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NICE criticised for 'missed opportunity' with PTSD guidance

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Mothers who suffer post-traumatic stress disorder after giving birth will not be specifically considered in new guidelines by the National Institute for Health and Care Excellence.

NICE said it decided to exclude postpartum PTSD from the scope for its forthcoming review into guidelines for treatment because of “inconclusive evidence” on the success of any specific interventions.

“Many of the 10,000 women a year experiencing postpartum PTSD are not diagnosed and do not receive the treatment they need”

Maureen Treadwell

The move has been criticised by the Birth Trauma Association and the Royal College of GPs, which both made recommendations to NICE that the condition, thought to affect 10,000 new mothers a year, should be considered. NICE is expected to publish new guidance for the treatment of PTSD in 2018.

In its antenatal and postnatal mental health guidance, NICE accepted that women with PTSD resulting from a traumatic birth, miscarriage, stillbirth or neonatal death should be offered a psychological intervention in line with its guidance on PTSD. However, the new guidance will refer back to the original antenatal and postnatal mental health guidance.

Maureen Treadwell, research officer at the Birth Trauma Association, said: “This is a huge missed opportunity for NICE. Many of the 10,000 women a year experiencing postpartum PTSD are not diagnosed and do not receive the treatment they need. Women come to us in despair, not knowing what is wrong with them and unable to find support.

“NICE had the chance to make a real difference by issuing guidance that would enable health professionals to identify and support women who have experienced PTSD after birth, as well as recommending measures that would help prevent women from experiencing PTSD. The omission of postpartum PTSD from the new scope means that a huge group of women will continue to have their condition undiagnosed and untreated.”

“Healthcare professionals need good clinical guidance to help improve the identification and management of post-natal PTSD”

Liz England

The BTA wanted mothers to be treated separately and warned final recommendations for treatments that may be appropriate for other sufferers, such as military personnel, would not be suitable for mothers.

The RCGP also suggested mothers should be considered separately by NICE. RCGP clinical lead for mental health, Liz England, said: “This is very disappointing and the college echoes the sentiments of the BTA.

“Healthcare professionals need good clinical guidance to help improve the identification and management of post-natal PTSD, and the decision taken by NICE to overlook our recommendations ultimately risks having a negative impact on the care our patients suffering from this distressing condition receive.”

“Due to inconclusive evidence we were unable to make a recommendations for any specific interventions”

NICE spokesman

A NICE spokesman said: “We examined the evidence for postpartum PTSD in our recent antenatal and postnatal mental health guidance.

“Due to inconclusive evidence we were unable to make a recommendations for any specific interventions for women with PTSD which has resulted from a traumatic birth, miscarriage, stillbirth or neonatal death.

“Instead we recommended this group should be treated in line with the guideline on PTSD, which is currently being updated.

“The antenatal and postnatal mental health guideline is due to be reviewed in 2018, at which point we will look at all the appropriate evidence that has been published to see if the guideline needs to be updated.”

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