable that women with fear of childbirth frequently request epidurals and caesareans. What is interesting is that our current NHS system is very keen to reduce caesareans and, low epidural rates, considered an intervention, are often cited as a measure of effective midwifery care. The result is a health care systems that creates patterns of care that are the opposite of what tokophobic women want.
So is the fear real or is the fear created…a possible line of research? It has certainly got me thinking ….
Hi Maureen
I note with great interest this information. I am an Australian midwife and presently researching ‘somatic and psychological effects of traumatic vaginal birth’ re my PhD with an obstetrician and urogynaecologist Prof Hans Peter Dietz who is my supervisor at Sydney Uni Medical School – he has written hundreds of articles on the somatic issues re traumatic vaginal birth
http://sydney.edu.au/medicine/people/academics/profiles/hans.dietz.php
We presented this year at a Sydney ‘perinatal mental health forum’ the topic of ‘Tokophobia – who is crazy who is sane?’ The response was very positive from the mental health and midwifery community.
My data collection of 40 interviewed women is demonstrating an emerging theme of PTSD postpartum and similar issues. I am now commencing data analysis.
I have also just co authored the following article for the ANZJOG with Prof Dietz that will be in print soon.
Australian and New Zealand Journal of Obstetrics and Gynaecology
“Sequelae of traumatic vaginal delivery? Maternal urinary & faecal incontinence, vaginal prolapse & sexual and psychological dysfunction: a literature review”
Keen to be in touch.
Liz
My apologies, Elizabeth, somehow I managed to miss your message and yes, please do keep in touch. I have been following the work you have been doing with great interest and appreciation. If there were better understanding of the impact of traumatic vaginal birth and its true cost to women, their families, and health care services, then we would have maternity services with a very different focus.
Hi Maureen
So glad to talk to you. I tried to catch up with you in UK last year after talking to Prof Susan Ayers. Maybe next time I visit we can meet. I am at present writing another paper from my research which was presented at Montreal ICS 2015. I am unsure whether I posted that published abstract – will check
I have read with great interest many of your comments.
Warm regards
Liz (Elizabeth) Skinner
Hi Maureen
Unsure if you want the whole abstract online but here is the link:
http://www.ics.org/Abstracts/Publish/241/000214.pdf
16:07 214 PDF Abstract Disclosure Psychological consequences of traumatic vaginal birth
Skinner E1, Dietz H P1
1. Sydney Medical School Nepean, University of Sydney
Keywords: Pelvic Floor, Quality of Life (QoL), Sexual Dysfunction
Hi Maureen
Just realized you may not have the radio interview Prof Dietz and I gave in March 2016 or any of the newspaper articles.
Links:
http://www.dailylife.com.au/life-and-love/parenting-and-families/we-need-to-speak-more-honestly-about-traumatic-births-20151013-gk87bv.html
http://www.abc.net.au/news/2016-03-15/concern-over-maternal-injuries-caused-by-forceps/7248