About Birth Trauma and PTSD

What is Postpartum PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop following a traumatic event. A traumatic event is any event that is scary or shocking where a person’s life or the life of someone they care about is threatened. This can include accidents, natural disasters, or abuse. 

Postpartum PTSD is a form of PTSD that follows a traumatic birth. It is a type of perinatal mood and anxiety disorder (PMAD), which is a mental health condition that occurs at any point during pregnancy or after giving birth. Roughly 9% of new mothers experience postpartum PTSD.

What is a traumatic birth experience?

A traumatic birth is a birth experience involving an emergency or where things take an unexpected turn. In some cases, a mother or baby’s life may be threatened. 

Examples of events that could lead to birth trauma include:

• An unplanned C-section
• NICU stay
• Umbilical cord prolapse
• Use of forceps or vacuum during delivery
• Severe complications or injury
• Feeling ignored or unsupported by your medical team
• Feeling powerless or like you didn’t have a say during your delivery

Around 45% of births are considered traumatic by the birthing mother. Trauma is a very personal experience that is ‘in the eye of the beholder.’ What really matters is if you consider an event to be traumatic. If you experienced your birth as traumatic, then it was. 

How soon after giving birth can PTSD develop?

Usually symptoms of PTSD begin within three months of the traumatic event. However, in some cases symptoms may not develop for six months or more. This is called “delayed expression.”

Signs and Symptoms of PTSD

Mothers with postpartum PTSD will experience a range of symptoms. These symptoms fall into four categories:

• Re-experiencing the birth trauma
• Avoidance
• Increased arousal and reactivity
• Changes in thoughts and feelings

Re-experiencing

Women who have experienced a traumatic birth may find themselves reliving the trauma through upsetting memories, nightmares, and flashbacks. When faced with reminders of what happened, they may have overwhelming physical and emotional reactions. It can feel like they are reliving the birth over and over again.

Avoidance

It is common for women who have experienced a birth trauma to avoid people, places, and things that remind them of what happened. For example, they may avoid driving past the hospital where they gave birth or skip follow-up appointments with their healthcare provider. They may also try to suppress thoughts and feelings about the trauma. This could lead to self-medicating with drugs or alcohol.

Arousal and reactivity

Trauma activates the “fight-or-flight response” in the body. In some cases the nervous system has difficulty recovering and remains in this state for a prolonged period of time. This could lead to heightened arousal and reactivity long after the traumatic event has ended. For example, women may find themselves feeling easily startled and tense. They may have trouble concentrating and sleeping, since sleep requires the body to relax and let go. Women may also find themselves feeling more irritable and anxious and have angry outbursts at others.

Changes in thoughts and feelings

Women who have postpartum PTSD may also notice a significant change in their thoughts and feelings. They may experience more negative emotions on a regular basis, like sadness, fear, guilt, or shame. They may have negative thoughts about themselves, others, or the world. It’s also common for women to have trouble remembering the trauma, to isolate themselves from other people, and have trouble experiencing any positive emotions. This can make it difficult to bond with their baby and find pleasure in motherhood.

Why do I feel so disconnected?

Some women who experience birth trauma may also experience dissociative symptoms. Dissociation is a lack of connection between a person’s thoughts, feelings, memories, and identity. Women with postpartum PTSD may experience one or both of the following:

• Derealization: A feeling that the outside world is unreal. It can feel as though you are in a dream-like state.
• Depersonalization: A feeling of being detached from your own body or mind. It can feel like you are an outside observer of your own body. 

Dissociation is your brain’s way of coping with a highly stressful event. While it may occur with PTSD, frequent and prolonged dissociation usually indicates another mental health condition. 

The Impact of Birth Trauma

Postpartum PTSD can be debilitating for mothers and affect many aspects of their lives. If you have postpartum PTSD, you may also experience depression, anxiety, and other emotional issues. Studies on this condition show that it can negatively affect your marriage and your ability to bond with your baby. 

Women with postpartum PTSD may avoid any reminders of the trauma, including the healthcare providers who were present during birth. This can stop mothers from getting proper follow-up care. Women may also feel anxious or avoid future pregnancies because of their fear of experiencing another traumatic birth. If they become pregnant with another child, they may find themselves feeling increasingly anxious as childbirth draws closer.

Risk Factors

Anyone who experiences a birth involving complications, injury, or where the mother or baby’s life is threatened is at risk of developing postpartum PTSD. Other factors that may increase the risk of PTSD after a birth trauma include:

• Current or past depression, anxiety, or other mental health issues.
• History of any previous trauma, including past sexual abuse.
• Experiencing medical issues during pregnancy or childbirth, such as preeclampsia, postpartum hemorrhage, or cardiovascular (heart) disease.
• Giving birth prematurely.

Fortunately postpartum PTSD is a treatable condition. With proper support and help, you can recover. Read on to learn more about treatment options. 

Treatment

For many new mothers, getting help for postpartum issues is difficult especially when you also have a baby to care for. However, postpartum PTSD is a condition that can get worse over time. If you’re struggling, consider the following forms of treatment. 

Therapy

Therapy is an effective treatment for perinatal mood and anxiety disorders like postpartum PTSD. It involves speaking with a mental health professional who can help you process the trauma and develop coping skills. This form of treatment can be helpful in mild to severe cases of postpartum PTSD but is especially recommended if:

• Your symptoms last for several weeks or longer and don’t seem to be improving.
• Your symptoms are affecting your life in negative ways.
• You are having suicidal thoughts or urges to harm yourself

There are many different approaches to psychotherapy for treating postpartum PTSD. The following types of therapy are effective:

• Cognitive behavioral therapy (CBT): CBT focuses on helping people shift their thoughts about a traumatic event. It assumes that when you change your thoughts, your emotions also change. 
• Prolonged exposure (PE): PE, also known as exposure therapy, helps people gradually face thoughts, feelings, and memories associated with a trauma. By facing what they had previously avoided, other symptoms also improve.
• Eye movement desensitization and reprocessing (EMDR): EMDR is a type of therapy where a trained therapist guides a person through specific eye movements while processing the traumatic memory. 

Medication

For moderate to severe cases of postpartum PTSD, psychiatric medication may be beneficial. You can speak with your primary care doctor, OBGYN, or psychiatrist about the risks and benefits of taking medication. If you’re currently breastfeeding, your doctor will take this into consideration, since certain medications can pass into your breast milk. If you decide to take medication, your doctor will discuss how you can safely do so while breastfeeding. 

Coping with Birth Trauma

Treatment is strongly recommended for postpartum PTSD, but there are things you can do on your own to aid in your recovery.

If you’ve experienced a traumatic birth, remember to:

• Take care of your physical health by drinking enough water, eating a healthy diet, and moving your body on a regular basis.
• Use breathing exercises to reduce anxiety.
• Practice mindfulness or meditation.
• Spend time outdoors and get plenty of fresh air.
• Engage in regular self-care.
• Share your thoughts and feelings with someone you trust.

It’s important to also remind yourself that the traumatic event is not your fault. People who have experienced trauma have a tendency to blame themselves, even when it is clear that they were not responsible for what happened. You also need to give yourself time to grieve the birth that you wish you had. It can take time to accept that things did not go the way you hoped or imagined.

A traumatic birth is an experience where a woman feels scared or helpless. Therapy can help a new mother process her birth experience and work through the trauma. 

At Phoenix Health, we specialize in treating maternal mental health conditions like postpartum PTSD. If you have experienced a birth trauma and/or are experiencing signs of PTSD, we are here to help. Schedule an appointment with a maternal mental health specialist and start feeling better today.