Postpartum post-traumatic stress disorder symptoms: the uninvited birth companion.

BACKGROUND While many are familiar with postpartum depression, the phenomenon of postpartum post-traumatic stress disorder (PTSD) is less well known and investigated. OBJECTIVES To assess the prevalence of postpartum PTSD in a cohort of women in Israel and examine factors affecting its development. METHODS Eighty-nine women completed several ratings immediately post-delivery and after a month. Factors examined related to the pregnancy, childbirth expectations, and delivery. Rating scales comprised evaluations of attachment, personality, PTSD, and demographic variables. RESULTS The prevalence of post-partum PTSD was 3.4% (complete PTSD), 7.9% nearly complete PTSD, and 25.9% significant partial disorder. Women who developed PTSD symptoms had a higher prevalence of "traumatic" previous childbirth, with subsequent depression and anxiety. They also reported more medical complications and "mental crises" during pregnancy as well as anticipating more childbirth pain and fear. Instrumental or cesarean deliveries were not associated with PTSD. Most of the women who developed PTSD symptoms delivered vaginally, but received fewer analgesics with stronger reported pain. Women with PTSD reported more discomfort with the undressed state, stronger feelings of danger, and higher rates of not wanting additional children. CONCLUSIONS The study results indicate the importance of inquiring about previous pregnancy and birthing experiences and the need to identify at-risk populations and increased awareness of the disorder. The importance of addressing anticipatory concerns of pain prior to delivery as well as respecting dignity and minimizing the undressed state during childbirth should not be underestimated. A short questionnaire following childbirth may enable rapid identification of symptoms relevant to PTSD.