Birth Trauma

Often, when we think of birth, we think of this magical moment, where exhausted yet ecstatic parent(s) gaze lovingly at a tiny newborn nestled on the birthing person’s chest, pink and blue hat and all. This is often the picture that makes it onto social media, perhaps with some gentle editing to soften the messiness of birth and new parenthood. What you don’t see, or think about, is the physical and emotional intensity of the previous hours or even days. Behind the smiles may be one, or more, overwhelmed nervous system that has been pushed beyond its capacity to adaptively process the experience it just went through. Others don’t have the opportunity to take that picture, because baby was whisked away by a NICU team, or the birthing person needs medical intervention.

Research has shown that around 1 in 3 births are experienced as traumatic. One systematic review of studies on postpartum PTSD found that 5-8% of birthing persons met criteria for PTSD at 1-3 months after birth, while 9.6-27.3% reported clinically significant symptoms. Further, 1.2% of fathers are reported to experience postpartum PTSD.

As a therapist who works with many new parents, especially new moms who experienced childbirth, this does not surprise me. I’ll refer to the birthing person as “mom” here, understanding that not every birthing person identifies as mom. It’s not just moms who had emergency procedures or complicated and dangerous deliveries that report trauma symptoms, although those are certainly risk factors. Some describe their births as pretty normal, and struggle to understand why it has impacted them like it has. Often, as we dig a little deeper, we start to identify moments where they felt overwhelmed, helpless, out of control, or scared. For some, their experience has been normalized by medical professionals as “just part of having a baby,” so they don’t seek help, or they assume they must be feeling this way because of something else (e.g. hormones, postpartum depression or anxiety, etc.) This can lead to unnecessary suffering.

For the purpose of this post, I’m not distinguishing between diagnosable PTSD and trauma symptoms that may not meet the threshold for diagnosis. The below information is based on my experiences processing birth trauma with clients, as well as various books, articles, and trainings I’ve seen over the years.

I also want to note that I’m not specifically addressing infant or pregnancy loss here, although of course those experiences are often traumatic and much of the below information does apply.

Signs and symptoms of birth trauma

• Startling easily or feeling like you are on high alert.

• Feeling like you are re-experiencing an aspect of the memory (e.g. physical sensations, emotional states, images, sounds, smells, etc.).

• Intense reactions to reminders of the experience (e.g. physical sensations, emotional reactions or “outbursts”).

• Nightmares.

• Difficulty sleeping.

• Difficulty concentrating.

• Mood changes, or persistent feelings such as fear, anger or hopelessness.

• Feeling overly guilty or ashamed (“it’s all my fault,” or “there’s something wrong with me”).

• Persistent negative thoughts about yourself (e.g. “I’m a bad mom” “I mess everything up”) or the world. 

• Avoiding reminders of the experience (e.g. not looking at pictures of your newborn, driving the long way so you don’t pass the hospital, or avoiding recommended care after birth.)

• Feeling detached, disconnected from reality, or numb.

Risk factors

• Previous traumatic experiences (particularly past sexual trauma).

• Not feeling supported, heard, or included in decision-making during birth.

• Past negative experiences in the medical system.

• Fear of being discriminated against, of being ignored, or of receiving inferior care due to race, ethnicity, size, disability, sexual orientation, gender identity, and more.

• Complicated pregnancy or birth experience(s).

• Unexpected medical intervention.

• Baby having to spend time in the NICU or being separated from the baby for another reason.

• Prior mental health struggles.

Supporting a loved one

If you are close to someone who may have experienced their birth as traumatic, you may be wondering how you can support them. I’ve included some ideas below, but remember that each person is unique and needs different things.

• Listen to what they have to say and validate their experience. Remember that the experience doesn’t need to seem traumatic to you for it to have been traumatic for them. 

• Ask how you can help, and know that they might feel overwhelmed and not know what they need. You can offer a few different things like picking up groceries, listening, doing laundry, watching baby, or giving them space.

• If they’re seeming overwhelmed or flooded by emotions, you might try:

  • Taking some slow deep breaths with them (lengthening the exhale can help calm down the nervous system).

  • Offering ways to engage the senses (e.g. smelling a lotion or candle they find calming, having a cup of warm tea, drinking a cold or flavorful beverage, eating a crunchy snack or sucking on a strong mint, using a weighted blanket or feeling something soft and fuzzy, listening to music, splashing cold or warm water on their face or just feeling it on their hands). 

  • You can also help them ground to their environment by having them name 5 things they see, 4 things they can touch, 3 things they hear, 2 things they smell, and 1 thing they taste.

• Encourage them to seek help from a therapist or support group. See the section below for more resources.

While you can offer comfort and support, remember that you can’t fix this for them. Hearing about others’ difficult experiences, or sitting with their strong emotions, can impact us too, so make sure you care for yourself as well.

Getting professional help

You can find a list of Texas therapists who specialize in the perinatal period here https://nurturedtx.org/kristis-list-provider-directory. For more resources, including information on different mental health conditions in the perinatal period and virtual support groups available all over the country, visit https://www.postpartum.net 

When looking for a therapist, consider their training, experience, and how you feel when speaking with them. If finances are a concern, look for someone who takes your insurance or who is able to see you at a reduced fee. EMDR and CBT are commonly used to treat PTSD, but they are not the only options. Try to find someone who has specific training in perinatal mental health in addition to experience and training in treating trauma. 

While birth-related trauma can feel overwhelming and scary, please know that it is highly treatable. There is help and you can heal!