Mothers who experience childbirth-related post-traumatic stress disorder may have more trouble bonding with their children up to a year after giving birth, according to a new analysis from Pennsylvania State University researchers.

The findings, published in the Journal of Psychosomatic Research on March 17, showed that Pennsylvania mothers who experienced PTSD after giving birth were twice as likely to score in the bottom third of child bonding evaluations. Of the more than 3,000 first-time mothers who were tracked as a part of the study, 7.5% reported symptoms of PTSD. The data was collected from new mothers who gave birth between 2009 and 2011. 

Kristen Kjerulff, a lead author on the paper and a professor at Penn State's Department of Public Health Sciences who has studied women's health for around 30 years, said the way hospital staff in the United States treat mothers could play a role in the alarming trauma rates. 

"Once you have your baby, the moment that baby's out, the mother is kind of ignored or criticized," Kjerulff told The Academic Times. "The woman should be rewarded, and there should be some comfort and support from the nurses and the staff and the physicians. But there isn't anything like that in US hospitals."

Kjerulff's findings are consistent with a 2017 study, which found that two-thirds of mothers with  childbirth-related PTSD, referred to as CR-PTSD, reported distressing or dismissive interactions with hospital staff as the biggest factor that led to long-term trauma. 

In the Penn State study, other factors that contributed to the development of CR-PTSD included "maternal-reported complications, unplanned cesarean delivery, and hospital length of stay of four days or more for the mother and the newborn." Unlike prior investigations into pregnancy-based trauma, the study found that mothers who have a fear of childbirth are no more likely to face PTSD than those who don't. 

Researchers are still exploring ways to prevent CR-PTSD, but they've speculated that skin-to-skin contact, debriefings with health care workers and psychological interventions could play a role in limiting the traumatic effects of a pregnancy. One 2018 meta-analysis of 13 studies found that expressive and reflective writing was the most successful technique for preventing CR-PTSD.

The seconds after delivering a baby are an especially vulnerable time for a mother who has endured a traumatic pregnancy, researchers say. Meanwhile, CR-PTSD may be avoidable, even when a mother has endured a traumatic childbirth, if health care workers are able to promptly respond to her concerns.

"It's those first few moments after delivery that are the strongest predictor of the development of PTSD after childbirth," Kjerulff said. "And PTSD is a psychological response that sort of happens over the course of weeks, even months after the traumatizing event."

A mother's traumatic experiences can also alter her parenting style, Kjerulff noted. For some mothers, interactions with a child may serve as a reminder of traumatic childbirth experiences and could result in less concern about a child's health and well-being.

The CR-PTSD paper was part of the First Baby Study, a long-term investigation into the effects of first-time childbearing that has so far resulted in over 30 publications that add new perspectives on the health outcomes of mothers and their children following pregnancy. 

In future studies, Kjerulff intends to explore whether traumatic childbirth experiences play a role in the higher rates of maternal mortality seen in the United States compared to other developed nations. The risk of maternal death is particularly high for Black mothers, who are more than three times as likely to die during childbirth compared to white mothers, according to the CDC.

Postpartum depression is a well-established diagnosis among obstetricians, and women are often screened for symptoms of the disorder in follow-up appointments after giving birth. But because CR-PTSD is not yet well established in the medical field, mothers with the disorder are less likely to be diagnosed or treated. With no explanation for their symptoms, some mothers may feel further isolation and stigma while living with PTSD.

But Kjerulff said there is reason to believe that CR-PTSD will become a larger part of the conversation, as obstetricians become more familiar with the ways to identify and treat mothers who are experiencing the disorder.

"It's the obstetricians that can really change things and improve things for women in childbirth in the US," Kjerulff said. "I was really glad to see that there's starting to become some interest in that."

The study, "A prospective cohort study of post-traumatic stress disorder and maternal-infant bonding after first childbirth," published March 17 in the Journal of Psychosomatic Research, was authored by Kristen H.Kjerulff, Kristin K.Sznajder, and Laura H.Brubaker, Pennsylvania State University, and Laura B.Attanasio, University of Massachusetts Amherst.