“A third of all women find some aspect of the birth experience difficult, yet few of them know that birth trauma is actually a ‘thing,’” says Rebecca Moore, a perinatal psychiatrist and co-founder of Make Birth Better.

Growing awareness of birth-related PTSD (post-traumatic stress disorder) seems like a recent development, but its reality is not. Fellow co-founder of Make Birth Better and psychologist Emma Svanberg explains, “There is a lack of understanding or acknowledgment from wider society around PTSD after birth. The gap this creates between what a parent is experiencing, and what they feel they should experience, can really increase shame, making it even less likely that someone will seek support.”

“Clinical PTSD and postnatal PTSD are the same, but there is an argument to use a different model for the latter—not least because you may be facing one of your trauma triggers daily with your baby.”

How Do You Recognize Birth Trauma?

The criteria for diagnosing PTSD includes at least one symptom of “intrusion” such as flashbacks, nightmares, and feelings of distress when reminded of the event; one symptom of “avoidance” such as not wanting to think or talk about the event; and at least two changes to mood or behavior such as being jumpy or irritable. You can, however, still be traumatized without meeting all of these criteria.  

Rebecca explains, “A lot of women think this is simply what it’s like to be a new mum, since they have no frame of reference. We all have terrible days with no sleep, but if every day is still the same six months later, that’s different. If any of these symptoms are profoundly impacting your daily life, then ask for help.”

“Trauma is really a spectrum of responses to the birth experience. One woman can have nightmares for a week; another can have them for a month. And others may feel compelled to replay the birth over in their minds for six months.”

Is Postnatal PTSD the Same As PND?

Postnatal depression (PND) can manifest in the weeks after giving birth as extreme fatigue, insomnia, indecisiveness, loss of appetite, and panic attacks. But these symptoms can cross over with those of trauma, as Emma explains, “Typically, if you have PTSD, you become preoccupied with the birth. You cannot stop thinking or talking about it, or you don’t want to talk about it all. It gets complicated when you also experience symptoms of depression.”

“PTSD after birth is frequently misdiagnosed as PND, even though they can go hand in hand. If you can, speak to a qualified professional to differentiate between the two. Diagnosis can be important to make sure you get appropriate support since the therapies recommended for each can be different.”

“A medically complicated birth can have a psychological impact. But, more than that, trauma is in the eye of the beholder. What seems from the outside to be a perfectly straightforward birth can be very distressing for the mother.

Who Is Most Vulnerable to Birth Trauma?

Factors before and after birth can influence whether or not a woman becomes traumatized. Those with a history of trauma, sexual abuse, depression, or other psychological difficulties are more vulnerable. First time mums can be susceptible too. Initial symptoms can also be magnified if insufficient postnatal care or support systems are available.

Emma says, “A medically complicated birth can have a psychological impact. But, more than that, trauma is in the eye of the beholder. What seems from the outside to be a perfectly straightforward birth can be very distressing for the mother. Equally, difficult births don’t always lead to PTSD. It’s down to the subjective experience and how a woman felt at the time — especially how supported she felt. Compassionate, respectful care is what can make the difference between a positive and negative experience.”

Rebecca agrees, “If there was a medical emergency, the mother might think she or the baby will die. Even if this wasn’t the case, it was the mother’s perception of events. What’s more, if medical staff are burnt out themselves, and simply going through the motions, their lack of compassion can be as harmful during childbirth as someone being overtly aggressive. The interpersonal input is therefore as important as the medical. How you’re made to feel; were you “talked to” or “talked about.” The language used could seem impersonal, as if there’s a lack of empathy, and a lot of women struggle to accept that nobody recognized how scared they were.”

Can You Recover From Birth Trauma?

Most women make a full recovery, even from PTSD, although some can experience repercussions during later pregnancies. Treatments vary from medication to diet and meditation. Eye movement desensitization and reprocessing, and cognitive behavioral therapy are also recommended.

The recovery process is as subjective an experience as the trauma itself. Rebecca explains, “It depends on the intrusiveness and severity of the symptoms. Some women just want to tell me their story because they’ve never shared it before. They can talk for two hours straight and that’s enough. I also recommend writing it down.”

Can You Have a Birth Plan for Birth Trauma?

Antenatal care is key in helping mothers to prepare emotionally, says Rebecca, but birth plans can be contentious. “If you get too focused on the plan, you don’t consider the “what if” or the “what next,” which makes it harder to accept when the plan changes. Focus on preferences instead. If you discuss all possibilities, you can state what you would like to happen in each situation. This gives you a sense of control when everything else is out of control.”

Emma adds, “I recommend reading The Positive Birth Book by Mill Hill. And think about what you need in different circumstances, including your worst-case scenario, and how you’d want to be supported if it happened. Discussing this with others—your partner or anyone who will be present at the birth—allows them to advocate for you. Friends and family have to listen, really listen to you, without interjecting or trying to shut down difficult feelings.”

“Plus healthcare professionals, in the main, want to support you in the best way they can. Let them know if you have particular fears or past experiences that leave you feeling vulnerable. Having the support of someone who knows about birth, like a doula, can help if your partner becomes anxious too.”

Rebecca agrees, “Women can lose their voice during childbirth, so involve others who can speak up for you. Continuity of care is often the missing piece. You need those around you who’ve been involved in your antenatal and postnatal preparation, people you can trust and talk to without fear of judgement. Often after a difficult birth women just really want to be heard.”

“I’m pretty clued into mental health, since I’ve been depressed before, so I knew this wasn’t PND, but I thought PTSD was reserved for war veterans or victims of natural disasters, not something as ordinary as childbirth.”

Is the Conversation Changing Around Birth Trauma?

There is growing awareness thanks to campaigns like 2020 Mom, and Emma believes the bravery of those sharing their stories on social media has helped.“I also think the conversation is changing due to the increased number of interventions, such as emergency C-sections, and how overstretched medical staff are. I’d like to see this conversation shifting from the natural v. medicalized birth debate towards something more collaborative. Women, and their partners, need to know they are supported in their choices, whatever their choices may be.”

Give Moms the Last Word

Laura Wood’s birth experience was so fraught with complications that she’s writing a book about it, and her recovery from PTSD. “I came out of the birth experience not really knowing what happened,” she says. “I’ve since been piecing it together like a puzzle. My baby was back to back so I was in labor for four days, in excruciating pain, with an undiagnosed urinary tract infection. I was only intermittently aware of what was happening, which I believe was a form of self-protection. I was in a dissociative state.”

After an attempted forceps delivery failed, Laura had an emergency C-section, after which the care she received fell short. “There was this sense of authority amongst some of the staff, and I just did what I was told.” Laura has since found her voice and is encouraging other moms to do the same. “Sharing my story has been hugely therapeutic. I’m not yet 100 percent, but it’s a process. For weeks after the birth I did everything a new mum should do, but I was on autopilot, literally, the lights were on but no one was home.”  

Laura eventually experienced flashbacks, high anxiety, and nightmares. “It felt like there was an emergency, but I didn’t know what the emergency was. I’m pretty clued into mental health, since I’ve been depressed before, so I knew this wasn’t PND, but I thought PTSD was reserved for war veterans or victims of natural disasters, not something as ordinary as childbirth.” Is birth trauma really so ordinary? “My experience of trauma was extreme,” she adds, “But it illuminates what is actually a common phenomenon.”

Laura is currently crowdfunding the publication of her book, All My Worldly Joy.  

Featured image by Kirstie Perez

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