Therapy after traumatic childbirth may protect against PTSD symptoms

Key takeaways:

• Combined secondary preventions moderately reduced childbirth-related PTSD symptoms vs. usual treatment.
• Trauma-focused therapy and psychological counseling significantly reduced childbirth-related PTSD symptoms.

Brief psychological therapies delivered soon after traumatic childbirth may provide an opportunity to protect against childbirth-related PTSD symptoms, researchers reported.

“Childbirth-related PTSD has unique attributes that support the potential for early intervention and even prevention. The symptoms ensue after a specified time-defined event, indicative of a clear onset, and usually during maternity hospitalization stay,” Sharon Dekel, PhD, assistant professor of psychology in the department of psychiatry at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “Hence, there is access to exposed individuals, unlike after most other traumas. The biological underpinnings and proposed pathophysiology of PTSD suggest that in the period after exposure to a traumatic event and before the full manifestation of the disorder, there is a window in which biological and psychological processes can be promoted that can prevent or reduce over-consolidation of the traumatic memory.”

For a systematic review and meta-analysis, Dekel and colleagues searched various health-related databases and identified 41 studies published from inception to September 2023. All studies evaluated any type of therapy for childbirth-related PTSD and tested brief psychological therapies, including debriefing, trauma-focused, memory consolidation/reconsolidation blockage, mother-infant focused and educational interventions.

Of the studies, 32 were randomized controlled trials and nine were nonrandomized trials. Twenty-four studies targeted secondary prevention to protect against childbirth-related PTSD usually after traumatic childbirth, 14 studies targeted tertiary preventions for new mothers with probable childbirth-related PTSD and three studies targeted primary prevention during pregnancy.

This study, published in the American Journal of Obstetrics and Gynecology, demonstrated that combined randomized secondary preventions moderately reduced childbirth-related PTSD symptoms compared with usual treatment (mean difference = –0.67; 95% CI, –0.92 to –0.42). Within 96 hours postpartum, single-session interventions were also helpful in reducing childbirth-related PTSD symptoms (mean difference = –0.55; 95% CI, –0.91 to –0.18), but were not statistically different from multiple-session interventions.

Brief trauma-focused psychological interventions (mean difference = –0.95; 95% CI, –1.5 to –0.4) and semi-structured midwife-led dialogue-based psychological counseling (mean difference = –0.91; 95% CI, –1.61 to –0.21) had the largest impact on reducing childbirth-related PTSD symptoms.

Other treatment options, such as mindfulness and mother-infant focused interventions, require more research in childbirth-related PTSD, the researchers wrote.

Tertiary preventions demonstrated smaller effects on reducing childbirth-related PTSD symptoms compared with secondary prevention (mean difference = –0.37; 95% CI, –0.6 to –0.14).

“Ultimately, advances in neuroscience will likely provide a clearer picture of the mechanisms of childbirth-related PTSD to inform personalized medicine approaches rather than ‘one size fits all,’” the researchers wrote. “However, before this can take place, providers are encouraged to consider on a case-by-case basis the available psychological treatment options to lessen maternal psychological burden after traumatic childbirth.”