Can we prevent PTSD after a bad birth?

I wanted to be sure you knew about this systematic review on preventing PTSD after childbirth.1 I also wanted to make sure you understood what the authors meant by primary and secondary prevention.

In health care, there are three “types” of prevention, named of course primary, secondary, and tertiary.  But it may be easiest to think of these as three “timings” of prevention because the difference between them is how far a problem has progressed.

Primary prevention are the things we do before you become sick or injured to prevent it from happening in the first place.  So these are things like educating you about health and safety, ensuring access to clean water and food, seat belts in cars, hand-washing.  Most people don’t think about these as part of health care because most people equate health care with medical care and hospitals. Some primary prevention is performed within the medical system (education, vaccinations), but most of it is done through communities, for example our education system (physical and health education in schools), public health law and regulations (no smoking areas, clean air and water Acts, regulation of hazardous chemicals), and social programs like WIC and SNAP.

Secondary prevention are the things we do to minimize the impact of an illness or injury once it happens.  These are things like screening programs to identify cancers early, education about lifestyle changes to address issues like hypertension, and treatments (like physical therapy) and medications (like insulin) that prevent diseases from causing severe disability or death.

Tertiary prevention are the life-saving things we do when there is an exacerbation of a chronic condition or an injury.

Why is this important? Because the authors of the systematic review found there is no research yet testing primary prevention of PTSD from childbirth.  In other words, even though we know risk factors, we are not testing ways to prevent it from happening – we are not identifying the best ways to care for women who are at risk.  Instead the research is focused on minimizing the impact of PTSD from childbirth after it happens.

Does this mean no one knows anything?  No, midwives and obstetricians learn from experience and share ideas in ways other than journal articles.  But without scientific testing we don’t really know if what we are doing is helping, or if we are just convincing ourselves that it helps. If you have a program you’ve created to work with women at risk for PTSD from childbirth, I’d love to help you find a midwife research team that can help you get the program tested and published so others can benefit from what you’ve learned.

de Graaff LF, Honig A, van Pampus MG, Stramrood CAI. Preventing Posttraumatic Stress Disorder following childbirth and traumatic birth experiences: A systematic review. A. January 2018. doi:10.1111/aogs.13291
Jennifer (Author)