In this installment, Cheryl Beck discusses the importance of screening and education for preventing PTSD after childbirth.
Walker: In your 2006 work with Jeanne Watson Driscoll, Postpartum Mood and Anxiety Disorders: A Clinician's Guide, you recommended clinicians use the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) self-report inventory. What other screening tools do you recommend?
Cheryl: The Posttraumatic Stress Disorder Symptom Scale- Self Report (PSS-SR) is definitely one I would recommend. It is the one we used in the LTMII U.S. national survey. Their psychometrics are quite good. I especially like that you can use Foa's algorithm for determining if a mother meets all the diagnostic criteria for diagnosis of PTSD according to the DSM-IV-TR. The reference for this scale is Foa, et al. (1993). Reliability and validity of a brief instrument for assessing posttraumatic stress disorder (PSS-SR). Journal of Trauma and Stress, 6, (4), 459-473. Ayers modified this scale to focus on childbirth. You can find this modification in Birth, 2001, 28 (2), 111-118. The title of the article is "Do women get posttraumatic stress disorder as a result of childbirth?"
Walker: What are your thoughts regarding childbirth educators, birth and postpartum doulas screening for PTSD as well as perinatal and postpartum mood and anxiety disorders?
Cheryl: I think that childbirth educators and doulas are perfect for providing information to women on the symptoms of postpartum mood and anxiety disorders so that if a mother does start to experience any of these symptoms after birth, she will know to make an appointment with her health care provider. I think it is the role of the professionals, i.e. nurses, physicians, social workers to do the actual screening.
Walker: What resources do you recommend childbirth professionals consider when working with women who have experienced PTSD following childbirth?
Cheryl: My series of qualitative studies on traumatic birth and its resulting PTSD can be used to help mothers understand what they are experiencing and also to let them see that they are not alone in this and that other women are experiencing what they are. Some of the topics I have published articles on are (1) Birth trauma: In the Eye of the Beholder, (2) PTSD: the Aftermath, (3) The Anniversary of Birth Trauma: Failure to Rescue, (4) Impact of Birth Trauma on Breastfeeding: A Tale of 2 Pathways, and Subsequent Childbirth following a Previous Traumatic Birth. My co-author in some of these studies was Sue Watson who founded Trauma and Birth Stress (TABS), a charitable trust located in New Zealand. TABS' website is a valuable reference for both clinicians and mothers regarding traumatic childbirth and its PTSD.
Walker: Do you find more partners expressing their own trauma?
Cheryl: Yes. I am currently conducting a qualitative study with Sue Watson on fathers' experiences being present at their partners' traumatic births. The mothers who participated in my earlier studies on birth trauma were the ones who kept saying, "You should research my husband, he was just as traumatized as I was."
Walker: Given the knowledge of risk factors for PTSD following birth, what would prevention entail?
Cheryl: In international studies the most frequently reported risk factors for PTSD due to childbirth have been high levels of obstetric interventions (i.e. inductions, forceps), lack of caring and support by labor and delivery staff, cesarean birth, prenatal depression, a history of prior counseling, history of prior trauma, and feelings of loss of control during labor. Women can be screened during pregnancy for some of these risk factors such as histories of prior trauma and/or counseling, and prenatal depression. Women should also be screened after delivery for postpartum depression. Research is confirming a comorbidity of postpartum depression and PTSD due to birth trauma. Lowering rates of cesarean birth and decreasing obstetric interventions are also preventive measures. In my series of qualitative studies on traumatic childbirth what came out loud and clear was that women felt there was a lack of caring on the part of clinicians. Women frequently shared that they felt raped on the delivery table with everyone watching and no one offering to help them. Women felt stripped of their dignity. During labor and delivery clinicians need to focus on truly caring for women, making them feel like individuals who deserve respect and to be communicated with.
Walker: What are hopeful treatments on horizon?
Cheryl: EMDR- eye movement desensitization reprocessing is beginning to be used with women who are suffering with posttraumatic stress symptoms due to childbirth. EMDR had been used for a while with veterans coming home from war.
In the next installment, Cheryl shares her insight into the work and life of a researcher.