When I started my PhD into maternal and paternal experiences of posttraumatic stress following childbirth, over a decade ago, this was a relatively new area of research. Over the decade previous to this, research and clinical observations had started indicating that whilst having a baby is for many a time of happiness, the labour and childbirth experience itself can, for some, be an incredibly distressing experience, leading to intrusive and upsetting symptoms lasting into the postnatal period. However, at that time, despite emerging evidence, the jury was still out as to whether postnatal trauma, as a result of labour and/or childbirth, actually existed as a ‘diagnosis’ in its own right, or was in fact perhaps a feature of postnatal depression or anxiety.
Fast forward to 2015, over ten years later, and this debate has evolved alongside the substantial growth in research in this field. Evidence indicates that posttraumatic stress following childbirth can occur independently of other postnatal mental health difficulties, and in some cases can have lasting impacts on the mother, infant, and the family. In recognition of the mounting research in this field, this month the Journal for Reproductive and Infant Psychology has published a special issue focusing entirely on posttraumatic stress following childbirth (JRIP, Issue 33, Volume 3).
Given that it is now recognised that some new mothers and fathers may experience these incredibly distressing trauma symptoms, it seems that the clinical and research focus now needs to shift towards what can be done about this. Studies exploring prevention, assessment and treatment of these symptoms and experiences are perhaps lagging slightly behind, and warrant further attention (Ayers, McKenzie-McHarg & Slade, 2015). This special issue includes a paper on a qualitative grounded-theory study I conducted with Dr Helen Pote, exploring first-time mothers’ experiences of postnatal posttraumatic stress. The study aimed to use these qualitative accounts to build a theoretical model of maternal trauma symptoms, which can be used to guide clinical understanding and intervention. Eleven mothers were interviewed about their thoughts, feelings and experiences in pregnancy, during labour and birth, and into the postpartum. All the mothers who took part fulfilled criterion A of the DSM-IV diagnostic criteria for posttraumatic stress (perceived the event to be traumatic), and reported either full or partial trauma symptoms.
Current clinical interventions for postnatal posttraumatic stress are informed by existing and widely used ‘generic’ models of posttraumatic stress, such as Ehler’s and Clark’s (2000) cognitive model. Whilst this model, and others, have been found to be effective when treating trauma symptoms following a range of traumatic experiences, the current study indicated that trauma following childbirth includes other event-specific factors which are important, and should be taken into account when working with women in the postpartum, and when developing clinical interventions. These include the expectations a mother has regarding childbirth prior to and during pregnancy, pre-event anxiety, social support during and after the birth, and perceptions of others’ responses following the birth.
This paper is a first step towards development of a theoretical model of postnatal posttraumatic stress. The model developed in this study may not be applicable to all new parents experiencing these difficulties, due to the very small sample size and the specific focus of the paper on first-time mothers. Further research and exploration is undoubtedly required to test whether this model fits a wider population, including new fathers and parents with previous children. However, it does represent an important step towards helping clinicians conceptualise and provide clinical treatment for new mothers experiencing trauma symptoms at a time when they are also attempting to cope with a number of other competing and important demands, such as adapting to a life with a new-born infant, and developing a positive relationship with their new baby.
You can download a copy of this paper by clicking the link below.
Fast forward to 2015, over ten years later, and this debate has evolved alongside the substantial growth in research in this field. Evidence indicates that posttraumatic stress following childbirth can occur independently of other postnatal mental health difficulties, and in some cases can have lasting impacts on the mother, infant, and the family. In recognition of the mounting research in this field, this month the Journal for Reproductive and Infant Psychology has published a special issue focusing entirely on posttraumatic stress following childbirth (JRIP, Issue 33, Volume 3).
Given that it is now recognised that some new mothers and fathers may experience these incredibly distressing trauma symptoms, it seems that the clinical and research focus now needs to shift towards what can be done about this. Studies exploring prevention, assessment and treatment of these symptoms and experiences are perhaps lagging slightly behind, and warrant further attention (Ayers, McKenzie-McHarg & Slade, 2015). This special issue includes a paper on a qualitative grounded-theory study I conducted with Dr Helen Pote, exploring first-time mothers’ experiences of postnatal posttraumatic stress. The study aimed to use these qualitative accounts to build a theoretical model of maternal trauma symptoms, which can be used to guide clinical understanding and intervention. Eleven mothers were interviewed about their thoughts, feelings and experiences in pregnancy, during labour and birth, and into the postpartum. All the mothers who took part fulfilled criterion A of the DSM-IV diagnostic criteria for posttraumatic stress (perceived the event to be traumatic), and reported either full or partial trauma symptoms.
Current clinical interventions for postnatal posttraumatic stress are informed by existing and widely used ‘generic’ models of posttraumatic stress, such as Ehler’s and Clark’s (2000) cognitive model. Whilst this model, and others, have been found to be effective when treating trauma symptoms following a range of traumatic experiences, the current study indicated that trauma following childbirth includes other event-specific factors which are important, and should be taken into account when working with women in the postpartum, and when developing clinical interventions. These include the expectations a mother has regarding childbirth prior to and during pregnancy, pre-event anxiety, social support during and after the birth, and perceptions of others’ responses following the birth.
This paper is a first step towards development of a theoretical model of postnatal posttraumatic stress. The model developed in this study may not be applicable to all new parents experiencing these difficulties, due to the very small sample size and the specific focus of the paper on first-time mothers. Further research and exploration is undoubtedly required to test whether this model fits a wider population, including new fathers and parents with previous children. However, it does represent an important step towards helping clinicians conceptualise and provide clinical treatment for new mothers experiencing trauma symptoms at a time when they are also attempting to cope with a number of other competing and important demands, such as adapting to a life with a new-born infant, and developing a positive relationship with their new baby.
You can download a copy of this paper by clicking the link below.
| Postnatal posttraumatic stress: A grounded theory model of first-time mothers’ experiences. Iles & Pote (2015) |
Author: Jane Iles
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