Intended for healthcare professionals


Post-traumatic stress disorder may follow childbirth

BMJ 1996; 313 doi: (Published 28 September 1996) Cite this as: BMJ 1996;313:774

Post-traumatic stress disorder is an under-recognised complication of difficult childbirth and can be caused by insensitive obstetric care, according to a consultant psychiatrist.

Dr Fiona Blake from the John Radcliffe Hospital in Oxford told a multidisciplinary conference on childbirth held at the Royal Society of Medicine last week that women who have had a difficult birth experience can fall prey to a syndrome similar to that described in Vietnam war veterans.

Dr Blake said that women may suffer lasting distress, as well as symptoms such as flashbacks, depersonalisation, and hypervigilance, and the delivery need not have been abnormal from the clinician's perspective for the syndrome to occur. “The long term consequences for the woman, her child, and her family can be disastrous. What is routine to an obstetrician may be extremely distressing for the mother. Obstetricians are often simply unaware of the distress they have caused,” she said.

Mrs Helen Allott, consultant obstetrician at the Royal Berkshire Hospital, runs a post delivery stress clinic, where she sees some women suffering such a sense of violation after a psychologically traumatic delivery that they are unable to contemplate smear tests, future pregnancy, or even a sexual relationship with their partner. “Some have aborted much wanted pregnancies because they were unable to deal with the idea of another delivery,” she said.

In a study of 500 consecutive women volunteers Dr Janet Menage, general practitioner and counsellor, found that one in five women reported having found an obstetric or gynaecological procedure “very distressing” or “terrifying.” Of the women she studied, 1.5% fulfilled the criteria for a diagnosis of post-traumatic stress disorder.

The degree of distress was less related to any specific procedure (such as forceps delivery) than to factors such as lack of consent for interventions, inadequate information, feeling ignored or powerless, hostility on the part of clinical staff, and the degree of physical pain experienced.—SANDRA GOLD-BECK-WOOD, BMJ


Obstetricians may not be aware that a birth has been distressing for the mother