Traumatic birth and post-traumatic stress disorder

Some people have a tough time giving birth and feel traumatised afterwards. Read on to find out what a traumatic birth is, whether you might have post-traumatic stress disorder and how to get support.

Feeling upset or distressed by what happened when you were giving birth might mean you had what’s known as a traumatic birth. Many mums’ traumatic births are linked to medical staff using forceps or a ventouse, induction or poor pain relief. Women can have traumatic births because of very lengthy or short but very painful labours, or an unplanned caesarean (Birth Trauma Association, 2009; Shaban et al, 2013).

Many new mums who have had traumatic births are also recovering physically, for example from stitches and bruising (Birth Trauma Association, 2018a). But not all traumatic births are down to injury during labour. You might feel you were not treated with respect or that your dignity was compromised (Reed et al, 2017).

Emotional trauma

Some mums who feel they weren’t able to make their voices heard during labour can suffer a traumatic birth. Others might feel they were treated in an impersonal way with a lack of information and explanation (Reed et al, 2017; Birth Trauma Association, 2018a). These psychological factors can be more important than the events themselves when a mum considers her birth to be traumatic (Elmir et al, 2010).

It is important that your experience is listened to and that you are able to express how events made you feel, even if others would not feel the same. Often people assume that as long as you and the baby are healthy, you will be happy (MIND, 2013). You’re not alone if you’re finding it difficult to put into words that your experience mattered and had a huge impact on you after a traumatic birth (MIND, 2013; Birth Trauma Association, 2018a).

Impact on birth partners

Birth partners may also feel traumatised after witnessing a distressing event, sometimes even if the mum is feeling well herself (PTSD UK, 2018a). Although there’s not much research into this area, it’s thought that as many as 5% of partners develop trauma symptoms after witnessing a birth (PTSD UK, 2018a).

Partners who witness stressful events and numerous medical procedures during the birth sometimes feel out of control and fearful of what is happening as they aren’t able to help. Read more about support for partners when it comes to a difficult birth here.

Effects of traumatic birth

Traumatic birth affects women in different ways. It can take some time to come to terms with what has happened too (Birth Trauma Association, 2018a).

Many mums find it difficult to bond with their baby to start with as the baby is a constant reminder of the trauma they have experienced (Birth Trauma Association, 2018a). It might also affect relationships with partners (MIND, 2013).

If you notice these symptoms continuing for longer than around four weeks after the birth, then you could be suffering from post-traumatic stress disorder (PTSD) (NHS, 2018). Around 3% to 4% of women will develop PTSD after birth. You’re more likely to get PTSD if you suffered from anxiety or depression in pregnancy or suffered previous traumatic experiences (Andersen et al, 2012). It’s also important to remember that PTSD can develop weeks, months or even years after the birth (NHS, 2018).

Symptoms to look out for

PTSD can affect you in various ways. You might have:

  • intrusive thoughts (unwelcome and upsetting thoughts that are hard to ignore) or images,
  • flashbacks, feeling as if you are reliving events repeatedly,
  • nightmares,
  • physical effects, such as shaking, sweating or problems breathing,
  • reactions that are triggered by reminders of the event, for example seeing a pregnant woman or watching a TV programme that shows a woman in labour (you or others might notice you go out of your way to avoid situations that remind you of the trauma),
  • you may have blanked out parts of the labour or birth from your mind as you find them too difficult to process, which can cause distress and/or
  • irrational thoughts, such as ‘all doctors are bad people’ or ‘it was my fault that my baby was hurt during the birth’.

(Affonso 1977; RCM 2009; PANDAS 2011; MIND, 2013)

Because of the stress of living with PTSD, you or others may notice that you are:

  • felling anxious and fearful a lot of the time,
  • keeping very busy to avoid intrusive thoughts,
  • finding it difficult to sleep,
  • feeling angry, upset, aggressive, irritable or detached,
  • getting involved in destructive behaviours, such as excessive drinking, using drugs or forming a new relationship,
  • not feeling connected to your baby and/or
  • afraid of getting pregnant again.

(PANDAS, 2011; MIND, 2013; Birth Trauma Association, 2018a)

PTSD and postnatal depression

It’s worth remembering that while the symptoms of PTSD and postnatal depression (PND) might be the same, the two illnesses are different. It is important that PTSD is recognised as such and not treated as PND, although the two can go hand in hand (Birth Trauma Association, 2018a).

Getting help and support

Talking

Although talking about what happened can feel like the most difficult thing in the world, it could help you to process the events (RCPsych, 2018). If you feel ready, you might like to consider who you feel comfortable opening up to – it could be your partner, a friend or a relative.

Alternatively, you might feel you would like to talk through what happened with someone who works in pregnancy and birth but is not directly related to the situation. This might be your midwife or GP. They should offer you the chance to talk about your experience and will have spoken to others with similar experiences before (NICE, 2014). So don’t be afraid to talk to them.

A lot of hospitals offer a birth reflections service where you meet with a midwife or maternity support worker to go through your notes and explain the events. This is not about blaming anyone.

Going to a birth reflections service can be useful in terms of understanding why particular decisions were made or certain interventions occurred. Yet although some women find it helpful, it is unlikely to resolve established symptoms of PND or PTSD (Birth Trauma Association, 2018a). It is important that you only do this when you feel ready to, even if this is months or years later (PTSD UK, 2018b).

You might find it useful to contact a support group and gain peer support from others who have experienced PTSD. The Birth Trauma Association or PANDAS are good ones to try.

Learning relaxation techniques

Understanding how to cope with your thoughts and triggers using mindfulness, breathing awareness or meditation could help you to feel calmer (MIND, 2013).

Psychological therapies

The National Institute for Health and Care Excellence (NICE) recommends cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EDMR) to treat post-traumatic stress disorder after childbirth (NICE, 2014). Evidence shows that both of these methods work well.

CBT is a form of talking therapy where you will be encouraged to find ways of coping with the trauma as well as thinking about the traumatic situation in a different way. It is different from counselling in that it focuses on the incident rather than other events in your life (Birth Trauma Association, 2018b).

EMDR practitioners use a combination of eye movements, taps and sounds to retrain the way your brain is processing the memory of the birth (Birth Trauma Association, 2018c).

Medication is not usually given to treat PTSD. But if you are also suffering from anxiety or depression, you may be offered anti-depressants (MIND, 2013).

This page was last reviewed in November 2018

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

The Birth Trauma Association (BTA) is charity that supports women who suffer from birth trauma. The website has lots of information, parent case studies and support.

Affonso DD. (1977) ‘Missing pieces’ – a study of postpartum feelings. Birth and the Family Journal. 4(4):159-164. Available from: https://journals.sagepub.com/doi/abs/10.1177/0894318411419211 [Accessed 22nd November 2018]

Andersen LB, Melvaer LB, Videbech P, Lamont RF, Joergensen JS. (2012) Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review. Acta Obstet Gynecol Scand. 91(11):1261-72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22670573/ [Accessed 22nd November 2018]

Birth Trauma Association (2009) Coping with a difficult birth experience and where to get help. Birth Trauma Association. Available from: www.birthtraumaassociation.org.uk [Accessed 22nd November 2018]

Birth Trauma association. (2018a) The Birth Trauma Association (BTA). Available from:  https://birthtraumaassociation.org.uk/  [Accessed 22nd November 2018]

Birth Trauma Association (2018b) Cognitive behavioural therapy. (2018) Available from:  http:// www.birthtraumaassociation.org.uk/images/Latestleaflets/CBT_leaflet.pdf [Accessed 22nd November 2018]

Birth Trauma Association. (2018c) EMDR. Available from:  http://www.birthtraumaassociation.org.uk/images/Latestleaflets/EMDR_leaflet.pdf [Accessed 22nd November 2018]

Elmir R, Schmied V, Wilkes L, Jackson D. (2010) Women's perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing. 66(10):2142-2153.  [Accessed 22nd November 2018]

MIND. (2013) PTSD and birth trauma. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/ptsd-and-birth-trauma/ [Accessed 22nd November 2018]

NHS. (2018) Post traumatic stress disorder. Available from:  https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/ [Accessed 22nd November 2018]

NICE. (2014) Treating specific mental health problems in pregnancy and the postnatal period. Available from: https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations#treating-specific-mental-health-problems-in-pregnancy-and-the-postnatal-period [Accessed 22nd November 2018]

PANDAS. (2011) Postnatal PTSD or birth trauma. Available from: http://www.pandasfoundation.org.uk/postnatal-ptsd-or-birth-trauma/ [Accessed 22nd November 2018]

PTSD UK. (2018a) Postnatal PTSD in men. Available from: https://www.ptsduk.org/what-is-ptsd/who-is-affected-by-ptsd/post-natal-ptsd-in-men/  [Accessed 22nd November 2018]

PTSD UK. (2018b) What is PTSD? Available from:  https://www.ptsduk.org/what-is-ptsd/post-natal-ptsd/ [Accessed 22nd November 2018] [Accessed 22nd November 2018]

RCM. (2108) Exploring women’s descriptions of distress and/or trauma in childbirth from a feminist perspective. Available from: https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/exploring-women’s-descriptions-of-distress [Accessed 22nd November 2018]

Rcpsych (2018) Post traumatic stress disorder. Available from: https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-traumatic-stress-disorder [Accessed 22nd November 2018]

Reed R, Sharman R, Ingliss C. (2017) Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy Childbirth. 17:21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223347/ [Accessed 22nd November 2018]

Shaban Z, Dolatian M, Shams J, Alavi-Majd H, Mahmoodi Z, Sajjadi H. (2013) Post-traumatic stress disorder (PTSD) following childbirth: prevalence and contributing factors. Iran Red Crescent Med J. (3):177-182. Available from:  https://birthtraumaassociation.org.uk/for-parents/useful-weblinks [Accessed 22nd November 2018]

Further reading

Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. (2015) Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. (4):CD007194. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007194.pub2… [Accessed 22nd November 2018]

 

 

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