While scrolling through TikTok, I've seen many women share their traumatic birth experiences: an emergency C-section followed by significant blood loss; a home birth turned into an ambulance ride to the nearest hospital; and a seemingly perfect delivery followed by an extremely rare medical condition that resulted in the patient being in a coma for a month.
To some medical providers with years of experience under their belts, these may be familiar stories. In fact, some practitioners may be numb to the complications that can accompany childbirth. But as a medical student, when I hear these stories I can't help but wonder: who is checking in on these women? Is anyone?
(CB-PTSD), the development of PTSD after childbirth, is a recognized phenomenon affecting 4.6%-to-6.3% of women postpartum. It is multiple negative maternal and child health outcomes, including decreased maternal attachment. This isn't too surprising; it's understandable to feel distant from the source of trauma, in this case the baby.
In fact, that's something that makes CB-PTSD so unique. There is a constant trigger in the patient's life: the newborn. Also, society tends to romanticize childbirth, celebrating the arrival of a patient's precious bundle of joy. As a result, the challenges a mother faces when bringing a child into the world are often overlooked.
In routine clinical practice, postpartum patients are screened for postpartum depression at ob/gyn visits that take place in the weeks following childbirth. But what about PTSD, specifically CB-PTSD? Sure, the depression screening questionnaire may capture some of these patients who are experiencing CB-PTSD, but not all of them.
For the few patients who may actually be given a standard PTSD screening questionnaire to fill out, they answer questions based on well-recognized traumatic events, including wars, fires, and physical or sexual assault. The standard PTSD screening questionnaire fails to as a traumatic event, leaving most patients who suffer from CB-PTSD going undetected and untreated.
We're not being specific. We're not asking if these patients are having recurrent nightmares about their birth experiences or flashbacks to the moments in which they had to quickly make critical life-or-death decisions. Instead, we're just letting them continue with their lives, prioritizing their newest addition to the family while suppressing unwanted memories of their traumatic birth experiences.
After a patient delivers her baby and enters the postpartum period, she's seen in the hospital by a medical team for the first few days. We ask the standard questions: How are you feeling? Are you in any pain? Are you bleeding? How's the baby doing? We check to make sure she is physically doing well, but not necessarily mentally. Everyone experiences childbirth differently, and we're missing the opportunity to identify early the high-risk patients who may have found their birth to be traumatic. The sooner we identify these patients, the sooner we can provide help before their PTSD symptoms worsen.
If these patients can be identified in their first few days postpartum, great. If not, we aim to see them at a routine 6-week postpartum visit where we get the opportunity for another assessment. We already screen these patients for postpartum depression. What harm could come from an extra sheet of paper with a that recognizes childbirth as a potential traumatic trigger? And what about collaborating with our psychiatric colleagues to ensure that these patients are connected with appropriate and tailored therapy, as well as medications if deemed necessary?
As an aspiring ob/gyn, I urge providers to keep CB-PTSD in the back of their minds when seeing postpartum patients. There is so much to cover in clinical visits, making it challenging to add something else to the slew of things to discuss. However, addressing CB-PTSD could make a huge difference in how patients process their experiences and ultimately heal. Instead of having to turn to social media as an outlet, our patients should be able to turn to us.
is a fourth-year medical student in the combined MD/Master's in Public Health Program at the University of Miami Miller School of Medicine.