Childbirth, pregnancy tied to PTSD, expert says. (Recognition is Low).

NEW YORK -- Pregnancy and childbirth should be added to the list of risk factors for posttraumatic stress disorder and a diagnostic code for traumatic childbirth should be created, according to Dr. Diana Dell.

"Every obstetrician and gynecologist has seen patients with posttraumatic stress disorder related to pregnancy and childbirth, but physician recognition of PTSD--in all patients, including women who have had difficult births--is still low. Nonetheless, there is a growing awareness that a difficult childbirth can result in PTSD," said Dr. Dell, who is a member of both the departments of obstetrics and gynecology and psychiatry at Duke University Durham, N.C.

The potentially traumatizing features of childbirth include extreme pain and loss of control. Whether childbirth is traumatic depends on the individual, she said at a meeting on PTSD and collaborative care sponsored by the PTSD Alliance.

"An emergency C-section may be traumatic for one woman and not for another. As with any trauma, the individual's response to the event and their risk factors for PTSD, such as a previous trauma or psychiatric disorder, poor social support, and a family history of mental illness--and, I would add, a previous traumatic pregnancy or childbirth--determine the occurrence of PTSD," she said.

Women who have traumatic births may not be able to fully articulate the event later on.

"We have a cloak of normalcy with childbirth now. No woman consciously thinks that something traumatic ...