Emotional well-being of childbearing women: A review of the evidence

Abstract

Childbirth can be associated with a range of short and long-term psychological consequences. While postnatal depression is the most prevalent psychological condition associated with childbirth, several other disorders such as anxiety and post-traumatic stress disorder (PTSD) can occur but are often neglected in relation to postnatal depression. This paper argues that adverse events during childbirth can act as powerful triggers in the onset of anxiety, posttraumatic stress disorder (PTSD) and subsequently, postnatal depression. This lecture describes these conditions and reviews available evidence in terms of treatment of postnatal depression. Drawing on data gathered during two mixed method, longitudinal prospective studies with childbearing women (n = 800), case studies are used to illustrate the experiences of women during childbirth and the contribution of childbirth practices and postpartum care on subsequent maternal emotional wellbeing. Childbirth events involving life threat and personal injury were found to give rise to trauma reactions. Trauma symptoms in the postpartum period may be missed and their relationship to maternal depression may be overlooked. A review of the research evidence on treatment of PND identified several approaches – (1) pharmacological, (2) psychological; (3) combined pharmacological and psychological; (4) social support and relaxation; and (5) hormonal. The limitations of these studies are presented. It is argued that the efficacy of these treatments has not been clearly established and there is very little evidence available on which to make policy or practice recommendations. Further work in this area is warranted. Health professionals need to acknowledge the unique nature of childbirth for each woman and attend to the emotional aspects of care in order to minimize adverse psychological consequences.