Understanding Birth Trauma

            There can be a lot of unknown factors when labour sets in and parents are getting ready for the birth of their child. It is a time of excitement, anticipation, and maybe even a little fear. What happens when the labour and delivery process do not go exactly as planned, or does not feel as though it went well? A birth trauma can occur from direct or perceived negative experiences during the labour and delivery process. A birth trauma could lead to postpartum posttraumatic stress disorder (P-PTSD), which is a perinatal mood and anxiety disorder (PMAD) that can impact the mother, father, and family as a whole. Research has indicated up to 44% of women classify their labour and delivery experiences as traumatic. As there is such an incredibly high proportion of women identifying their birthing experiences as traumatic, birth trauma and P-PTSD very important topics to discuss. So, what does birth trauma and P-PTSD look like?

 

Some common symptoms of birth trauma and P-PTSD can include:

  • Reoccurring intrusive memories of the childbirth experience
  • Nightmares
  • Feelings of shame, guilt, and helplessness
  • Dissociation, or feeling disconnected from thoughts, feelings, and surroundings
  • Depressive like behaviours

 

There are many common interactions or situations that can trigger a mother with P-PTSD to experience some of the negative symptoms listed above. The newborn baby can actually act as a trigger for the mother. This can be quite problematic for mother-child bonding. Some mothers can associate the trauma they experienced with their newborn, which could cause them to withdraw from the child as a protective measure for themselves. This can then create the feelings of guilt and shame in the mother, which could lead to negative cycle of unhelpful thoughts and feelings.    

 

            A traumatic childbirth can be quite hard to identify because there really are no universal negative experiences that impact all birthing mothers in the same way. Rather, it is how each birthing mother perceives the experience. For example, some researchers found approximately 47% of mothers who had emergency caesarean sections classified their birthing experience as traumatic. This statistic suggests not all women who had an emergency caesarean section identified the overall birthing experience as traumatic. An important aspect of what makes a birth traumatic for each individual mother is the perception of the childbirth experience. There are some key factors that can influence how a mother perceives the overall birthing experience.

 

            The medical team: The medical team the mother has, can greatly impact her perception of the birthing experience. Birthing mothers are in a particularly vulnerable time of their lives, and if the medical team (which could include doctors, nurses, midwives – any medical professional interacting with the mother) is not responsive to the mother, it can significantly increase the chances of a traumatic childbirth. Mothers might feel unimportant and neglected if their medical team does not positively interact with them. It can also lead to distrust of medical personnel, which can have a widespread impacts on the mother, and also the newborn baby. There is some good news! When the medical team positively interacts and supports the birthing mother’s needs, it can actually be a strong protective factor of a birth trauma – even in instances in which there were complications.

 

            Social Support: The social support the mother has can also influence if a birthing experience is positive or negative. Some mothers struggling as a result of a birth trauma can unexpectedly withdraw from her previous social supports. Researchers indicated this might be because the birthing mother could assume her social supports did not understand what she went through as a result of the traumatic birth, or she had feelings of resentfulness for other women who did not have a traumatic birthing experience. The withdrawing from previous relationships can emphasize feelings of helplessness due to isolation. This is also true for the partner of the birthing mother. Some mothers withdraw from their partners, which can lead to a breakdown in the couple’s relationship. However, maintaining positive relationships throughout and after the birthing experience can safeguard the mother from experiencing trauma or P-PTSD.

 

            Cultural Expectations: The cultural identity of each individual mother can also impact their birthing experiences. All cultures have unique ideals, traditions, and practices that can influence the mother’s birthing perspective. The expectations of what childbirth involves varies from culture to culture. The cultural values each mother has, shapes her perception of the childbirth experience. It can be a situation in which the mother is triggered, particularly if the mother did not feel as though her childbirth experience met her cultural expectations. It can also be a significant protective measure, as the mother could feel very supported in her labour and delivery process.

 

            There can also be a lot of overlapping symptoms between postpartum depression (PPD) and P-PTSD. As such P-PTSD can be misdiagnosed, and the trauma from the birthing experience could still remain. So, what can be done to help process the trauma? There are some treatment options that have been demonstrated as effective in treating birth trauma in the current literature.

 

            Cognitive Behavioural Therapy (CBT): CBT addresses negative thoughts an individual might have, and the relationship between the thoughts, feelings, and behaviours. There are methods of CBT that have been specifically modified to meet the unique needs of mothers within the postpartum period. To address birth trauma, CBT focuses on the negative thoughts of the birthing mother that create unhelpful feelings, such as shame and guilt that were tied to the birth trauma.

 

            Eye Movement Desensitization Reprocessing (EMDR): EMDR has also been demonstrated effective in treating individuals with trauma. EMDR employs grounding techniques such as eye movements or tapping, while the client is discussing their past traumatic events, and how it impacts their beliefs about themselves in the present.

 

There are also many other types of therapeutic approaches that can help mothers process birth trauma. Many of the approaches can be modified to support mothers who experienced a traumatic birth or P-PTSD. When seeking professional help, it is important to ensure the mental health practitioner is competent in working with women within the perinatal period. With the proper support and treatment, women can overcome a traumatic childbirth, P-PTSD, or any PMAD.

 

Beck, C.T. (2004). Birth trauma: in the eye of the beholder. Nursing Research53(1), 28-35. http://dx.doi.org/10.1097/00006199-200401000-00005

Beck, C.T. (2004). Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research53(4), 216–224. http://dx.doi.org/10.1097/00006199-200407000-00004

De Graaff, L.F., Honig, A., Van Panpus, M.G., & Stramrood, C.I.A. (2018). Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 97(6), 648 – 656. http://dx.doi.org/10.1111/aogs.13291

Fenech, G., & Thomson, G. (2014). Tormented by ghosts from their past: a meta-synthesis to explore psychosocial implications of a traumatic birth on maternal well-being. Midwifery, 30(2), 185-193. http://dx.doi.org/10.1016/j.midw.2013.12.004

Grekin, R., & O’Hara, M.W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389-401. http://dx.doi.org/10.1016/j.cpr.2014.05.003

Haagen, J.F.G., Moerbeek, M., Olde, E., van der Hart, O., & Kleber, R.J. (2015). PTSD after childbirth: A predictive ethological model for symptom development. Journal of Affective Disorders, 185(2015), 135-143. http://dx.doi.org/10.1016/j.jad.2015.06.049

About the Author

Samantha has her Master’s Degree in Counselling Psychology and has advanced training in Perinatal Mental Health from Postpartum Support International (PSI), the Gottman Institute and EMDR.  Samantha presented academic posters at the many conventions about birth trauma and has conducted several professional and public presentations.  She is a currently a Non-Registered Therapist in Edmonton, Alberta at Pine Integrated Health Centre in the process of becoming a Psychologist.  Sam is passionate about supporting women and couples throughout the lifespan. 

We specialize in Maternal Mental Health including Birth Trauma, Postpartum Depression and Postpartum Anxiety at Pine Integrated Health Centre.  We also are able to support women, men, couples and children throughout the lifespan.