What is birth trauma?

When we talk of birth trauma, we mean Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. We also include those women who may not meet the clinical criteria for PTSD but who have some of the symptoms of the disorder.

PTSD is the term for a set of normal reactions to a traumatic, scary or bad experience. It is a disorder that can occur following the experience or witnessing of life-threatening events. We usually recognize these as things like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. However, a traumatic experience can be any experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby) so it is now understood that Post Traumatic Stress Disorder can be a consequence of a traumatic birth.

Characteristic features of PTSD include:

• An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
• A response of intense fear, helplessness or horror to that experience.
• The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
• Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
• Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time).

It is important to remember that PTSD is a normal response to a traumatic experience. The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are beyond the sufferer’s control. They are the mind’s way of trying to make sense of an extremely scary experience and are not a sign individual ‘weakness’ or inability to cope.

Who gets Birth Trauma?

Birth trauma is in the eye of the beholder’
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)

It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person. For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.

Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD which include a very complicated mix of objective (e.g. the type of birth) and subjective (e.g. feelings of loss of control) factors.

They include:

• Lengthy labour or short and very painful labour
• Induction
• Poor pain relief
• Feelings of loss of control
• High levels of medical intervention
• Traumatic or emergency birth, e.g. emergency caesarean section
• Impersonal treatment or problems with the staff attitudes
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby’s safety
• Baby’s stay in SCBU/NICU
• Poor postnatal care
• Previous trauma (for example, in childhood, with a previous birth or domestic violence)

In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support. Also men who witness their partner’s traumatic childbirth experience may also feel traumatised as a result.

What is different about Post Natal PTSD?

It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as childbirth can be traumatising but it has been clear for many years that women can suffer extreme psychological distress as a consequence of their childbirth experience for a complex variety of reasons which are frequently related to the nature of delivery. Unfortunately, the difference between the common perception of childbirth and some women’s experience of it means that women who suffer Post Natal PTSD symptoms frequently find themselves very isolated and detached from other mothers. They also find themselves without a voice in a society which fails to understand the psychology of childbirth and which therefore expects mothers to get over their birth experience very quickly.

Consequently, women affected by Postnatal PTSD often find that there is nowhere to turn for support because even other mothers, who have not had traumatising births, can find it hard to understand how affecting a bad birth can be. This can make sufferers lonely and depressed as they often feel they are somehow ‘weaker’ than other women because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’. They may feel incredibly guilty as a result.

This is a terrible burden for women to shoulder and one which profoundly affects their lives.

The nature of PTSD means that constant ruminating on the birth experience is beyond the sufferer’s control but this is constantly misunderstood, even by health care professionals. Unfortunately, for women suffering from Postnatal PTSD, their detachment from others and the lack of support provided to them can mean that relationships with friends and family may deteriorate. For example, many women end up feeling torn between their desire for more children and their determination to avoid another pregnancy. They may also lose interest in sex and these problems can place a great strain on relationships.

Worryingly, it is suggested that women may also try and avoid medical treatments like smear tests.

For many women, their greatest concern is the day to day difficulties they encounter bonding with their baby who may be viewed as a constant reminder of the trauma they have experienced.

Isn’t this just Post Natal Depression?

No. PTSD can overlap with Post Natal Depression (PND) as some of the symptoms are the same, but, the two illnesses are distinct and need to be treated individually.

Unfortunately, because awareness of this issue is generally poor, many women are wrongly diagnosed with Post Natal Depression and are prescribed medication that may do little, or nothing, to help their situation. Women tell us that they are frequently told by their health care professionals that they should try and ‘move on’ with their lives or that they should just be grateful that they have a healthy baby. Unfortunately, this type of reaction shows a gross misunderstanding of the nature of Post Natal PTSD and may actually exacerbate the feelings of guilt and isolation that women already feel. Women may then end up with prescriptions for anti-depressants, simply because doctors do not understand the disorder.

Depression can go hand in hand with Postnatal PTSD

However, it is important to note that depression can go hand in hand with Postnatal PTSD, so not everyone is misdiagnosed. If you have been prescribed anti-depressants, this may well be an appropriate course of action for your particular circumstances. If you are concerned about this issue in any way, you must speak to your health professional (e.g. GP or Midwife) for further advice. Please show them a copy of our leaflet if they appear to be unaware of Post Natal PTSD or the fact that it requires specialised treatment.

© Reproduced with permission 2010