Post traumatic stress disorder post childbirth versus postnatal depression: a guide for midwives
Post traumatic stress disorder-post childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between 1–6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women's social interactions, ability to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond 1 month, a diagnosis of PTSD-PC should be considered. In awareness that there are additional mental health problems that a childbearing woman could encounter, the authors have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and postnatal depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and PND, because diagnoses and treatments differ. Generally, PND is treated with antidepressants and cognitive behavioural therapy (CBT), while PTSD is treated with eye movement desensitisation and reprocessing (EMDR) therapy or emotional freedom technique (EFT). There is potential for a women to develop a dual diagnosis, with partner and family also affected. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment
The transition to motherhood is multifaceted, with many biological, physiological, social and psychological changes occurring simultaneously. Although the majority of women make the transition to motherhood successfully, some experience perinatal mental health problems, as they attempt to psychologically adjust to the radical changes that childbirth and parenting brings. In their primary role, midwives hold responsibility for recognising, assessing, and referring perinatal mental health problems when delivering maternity care to women. Missing or providing an incorrect diagnosis of a mental health problem can have many implications for the woman, infant, and wider family. Perinatal mental health problems are a major cause of maternal morbidity and, in some cases, mortality, with 17% of recorded maternal deaths of UK childbearing women dying directly or indirectly from mental health problems between 2012 and 2014 (Knight et al, 2016). Consequently, the midwife's role is crucial for the initial recognition, referral for diagnosis, and treatment of perinatal mental health problems. This article will focus upon the more commonly experienced conditions of post-traumatic stress disorder (PTSD) and postnatal depression (PND); however, there are many mental health problems that childbearing women can experience.
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