Cheryl Tatano Beck, DNSc, CNM, FAAN, is a Board of Trustees Distinguished Professor, University of Connecticut School of Nursing and a certified nurse-midwife-having received both her certificate in nurse-midwifery and Master's degree in maternal-newborn nursing from Yale University. Cheryl also holds a Doctor of Nursing Science degree from Boston University and is a fellow in the American Academy of Nursing (FAAN).

Her research into the relationship between maternity care and maternal mental health spans 20 years. She is widely recognized as the leading research expert with over 100 journal articles published on topics such as postpartum depression, postpartum onset of panic disorder, birth trauma, PTSD due to childbirth, and the effects of PTSD following childbirth on breastfeeding.

She has received numerous awards such as the Eastern Nursing Research Society's Distinguished Researcher Award, the Distinguished Alumna Award from Yale University and the Connecticut Nurses' Association's Diamond Jubilee Award for her contribution to nursing research. Currently she serves on the editorial boards of Advances in Nursing Science, Journal of Nursing Education, and the Journal of Nursing Measurement.

It is my honor to introduce Cheryl to the Lamaze International community with a four part interview. In this first installment Cheryl discusses the prevalence rates of PTSD following childbirth.

Walker: What is your sense of the accuracy of prevalence rates for PTSD following childbirth?

Cheryl Beck: The majority of studies across the globe examining the prevalence of PTSD report this rate to be between 1-3%. Most studies only rely on self-report instruments and do not include a diagnostic interview for PTSD. Therefore most are rates of elevated posttraumatic stress symptoms in new mothers.

Walker: Listening to Mothers (2008) reported a prevalence rate of 9% -do you sense it is more widespread?

Cheryl Beck: The Listening to Mothers II (LTMII) U.S. national survey did report that 9% of the sample screened positive for PTSD. We used a self-report instrument, the Posttraumatic Stress Disorder Symptom Scale- Self Report (PSS-SR). The answers provided by the mothers on this scale can be analyzed in a way that can determine if a woman screened positive for meeting all the necessary diagnostic criteria set by the DSM-IV. It does not, however, provide a diagnosis of PTSD. In the LTMII survey we did not ask women whether they had a history of PTSD prior to birth. Therefore it is now known what percent of the sample was experiencing PTSD for the first time or was re-traumatized during childbirth. 18% of the sample did report they were experiencing elevated levels of posttraumatic stress symptoms. I think this reported rate of 18% of mothers suffering with elevated posttraumatic stress symptoms is not over inflated. With the high level of obstetric interventions in childbirth women are more at risk for perceiving their births to be traumatic.

Walker: What are global indications of prevalence rates for PTSD following childbirth?

Cheryl Beck: Research studies are confirming that posttraumatic stress symptoms/ PTSD is an international phenomenon. Studies have been conducted in the U.S., United Kingdom, Sweden, Australia, Israel, Switzerland, Italy, Germany, Canada, the Netherlands, and Nigeria. All of these studies are reporting rates between 1.25% to 14.9%. In my series of qualitative studies on traumatic childbirth and its resulting PTSD I have repeatedly found that it does not matter what continent the birth trauma occurred, the themes are all the same.

Walker: In a large part due to your research, awareness of PTSD secondary to childbirth has greatly increased. What factors need to be addressed in order for PTSD following childbirth to be widely acknowledged in medical, public health, childbirth, and mental health communities?

Cheryl Beck: NIH funding needs to be increased and targeted for PTSD due to childbirth. Curricula in nursing and medical schools need to include information on this postpartum anxiety disorder plus the other postpartum mood and anxiety disorders. Screening for posttraumatic stress symptoms in new mothers needs to be initiated.

In the next installment, Cheryl discusses PTSD screening and resources for childbirth professionals.

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