Dr Kim Thomas shares the signs and how to get help
[TW: This article discusses birth trauma and may be triggering for some readers.]
Kerry had a 16-hour back-to-back labour, in which her baby got stuck. The baby’s heart rate dropped and was born with the help of forceps. With only gas and air to relieve the pain, Kerry drifted in and out of consciousness. After the birth, she needed a catheter – but the swelling she’d developed made it hard to fit and she screamed out in agony. After six days in pain, but with no obvious cause, she was discharged – only to be sent back to the hospital with sepsis where she was put on an IV drip and had to undergo surgery. As a result, Kerry developed post-traumatic stress disorder (PTSD), with flashbacks to the birth, a constant feeling of anxiety and an inability to sleep.
At the Birth Trauma Association, we often hear stories like Kerry’s – not always as extreme, thankfully, but nonetheless stories of traumatic birth that leave women feeling helpless and emotionally damaged.
About 4-5% of women who give birth go on to develop PTSD – that’s about 25,000 to 30,000 a year in the UK. Most people associate PTSD with soldiers who have fought on the frontline, but it can affect anyone who has had a traumatic experience such as rape, assault, domestic violence or a car accident.
Doctors used to believe a joyful experience such as birth couldn’t be traumatic, and it’s only since the 1990s that they have gradually come to recognise postnatal PTSD as a condition. Postnatal PTSD is a bit of a mouthful, so we tend to say ‘birth trauma’ instead. We use the term broadly to include women who have some symptoms of psychological distress as a result of traumatic birth, but not enough for a full PTSD diagnosis.
"Most people associate PTSD with soldiers who have fought on the frontline, but it can affect anyone who has had a traumatic experience such as rape, assault, domestic violence or a car accident."
Scientists believe people develop PTSD when their trauma becomes stuck in short-term memory rather than being channelled, as usually happens, into long-term memory. It then manifests itself in four sets of symptoms.
You’re probably already familiar with the most well-known of these, which are flashbacks and nightmares. People with PTSD find themselves suddenly reliving the moment of the trauma – it’s a sensation much stronger than a simple memory and can include smells and sounds associated with the trauma as well as the sight. Flashbacks are often sparked by particular triggers, such as the smell of soap or the sight of strip lighting, that remind them of the traumatic event.
The other three sets of symptoms are hyperarousal, where you constantly feel jumpy and on high alert, as if something bad is going to happen; avoidance, which entails avoiding any reminder of the trauma; and negative cognition, which refers to a range of feelings including low mood and an inability to remember parts of the trauma.
Having PTSD when you’re looking after a new baby can be particularly difficult. Women may find it hard to bond with their baby or, alternatively, become very overprotective. They may become irritable or jumpy, which can lead to tension in their relationship with their partner or family. Often, they will avoid any reminders of the trauma, including other mums with babies, pregnant women, or health professionals. This makes life as a new mother very isolating.
"Women may find it hard to bond with their baby or, alternatively, become very overprotective."
So, what causes birth trauma?
Very often, it’s an emergency during childbirth – being rushed to theatre, for example, for a caesarean section or forceps birth. Some women talk about the visceral fear of believing either they or their baby are going to die. Other common causes include postpartum haemorrhage, extreme pain (and being denied pain relief), or a baby being born unwell and having to spend time in special care. Sometimes, however, the birth seems straightforward to outsiders, but the woman nonetheless feels traumatised by aspects of the experience.
Many women tell us the most traumatic element of their birth experience is not the objectively difficult part, such as an emergency caesarean, but the way they are treated. Women often report staff speaking to them sharply, ignoring their pleas for help, failing to communicate what is happening, or even laughing at them.
The feeling of being let down by a professional you trusted can be devastating, and often plays a major part in the subsequent birth trauma.
GPs and other health professionals are not always clued up about birth trauma or postnatal PTSD, and some women are wrongly diagnosed as having postnatal depression (PND). There is an overlap in symptoms, and some women do develop both PTSD and PND. The big difference is the experience of flashbacks and nightmares – a feature of PTSD, but not of PND.
"GPs and other health professionals are not always clued up about birth trauma or postnatal PTSD, and some women are wrongly diagnosed as having postnatal depression (PND)."
Birth trauma can be a debilitating condition to live with, but fortunately, help is available.
Two treatments work very well - trauma-focused CBT (cognitive behavioural therapy) and EMDR (eye movement desensitisation and reprocessing). Both are intensive therapies over eight to 12 sessions that involve reliving some aspects of the trauma.
They aim to move the trauma from your short-term memory, where it feels constantly present, to the safety of your long-term memory, where you can think about it without becoming upset. Fortunately, Kerry found that having CBT with a good counsellor helped her overcome her anxiety and end the flashbacks.
To access therapy, you can ask your GP or health visitor for a referral, though if you're in England, you can self-refer to mental health services through your local IAPT (Improving Access to Psychological Therapies) service. NHS England is also in the process of setting up dedicated perinatal mental health services, available for up to two years after birth. They should all be in place by April 2024.
Having your trauma recognised is an important part of recovery. We have a team of peer supporters who have all recovered from traumatic births and are available to chat. You can email them at email@example.com or phone them on 0203 621 6338.
Finally, you’re welcome to join our Facebook group and share your story with others who have experienced traumatic birth.
The good news is that women do recover from birth trauma. We hear so many women say they went from believing they would never get better to finding that a course of EMDR or CBT enabled them to make a complete recovery. Of course, the memory of the trauma never goes away, but with treatment it becomes just that – a memory – rather than an ever-present reality.