Internationally Birth Trauma is still represented in research as a surprise in some parts of the world, or un-represented altogether.
I have been working as a birth trauma therapist for the past 9 years. Sitting in front of my very first 5 new clients whose experiences of birth and subsequent mental health concerns as described by them, fell entirely short of my lived experience then as a midwife. I grew up as a midwife in an era where we believed and were taught that depression was the main psychological symptom that women experienced after their baby was born. Women today, suffering from PTSD or post traumatic birth symptoms are still being misdiagnosed with depression and anxiety. (Check out 1980’s 90’s research and compare with the sheer quantity of articles now that explore many aspects of this phenomenon).
I had to learn. I’m still learning. Focus here is on PTSD and Vaginismus.
Even with pain relief and the intention towards active management of normality women still develop PTSD in the postnatal period. These next three (4-6) contributions will focus on various aspects of the trauma response in birthing and suggest some very practical interventions which may assist in prevention or amelioration of symptoms.
DSM V and postpartum PTSD.
The following statistics are based on a study done in the USA.
‘Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centred maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD?’ (Vesel, Nickasch, 2015). Ref 1
Postpartum PTSD appears in DSM-V as a subset of PTSD itself. This is new. Previous trauma which may leave women vulnerable to developing PTSD can also contribute to the diagnosis of postpartum PTSD. To fulfil the criteria for a Diagnosis of Postpartum PTSD there needs to 4 categories of symptoms present. Ref 2
- Persistent re-experiencing of the Trauma. This may happen in a variety of ways but may present in dreams or nightmares/ persistent thoughts and re-living various parts of the birth story. Flashbacks may occur spontaneously and uninvited
- Avoidance may present as not being able watch a TV programme or attending mother and baby groups as they may be asked about the baby’s birth. Women have told me in session that they will take any road rather than pass the hospital their baby was born in because of the severe symptoms of fear and anxiety which happen when they come near.
- Negative mood or cognitions. Low mood, feeling sad or bad about the birth. Feeling of being detached or apart from others, or even themselves. Poor memory of events mean that the story of their baby’s birth does not always have a complete narrative.
- Poor concentration, Being angry or irritable. Sleep changes; difficulty getting to sleep or staying asleep
Other symptoms may occur and feel very bewildering to Mum’s who had anticipated the birth of their baby to be a joyful experience.
Trauma responses vary depending on the story. Women may have had a number of fearful or psychologically disturbing incidences throughout their birthing experience. Bonding can be disrupted. A somatic (physical) remembering of an instrumental delivery may cause a woman to refrain from intercourse, with the very obvious possibility of a consequential deterioration in relationship with their significant other. Women feel unable to attend for smear test (cervical screening), or may develop vaginismus postnatally.
Decisions about another pregnancy may be delayed for years or permanently postponed. There are a number of treatment pathways for these responses. I use Rewind and EMDR alongside person centred psychoeducation and some more light hearted exercises for vaginismus. Please talk to a professional or investigate this further if any of these are your experience. A response such as this post birth where it has not been part of your history before, is most likely to be based in a trauma response which occurred and was beyond your control. Understanding that and learning to re-process the trauma response can be entirely possible in just a few sessions, but also, it may take a little time.
Complex trauma and previous life experiences may also play their part in the development of postpartum PTSD. In my experience the deepest emotional wounds are when the essential sense of self is shaken. This may also pre-dispose women to postnatal depression. There may be a disruption in natural confidence, a waking to a part of the self, unknown before; with no immediately visible road to lead them back to their core.
Blogs are short pieces on large topics. I attempt at the end of each contribution to provide some extra resources which I believe might be helpful. Please consider these alongside each piece I contribute but also look back at other footnotes which may be more relevant to you.
This series is designed to open discussion with therapists and parents and raise the possibility of interest in birth trauma counselling and training. It may be that you are intimately aware of the burden of Post-Partum PTSD. Some tools and resources are available on previous pages for anxiety and depression (2,3). Please take care and share how you are feeling with your partner/family or a friend. Please judge if you need to see a GP and discuss your symptoms.
It is hard to believe that things could become so bad that suicide might occur to you as the parent of a new baby. Unfortunately, we know that women in depression and trauma might wonder if that is a viable solution. Please. If you are in immediate danger of suicide or you think you might harm yourself or even if it all feels too hard just now contact a friend, family member: speak candidly, say it how it is.
- Lifeline (NI) 0808 808 8000 (24 hour crisis helpline 7 days a week)
- Talk to your Midwife or Health Visitor. Make an emergency appointment with your GP.
- If actively suicidal you should call 999 or present at your local emergency department
- Samaritans (UK) 116 123
- Or contact your therapist for an emergency session
Anne Marie has joined Have you seen that girl? as a regular guest blogger, for the next few months.
Find out more about her and how to get in contact with her HERE.
You can also find all her blog posts, as they are published, HERE on the website.
Vesel,J. Nickasch, B. An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder. Nursing for Women’s Health. 2015 Dec-2016 Jan;19(6):504-25. doi: 10.1111/1751-486X.12234.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC:
Reference 3 For more information https://www.birthtraumaassociation.org.uk/for-health-professional/supporting-parents-with-birth-trauma
Reference 5 Afterthoughts Counselling and Training Ltd. Expressions of interest in Training or Therapy to: Anne Marie McKinley @Afterthoughtsni@gmail.com 07711105676 Skype or Zoom sessions available