Postpartum PTSD: How to Cope With Birth Trauma
When I went into labor with my second daughter at 33 weeks, I thought I knew what to expect; my first child came early too. But this time was different. There was a week of hospital bed rest, medical interventions, poor communication and, ultimately, an umbilical cord wrapped about my sweet baby’s neck. Four terrifying hours after my little girl’s birth, I finally got to meet her in the neonatal intensive care unit (NICU), where she was sedated in an incubator and on a ventilator. The experience was nothing like I had expected, and it left me with postpartum post-traumatic stress disorder (PTSD).
Postpartum PTSD, which can arise from birth trauma, affects around nine percent of women. It can bring on feelings of fear and panic, incite flashbacks, spark depression and even make it difficult to bond with baby. Much like other postpartum mood disorders, postpartum PTSD can happen to anyone—regardless of whether their birth experience was particularly grueling or totally by-the-book. So what is birth trauma, exactly, what are the symptoms and how can you find healthy, healing ways to cope? Read on for expert insight.
In this article:
What is birth trauma?
Risk factors for birth trauma
How to identify birth trauma symptoms
Birth trauma vs. postpartum depression: How to tell the difference. Ways to cope with birth trauma
“When someone experiences trauma during birth, they may experience postpartum PTSD or birth trauma,” explains psychotherapist Ilyse Kennedy, LPC. “It’s not the event that determines whether it registers as trauma, but the physiological response to an event. Any part of birth that causes a threat response—fight, flight, freeze or fawn—may register as trauma.”
Of course, trauma is a subjective experience. “What one person may not consider a traumatic event can be traumatic to another person,” says Lacey Fisher, LPC-S, a counselor specializing in trauma and maternal health. For example, even though I walked away relatively unfazed by my first daughter’s vacuum-assisted delivery, another mom may have found the experience to be traumatic.
The reality is that there are no definitive risk factors for birth trauma. Since it results from perceived trauma during the birthing experience, someone who has a completely ordinary delivery can still emerge with PTSD after birth. “During such a vulnerable experience that holds so much unknown, we are at greater risk for it to register as trauma,” says Kennedy.
The triggering traumatic event can also happen after the birth itself. This is common among parents of NICU babies. Catherine W., a mom of two, experienced postpartum PTSD after her baby had an unexpected surgery for a ping-pong skull fracture. And she’s not alone in this experience; one study found that as many as 38 percent of NICU parents experience symptoms of postpartum PTSD in the year following their child’s birth.
There are other situations and circumstances that experts say put a mom at an even greater risk of experiencing birth trauma and postpartum PTSD. These include:
- A near-death experience for baby and/or birthing parent
- A prior history of trauma (sexual abuse/assault, intimate partner violence, emotional abuse, race-based trauma or discrimination)
- A high-risk pregnancy and/or pregnancy complications
- Prior mental health issues
- History of prior pregnancy or birth trauma (fertility struggles, pregnancy loss and stillbirth)
- A recent loss
- Not feeling heard in the delivery room
- Unexpected medical intervention (use of forceps or vacuum extraction, emergency episiotomy, unexpected c-section, blood transfusions or injury to baby)
- Baby going to the NICU
- Having a different birth experience than what you expected
- Experiencing overwhelming pain
“All of these events can cause the birthing person and their partners or other support persons that were present to feel powerless, out of control, fearful for their lives or their baby’s life, not supported or heard and/or very anxious,” says Fisher. And this feeling of helplessness and fear can resurface later as postpartum PTSD.
Much like with other postpartum mood disorders, it’s not always easy to realize that the things you’re feeling are symptoms of birth trauma. For example, Laura S., a mom of one, says she felt panicked for a long time after delivery whenever people would talk about birth. Simply avoiding the topic may not seem like a red-flag emotional response to someone who’s never experienced trauma before—but it absolutely can be.
For me, a tip-off that something was wrong happened when my husband tried to leave me at home alone for the first time after we brought our baby home from the NICU. He grabbed his keys to run an errand, and I cried and begged him not to leave. I felt pure, unfiltered panic in that moment. A few days later, my psychiatrist explained that this was because he was the one person advocating for me when complications surfaced and invasive medical interventions were being performed without my consent. She then went through the other symptoms of PTSD; it turned out I checked off a lot more boxes than I had realized.
Common signs of birth trauma and/or postpartum PTSD include:
- Flashbacks and disturbing memories
- Insomnia and bad dreams
- Feeling triggered when going to see doctors for follow up visits/exams
- Rage
- Extreme anxiety
- Shame and guilt
- Detachment from baby
- Intrusive thoughts and negative self-talk
- Isolation
You don’t have to experience all of these symptoms to have birth trauma. “A person can still be traumatized from their birth experience even if they don’t meet all of the requirements to receive a PTSD diagnosis,” notes Fisher.
While many of the symptoms of birth trauma may overlap with symptoms of postpartum depression (PPD), they’re not the same thing—though they can co-exist. “Postpartum depression can be traumatic or can be influenced by a traumatic birth, but it differs from birth trauma,” explains Kennedy. “Birth trauma is endured following a physiological response to a distressing factor of the pregnancy or birthing process.”
Some symptoms may overlap (withdrawing from loved ones, having feelings of guilt and hopelessness), but with PTSD after birth, they’re triggered by birth trauma reminders that make you feel scared or alone. Fisher adds that, with birth trauma, you may carry guilt because you feel like you were in some way responsible for the outcome of your birth experience.
When you’re in the thick of birth trauma and trying to process everything that transpired, it can seem like the feelings, triggers and nightmares will never end. But there is hope.
First and foremost, don’t trivialize what you’ve been through. “There can be the impulse to minimize the experience by saying ‘others have it worse,’” Kennedy explains. “It’s important to acknowledge that the nervous system determines what registers as trauma, not the intellectual brain.”
What’s more, seeking professional help can be a huge leap forward in facilitating your recovery. “Moms should look for a therapist trained in perinatal mental health as well as trauma treatment,” says Kennedy.
Going to therapy really helped turn things around for Erin W., a mom of two. “When my husband brought up having a second [baby], I had a panic attack, which led me to find a trauma therapist,” she says. “It was very helpful, and I ended up having a wonderful second birth experience.”
Fisher also recommends some exercises to help you cope with birth trauma triggers in the moment:
- Remind yourself that you’re not responsible for your experience
- Try breathing exercises
- Practice mindfulness or meditation
- Make time for self-care to relax the body and nervous system
- Get outside for a change of scenery when you’re experiencing flashbacks
- Take time to grieve the birth experience—both the one you hoped for and the one you had
While your instinct may be to shirk away from friends and loved ones, now is the time to embrace your support system. Moreover, you may want to find an in-person or virtual community where you can share your story—once you’re ready. “Trauma thrives in isolation; it’s important not to go through recovery alone,” says Kennedy.
It’s been two-and-a-half years since my birth trauma. Thanks to therapy, community and a husband who offered me so much love and support, triggering moments are few and far between. And when they do occur, I have the tools I need to bring myself back to reality.
The truth is: Birth trauma isn’t something that will simply go away on its own. You have to put in the work. Postpartum PTSD is life-changing, but it can and will get better.
About the experts:
Lacey Fisher, LPC-S, RPT-S, PMH-C, is a licensed professional counselor-supervisor, play therapist and perinatal mental health specialist at Open Heart Counseling of Austin. She also serves as the clinical director for the Pregnancy and Postpartum Health Alliance of Texas. She earned her Master’s degree in professional counseling from Texas State University.
Ilyse Kennedy, LPC, LMFT, PSEP, PMH-C, is a professional counselor, marriage and family therapist, certified perinatal mental health counselor and EMDRIA-certified clinician at Moving Parts Psychotherapy in Austin, Texas. She earned her master of arts in counseling from St. Edward’s University.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
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