Postnatal depression and postnatal post-traumatic stress disorder are psychological conditions that can affect parents after their baby is born. They may be caused by difficult or traumatic experiences before, during or just after childbirth.
What is postnatal depression?
Postnatal depression is a type of depression which can affect new mums and dads after the birth of a baby. It is quite common; about 1 in 10 parents will develop postnatal depression.
The difference between postnatal depression and the ‘baby blues’
‘Baby blues’ can affect women the week they give birth and can cause new mums to feel anxious, depressed, emotional and tearful. This can be particularly upsetting at a time when mums expect to be enjoying their newborn and settle into their new routine. ‘Baby blues’ are very common, and can happen to anyone – even if the delivery was routine and mum and baby are healthy. Normally, the symptoms go away by themselves after just a few days.
Postnatal depression is different to ‘baby blues’. It can affect both mums and dads, lasts longer and can develop up to a year after a baby is born. Unlike ‘baby blues’, many parents need therapy to get through postnatal depression. If you think you might have postnatal depression, you are not alone and there is support available. If you are worried about your mental health, your doctor should take you seriously and listen to you. Doctors, midwives and health visitors are trained to recognise signs of postnatal depression and can refer new parents for treatment and support.
Causes of postnatal depression
Doctors don’t know exactly what triggers postnatal depression. By nature, birth is a very personal and unique experience and people react differently. Postnatal depression is very common, even if you have had a baby before. There are many organisations that are able to help you. Doctors and midwives are also able to refer a mother/ father to the appropriate services for management where signs of postnatal depression are spotted.
Research suggests that a difficult experience during birth can increase the risk of developing postnatal depression. Parents who experience one or more of the following may be more at risk:
- particularly long or difficult labour
- birth injury to the mother or baby
- traumatic experience during birth.
Birth injuries to mother or baby can be devastating and difficult for new parents to process. They can make it harder to cope, physically and emotionally, in the months after baby is born.
Similarly, a difficult experience during birth and labour can affect parents for a long time. This can happen even if mother and baby are healthy following delivery. For example, a lack of communication from obstetric and midwifery staff can cause worry and stress during a baby’s birth, and make parents feel that they have no control over the situation. In other cases, parents may not be given enough time to bond with their baby after delivery. The circumstances of the baby’s birth, even if there is no physical injury, can have a long-term effect on parents and your caregivers should be aware of this.
Medical negligence can cause postnatal depression, but it can happen during any birth – even if no negligence was present.
Signs of postnatal depression
The NHS lists the following symptoms as possible signs of postnatal depression:
- consistent feeling of sadness or loss of interest in the world
- feeling unable to properly care for the baby
- difficulty bonding with the baby
- lack of energy and persistent feeling of tiredness
- anxiety about the baby.
A full list of symptoms is available on the NHS website.
Postnatal depression can be debilitating. It affects the bond between parents and their new baby. It can also effect relationships within the family unit. Fortunately, it is a widely recognised condition and a lot of help is available. There are a number of charities committed to helping parents with postnatal depression, support groups and therapies available through your doctor. In very serious cases, your doctor may recommend admission to a specialist mother and baby unit.
Recognising the signs of postnatal depression is crucial. New parents should feel confident enough to be open with their midwife, doctor or health visitor about their feelings. Friends and family should also be aware of any unusual behaviour, and encourage parents to talk to their care provider if anything seems amiss.
What is postnatal post-traumatic stress disorder?
PTSD is a serious psychological condition which is caused by experiencing or witnessing stressful, frightening or life-threatening events. PTSD is often associated with situations such as military combat, serious accidents, terrorist attacks and sexual assault. People suffering from PTSD relive the traumatic event and may experience intrusive flashbacks and nightmares about it. Other symptoms include anxiety, insomnia and feelings of isolation and guilt.
Postnatal post-traumatic stress disorder ('PNPTSD') can also be called ‘PTSD (AC)’ – post-traumatic stress disorder after childbirth. It is a term used to describe PTSD which develops because of a traumatic experience during childbirth. It’s a natural reaction to a traumatic experience.
Women with postnatal post-traumatic stress disorder may experience flashbacks of their labour and try and avoid situations that remind them of the experience.
Symptoms of postnatal post-traumatic stress disorder
Every case of birth trauma is different, and the symptoms are very individual and personal.
Possible symptoms of postnatal post-traumatic stress disorder can include:
- feelings of inadequacy and failure
- flashbacks or nightmares about the birth (feeling of reliving the experience) or difficulty remembering parts of the birth
- fear of sex, becoming pregnant again and childbirth (‘tokophobia’)
- problems bonding with the baby
- difficulty breastfeeding
- emotional problems – feeling isolated, depressed or numb.
Women with postnatal post-traumatic stress disorder may feel isolated, and it can be very difficult to talk about what you’re going through. If the baby was born healthy, it’s not uncommon for women to feel as though they should not be feeling this way. Often, this makes the problem worse and can stop women from seeking the support they need.
Birth debriefing if you suffer a traumatic birth experience
If you have a traumatic birth, you can request a debriefing session with the consultant responsible for your care. It’s a chance to ask questions about your care and understand what happened, and why. The session is designed to provide you with answers and help provide some closure after a traumatic experience.
The consultant will go through the events surrounding the birth, and explain why certain decisions were made. The debriefing session can happen at hospital, or once you have been discharged home. It is best to have the session soon after the birth, when you feel able to do so. Some units will offer a debriefing session automatically – but, if you are not offered one, you can request one.
Your partner or family can, with your consent, request a debriefing session on your behalf.
Causes of birth trauma
The Birth Trauma Association lists the following as the most significant causes of postnatal post-traumatic stress disorder:
- mode of delivery: the method used to deliver the baby can be traumatic for the mother. Any type of delivery can be traumatic, and mothers who experience very medicalised or invasive deliveries may be more at risk of birth trauma. This includes invasive procedures such as emergency caesarean sections, inductions and instrumental deliveries (e.g. forceps or ventouse deliveries)
- fear for the mother or baby’s life during delivery: if there is a problem during labour and the mother or baby’s life is at risk it can be a traumatic experience (e.g. if the baby is premature or in distress)
- lack of control during labour: research indicates that it is important for women to feel secure and protected during labour. It can be frightening and traumatic for mothers who experience medical interventions they didn’t plan for, feel they should not have had or didn’t have much information about
- poor attitudes of care team: the way attending staff treat mothers during labour can have a significant impact on their birth experience. Lack of communication, empathy and understanding from midwives and doctors can make labour harder. Such attitudes can contribute to a loss of control, dignity and privacy
- inadequate pain relief: mothers should be able to choose what pain relief they want during labour, without fear of judgement by midwives and doctors. When women do not have access to pain relief, or don’t have all the information about the options available to them, it can contribute to a traumatic birth experience. If the labour is particularly long, painful or the mother feels unable to make her own decisions, this can contribute to a traumatic experience
- lack of support: proper care, and a wider social support network, can contribute to a mother’s sense of protection during and after labour. Without this, new mothers may lack the practical and emotional support they need
- previous traumatic event: research suggests that, if a woman has experienced PTSD before, she may be more likely to develop postnatal post-traumatic stress disorder.
It is important that women feel safe and supported enough to speak out and ask questions about their birth experience. Having a good support network in place can help with this.
Having another baby after a traumatic birth
Lots of women who suffer a traumatic birth have concerns about getting pregnant again. If you are concerned, talk to your doctor or midwife during your pregnancy. If your care providers are aware of your situation, and your feelings, they should listen to you and support you. You may wish to include this in your birth plan, to remind your midwife during the delivery. Mothers who’ve been through a traumatic birth are encouraged not to internalise their emotions, but to share their thoughts and concerns with a midwife or doctor.
Birth trauma claims
Birth trauma can be devastating for mothers and their families, and the consequences can be wide-reaching. Possible consequences of birth trauma include:
- the mother may be unable to return to work
- breakdown of the relationship between the parents
- difficulty bonding with the new baby
- psychological difficulties
- fear of having another child.
Unfortunately, birth trauma can occur as a result of negligent care during pregnancy and delivery. Even if there is no physical harm to mother or child, the circumstances surrounding the birth can be psychologically damaging. If this happened to you, a claim can help provide closure and financial security - for example, if you have been unable to return to work, you may be able to claim for loss of earnings.
If you are concerned about the care you received during your pregnancy, and think it might have caused a problem, talk to our birth injury claims specialists. We’ll listen to what happened, and help you find out what happened during your care.
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