During childbirth we often feel intense pain which can cause us to feel out of control and vulnerable. Like most animals, humans have the “Fight or Flight” response. In the face of danger, adrenaline is released in the brain to assist in this response. When one is unable to fight or flee, a feeling of helplessness sets in. Extreme trauma can cause abnormally high levels of adrenaline to be released in to the blood, which appear to inhibit the normal processing of memories. (Turnbull, 1994) In time, any sensation of an adrenaline surge can trigger the individual to relive the original trauma as a flashback.

PTSD is not widely recognized as a postpartum disorder. Women who have been sexually abused or raped in the past or who have a history of PTSD are much more susceptible to developing the disorder than women who have not. Trauma is different for everyone. Two women may go through the exact same experience. One may develop PTSD and one may not. PTSD can occur at any time after the traumatic event.

According to the DSM IV, one must meet the following criteria to be diagnosed with Post Traumatic Stress Disorder (PTSD):

A. The person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND the person's response involved fear, helplessness or horror.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1. Recurrent and intrusive distressing recollections of the event.
   
2. Recurrent distressing dreams of the event.
   
3. Acting or feeling as though the event were recurring (including flashbacks when waking or intoxicated).
   
4. Intense psychological stress at exposure to events that symbolize or resemble an aspect of the event.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the event) as indicated by at least three of the following:

1. Effort to avoid thoughts or feelings associated with the event.
   
2. Efforts to avoid activities or situations which arouse recollections of the event.
   
3. Inability to recall an important aspect of the event (psychogenic amnesia.)
   
4. Markedly diminished interest in significant activities, such as hobby or leisure time activity.
   
5. Feeling of detachment or estrangement from others.
   
6. Restricted range of affect; eg, inability to experience emotions such as feelings of love.
   
7. Sense of a foreshortened future such as not expecting to have a career, more children or a long life.

D. Persistent symptoms of increased arousal (not present before the event) as indicated by at least two of the following:

1. Difficulty in falling or staying asleep.
   
2. Irritability or outbursts of anger.
   
3. Difficulty concentrating.
   
4. Hyper-vigilance.
   
5. Exaggerated startle response.
   
6. Physiological reactivity on exposure to events that resemble an aspect of the event, eg breaking into a sweat or palpitations.

E. B, C, and D must be present for at least one month after the traumatic event.

F. The traumatic event caused clinically significant distress or dysfunction in the individual’s social, occupational, and family functioning or in other important areas of functioning.

Some Risk Factors for developing PTSD include, but are not limited to:

• Managed labour
• Induction
• Poor pain relief
• Feelings of loss of control
• Unnecessary trauma
• Traumatic delivery
• Impersonal treatment, overly professional, stand-offish or judgemental attitude of staff
• Multi handling
• Shift changes
• Lack of explanations
• Feelings of loss of control
• Not being believed or listened to
• Lack of attention to dignity, e.g. no coverings
• True obstetric emergencies
• Invasive procedures without explanations or consent
• Forceps, suturing without adequate analgesia
• Prolonged latent phase - resulting in demoralisation
• Conflicting advice
• Having baby(ies) admitted to SCBU (Special Care Baby or Unit) or NICU (Neonatal Intensive Care Unit)
• Severe postnatal anaemia
• Post Partum Haemorrhage
• Poor postnatal care
• Old trauma
• Unmet need to debrief, review, or to understand what happened
• Emergency Caesarean Section
• Shoulder dystocia
• Poor Postnatal Care
• Postnatal problems

Accurate diagnosis of PTSD is often difficult due to the number of characteristics of the illness. The sufferer may not want to think or talk about the trauma because this means reliving it. Sometimes the mother may not know that her negative feelings, thoughts, and problematic behaviour are linked to the trauma. The longer the person has suffered from untreated PTSD, and the more severe the trauma, the more likely the PTSD will be hidden by Cover-Up Symptoms. This is especially so in the numbing stages of PTSD.

Cover-Up Symptoms:

• Alcohol and drug abuse
• Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
• Compulsive gambling or compulsive spending
• Psychosomatic problems
• Homicidal, suicidal or self-mutilating behaviour
• Phobias
• Panic disorders
• Depression or depressive symptoms
• Dissociation symptoms
• Fainting spells

I encourage each every one of you to see your doctor and a counselor after having a baby, and to tell him/her how you are feeling. Be specific! Something you may think is unimportant may be very important for your doctor to know. You know your body.

This condition improves with treatment. According to The University of Maryland Medical Center, some treatment options include:

Prevention

Early intervention immediately after a traumatic event -- through support groups, psychotherapy, and certain medications -- may help prevent PTSD. Rituals such as prayer or healing ceremonies may be helpful in relieving stress and other effects of the trauma.

Treatment Plan

The treatment for PTSD includes:

• Cognitive-behavior therapy -- With the help of a psychotherapist, you learn techniques to manage your thoughts and feelings when you are in situations that remind you of the traumatic event. You may gradually expose yourself to situations and thoughts that cause anxiety, as you build up a tolerance for them and your fear is lessened. Ultimately, the goal of cognitive therapy is to allow you to control your fear and anxiety.
• Stress management therapy -- With a therapist, you work to learn relaxation techniques that help you overcome fear and anxiety, and to break the cycle of negative thoughts.
• Medication may be used as well.

Drug Therapies

• Antidepressants such as selective serotonin re-uptake inhibitors (SSRIs), including sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), or paroxetine (Paxil).
• Benzodiazepines, a group of medications sometimes used for anxiety, including lorazepam (Ativan) and alprazolam (Xanax). These drugs have sedating properties and may cause drowsiness, constipation, or nausea. Do not take them if you have narrow-angle glaucoma, a psychosis, or are pregnant. They also interact with other drugs, including some antidepressants (such as Luvox).

Complementary and Alternative Therapies

Conventional psychotherapy, such as cognitive behavior therapy, is the main treatment for PTSD. However, several mind-body techniques may be used as supportive treatments:

• Eye Movement Desensitization and Reprocessing (EMDR), in which you move your eyes rapidly from side to side while recalling the traumatic event, seems to help reduce distress for many with PTSD. Doctors aren't sure how it works, but has comparable results to standard treatment. In a study published in the Journal if EMDR Practice and Research in 2007, 89% of patients treated with EMDR no longer had symptoms of PTSD six months after treatment. (Van der Kolk et al. p.7)
• Biofeedback involves using a machine, at first, to see bodily functions that are normally unconscious and occur involuntarily (for example, heart rate and temperature). As you see how your body reacts to stress, you learn to control the reactions, and eventually you can perform the techniques to control the reactions without using a machine. Some studies suggest that biofeedback, among other forms of relaxation training, may be an effective treatment for some people with PTSD.
• Hypnosis has long been used to treat war-related post-traumatic conditions. More recently it has been used in cases of sexual assault (including rape), anesthesia failure, Holocaust survival, and car accidents. Hypnosis induces a deep state of relaxation, which may help people with PTSD feel more safe and less anxious, decrease intrusive thoughts, and become involved in daily activities again. Hypnosis is usually used in conjunction with psychotherapy and requires a trained, licensed hypnotherapist.

Nutrition and Supplements

Although no studies have examined how nutrition can be used to treat PTSD, these general nutritional guidelines may be helpful:

• Avoid stimulants, such as caffeine and nicotine.
• Avoid alcohol.
• Maintain balanced blood sugar to help stabilize mood. For example, eat small, frequent meals that include a small amount of protein. Avoid processed and refined foods.
• Eat whole grains, fresh fruits and vegetables, protein from plants (legumes and nuts, for example) and fish to nourish the nervous system.
• Inositol (18 g per day), a B vitamin that is found in citrus fruits, vegetables, cereal grains and meats, helps the nervous system function properly and may play a role in reducing depression and anxiety associated with PTSD.

Herbs

Herbs are a generally safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your doctor to get a clear diagnosis before you start any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerin extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures singly or in combination as noted.

Although studies using herbs specifically to treat PTSD are lacking, some herbs have been studied for symptoms such as depression and anxiety.

• Kava kava ( Piper methysticum, 100 - 200 mg two to four times per day) may help reduce mild to moderate anxiety, although it has not been studied specifically for PTSD. The FDA has issued a warning concerning kava kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
• Valerian (Valeriana officinalis, 150 mg two to three times per day), sometimes combined with lemon balm (Melissa officinalis) , has also proven effective for mild to moderate anxiety, although it has not been studied for PTSD either. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian also can affect the liver, so do not take it if you have liver problems.
• St. John's wort (Hypericum perforatum, 300 mg three times per day) has been sued to treat mild to moderate depression and may help symptoms of PTSD, though studies are lacking. St. John's wort interacts with numerous other drugs and herbs, and should be avoided when pregnant or nursing. Speak to your doctor before using St. John's wort with any other medications.

The following herbs may help relieve restlessness, nervousness, and anxiety that can be associated with PTSD:

• Passionflower herb ( Passiflora incarnata )
• Ginger (Zingiber officinalis)
• Chamomile (Matricaria chamomilla)
• Catnip ( Nepeta cataria )
• Lemon balm (Melissa officinalis)

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PTSD based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. When being treated with homeopathic remedies, it is possible to experience a brief intensification of symptoms before your condition improves. In the case of PTSD, it is important to have a qualified support team in place to help you handle any worsening of symptoms. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum -- for recurring panic following a traumatic experience. This remedy is most appropriate for individuals who have heart palpitations and shortness of breath which produce a tremendous fear of death. Aconitum is often the first remedy given for trauma, even if the trauma occurred years ago.
• Arnica -- for chronic conditions (such as depression) that occur after a traumatic experience. This remedy is most appropriate for individuals who generally deny that anything is wrong.
• Staphysagria -- for individuals who feel fearful, powerless, or unable to speak up or defend themselves.
• Stramonium -- for anxiety disorders that occur after a shock or traumatic experience involving violence. The individual for whom this remedy is most appropriate tends to be generally fearful and have night terrors.

Acupuncture

Acupuncture may help with symptoms of PTSD, including insomnia, anxiety, and depression. In one case involving a Vietnam War veteran, acupuncture and relaxation with guided imagery reportedly reduced insomnia, nightmares, and panic attacks over a treatment period of 12 weeks. One study for anxiety (not PTSD-related) found that benefits lasted as long as 1 year after treatment. Acupuncturists treat people based on an individualized assessment of the excesses and deficiencies of qi located in various meridians in the body.

More Information about PTSD After Childbirth: