Birth Trauma and Post Natal PTSD

Birth Trauma and Post Natal PTSD

The experience of childbirth can be complicated and even traumatic. One-third of people who give birth report their childbirth as traumatic and it is now more widely recognised that following a difficult or traumatic childbirth some people may go on to develop psychological problems. However, it is only relatively recently that it has become accepted that they can develop Post Traumatic Stress Disorder (PTSD) or C-PTSD as a result.

The perceptions of childbirth and genuine experiences can vary wildly and so Post Natal PTSD sufferers frequently find themselves very isolated and detached from other mothers who may find it hard to understand how much a bad birth can affect them.
 
In the UK, it is thought that up to 15.7% of people will develop some trauma-related symptoms after childbirth, but it’s estimated that 4–6% of people who give birth develop PTSD following childbirth. This can come through experiencing a number of complications and traumatic situations throughout pregnancy and childbirth such as stillbirth, emergency delivery, cardiac arrest, inadequate pain relief, forceps, post-partum haemorrhage, prolonged painful labour, rapid delivery, severe toxaemia, caesarean or many other serious complications or events.
 
For birthing partners, they will also witness these situations and quite often will feel out of control and fearful of what is happening. They aren’t able to do anything to help and may see a lot of stressful sights, including lots of blood or medical procedures. Although research into this area is limited, it is thought that as many as 5% of partners develop trauma symptoms having been present during the birth. It is a considerably large yet unacknowledged public health problem.

Post Natal PTSD can make sufferers feel lonely and depressed as they often feel they are somehow ‘weaker’ than other people who gave birth because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’ or just ‘be grateful you’ve got a healthy baby’. This may also result in intense feelings of guilt.

PTSD or C-PTSD isn’t necessarily caused by sensational or dramatic events during childbirth or pregnancy but there a complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors such as:

  • You had a very lengthy labour
  • You had a very painful labour
  • You had an assisted birth with ventouse or forceps
  • You had an emergency caesarean section
  • Your baby was born with a disability
  • Your baby spent time in special care
  • You feared for your, or your baby’s life or health, during or after the birth
  • You felt powerless during the birth.
  • Your medical carers were unsupportive or unsympathetic.
  • You’ve had a traumatic event in your past
  • You felt you were not in control
  • There were high levels of medical intervention
  • You felt you were not being listened to
  • You felt a lack of information or explanation
  • You felt a lack of privacy and dignity
  • Your baby was stillborn
  • You experienced poor postnatal care
  • The birth had to be induced

In these scenarios, people who witness their partner’s traumatic childbirth experience may also develop PTSD or C-PTSD as a result.

In addition, research shows that people who had encountered traumatic events before were more likely to exhibit symptoms of PTSD after childbirth compared to those who hadn’t. Research assessing the risk factors associated with childbirth-induced PTSD emphasised the significant role of prior exposure to trauma in predisposing individuals to postpartum PTSD. Notably, the likelihood of developing PTSD following childbirth was found to be elevated for people who had undergone multiple traumatic events, had a history of sexual trauma, experienced trauma during childhood, or had suffered childhood maltreatment.

These findings highlight the influence of past traumatic experiences during the postpartum phase, contributing to an increased vulnerability to future PTSD for people who’ve given birth. Moreover, studies show the pivotal role of resilience as a protective factor against potential PTSD from childbirth. For people at higher risk of developing PTSD, interventions aimed at enhancing resilience have shown to be beneficial.

What is different about Post Natal PTSD and PTSD?

There are many symptoms of PTSD and C-PTSD, but it’s thought that PTSD from a traumatic childbirth has some specific symptoms too

  • revisiting images of labour and birth
  • fear of and avoidance giving birth in the future
  • poor self-image and feeling inadequate
  • relationship difficulties
  • difficulty in feeding
  • lack of interest in, and avoidance of, sex and shunning physical contact
  • difficulty with bonding with your baby, and guilt as a result
  • isolation and loneliness
  • postnatal depression (PND)
  • avoidance of medical treatments like smear tests

While some of these symptoms are very normal following a birth, if they continue for months afterwards, you should consult your GP or midwife.

As one of the characteristics of PTSD is persistent re-experiencing of a trauma, for some Post Natal PTSD sufferers, the new baby could be a reminder of the traumatic birth and trigger flashbacks.  A parent may seek to avoid their baby because of their association with the traumatic birth.

It’s acknowledged that there is some symptom overlap between Post Natal Depression and Post Natal PTSD but the two conditions are different, and therefore need to be treated separately.

Due to the similarity in symptoms, and current lack of awareness of PTSD and C-PTSD, many people who give birth are often misdiagnosed with Post Natal Depression, and therefore treatments are unsuccessful, but it’s key to note that it is not uncommon for people with PTSD to also have postnatal depression too – but the presence of one does not always imply the presence of the other.

Research shows that up to 25% of people who have PTSD could remain undetected because they are also experiencing postnatal depression, so the PTSD goes undiagnosed.

How common is Post natal PTSD?

In the UK, it is thought that up to 15.7% of people will develop some trauma-related symptoms after childbirth, but it’s estimated that 4–6% of people who give birth develop PTSD following childbirth. A number of studies have been done globally to see how common it is for people to experience PTSD after giving birth and the results range. The differences in these numbers are expected to be because researchers looked at the experiences at different times and used different methods to figure out if someone had PTSD.

One study found that overall, around 3.1% of people who have given birth had PTSD, but the number was higher at 15.7% for those who went through to specific situations during pregnancy or child-birth, like complications or emergency surgeries.

People with significant signs of stress from these experiences were found in different studies to be between 9.6% and 27.3%.

What can I do now?

Speak to your GP NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for PTSd and C-PTSD in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).

Read and discuss your labour notes If you have Post Natal PTSD, it would be understandable to have ‘blanked out’ the traumatic aspects of the birth, but going through your labour notes with your midwife can help you understand things better, and give you a fuller picture of what happened.
You should be able to request a copy of your notes from the hospital where you gave birth (likely from the patient services manager or medical records officer).

Use a ‘birth reflecting’ service Many hospitals offer a ‘birth debriefing’ service about six weeks after the birth. It’s important not to worry if you don’t feel ready to talk over your experience for months, or even years – so it at a time that’s right for you.

Speak to your midwife, GP or health visitor Use the home visits from your community or health visitor to ask any questions you may have about how you’re feeling.

Consider making an appointment with your GP who may refer you to a counsellor so you can talk things through with a professional.

If you are having another baby, make sure you get the care that you need Make sure you speak to with your midwife about what happened before, and how it made you feel.

It may be difficult, but try to make a birth plan and get to know the midwives who will be caring for you – having someone you trust at your next birth is likely to be very important to making it a better experience.


For specific support for Birth Trauma, the Birth Trauma Association can help 

Sources
  • Birth Trauma Association
  • Dekel S, Stuebe C, Dishy G. (2017) Childbirth induced posttraumatic stress syndrome: A systematic review of prevalence and risk factors. Frontiers in Psychology.
  • Shaban Z, Dolatian M, Shams J, Alavi-Majd H, Mahmoodi Z, Sajjadi H. Post-Traumatic Stress Disorder (PTSD) Following Childbirth: Prevalence and Contributing Factors. Iran Red Crescent Med J. 2013 Mar;15(3):177-82. doi: 10.5812/ircmj.2312. Epub 2013 Mar 5. PMID: 23983994; PMCID: PMC3745743.
  • Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice, PSYCHOLOGY, HEALTH & MEDICINE, VOL. 8, NO. 2, 2003D. Bailham & S. Joseph
  • How to recover after a traumatic birth
  • Sjömark J, Parling T, Jonsson M, Larsson M, Skoog Svanberg A. A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol. BMC Pregnancy Childbirth. 2018 Oct 1;18(1):387. doi: 10.1186/s12884-018-1988-6. PMID: 30285758; PMCID: PMC6167807.
  • Ertan D, Hingray C, Burlacu E, Sterlé A, El-Hage W. Post-traumatic stress disorder following childbirth. BMC Psychiatry. 2021 Mar 16;21(1):155. doi: 10.1186/s12888-021-03158-6. PMID: 33726703; PMCID: PMC7962315.
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