Like most women, you imagine the day you give birth will be the happiest day of your life.
For months you look forward to meeting your baby.
You imagine spending the days and months after birth adjusting to your life as a new mother.
But what if the day you become a parent is the start of the most traumatic experience of your life?
PTSD After Birth – What Is Postnatal PTSD?
It’s difficult to imagine being so traumatised by birth you have nightmares or insomnia.
You don’t expect to have panic attacks or flashbacks.
You aren’t sure it’s even possible to experience post-traumatic stress disorder (PTSD) after having a baby.
Health experts are divided on whether birth qualifies as a traumatic event. Yet research has found about one in three women exhibit some symptoms of PTSD after birth.
The World Health Organization lists psychological illness as a significant indirect cause of maternal death in the first year after birth. Research has found 65% of women with PTSD also had depression 11 months after giving birth.
PTSD doesn’t only affect mothers – it can also have an impact on whole families. Evidence is beginning to show us maternal mood disorders can predispose babies to adverse psychological conditions in the long term.
What Is Postnatal PTSD?
Post-traumatic stress disorder is a condition we most usually associate with survivors of terrorist attacks, wars, and major disasters such as earthquakes or bushfires.
Postnatal PTSD occurs when a woman experiences a real or perceived trauma during birth or in the post partum period.
These traumas can include:
- Feelings of powerlessness, lack of support, or poor communication during birth
- Re-experiencing previous trauma, such as sexual abuse or rape
- An unplanned c-section
- Use of instruments to assist birth, such as forceps or vacuum
- Complications such as preeclampsia, severe perineal trauma, post partum haemorrhage, unexpected hysterectomy, manual placenta removal, cardiac disease, or reaction to medications
- Prolapsed cord
- Precipitous labour
- Baby needing resuscitation
- Baby going to NICU.
After going through a stressful and traumatic experience, some women can move on from it; some can’t. It largely depends on how they felt during the actual event.
How a woman feels, during birth and after, can lead to feelings of trauma or distress and the result is PTSD.
How Can Birth Be Traumatic?
When we talk of birth trauma, people tend to think of physical damage or injury. If, for example, a baby is cut during a c-section incision, or a mother has a severe vaginal tear.
But how can birth, such a common and ‘everyday’ experience, cause a physiological reaction in a mother?
The vast majority of women give birth in environments that don’t support the normal, physiological process of labour and birth.
They give birth with lights on, surrounded by noise, and with no privacy. There are strangers present, and discussions taking place around them, as if they’re not even there. They might be refused food and water, or be confined to a bed.
Women might trust their care providers to treat them with dignity and respect, only to find out they were misled in terms of their care providers’ support or beliefs.
They might be left alone and frightened, or constantly observed with a clock ticking. Their partners might side with medical staff about interventions.
Women might be extremely fearful of labour pain and their ability to cope, or afraid of the process of birth itself.
Any of these factors might be present. They will influence how a woman feels – whether isolated, frightened, stressed, or unsafe. The sum effect of these feelings is that she experiences birth as traumatic, which leads to PTSD.
Who Is Most Likely To Experience Postnatal PTSD?
Statistics vary but most research suggests 9% of women who give birth will go on to develop symptoms of post-traumatic stress disorder after birth.
The Birth Trauma Association estimates that in the UK alone, as many as 200,000 women per year will feel traumatised by birth and develop some PTSD symptoms. Statistics vary, but 1% to 9% of women will develop a diagnosable, clinical episode of PTSD.
Postnatal PTSD is a relatively common occurrence.That’s the reality.
Science doesn’t really know what predisposes people to develop PTSD but, as with many mental health issues, there is likely to be a complex mix of factors:
- Inherited mental health issues, such as a family history of depression and/or anxiety.
- The way your brain regulates hormones which are released when you experience a stress response.
- Previous stressful or traumatic experiences – particularly the amount and severity of trauma.
- Personality features which might predispose you to cope in particular ways.
In terms of the risk factors that contribute to postnatal PTSD, women might:
- Feel abandoned by their care providers or support people during pregnancy or birth.
- Feel unheard during labour and birth, when the reasons for their choices aren’t validated.
- Lack the information they need to make informed decisions about care during pregnancy and birth.
- Feel powerless and unprotected, with no control over their birth experience.
- Have feelings of intense fear and uncertainty about the birth process, which triggers past traumas.
- Feel ‘invisible’ because the focus is only on a healthy baby.
What Are The Symptoms Of Postnatal PTSD?
Many women experience some form of what is known as ‘the baby blues’ in the first week following birth. This is a biological response to hormonal changes, and usually coincides with a woman’s milk ‘coming in’. She might feel emotional for a day or two, but this is usually resolved.
About 15% of women will go on to develop postnatal depression (PND) in the first year after birth. This is significant depression which is different from PTSD, although some symptoms overlap.
One of the key characteristics of PTSD is constant re-experiencing a traumatic event; this is one way to differentiate it from PND.
If you have any of the following symptoms, speak to your care provider:
- Persistent re-experiencing of the birth trauma.
- Nightmares, flashbacks and distressing recollections.
- Increased arousal, which includes irritability, insomnia, hyper-vigilance, exaggerated startle response.
- Avoidance of anything associated with the event, including people (baby, doctors, support people), and places. (hospitals, clinics). You might even avoid thoughts, feelings, and any details connected with the event.
- Feeling a sense of detachment.
- Experiencing anxiety and panic attacks.
What Are The Ramifications Of Postnatal PTSD?
If a woman experiences ongoing symptoms of PTSD, it is debilitating and can be very damaging.
Women with postnatal PTSD:
- Are less likely to have another baby in the future
- Often request epidural or elective c-section if they have more children
- Tend to avoid follow up postnatal care
- Are less likely to breastfeed, and will probably not seek professional breastfeeding support
- Will more likely have problems bonding and attaching with their newborn
- Might experience relationship problems
- Are likely to experience sexual dysfunction.
Suicide is a leading cause of maternal death in the first year after birth. In the UK, between 2009 and 2013, more than 100 women died by suicide.
How Do We Avoid Postnatal PTSD?
In order to prevent postnatal PTSD we need to look at why it has happened in greater numbers in the last few decades.
Most women give birth feeling incredibly fearful of the experience. Very few achieve a normal, physiological birth. Instead, birth is seen as a medical event, taking place in obstetric settings.
Most women are resilient and can recover from birth trauma. This is more likely to happen, however, when they have support, during pregnancy and birth, from known and trusted care providers.
Research worldwide has shown that respectful maternity care and dignity for all women are critical. Reducing the number of unnecessary medical interventions, and focusing on women-centred care can positively shape women’s birth experience and limit the factors contributing to postnatal PTSD.
Very little research has looked at screening or treatment for postnatal PTSD. However, the evidence from the available studies suggests appropriate midwifery care is likely to be the best prevention.
I Think I Have Postnatal PTSD
The positive news is postnatal PTSD is a treatable condition. It’s important for any woman with postnatal PTSD to realise she isn’t alone. While her feelings are disturbing, they aren’t unusual in someone who has been through a traumatic experience. In fact, surviving a traumatic experience deserves respect and support.
If you have experience these feelings, it’s important to seek support from your partner, family and friends, so they know you are struggling and need help. It can take time to recover from a traumatic birth, and their patience and support are essential.
Your partner might not understand why you’re so adversely affected by your child’s birth. It can help to explain that while s/he might not understand, it’s important to accept your feelings, and this will help you recover.
Seek the support you need. It’s important you speak to your care provider about how you are feeling. Treatment for postnatal PTSD usually involves trauma-focused psychology, and might include cognitive behavioural therapy (CBT), or eye movement desensitisation and reprocessing (EDMR).
If you, or someone close to you, has experienced birth trauma, you might find these articles useful: