Brief psychological interventions can reduce post-traumatic stress symptoms after childbirth

After a childbirth that was traumatic (and/or medically complicated) women can develop post-traumatic stress disorder (PTSD), which poses numerous risks for themselves and their children. Identifying and implementing treatments to reduce the symptoms of PTSD could reduce those risks and make families healthier.

When investigators at Massachusetts General Hospital (MGH) analyzed relevant published clinical trials, they found strong evidence that brief psychological interventions delivered after traumatic childbirth can reduce maternal PTSD symptoms. Their findings are published in the American Journal of Obstetrics & Gynecology.

"PTSD after childbirth occurs in 6% of women and can impair a mother's health and also her ability to provide care for her infant," says lead author Sharon Dekel, Ph.D., director of MGH's Postpartum Traumatic Stress Laboratory and an assistant professor of Psychology at Harvard Medical School. "Recommended treatments for postpartum PTSD are unclear. To provide insights, we reviewed all studies that tested a therapy for postpartum PTSD, with a focus on prevention."

The systematic review and meta-analysis by Dekel and her team included 41 clinical trials (with a total of 4,934 participants) for any type of intervention to prevent postpartum PTSD published through September 2023.

The analysis revealed that the most promising interventions were conventional trauma-focused therapies, which directly focus on processing the traumatic (birth) event, and midwife-led dialogue-based counseling at the bedside.

Also, interventions were more effective when administered in the first days after childbirth, rather than later.

Educational material alone did not seem to help in an event of traumatic childbirth. Some approaches—such as the computer game Tetris, mindfulness-based stress reduction therapy, and mother–infant focused interventions—may be promising but were not thoroughly studied and warrant further investigation.

Research is needed to develop and assess the potential of new treatment strategies in high-risk women to prevent enduring stress symptoms, the researchers say, and also test treatment outcome using objective (biological oriented) measures in addition to patient response.

"We are now testing under a National Institutes of Health award a simple expressive writing approach in which patients reprocess their traumatic experience through writing about childbirth in the very first postpartum," says Dekel.