Why ‘It’s Just Postpartum Depression’ Misses the Mark for So Many Mothers: Dr. Sharon Dekel, PhD

Although postpartum depression is the most common side effect of pregnancy–roughly 1 in 6 women will experience a less often studied condition that may be equally common-- post delivery post traumatic stress disorder. 

Dr. Sharon Dekel, PhD is a leading researcher in the developing field of childbirth related PTSD.  Her lab is focused on understanding, diagnosing and treating this regrettably common mental health challeng, and disentangling CB-PTSD from PPD. Diagnosis can be difficult to uncover because many women imagine themselves to be responsible for the natural challenges of labor and delivery; when the delivery doesn’t accord with their wishes, or takes a significant turn–which happens in roughly 20 to 30 percent of deliveries–women tend to blame themselves, and then fail to attend to the trauma and stress that follows them home from that experience. Dr. Dekel’s goal is to more quickly and accurately identify PTSD associated with childbirth, distinguish it from other postpartum mental health challenges, and get help for women who experience it. In our conversation today she talks about why this work is so important: not only does it address a significant source of stress on mothers, but PTSD can have dramatic impacts on the mother child bond, on the child’s development, and on the mother’s willingness to have more children.

Dr. Dekel also talks about her work training large language models to potentially identify PTSD after childbirth based on narrative based stories provided by women who’ve recently given birth.

To find Dr. Dekel's work: https://www.massgeneral.org/doctors/22372/sharon-dekel-tsvetkov

Find Dr. Dekel's Lab here: https://massgeneral.link/DekelLab

Transcript

In recent years, postpartum depression has gotten more attention and well, it should. Something like one in six women encounter this condition during or after birth. What's less well-recognized is childbirth related PTSD. Post-traumatic stress disorder. Although 70% of births in the us are uncomplicated. 

Some 30% involve complications to varying degrees. Almost 2% or something like 60,000 births a year in the U S. Include what's called a quote near miss, which means the mother nearly died in childbirth, but didn't. These kinds of medical encounters, as you can imagine, can come with trauma. And that trauma can be the seed for PTSD. My guest today is working to highlight childbirth related PTSD and to distinguish it from [00:01:00] postpartum depression. Welcome to making sense of pregnancy. 

This show is a new pregnancy reference. 

I'm finding and talking with experts, doing cutting edge work to better understand what we do and don't know about pregnancy and what you can do to better understand your own experience. Each week, I'll be talking to scientists, doctors, and researchers who are trying to uncover the many mysteries that still exist in reproduction, giving you the most current evidence-based way to approach this enormous transition in your life. 

I hope it will become your go-to source for how to make your pregnancy better. Please enjoy my conversation with Dr. Sharon Dekel about childbirth related PTSD. 

Today we're lucky to have Dr. Sharon Deckel on the show. She's an associate professor of psychology at Harvard Medical School and the director of the Postpartum Traumatic Stress Disorders Research Program at Massachusetts General Hospital. She [00:02:00] runs her own lab, the Dekel Lab at Harvard Medical School and at Massachusetts General Hospital as well.

Dr. Dekel, thanks so much for coming on. 

Thank you so much for inviting me. Pleasure to talk to you today. Great. 

So you're doing super important work and we could talk about the, the many, many articles that you have published in depth, but let's just give a broad overview to start. In general, can you describe what your lab is studying?

Sure. 

So we focus on childbirth as a potentially highly stressful, stressful, if not traumatic event. And we're interested in understanding the psychological, biological, and the long term implications on maternal infant bonding and child development, vis a vis exposure to or undergoing a birth trauma.

And we are hoping to better Characterize what we call childbirth with [00:03:00] PTC, so post traumatic stress disorder, a psychopathology that is induced by exposure to a traumatic birth experience, and are in the making of developing novel screening methods to early on detect who is likely to develop PTC of childbirth, as well as novel psychological and biological oriented interventions to ideally prevent.

what I call CBPTC or child birth with APTC. 

Super interesting. And, and as we spoke a little bit before we started taping a long time coming, right? Women have been giving birth for millennia and here we are recognizing that some of those births don't go according to plan in any way, shape or form.

And even if your child survives, there are consequences for the mother, for the birthing person who goes through that experience. Can you tell us how you got interested in the field? 

So, you know, I think it's really [00:04:00] important to emphasize how much it took us and I'm talking about, you know, most of us kind of scientific, , research and then , you know, the implication on clinical care is, is often coming from what is happening in the United States.

And We have been studying and putting attention in routine perinatal care to more recently what it was called I'm sure the audience would know postpartum depression which relates to what we talk about postpartum blues. And of course we know of unfortunately postpartum psychosis, but childhood APTSD is something that has been studied significantly, substantially only in the past years.

And there could be many reasons to this. I think one is as a society, it might be very daunting to think about childbirth as not only stressful events but as a trauma. It's much easier as a society to think about war as a trauma, terrorism as a trauma, unfortunately sexual [00:05:00] assault, but childbirth we think as you know, the, for some people, the peak of the existence of the person who's delivering the baby and the society, like a happy and joyful event.

And I think in this context, there has been maybe intentionally, but also unintentionally some kind of pushback against conceptualizing childbirth as for some people to fall. Could be a traumatic experience. And then what I would say, my more kind of traditional medicine, the focus has been on, , the person is physically healthy, the infant is physically healthy.

So the mental health was not really the focus of attention. This has really changed significantly. Definitely in the U S when it comes to postpartum depression, not yet for postpartum with CPTSD, but we are really in the right direction. And definitely with our lab has been generously supported by the NIH, so I think a lot of things will change eventually.

But what has been going on not that far was really focusing on the more [00:06:00] physical health of the mother and the infant, and if the physical outcomes, were fine, even in the context of a person having a traumatic delivery that there was a clear indication that the life of the child or the mother was at threat.

And it is likely that the person was at high risk for PTSD. This is something that was really not considered. And Yeah, quite shocking to me as somebody who is in the field of mental health, but this is what has been going on until not recently. So to your question,, how did I become interested in studying childbirth, PTC and traumatic events?

I, I have three children, three girls and I think intuitively as I became a mother, I be. Came much more interested in studying women's health and women's maternal mental health. And as I was diving into this field, I observed that most of our understanding is really thinking at least in the past about childbirth and [00:07:00] more in terms of the The process of delivery, which relates to physiological changes and hormonal changes.

And this is how traditionally we thought about postpartum depression as, hormonal, hormonal imbalance. And the more I read the literature And then coming also kind of combined with more clinical cases of people that I saw in prior practice and also people that I studied, I actually observed that people are talking about not so much the process of delivery, but the event of childbirth and potentially an event that is Not simply stressful, but maybe even traumatic.

And then I collaborated with a nonprofit organization postpartum support at the time. They don't, I don't think they actually exist as organization anymore. And together we launched a study survey open , mostly completed by women residing in the U. S. And In this study, certainly, we also collected birth narratives.

So we asked people if I recall correctly, describe your [00:08:00] birth in your own words, something pretty broad. And if there are any stressful aspects also convey them, but it wasn't like, you know, the trauma was very kind of open ended, what I would call like a semi structured interview.

And we collected a lot of these narratives and reading these narratives, In addition to giving what is called the PTSD checklist for DSF 5, which is the PCL 5, which is the I would say potentially the most common validated questionnaire to assess PTSD among combat individuals and those people who are what we have in the VA, kind of the common way to assess for PTSD In the army, we, we saw that people report clear cut PTC symptoms and the questionnaires, the questionnaire asked specifically about symptoms in regard to the childbirth.

This is how we kind of modify the questionnaire and based on people's self reports, that was kind of, clear to me, along with our narratives, that this is not postpartum depression, [00:09:00] but more so a traumatic response that relates specifically to childbirth. And then we I think that was around 20.

Maybe 17 or 2018, we launched a physiological study. So basically, I would say most of the people in the field of PTSD, the general PTSD would argue that physiological reactivity to the reminder of a traumatic event Is the what we could consider the biomarker of PTSD. So people who have PTSD usually present with this, , heightened arousal to the reminder of the trauma.

So we tested a similar paradigm for people who reported by questionnaires. high PTSD in regard to the childbirth experience. So we basically adapted the paradigm was developed to study Vietnam war veterans to study postpartum mothers in our lab at Mass General. And we identified that in our [00:10:00] sample, Women endorse the same physical activity that we know is the kind of altered physiological manifestation of PTSD in regard to war and, you know, and any other traditional traumas, war sexual assault, the same thing was evident among these mothers, I have this vivid recollection of looking at the results that to me, I was, I was really, really, really Kind of shocked to see how much similar alterations exist.

That's kind of level. That's what was for me a validation that indeed. There is a PTSD that relates to childbirth, yeah. It was, that was very it was a, a significant moment for us in the lab to see this is, this is a real condition that is not postpartum depression, because we know that depression and PTSD are highly comorbid, but people could experience PTSD of childbirth.

And we were able to really perform a test that offers very strong validation for a condition that we don't really, [00:11:00] even these days in the U. S. and I know also for my colleagues in Europe, We don't really screen for metronome PTC or CPTC in routine care. There is no recommended treatment and hopefully in future pregnancies, as we talked before, possibly we will see improvement, but we're not there, not there yet.

And , in this study, as we validated the CPTSD, we also , noticed that and this is why I find the PTC of childbirth a very severe disorder. Because like other postpartum psychopathologies, the mental health of the mother could have direct implications on how the mother is parenting the child.

And we know when the, what we call the maternal infant attachment, how the mother provides this emotional bonding and emotional nurturing of the infant is a predictor of child development. And we found using observational data that the mother's level of maternal PTSD [00:12:00] As well as physiological reactivity, heightened reactivity relates to reduce bonding collected by observational data.

So basically, we concluded that the alterations or that kind of, you know, what we call the biological mechanism of CAPTC, which is similar to other PTC forms in this case. The same alterations are possibly mediating the impairment in maternal attachment. So not only are they impacting the, you know, if you, if you're somebody who is easily aroused by threats coming from the outside and where there is always threats, correct?

In our life, it's all about the emotional relation. It's very difficult to have a decent quality of life if this arousal also impairs your ability to, parent the infant in a way that we would consider like what we call a maternal sensitivity, the mother's ability to identify The cues coming from the infant and [00:13:00] to initiate appropriate behavior if that's impaired, especially in the early postpartum, that is very concerning and, , as I communicate with an age, that means to me that the maternal PTC or C BPTC could be a condition that has intergenerational impacts and not only impacting the mother, impacting the next generation, and if the infant is born and the infant themselves becomes a mother, and they have an reduced attachment with their own mom, that means that that's a risk factor for also having problems attaching to their infant when they become adults.

So really the idea of , let's make sure that mothers in the U. S. and, , all over the world, when it comes to their mental health and to the mental health relates to a traumatic delivery, that we're taking good care of our mothers because the implications are huge for our society. 

Amazing.

There's so much in what you said there and I want to break out two separate things. So the first thing is you were talking about how [00:14:00] it has gone undiagnosed and unrecognized for a long time. And if someone clicks on your website, they will see a video of a presentation that you gave to a society about the connection between gestational diabetes and childbirth related postpartum depression, which is super interesting.

And, when you think about it, you can imagine that some significant chemical changes in the mother's body could affect mental health. That connection seems legitimate. And if you have gestational diabetes, there are all these concerns during the pregnancy. So you could see how there might be an attachment there.

But what I wanted to focus on when I watched that video was , your talk was moderated by a person who is an OB, who I don't know at all, but who has the vibe of someone who is, generous and, and warm and just a very decent person and someone you would think of yourself as lucky to have as your OB.

And he said, For years, I watched this happen, the development of PTSD , [00:15:00] in the OR when we saved some child with emergency C section, and I didn't understand why the mother wasn't happy. And I literally choked when I saw that. Cause I thought. You are the best chance for seeing this and identifying it.

You're in the room day after day for so many births, and it doesn't register. , that to me is kind of shocking, and thank God you're in a medical school, because this is our first line, right? I had to pause the video and be like, what did I just see? That's 

a great, When you, when you started talking about this clip,, I was thinking, did you notice what he said at the end?

 I think , from my talk, that might be the most important moment and , this person by the way is definitely somebody very prominent in the field of maternal fetus medicine, which is high risk pregnancies. Yeah. He said it very genuinely.

And I believe that his response echoes the response of other obstetricians to this. In many ways, because obstetricians are not educated in mental health, they're not psychiatrists, [00:16:00] they're not psychologists, it's not their domain. And this has been just not detected, and, and I have to say what happens these days, and I know that from this point, I guess hundreds, if not thousands of women that we studied in the lab, report to us that they are experiencing PTC symptoms after giving birth, but, after giving birth with versus, again, I, I do this equivalent to other traumas, which is very important to, make the comparison that, you know, let's say you, unfortunately have developed PTC symptoms or acute stress response because an unfortunate experience such as sexual assault, often these events are kept very private might not even know necessarily you have PTSD or, it's very difficult to really know what's going on.

 God forbid, but when it comes to CPTD, because CPTD is usually associated with people who have medically complicated deliveries, these women stay in the hospital for several days. So people report to us that as they give birth, they stay in the [00:17:00] postpartum unit for several days, they might even experience nightmares and.

This kind of goes not detected. 

Yeah. 

 Either nobody from a treating team approaches them to really get a sense of what is going on. And I know that it doesn't happen on a routine basis like it does for postpartum depression these days. And what is also unfortunate, and this is again, if we talk about future, future pregnancies, is that people often keep the information private.

They don't want to disclose. There are symptoms as we know, when it comes to mental health, there's a huge stigma. It's very different to say, , I have headache versus I feel depressed or, , I have these nightmares. When it comes to postpartum mothers, I know that people have a concern that if they would report their symptoms, they might be asked, or if not forced, to stay in the hospital.

And in the U. S. If people are hospitalized for a postpartum mental health condition, a psychopathology, usually we're not equipped [00:18:00] enough to have units that also allow the mothers to bring the infant. Or the newborn. So the concern is is if I would disclose my symptoms, then I would need to either gently asked to stay in the hospital or I would be forced to stay in the hospital because they're concerned that I would not be able to take care of my baby, and then I will be separate from my baby so people don't.

These closure symptoms and we know the number one importance to treat mental psychopathology, especially PTSD is early intervention. So early detection resulting in early intervention and. Currently, the detection is not done I find it very unfortunate because again versus sexual assault we don't have access to the survivor here we have access to women, not only do we have access women actually are.

In the postpartum unit for a couple of days, we can even even offer in house treatment. So so many things could be done by , identify people who would like you to develop PTSD and [00:19:00] offering them potentially low cost safe interventions. 

Yeah, I, I totally agree that there is a cultural press not to recognize it because there's so much social media clamor around the beautiful birth with the photographer and I'm in makeup and everything is great and fantastic and you feel ungrateful as a mother if there's any suggestion that not everything is rainbows and unicorns.

But I do think for something as complicated. And multifaceted as birth, it seems silly to imagine there's one response, right? It can't all just be happy. And maybe you had a great delivery and that's fantastic, but the entire process, the transformation of person to parent is so dramatic and involves changes in almost every organ in your body, for sure, including your brain, that it can't all be, it can't all be la la happiness.

One thing that's important that you've touched on a number of [00:20:00] times is this conflation of PTSD and postpartum depression. So how do we tell them apart both on the doctor's side and on the patient's side? How do I know which box I fit into and why is that important? 

 That's a great question.

So PTC and depression can co occur, meaning that we know that people who are exposed to traumatic events, in which some of them develop PTC, often we also see that they endorse depression symptoms. And Sometimes we think about depression as stemming from unresolved PTSD, so there's a trauma, trauma leads to developing PTSD, unresolved PTSD, untreated PTSD could lead to depressive symptoms.

 It's a very important question discussed in the field of PTSD. Are we talking about Co occurring conditions, we know that, that these days when we define PTC, that the PTC by the DSM has a dysphoric cluster. So we also have some overlapping symptoms between PTs and depression.

But overall, these are two different conditions that could co [00:21:00] occur. Maybe they have some kind of shared, biological mechanism that increases risk for both conditions, but there are different conditions. The main way I think about PTZ, not, to say just child PTZ, but in general it is a condition that specifically relates to a traumatic event, meaning that you would endorse intrusive symptoms such as intrusive memories of a childbirth or nightmares so intrusive recollection of childbirth during your sleep, but all these, these intrusive symptoms, either flashbacks, nightmares, intrusive memories, they all relate to the birth event or any other specific trauma.

So the syndromes are tightly linked to a traumatic event. So we have this intrusiveness. This is one cluster of PTC. Then we have the hyper arousal, which is again, very different than depression. So people have a heightened starter response. They would have physiological arousal when something reminds them of in this case, like say childbirth and the [00:22:00] hyper arousal.

Plus the intrusive symptoms, plus the avoidance. So people don't just avoid things in general, but they would avoid any reminders of the trauma. So again, the avoidance is very specific to PTC versus let's say somebody who's depressed, that person might avoid social gatherings because, you know, they're kind of sad, they are withdrawn and inward.

So they might avoid engaging with other people, but avoidance doesn't relate to avoiding any kind of traumatic reminder. So it's different. It's different. So I think for an obstetrician, if I had to ask one question, I would ask, do you have nightmares of your childbirth experience? If people have nightmares of childbirth experience, I would say that's a Strong indicator of potentially endorsing PTSD or at least what we call subclinical PTSD related to childbirth.

Kind of intrusiveness and the hyperarousal. That's kind of the main components of the PTC We don't really see them in depression Although again by [00:23:00] DSM PTC is also defined by a dysphoric cluster, which is called negative alterations in mood and cognitions So people could be less happy, less socially engaged, but That's one of many other symptoms that they would have.

So the dysphoric is like a cluster within the other PTSD symptom constellation. Okay. . 

Yeah. So, so it sounds like there are some symptoms that overlap, but other symptoms that uniquely define PTSD from postpartum depression and with postpartum depression, I'm not familiar with how you would treat PTSD, but I have interviewed many people who work on postpartum depression, and they've suggested Things like new drugs, 

what do you do for PTSD? I'm assuming it's not the same. 

Yes. So you know, interestingly enough, when it comes to PTSD, the first line of treatment is actually psychological therapies, not pharmacological interventions. Antidepressants such as SSRIs are giving for people who present with [00:24:00] PTC, usually these medications help with reducing intrusive symptoms, but SSRIs cannot prevent PTC.

And usually when we talk about treatment for PTC in general, and the same might be true for CPTC, we, recently published a meta analysis paper. In the American Journal of Obstetrics and Gynecology and we find based on our meta analysis, although it's not based on so many RCTs, randomized control studies, because not so much research has been done on treatments for CAPTC, this is what we are actually doing in the lab, is that trauma focused therapies, so interventions that Expose the person either through behavioral approaches or what we call cognitive behavioral approaches different kind of variations that there is a exposure element.

This exposure element is usually something that helps people to extinction fear. So one of the ways we think about PTC in general is that it's a condition in which there is a failure in extinction, the fear. So [00:25:00] people who continue to be afraid of the. traumatic event and its reminder, even when the event has passed.

They can't really extinction the fear and through different ways of exposing them to the trauma or the traumatic reminders that over time, that's a way to reduce the severity of PTC symptoms. And in our meta analysis, we find that different cognitive behavioral approaches especially when they are given within the first potentially postpartum days, so really the first days after people give birth before they endorse the full blown PTSD, by DSM, you would be diagnosed with PTSD only when one more than one month has passed since the traumatic event.

And so if we give these. interventions really before people can meet criteria for PTC. This is likely to significantly reduce their acute stress response and even prevent enduring symptoms, but so suggesting that this would prevent [00:26:00] CEPTC from even developing altogether. We are currently testing in our lab at Mass General under NIH funding a brief psychological intervention.

which uses a narrative approach in which we ask people to providing writing for over several sequential days focusing on the most distressing aspects of their childbirth experience. We use the exposure through narrative writing and we are interested in examining whether writing about the childbirth, and again, it's a very low, relatively low burden, very low cost and safe intervention.

If it's done in the first postpartum days, we ask whether this could actually prevent CEPTSD, and hopefully in a year or two, we'll have the results, and we're happy to share back. So to your question, I think any form of trauma exposed therapy is likely to be the first line of treatment for CEPTSD, and I would argue that the early we [00:27:00] give that intervention we the early, even if we could do it in the first postpartum hour hours, even that would be ideal.

So two things to say about that again. One is that obviously you've interviewed way more people than I have with a specific focus on, on PTSD. But my experience in talking with women about their birth stories is that for people who think that things were done to them rather than for them.

There is much more negative feeling around the birth and a number of people have described what could very reasonably be, be imagined as a traumatic event. They have terrible hemorrhage or something like that, or they get an epidural and they feel paralyzed during the C section, which is, terrifying.

And a couple of people have said the next day, the doctor came to my room and said, That must have been really scary for you. That's not usually how it goes and that in their description Eliminated their the burden of that experience, which I think is so interesting and is [00:28:00] related to your idea about how you internalize that experience and if someone else comes to normalize it for you or say yeah What you went through was really scary.

It has a huge impact one thing I saw In your research, which I thought was super cool, was using AI to identify PTSD from narrative birth stories. Can you talk a little bit about that? 

Sure. So that's something that we ongoing line of research. We were hoping to Secure more funding and and be able to expand this line of research.

But from what we have found so far, we identified using pretty large cohorts of postpartum mothers that if you ask people to generate Stories of their childbirth pretty open ended and these stories are based on maybe at a minimum 30 words. So you need 30 words or more, that would be sufficient using what we call advanced large language models AI models that are able to [00:29:00] convert the words into vectors.

They will be kind of numerical representations. And then we use these vectors and we feed neural network machine learning model. We train the model to identify who has PTC or not. There's always a trained data set and a test data set. So the model, the machine learner will receive, or the AI model will receive, narratives that they do not know.

What is the PTZ status of the person and but just based on the word, the machine is able to classify with relatively high accuracy. We found that whether the person is likely to fall within the PTZ group or not PTZ group based on these 30 something words in their narratives. And I think in our data set, we find that the overall F score, which we can think about the F score as the overall accuracy of the model that was around 80%, the sensitivity, which basically among those who actually have [00:30:00] PTSD, how many people were classified accurately as having PTC based on the narrative words in their narrative, the language generated, that was around 80%.

So that's very promising that based on again, you know, we always want to talk about screening methods as something that is accurate. It's something that is a low burden especially for postpartum people who are handling so many things. And low costs. So our study suggests that these narratives could be used as a pretty robust.

Low burden, low cost feasible screening method that I hope at some point, again, we're hoping to extend and expand this line of research could be implemented in routine care that obstetrician will ask people to,, in writing, generate a story of their birth experience. And that would tell us how, , Likely there are to actually have PTSD and based on this early screening, possibly the second phase would be to people who score high [00:31:00] would meet one on one with a psychiatrist, a psychologist to do more full blown treatment.

psychiatric evaluation, but that would already reduce the burden of evaluating so many people because we know that roughly between 20 to 30 percent of women are likely to experience a traumatic childbirth. And among them around 6 percent overall will have most likely PTSD. 10 percent would have high PTSD symptoms, but not full blown PTSD, and among women who have complicated deliveries, we talk about between 20 to 44 percent are likely to actually have PTSD.

So in the context of medically complicated deliveries, especially what we call severe maternal morbidity, which is often More prevalent among underpresent minority women than the rates of PTC are actually very high 20 percent if we took the more conservative rates one out of five women That's a significant group of people who are likely to develop a [00:32:00] condition that can transform their life Unfortunately in a very adverse way.

So yeah, I don't 

want to oversell this but that seems to me genius in part because it's obviously very hard to screen and people are given Often postpartum surveys the Edinburgh survey for depression and many people that I talked to say Oh, I lied on that because exactly what you were saying I was worried about the implications for taking the baby home and with the baby be taken from me and etc, etc And even if that's not actually what would happen.

It's very hard to convince someone that that's the case So something like this, it's probably more difficult to differentiate PTSD from postpartum depression, although if you had the right kind of keywords that you are waiting to figure out who scores relatively higher in one realm than another, that seems like such a smart and conceivably more accurate way to identify people who actually will need this help in postpartum.

And as you say, postpartum. PTSD has [00:33:00] all these implications for the mother baby bonding and the future of that child if they have birth defects. Themselves and I'm sure I've talked to many people who have previous sexual assault is very much a risk factor for a lot of these conditions and nobody talks about sexual assault and you can imagine like a war veteran who goes and hears fireworks that may remind him or her of, of gunshots.

Pregnancy where you don't have control over your body and over your private parts can very much recall a sexual assault. So that, completely makes sense. So this would be amazing. 

I want to kind of follow up on your comment, which I think is important to really emphasize the severity of this condition.

Again, in comparing It to other trauma, PTC conditions stemming from other traumas that we see in our study during these clinical interviews and also based on questionnaire and analyses [00:34:00] that you know, because PTCs, one of the symptoms is avoidance. People avoid reminders of trauma. That would mean that they could avoid their infant as we talked about the bonding impairment, but also that means that they would likely attempt to avoid Becoming pregnant again, conceiving again.

And, , to me, and of course I'm biased. I'm a mother. It's shocking to me that an unresolved, undetected mental health condition that could be treated would then lead to the person you know, determine their, their decisions of, it's just the, the implications again are enormous.

And, , I know, from all the people interviewed in my lab, we have people who are religious, people who their ability to decide if they want to be pregnant or not might be different than, people affiliated with other socio demographic groups or, cultural groups.

And that means it's for some people, it's like, I would say, okay, you were in combat and now. I will not screen for PTC for you, although I know you're lucky to have PTC because, you were exposed to so much [00:35:00] trauma. And now I'm going to deploy you again, back to exactly the same war zone where you were.

So, I know for a fact that there are people who have undetected PTC, they're pregnant, they're terrified about, their forthcoming delivery, and we, Unfortunately, in our studies, we don't only study the people that's the first time giving birth, but people actually their second time, third time.

And we have people who have PTC in regard to their unresolved PTC in the previous pregnancy and the recent pregnancy and unfortunately unresolved PTC would increase risk for OB complications in forthcoming delivery. And increased risk for also having a kind of a double PTC response. So I don't want to, you know, create panic.

Most people are resilient. Most people actually don't have PTC of childbirth. It's important to remember. But we really need to make sure that we are taking care of mothers who are exposed to birth trauma. So they won't find themselves in the situation that they have to make the decision. Do I want to become pregnant again?[00:36:00] 

And this is really, I would say, One of the, most common implications of the CEPTC, the people say, I wanted to have more kids. I would never put my body and my mental sanity into, in this experience. And I, I decided not to have more kids. I would not do that.

So that's, very sad. And I hope again, With more recognition better screening methods, more interventions, which of course, to me, as a scientist, everything comes from research and more funding, we will be able to find ourselves if we have if we speak in five years from now, that hopefully things will look very different.

Yeah, I mean, there is this whole movement of women who are one and done and usually that's a response to something that happened. And actually in the interest of full transparency, I did not have a difficult birth, but a very very, very challenging pregnancy. Our child was diagnosed with heart block halfway through the pregnancy.

And I would have five kids and I have two because I can't do this again. This is way too stressful, but I [00:37:00] had kids in the early 2000s. So PTSD and childbirth were not even looking at each other. That was not a thing. And , I think your message is hopeful, which is to say, if you have a really challenging birth and this is affecting you, there are things you can do to ameliorate the situation so that you walk into the next birth with a different mindset and you are not carrying this with you.

So I think yours is the solution. Tricky births are going to happen. That's just the nature of the game, but there are things that you can do. So this is the news. So my last question for you is what does the future of childbirth look like in your ideal care model? 

Well, that's, 

We 

need two more hours to talk.

I would say, I think we need to better integrate maternal mental health into routine OB care which I think concretely could look like educating treating team and labor and delivery, I think people care. I work very closely with OB at Mass General.[00:38:00] 

People care, people have good intentions, but people are not necessarily educated the way we are in psychiatry. So I think better educating the treating team potentially. Increasing resources for having more mental health services integrated within OB care, so it would not be the case of the person would go home, then she would, if she had if she's educated if she has the time if she has the insurance.

Yeah, yeah. Yep. Yeah, it's a mess. We don't want it. We want everything to be integrated in one center and MGH, pending funding. If anybody hears us we, are hoping to develop an in house center to treat people who have birth trauma, psychological implications really within the first days postpartum to develop a center that would be able to offer services for free.

So as inclusive as possible. Also, , do people have the necessary insurance to receive the treatment they need? So I think educating the [00:39:00] tweeting team, providing more resources as part of the OB department for mental health services, because currently we, I don't think we have enough.

And I think this is a message for, if we have hopefully mothers, pregnant people, or postpartum people, people should feel entitled to speak up versus thinking something is wrong with me, which I often hear people would say, I betrayed my infant because I didn't have a vaginal delivery.

I'm a loser. , I didn't perform well. So internalizing all the, kind of guilt and shame in words. It's important that people say, well, you know, something bad happened to me. What can I do to, receive the help that I need, that I deserve to receive and feeling okay to ask for help and not to blame yourself in any capacity whatsoever.

That's really not helpful. And in my lab, I have a lot of young usually people identify themselves as, women. And I see about this maternal PTC is a bit of a me too campaign.

Let's make sure our voice is important. We have strong voices. Let's make sure [00:40:00] we are empowered and we are making sure that Postpartum women in general are safe and we advocate to what we deserve and I think it's very hopeful, it's very optimistic, the clip that you saw on my website, I am often invited to speak at maternal fetus medicine scientific gatherings because people are interested in the maternal mental health angle and the childbirth PTC.

So, so we're really in the right direction. It's a matter of time 

that is an awesome final message to leave people with, and if you have money, you don't know what to do with. Direct it straight to the DecoLab so that we can start there, get a model running send it everywhere.

Thank you so much for coming on and sharing some of your research with us. Lovely, lovely talking to you , today.

 Thanks so much to Dr. Deco for sharing some of her amazing research. PTSD became a condition recognized by the medical community in 1980. But PTSD related to childbirth, didn't really make the medical [00:41:00] map until 2015. Part of what's so important about correctly identifying it. Is that it has implications for the mother's life and worldview, just as we recognize that PTSD can affect a soldier's life after they've left the battlefield. It has implications for the bond between mother and baby. And conceivably, even the next generation, if that infant grows up with an attachment issue, they bring to their own pregnancy. And it's important because the treatment for PTSD is different than the treatment for postpartum depression. Here's an idea. 

Let's care for new mothers as if civilization depends upon it. Because in fact it does. Thanks for listening. If you like the show, please share it with friends. We'll be back next week with more amazing research.