Prenatal and postnatal patients When we think about post-traumatic stress disorder, it is easy to understand how populations such as veterans or abuse survivors can experience symptoms, but what about less acknowledged traumas? A 2024 study showed that 20% of postpartum patients experience PTSD at 6 weeks (Du et al., 2024). The United States leads the developed world when it comes to negative outcomes for infant and maternal health in correlation to childbirth. Black women share a majority of these negative outcomes. Statistics show that Black women are three to four times more likely to experience complications during pregnancy and childbirth. They are more likely to be overlooked with post-natal mental health conditions and, due to systemic social disparity, have a harder time accessing resources for prenatal and post-natal care (Chambers et al., 2022). Birth trauma is defined as “an event occurring during the labor and birth process that involves actual or threatened serious injury or death to the mother or her infant. The birthing woman experiences intense fear, helplessness, loss or control and horror” (Beck, 2004, p. 28). This definition provides a spectrum of things that could and can go wrong, or perceived danger for mother and baby during childbirth that can result in PTSD. Previous research has demonstrated that approximately 34% of women report a traumatic birth. The emergence of birth trauma seldom stems from a solitary event. Rather, it typically arises from a series of triggering incidents or from experiences that stir up past trauma. While physical events can be the catalyst for birth trauma, the subjective or psychological elements of the trauma often hold greater significance. For instance, two individuals undergoing emergency cesarean (C-section) births may interpret the experience differently due to various factors. As a result, while one may perceive the birth as traumatic, the other may not (Diamond & Colaianni, 2022). Some specific symptoms that accompany birth trauma are: ● Avoidance of reminders of the birth experience. ● Difficulty sleeping. ● Changes in arousal and activity. ● Intrusive thoughts and negative memories. Unfortunately, for new mothers it is incredibly easy for these symptoms to go undiagnosed as PTSD. A new mother is generally too busy and experiencing dramatic hormonal shifts to have normal arousal or activity levels. Most newborn parents experience difficulty sleeping, which could also be due to waking up every two hours with the new infant. Avoidance reminders of the birth experience may be due to PTSD or may be due to the fact that childbirth, even without fear or complications, is a painful and incredibly difficult experience. Intrusive thoughts and negative memories are a clearer sign that the mother may be experiencing PTSD but can also be diagnosed as postpartum depression, and depression as we know is also an accompanying symptom of PTSD. When a postpartum patient comes for a treatment, be sure to offer them the same considerations as you would for instance, a veteran. Clinicians should be providing PTSD and/or postpartum depression as an option on their intake form, providing a safe and comfortable space for them to receive manual therapy, and offer continuous and comforting communication throughout the treatment as you perform manual therapy work. If you notice any concerning symptoms throughout the session, you can talk to the client about reaching out to their primary healthcare provider or psychologist.
A 2019 survey of veterans’ interest in utilizing complementary and integrative health (CIH) interventions, 44% reported using therapeutic massage, 37% use chiropractic care, and 34% engaged in mindfulness. The reasons veterans report using CIH interventions were for pain relief and stress reduction/relaxation (Taylor et al., 2019). Manual therapies can play a useful role in releasing the memory of the trauma from the tissues. Children In 1996, a study examining the use of therapeutic touch to alleviate post-traumatic stress in children worked with sixth grade school students (chosen based on behavioral issues in class and elevated scores on the PTSD Reaction Index). The children who received manual therapy and therapeutic touch reported being happier and less anxious than the control group, and also had lower cortisol levels after the therapy (cortisol is associated with elevated stress levels). Additionally, children showed fewer symptoms of anxiety, and depression, and appeared more relaxed (Field et al., 1996). Child abuse victims In a 2013 study, it was shown that in the U.S. childhood sexual abuse has happened to 16% of men and between 25-27% of women. Of these individuals, 47% will develop childhood physiological disorders, and 26-32% will have adult-onset physiological disorders. The prevalence of childhood sexual abuse (CSA) was found to be the most prevalent in cases where the mother was widowed, single, or divorced. Many CSA survivors will develop physiological disorders, depression, substance abuse, or PTSD due to this unfathomable trauma (Pérez-Fuentes et al., 2013). Because the percentage of the general population that has suffered from CSA is so high, the chances of treating a CSA survivor in your practice also increases. Of course, history of sexual abuse is not something that we ask on a normal intake form as a manual or rehabilitative therapist. Thus, it is critical for therapists to be able to read physical and emotional signs that could indicate a patient may not be comfortable with therapeutic touch or manual therapy. Therapists must be able to adjust the treatment plan and create a safe space for the client to receive therapeutic touch. In essence, when treating someone who may exhibit symptoms of PTSD or even signs of abuse, therapists need to be mindful of their communication and professionalism. Giving this person the safe space to adjust and adapt to manual therapy and therapeutic massage is vital to creating an appropriate therapist-patient relationship. This can include securing privacy, communicating verbally exactly where you are going to have physical touch on the body, working over clothes, and asking permission to perform each technique as you move throughout the session. Every patient is different, and their trauma is unique to them. Therapists should make sure they are informed and prepared to alter the treatment plan if necessary throughout the session.
Self-Assessment Quiz Question #1 Many CSA survivors will develop: a. Anxiety. b. Obsessive compulsive disorder. c. Substance abuse disorders. d. All of the above.
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Book Code: MLA1225
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