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
- 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
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
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 delivery) and subjective (e.g. feelings
of loss of control) factors. They include:
- Lengthy labour or short and very painful labour
- Poor pain relief
- Feelings of loss of control
- High levels of medical intervention
- Traumatic or emergency deliveries, e.g. emergency caesarean
- 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
- Birth of a damaged baby (a disability resulting from
- 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.
Finally, men who witness their partner’s traumatic
childbirth experience may also feel traumatised as a result. Please
see our ‘partners’ section
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
The BTA aims to tackle this isolation by offering women
much needed support and showing them that they are far
from alone. By working together and providing women with
a voice, we hope that we can help change those practices
which contribute to Postnatal PTSD.
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
However, it is important to note that depression can go
hand in hand with Postnatal PTSD, so not everyone is misdiagnosed
and 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 Health Visitor) 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.