Psychiatric disorders of childbirth
|It has been suggested that Organic prepartum and postpartum psychoses be merged into this article. (Discuss) Proposed since March 2014.|
This entry covers the complications of childbirth (delivery, labour, parturition) itself, not those of pregnancy or the postpartum period. Even with modern obstetrics and pain control, childbirth is still an ordeal for many. Some women fear it so much that they avoid marriage or childbearing (tocophobia) and some have such a dreadful experience that they suffer post-traumatic symptoms for months, or give way to pathological complaining. Occasionally women, who cannot bear the pregnant state, make importunate demands for early delivery. On the other hand, delivery can occur without pain, or while the mother is unconscious. During delivery, and immediately afterwards, dramatic complications are occasionally seen - acts of desperation, delirium, coma, rage reactions or neonaticide. All these complications are explained in detail elsewhere.
The word comes from the Greek tokos, meaning parturition. Early authors like Ideler  wrote about this fear, and, in 1937, Binder  drew attention to a group of women who sought sterilization because of tocophobia. In the last 40 years there have been a series of papers published mainly from Scandinavia. Tocophobia can be primary (before the first child is born) or secondary (typically after extremely traumatic deliveries). Elective Caesarean section is one solution, but psychotherapy can also help these women to give birth vaginally.
Post-traumatic stress disorder (PTSD)
Postpartum PTSD was first described in 1978. Since then over 60 papers have been published. After excessively painful labours, or those with a disturbing loss of control, fear of stillbirth or complications requiring emergency Caesarean section, some mothers suffer nightmares, and intrusive images and memories (‘flashbacks’), similar to those occurring after other harrowing experiences. They can last for months. Some avoid further pregnancy (secondary tocophobia), and those who become pregnant again may experience a return of symptoms, especially in the last trimester. Rates up to 5.9% of deliveries have been reported. There is some evidence that early counseling reduces these symptoms. Enduring symptoms require specific psychological treatment.
- Brockington I F (2006), Eileithyia’s Mischief: the Organic Psychoses of Pregnancy, Parturition and the Puerperium. Bredenbury, Eyry Press, chapter 3.
- Ideler K W (1856) Über den Wahnsinn der Schwangeren. Charité-Annalen 7: 28-47.
- Binder H (1937) Psychiatrische Untersuchungen über die Folgen der operativen Sterilisierung der Frau durch partielle Tubenresektion. Schweizer Archiv für Neurologie und Psychiatrie 40: 1-49.
- Nerum H, Halvorsen L, Sørile T, Øian P (2006) Maternal request for Cesarean section due to fear of birth: can it be changed through crisis-orientated counseling? Birth 33: 221-228.
- Bydlowski M, Raoul-Duval A (1978) Un avatar psychique méconnu de la puerperalité: la névrose traumatique post obstétricale. Perspectives Psychiatriques 4: 321-328.
- Söderquist J, Wijma B, Wijma K (2006) The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynaecology 27: 113-119.
- Adewuya A O, Ologun Y A, Ibigbami O S (2006) Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors. British Journal of Obstetrics and Gynaecology 113: 284-288.