TRIGGER WARNING: This blog contains educational information about birth trauma, experiences that others have had that contribute to childbirth-related trauma, common symptoms, and ways to recover. Please take care of yourself while reading this information. Reach out to a qualified perinatal mental health professional for support.
The experience of childbirth is a momentous event that can be both joyous and challenging for expectant parents. While many have positive birth experiences, some may encounter birth trauma, which can have lasting effects on their mental and physical health and overall wellbeing. Birth trauma refers to the distress experienced during or just after childbirth. The trauma can be physical, emotional, or psychological, and may lead to negative outcomes for both the birthing parent, their partner, and the infant. It is a subjective experience, occurring often as a result of something unexpected happening during labor and delivery, and especially occurs where there is actual or perceived threats to the birthing person or their child's life.
Prevalence and Impact of Birth Trauma
Research conducted in the past few years highlights the prevalence of birth trauma and its impact on maternal and infant health. While much more research and information, and acknowledgement of birth trauma, is necessary there is emerging insights into this phenomenon. According to a study by Ayers et al. (2016), approximately 3% to 6% of women experience posttraumatic stress disorder (PTSD) following childbirth. Another recent opinion piece by the American College of Obstetricians and Gynecologists (ACOG) (2018) reported that between 3-16% of women in the United States experience significant postpartum traumatic stress symptoms. Postpartum Support International (2021) states that around 9% of women experience PTSD following childbirth. More research is needed into incident rates for better understanding of the prevalence of birth trauma, and with more research comes (hopefully) an increase in providers prioritizing trauma-informed care as to reduce negative experiences related to childbirth.
The consequences of birth trauma are not limited to the birthing parent alone; they can have adverse effects on the infant's development and attachment as well. Infants may experience difficulties in bonding, breastfeeding, and emotional health (Gentry, 2010). This highlights the urgent need to address birth trauma to ensure the well-being of both birthing parent and child. Additionally, the birthing partner, baby's other parent, doulas, doctors, and midwives can experience posttraumatic stress as a result of witnessing traumatic birth(s).
Understanding the Causes of Birth Trauma
Birth trauma can arise from various factors, including complicated labor, emergency medical interventions, feelings of powerlessness, and lack of support during childbirth. Medical procedures such as instrumental deliveries (forceps or vacuum-assisted), Cesarean sections, or episiotomies can contribute to the distress experienced by the birthing person. Extended or precipitous labor, poor management of pain, feeling a loss of control, postpartum hemorrhage, fearing death or permanent disability, hostile provider(s) and staff members, injury or death of baby, and stillbirth are reported (Birth Trauma Association, 2017). Prolapsed cord, Neonatal Intensive Care Unit (NICU) involvement, severe physical complication or injury (unexpected hysterectomy, preeclampsia/eclampsia, 3rd or 4th degree tear, heart issues), inadequate communication, and lack of informed consent also contribute to birth trauma (Postpartum Support International, 2021).
Common Symptoms of PTSD and Childbirth-Related Posttraumatic Stress
The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) identifies the specific criteria that must be met in order for a person to be diagnosed with Posttraumatic Stress Disorder. For people over age 6, the criteria includes:
"1. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
2. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
3. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
4. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
5. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)."
The symptoms must persist for more than one month, cause clinically significant distress or impaired functioning in important areas of life, and the disturbance can't be attributed to physiological effects of a substance or other medical condition (APA, 2013). Some individuals will experience a traumatic birth and not meet full criteria for PTSD. This could be because they have fewer symptoms or the symptoms have lasted less than one month (Prevention and Treatment of Traumatic Childbirth, 2022). Those who don't meet criteria are still experiencing posttraumatic stress and difficulty adjusting and coping with the experience(s) related to the birth of a child.
Some of the stories I've heard from mothers and fathers typically include flashbacks or nightmares about birth, avoiding doctor's appointments or going to the place where the birth occurred, difficulty attaching to baby, not wanting to talk or think about what happened, finding ways to distract or numb big feelings, relationship changes and challenges connecting as partners, negative beliefs such as "I'm a bad parent" or "I should have done something," feeling constantly on edge or alert, irritability, and feeling reactive/triggered by reminders of the birth experience (this especially happens on baby's birthday which is also the anniversary of a scary, upsetting event). Some feel their baby and family would be better off without them. This is not an exhaustive list, and a number of these experiences are shared by the parents I see who come to heal from birth trauma.
Interventions and Support for Birth Trauma
To address birth trauma effectively, healthcare providers and support systems must work collaboratively to create a safe and supportive birthing environment. Adequate communication, empathetic and trauma-informed care, and respectful treatment during childbirth can help mitigate the risk of trauma. According to ACOG (2021), implementing trauma-informed care principles, such as recognizing the prevalence and impact of birth trauma, can lead to improved outcomes for both mothers and infants.
Support groups and therapy sessions specifically focused on birth trauma have been shown to be beneficial in coping with the emotional aftermath of a traumatic birth experience. Utilizing evidence-based therapy modalities such as Eye Movement Desensitization and Reprocessing (EMDR) and Accelerated Resolution Therapy (ART) have noticeable benefits and expedited experiences of relief when used to process trauma. Other modalities such as Narrative Therapy, Trauma-Focused Cognitive Behavioral Therapy, and mindfulness-based practices can be supportive to one's healing as well. Additionally, midwives and doulas, with their focus on providing emotional support and personalized care, have emerged as valuable assets in reducing birth trauma rates (Lunda, Minnie, Benadé, 2018; Gruber, Cupito, Dobson, 2013).
Furthermore, it is essential to provide training to healthcare professionals in recognizing and addressing birth trauma. By enhancing their understanding of trauma-informed care, medical practitioners can promote a more compassionate and empathetic approach during childbirth.
-In Conclusion-
Birth trauma is a significant issue affecting both mothers, fathers, infants, families, and professionals. There is potential for long-term consequences on physical and mental health. The distress experienced as a result of exposure to actual or perceived harm is real, and it is subjective. As awareness of birth trauma grows, efforts to understand its causes, prevalence, and impact have increased. The studies cited in this blog shed light on the importance of trauma-informed care and the need for enhanced support systems during childbirth.
By prioritizing compassionate and respectful care, healthcare providers can work towards reducing the incidence of birth trauma and its associated challenges. Moreover, providing access to effective and quality therapy, and support groups can help people recover from traumatic birth experiences, fostering a healthy parent-child bond, and a positive start to parenthood.
As research in this field continues to evolve, it is crucial for policymakers, healthcare professionals, and communities to remain committed to addressing birth trauma and promoting positive birthing experiences for all.
Resources:
Sources:
American College of Obstetrics and Gynecology (ACOG). (2018). Optimizing postpartum care. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
American College of Obstetrics and Gynecology (ACOG). (2021) Important for obstetrician–gynecologists to adopt trauma-informed model of care. https://www.acog.org/news/news-releases/2021/03/important-obstetrician-gynecologists-adopt-trauma-informed-model-of-care
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological medicine, 46(6), 1121–1134. https://doi.org/10.1017/S0033291715002706
Birth Trauma Association. (2017). Coping with a difficult birth. https://www.birthtraumaassociation.org.uk/images/Coping_with_a_difficult_birth_2017.pdf
Gentry A. (2010). Preventing and healing infant birth trauma. Midwifery today with international midwife, (96), 48–49.
Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. The Journal of perinatal education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49
Lunda, P., Minnie, C. S., & Benadé, P. (2018). Women's experiences of continuous support during childbirth: a meta-synthesis. BMC pregnancy and childbirth, 18(1), 167. https://doi.org/10.1186/s12884-018-1755-8
National Partnership for Women & Families. (2023). Improving our maternity care now: Four care models state policymakers must implement for Healthier Moms and babies. https://nationalpartnership.org/resource/improving-our-maternity-care-now-four-care-models-state-policymakers-must-implement-for-healthier-moms-and-babies/
Postpartum Support International (PSI). (2021). Postpartum post-traumatic stress disorder. https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/#:~:text=Approximately%209%25%20of%20women%20experience,Prolapsed%20cord
Prevention and Treatment of Traumatic Childbirth (PATTCh). (2022). Birth trauma: Definition and statistics. https://pattch.org/birth-trauma-definition-and-statistics/
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