Birth Trauma: Signs, Symptoms, & Treatments

What Is Birth Trauma?

Childbirth is a potentially traumatic event which can lead to the development of post-traumatic stress disorder (PTSD). Several characteristics of this condition include a negative outlook on pregnancy and childbirth, difficulty bonding with one’s newborn, postnatal depression, and a strained marital relationship.¹ The consequences of leaving birth trauma untreated can be extreme due to the high incidence of post-partum depression and even suicide. Suicide is reported to be the leading cause of death during the post-partum period.^2,3

Professionals use the same criteria to diagnose PTSD in those suffering from birth trauma as in patients with other forms of PTSD. This condition is diagnosed following the first 30 days after delivery as is indicated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Women who experienced fear of dying, fear of their babies dying or who had an extremely painful, frightening, or distressing birth experience may be diagnosed with birth trauma.

Women with this condition are similar in some ways to individuals who are diagnosed with PTSD due to enduring traumas such as war, rape, or natural disasters. However, mothers with birth trauma differ in a significant way. Mothers are expected to feel thankful and happy following the births of their children. The feeling of depression, anxiety or postpartum rage is not one that is expected by family, friends, or even the women themselves. This can lead to increased feelings of guilt and shame surrounding their condition.

When Birth Trauma Leads to PTSD

There are things that put some women at increased risk for experiencing birth as traumatic or to go on to develop PTSD following giving birth. Some of these risk factors include a history of trauma. Those with a history of sexual abuse or rape may be triggered by the pain or feelings of helplessness associated with giving birth. Others may be triggered by the internal exams and overall lack of privacy during pregnancy, labor, and delivery.

A history of mental illness makes one more likely to experience birth trauma as well. It is, however, usually the traumatic nature of a birth that leads to a mental illness such as PTSD. There is an actual phobia of giving birth which is called tokophobia. A woman does not have to have given birth to have this condition. This fear is a common reason for women to elect a cesarean section (C-section). The fear of giving birth is generally centered around injury to the baby, damage to the vaginal tract, pain, or death.⁴

How Often Does Birth Trauma Happen?

Between 25-34% of women report that their births were traumatic to them, and approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth.^5,6 Some women who experience their births as traumatic will not go on to be diagnosed with PTSD. These women can and often do still suffer from mild symptoms at that time and can still benefit from professional attention.

Symptoms of Postpartum PTSD

The signs and symptoms of birth trauma are the same as the symptoms of PTSD following any traumatic event. There is a requirement that the symptoms last at least 30 days beyond the experienced trauma. Some of the symptoms can be present to a lesser degree after 30 days, but a diagnosis of PTSD will not be given if that is the case.

The symptoms will cause impairment in one or more areas of the person’s life such as in their relationships, employment, or educational pursuits. There are several categories of symptoms that professionals look for as well including intrusive symptoms (like flashbacks), avoidance symptoms (avoidance of people or places), mood and cognition symptoms (memory, emotions), and arousal changes (disrupted sleep, lack of concentration).

Common signs and symptoms of those who have experienced birth trauma include:

• Intrusive thoughts of the traumatic event(s) which may include the birth or surrounding events.
• Flashbacks of the traumatic events
• Nightmares
• Avoidance or places or events/people that are associated with the trauma
• Heightened arousal (exaggerated startle response, irritability, anger, hyper-vigilance)
• Disrupted sleep
• Anxiety and/or panic attacks
• Depression

Causes of Birth Trauma

Birth trauma is caused by an actual or perceived traumatic event transpiring during the delivery of a child.

Examples of these traumas include:

• An unplanned C-section
• Unplanned hysterectomy
• Long and/or difficult labors
• Ineffective pain management
• Mother experiencing preeclampsia/eclampsia
• Use of forceps or vacuum assisted birth
• Hemorrhage during or after delivery
• Perineal trauma (3rd or 4th degree tearing)
• Prolapsed cord
• Injury during birth for mother or baby
• Baby going to NICU after birth
• Mother not being able to breastfeed
• Other severe medical complications for mother or baby
• Lack of support/communication from medical personnel during or after delivery
• Significant deviation from birth plan
• Significant unplanned medical intervention

The Consequences of Birth Trauma

Trauma is not just an event that took place sometime in the past, it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.³

When recovering from a trauma, the individual not only has to address the physical injuries that may have been sustained during a traumatic birth, but also the emotional impact. These consequences are often more long-term and more difficult to address.

Disappointment

A significant emotional issue that women must address is the disappointment associated with birth trauma. Most have spent months eagerly anticipating the arrival of their babies. Their families have likely helped them plan and celebrate the impending births as well. With each medical appointment, baby shower, decorated nursery, and piece of clothing purchased for the growing child, the woman’s joy grows.

Grief

When a traumatic birth is the result of months of pregnancy, there is a grieving process that must be undertaken on the part of the new mother. This is a difficult task given the new responsibilities of motherhood. These challenges are compounded if she is struggling with depression, anxiety, and feelings of guilt and shame.

Postpartum Depression

25% of those with birth trauma go on to develop postpartum depression.³ There may also be barriers to bonding with the newborn in women who have suffered from birth trauma. This is related to difficulties in separating negative emotions about the traumatic events and the child. The newborn is a reminder of all that the mother has endured. If either the mother or baby was injured or required long-term medical care after the birth, a separation could exacerbate this and/or increase the mother’s feelings of guilt and shame over the incident.

Postpartum Anxiety & Hypervigilance

On the other hand, some mothers may become extremely anxious or overprotective due to fears related to the birth trauma. This pattern of hypervigilance can result in a long-standing parenting style and resulting anxiety disorders for mother and/or child.

Relationship Complications

Traumatic births may have an impact on couples and their relationship. As with most traumatic experiences, a traumatic birth may bring a couple closer together or cause strain in a relationship. Couples may experience sexual difficulties due to the trauma related to fear of another pregnancy or simply due to associated mental health conditions. Counseling will assist couples to address any stress that has been placed on the relationship.

11 Ways to Cope After a Traumatic Birth Experience

Every woman will be different in terms of what their recovery looks like. Some women will return to a version of normal within a few months, while others will require much longer to become symptom-free.

There are some things that women can do to make the recovery process a little less difficult, including:

1. Be Patient

There is no set time for recovering from birth trauma. Just as each birth experience is different, so is the timeline for recovery. There are many variables to consider including a person’s trauma history prior to the traumatic birth experience, whether the mother or baby have physical injuries to recover from, and the types of mental health issues that a mother may have to address following the birth. These variables will impact recovery times. Regardless of the time frame, patience with yourself is key.

2. Garner Social Support

Spending time with family and friends will increase a sense of support and a reduction in stress.

3. Be Kind to Yourself

Showing yourself compassion during the time following a traumatic birth will help to navigate the recovery process. A range of emotions is normal following an experience such as this. Expecting not to feel anger, disappointment, fear, and frustration can lead to self-loathing. Allowing yourself to feel emotions as they come up will help to decrease the possibility of depression and anxiety.

4. Make Time for Self-Care

After a traumatic birth is a time to prioritize self-care. Things such as adequate rest, proper nutrition, and moderate physical activity are important. Any mother will have a period of adjustment after giving birth. If you have experienced a trauma, this is especially true for you. Taking care of your physical and emotional needs is a must so you can attend to the demands of motherhood.

5. Cultivate a Positive Body Image

Women often have negative emotions regarding body image after a birth trauma. Engaging in moderate exercise and relaxing activities such as yoga, stretching, massage, and warm baths will increase positive associations with one’s body. Learning to appreciate your body and treating it in a gentle and loving way is restorative after a traumatic experience.

6. Try Relaxation Techniques & Meditation

New mothers may require some assistance in finding time to relax and ground yourself. If you have experienced trauma, this is important. Whether a short nature walk is your speed or a warm bath while listening to calming music or reading a good book is your idea of a relaxing time, you need to find out what works for you.

7. Reduce or Eliminate Caffeine

Reducing or eliminating caffeine intake will assist you in maintaining good sleep habits and avoiding any negative side-effects such as increased anxiety and stimulation that will interfere with efforts to relax.

8. Make a Complaint

Making a complaint about what took place may serve to bring you a sense of closure or resolution.³ Seeking details about what took place or asking to review your medical records may help to fill in gaps in your memory as well. Improvements in the quality of care may result from your complaint which could help other women and babies. This can be a healing experience.

9. Find Group support

Finding a group of supportive women who have been through similar experiences is often helpful for women that experienced a birth related trauma. Your therapist may be able to provide information regarding a local support group or you can locate one through online searches and directories.

10. Try Couples Counseling or a Couple’s Retreat

Often primary relationships are impacted by traumatic experiences. If your relationship has suffered, couple’s counseling or couple’s retreats may be helpful for you and your partner in the healing process.

11. Make a Childcare Plan

New mothers require breaks for the most routine of activities like showering, eating, and sleeping. Women who have been through a trauma will require even more assistance as they will need time to devote to therapy and additional medical appointments. Self-care is critical and taking time away is needed. Planning for others to assist with childcare for periods of time so that you can take care of yourself is crucial to your recovery.

How Is Birth Trauma Treated?

Many women suffer in silence because they do not share what they are experiencing with loved ones or their doctors. Professional assistance is available and will help the condition resolve much more effectively. Treatment for trauma usually involves therapy, medication, or a combination of the two.

Birth Trauma Therapy

Therapy to address birth trauma is important for improved quality of life for you and those you love. Patients who attend regular therapy appointments often reduce or get rid of PTSD symptoms by learning new coping skills.

Therapy may also help you:

• Improve your understanding of the events surrounding the trauma
• Learn skills to manage negative thoughts and feelings
• Improve relationships that may have been impacted by the birth trauma

Cognitive Behavioral Therapy (CBT)

CBT is strongly recommended for the treatment of PTSD.⁷ CBT focuses on the relationship between thoughts, feelings, and behaviors. A therapist will assist the patient to change patterns of behaviors, thoughts, and feelings that can lead to impaired functioning.

Eye Movement Desensitization and Reprocessing (EMDR)

Trauma-focused psychotherapy, including EMDR, is thought to be one of the most effective types of treatment for PTSD. It is a short-term form of treatment that usually lasts 8-12 sessions. EMDR can help you process upsetting memories, thoughts, and feelings related to the trauma.⁸

Group Therapy

Studies show that group therapy can be an effective treatment for PTSD symptom reduction.⁹ Group therapy is most often used in conjunction with individual therapy and medication. This type of therapy is usually less expensive than other modalities of treatment which can be of benefit to those with financial limitations. For new mothers who are feeling alone or to blame for their birth trauma, hearing that others have experienced similar situations can help to alleviate and normalize these feelings.

Medication

Medications for PTSD are most often prescribed in conjunction with some type of psychotherapy. Each patient should make their choice of treatment based on scientific evidence, their degree of comfort with available options, and consultation with a physician, psychologist, or a licensed mental health professional.¹⁰

Several medications are known to be useful in the treatment of PTSD. Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed to assist with PTSD and other co-occurring disorders such as depression. Examples of some of these anti-depressants are Zoloft and Paxil. They are both approved by the FDA for the treatment of PTSD.

There are others that are commonly used in an “off-label” manner. An off-label use of a medication means that it is being used for an indication other than one for which it was approved by the FDA. These may include medications from different classes including antidepressants, mood stabilizers, and anti-anxiety treatments.

How to Get Help for Birth Trauma

Often the first professional to identify birth trauma or related conditions is a woman’s Midwife, Obstetrician (OB-GYN) or Doula. A referral to a licensed therapist (LPC, LMFT, or PhD) and/or psychiatrist is usually made to begin outpatient counseling as well as medication management if used in conjunction with therapy. If you or a loved one is experiencing symptoms of birth trauma or depression following the birth of a child, speak to your midwife/OB-GYN or make an appointment with a professional counselor. You can locate a qualified therapist through calling your insurance carrier or by using an online therapist directory.

How to Get Help for a Partner

If your partner experienced a birth trauma, she is likely feeling a range of emotions from anxiety, fear, anger, sadness, and depression. She is going to need support from family and friends along with some professional assistance. You can start by checking in with her and asking her if she needs help. You can ask her if she would like you to attend a follow-up appointment with her OB-GYN or assist her to set up a counseling intake with a licensed therapist.

Birth trauma impacts relationships as well. Couples counseling is a helpful support along with individual therapy for family members. This can help loved ones to cope with the stressors involved with witnessing a loved one endure a traumatic event. Partners can utilize their own insurance benefits or attend family sessions along with their spouse or partner. When a loved one seeks out professional assistance, they become better equipped to support the individual who went through the birth trauma.

What’s the Outlook for Mothers & Babies After Birth Trauma?

Despite early bonding difficulties, opportunities for attachment can happen even after two years of age. So, whether mothers are slow to form strong attachments or they form anxious attachments to their babies due to birth trauma, the opportunities are still present. Mothers most often tend to their infants very well despite suffering from birth trauma and struggling to form strong initial attachments.¹¹