An overseas study in 2017 found that post-partum PTSD affects 4 per cent to 18 per cent of all new mothers. PHOTO: ISTOCKPHOTO
Having a baby is a cause for celebration, and worth all the sleepless nights. The traditional one-month ceremony and gift-giving underline the significance of the creation of the next generation. Yet, for some mothers, it brings traumatic memories and overwhelming stress.
Take Cheri (not her real name), who had a difficult pregnancy and an emergency caesarean section at 35 weeks. Complications with her infant’s health led to medical and surgical intervention during the birth. Anxious and confused, she was also on her own, as her husband –who travelled frequently for business – was overseas and could not return in time.
After childbirth, Cheri, who had stopped work, received help from her husband and confinement nanny. Cheri’s husband – her main source of support – noticed she easily became anxious, irritable and excessively vigilant around the baby. She often stayed up to monitor the baby despite the nanny’s presence. When she did manage to sleep, she suffered nightmares.
Over time, Cheri withdrew from friends and family. Her self-confidence dipped, and the prospect of returning to work appeared daunting.
Her husband encouraged her to speak to a doctor, who referred her to KK Women’s and Children’s Hospital (KKH), and she came under the care of the Psychosocial Trauma Support Service (PTSS) and was diagnosed with postnatal post-traumatic stress disorder (PTSD).
Cheri explained to us that she had uncontrollable, intrusive memories of the birth that made her worry about her baby’s well-being.
Some may think that having a new baby can make up for a traumatic childbirth experience – but this is not the case for some mums, whose mental health suffers to the point where relationships with family members, or their ability to carry out daily tasks, are affected.
Reaching out for psychological support with a bundle of joy in your arms may not be the norm. But research shows that seeking professional support for post-partum (after birth) trauma can have a positive effect on a woman’s mental health, breastfeeding experience, attachment bond with her baby and the baby’s physical and cognitive development. This message needs to be spread.
Who is at risk of developing PTSD?
Women who have experienced serious complications in pregnancy or at birth, such as preeclampsia (a serious blood pressure issue) or an early birth, may be at a higher risk of developing postnatal PTSD. The traumatic birth experience causes them to suffer significant stress.
It is also possible for women to suffer the condition without realising it, becoming aware only after an assessment with a mental health professional. Personal histories also play an important role.
Women who have had previous traumatic experiences – for instance, physical assault, childhood sexual abuse, or any other type of sexual violence – may be more vulnerable to developing PTSD if childbirth becomes complicated. Fears of childbirth, perceived low social support, poor health, and existing depression in pregnancy may also put women at risk.
An overseas study in 2017 found that post-partum PTSD affects 4 per cent to 18 per cent of all new mothers. There are no known records for rates in Singapore. However, as a dedicated tertiary care service supporting women with PTSD in Singapore, our PTSS team has found the number affected to be low.
Not just mum, but baby affected
Postnatal PTSD affects a woman’s mental, physical and behavioural health. It is said that PTSD can adversely affect the immune and endocrine (hormonal) systems, while increasing the risk of developing smoking, substance abuse and eating disorders.
The Covid-19 pandemic had a significant influence on postnatal mental health issues overseas. Women’s experiences of getting Covid-19, fears of becoming infected while pregnant, and worries about their own health and their infant were suggested to have triggered or magnified PTSD symptoms after birth. And safe distancing measures at healthcare facilities and extensive travel restrictions reduced the level of support for them.
Postnatal PTSD may also affect a child’s development.
Studies have reported links between postnatal PTSD and lower birth weight, as well as sleep difficulties. It has also been suggested that postnatal PTSD may influence a mother’s perception of her infant’s behaviour or needs, which could affect the mother-infant attachment bond during the critical phase of social-emotional development in young children.
What to look out for
While it varies depending on the person, these are the main symptoms:
- Flashbacks (the feeling of “reliving” a traumatic memory), intrusive memories, thoughts and feelings, and nightmares
- Avoiding external reminders such as people, conversations, places, or internal reminders such as memories, thoughts, or emotions tied to the event
- Difficulty concentrating, sleeping, or becoming easily startled, guarded, or becoming hyper-vigilant about their surroundings
- Having negative thoughts or beliefs of self, others, and the future, excessive self-blame or on others, loss of interest and motivation, and low mood.
Postnatal PTSD also affects a woman’s partner. Women experiencing it typically need to juggle managing their symptoms and caregiving demands, which could make it even more difficult to stay engaged with life and with others. This can create tension with their partners.
Often, as partners may not be aware that these symptoms are part of a mental health condition that requires professional support, it may cause further stress and tension in the household.
Reach out as soon as possible
Therapy involves identifying trauma reminders or triggers, learning strategies to cope with these reminders, reducing psychological distress from traumatic memories of the birth and helping women re-engage with loved ones and life in general.
Women who wish to seek treatment at KKH PTSS will first need to be seen by a doctor at KKH.
They should be encouraged to reach out for support with a psychiatrist or psychologist if they have experienced symptoms for more than one month, and if the symptoms are overwhelming their capacity to cope with everyday demands.
Seeking early treatment can help patients recover from traumatic stress symptoms and improve their overall well-being.
By working with dedicated professionals, new mothers can find the strength to face trauma’s shadows, rekindle connections with loved ones, and embrace life’s beauty, particularly the one they have just brought into the world.
Remember, seeking help is not a sign of weakness, but a courageous step towards reclaiming the joys that motherhood holds.
Difference between postnatal depression and postnatal PTSD
Postnatal depression (PND) is a mood disorder that affects one in 10 women who have recently given birth. Typically, PND develops gradually in the first five weeks to a year after childbirth. PND is different from “baby blues” in that women who suffer from the former would experience persistent symptoms on most days that do not seem to get better with time, causing significant impact on a woman’s day-to-day functioning.
PND symptoms include feelings of sadness, tearfulness, or low mood, loss of motivation and interest in things they used to enjoy, feelings of hopelessness, extreme tiredness, difficulties concentrating and making decisions, sleep problems, and having negative feelings towards their baby. These symptoms may result in them struggling to take care of their daily needs and sometimes their baby’s.
A main difference between PND and postnatal PTSD is that women with PND struggle most with persistent feelings of low mood, sadness, and low motivation, while women with postnatal PTSD would typically experience heightened stress or fear or anxiety. Signs of postnatal PTSD also typically surface sooner, around four to six weeks after the traumatic event.
- Dr Ho Yiling is principal psychologist at the Psychosocial Trauma Support Service, KK Women’s and Children’s Hospital.
- Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
- Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)
- Singapore Association for Mental Health: 1800-283-7019
- Silver Ribbon Singapore: 6386-1928
- Tinkle Friend: 1800-274-4788
- Community Health Assessment Team: 6493-6500/1
- TOUCHline (Counselling): 1800-377-2252
- TOUCH Care Line (for seniors, caregivers): 6804-6555
- Care Corner Counselling Centre: 6353-1180
- Counselling and Care Centre: 6536-6366
This article was first published in The Straits Times.