How to Move Forward After a Traumatic Birth Experience

Postpartum

Jun 27

trauma of labor & delivery.jpg — Authored by:
Anna Glezer, M.D.

When women think about childbirth, they often have many different hopes and plans. What happens when those dreams of a beautiful experience do not go as planned? What if, in fact, the experience was psychologically traumatic?

If childbirth was a traumatic experience for you, you might remember feelings of fear, anxiety, pain, helplessness, and a loss of control during labor and delivery. As many as a third of women describe their labor experience as traumatic.

Post-Traumatic Stress Syndrome/Disorder before and after childbirth

PTSD is a condition that occurs after a stressful life event and includes symptoms like avoidance of reminders of the event, intrusive thoughts or re-experiencing of the trauma, irritability and difficulty concentrating, changes in arousal (such as being more easily startled), and negative changes in thoughts and mood.

Women are much more likely to experience symptoms of PTSD in general, and many are likely to have gone through a traumatic event even before childbirth. In fact, one survey study found that over 90% of women reported previously experiencing an event in their lives they consider traumatic. About half of those met the more technical clinical definition of a traumatic event.

PTSD has been diagnosed in 1-9% of women after childbirth, with persistence of the diagnosis well into the postpartum period. In fact, several studies show that the prevalence of PTSD during the postpartum period peaks around 3-6 months.

However, many women who might not meet the technical criteria of PTSD may still be struggling psychologically and emotionally. Women have described feelings of guilt and anger, of depression, and even thoughts of self-harm.

What are the consequences of Post-traumatic stress after childbirth?

Implications for the postpartum period
Research shows that women who describe a traumatic birth experience are more prone to develop postpartum depression. As we have previously discussed, postpartum depression is a condition that can have wide ranging effects on both mom and baby and that relationship (See: Baby Blues or Beyond).

Even without the symptoms of postpartum depression, such as low mood, high anxiety, or poor motivation, if you have gone through a complication childbirth, it can lead to difficulties in attaching with your baby, your ability to parent successfully, and your relationship with your partner.

Implications for future pregnancies
Some women have described feeling so traumatized after a negative childbirth experience that it decreases or even eliminates their desire for a future pregnancy. Others have said that it changes their desired delivery options in the future. If you have had a difficult and challenging birth experience, you may be more likely to request more interventions, including c-section, with future pregnancies.

Who is vulnerable to Post-Traumatic Stress after childbirth?

There are several factors related to the delivery experience that increases the likelihood it will be described as traumatic. Many are related to interventions. That is, the more interventions during a delivery, the more likely it will be considered traumatic. This might include a c-section, forceps, significant blood loss, or anything that was not in the original birth plan.

Interestingly, research shows that some women view their childbirth experience as traumatic (meaning viewing it as having threatened their life or their baby’s) even when objectively this was not the case, while others who may have had complications that did in fact place them or their baby at risk do not feel traumatized. The point is that the subjective experience is essential – the view by mom not by doctors.

Another significant component is the relationship with clinical staff and with one’s OB team prior to delivery. Women who feel less informed or less connected with their treaters are more likely to report their childbirth as having been traumatic.

Some elements that predispose a woman to post-traumatic stress are those related to how a woman was feeling even before the delivery. This includes stressful life events or prior trauma or an anxious temperament. It also includes symptoms of depression or anxiety prior to delivery.

Can we decrease the likelihood of Post-Traumatic Stress after childbirth?

More Information
As we saw above, feeling less informed can lead to negative experiences. To decrease the likelihood of this, it is important to advocate for yourself prior to the delivery. This might mean an extra visit or two with your obstetrician to go over all the potential plans and interventions. It could also mean taking additional classes later in pregnancy to decrease anxiety and questions about the birth experience. Thirdly, if there is a fear of childbirth, psychotherapy and relaxation training in addition to information/classes is valuable.

Advocating for yourself during delivery is challenging because you are in labor! That is why it is also important to think about who you will have at your bedside during this important event. Having an involved and informed partner or a caring doula will make a difference. (See: Doulas)

Positive Relationship with Clinicians
It is also essential for clinicians who work with pregnant women to be aware of the risk factors for post-traumatic stress after childbirth. It is quite notable that one recurrent finding in research on this topic is the fact that women’s perceptions of staff affects their views on whether a delivery experience was traumatic. The labor experience can be a time of confusion, with many different providers in and out of the hospital room. It is valuable for each provider to introduce him/herself in a calm manner and explain what is going on to make the experience less bewildering for the laboring mom and to provide her with more of a sense of control.

Treating Pre-existing Conditions
Since a diagnosis of anxiety or depression prior to delivery can increase the possibility of a traumatic childbirth experience, it is crucial to seek treatment for these conditions in advance of delivery. (See: Depression in Pregnancy or How Much Anxiety is Too Much?)

What are the treatment options postpartum?

The best treatment that we have for post-traumatic stress disorder is psychotherapy. Therapy will help you process the event, move past the trauma, and learn skills to manage symptoms. There are many different kinds of psychotherapy, but those that have been studied best for PTSD include cognitive-behavioral therapy, exposure treatment, and eye movement desensitization and reprocessing (EMDR).

There are also several medications to consider. Many are those that we use to also treat depression and anxiety, and there are others that can help with very specific symptoms like nightmares.

Finally, support is key. This may be from a therapeutic group, from family or friends.

Selected References:
Bastos, M.H. et. al. Debriefing interventions for the prevention of psychological trauma in women following childbirth. 2015. The Cochrane Collaboration.
Alcorn, K.L. et. al. A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine (2010) 40: 1849-1859.
Zaers, S., Waschke, M. & Ehlert, U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. Journal of Psychosomatic Obstetrics & Gynecology (2008) 29:1, 61-71.
Garthus-Niegel, S. The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health (2013) 16: 1-10.

Anna Glezer, M.D.

Dr. Glezer began her training at Harvard and then transitioned to the University of California, San Francisco, where she has been a practicing physician, teacher, mentor, and is an associate professor. She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association, and the immediate past President of the Northern California Psychiatric Society.

She has worked with hundreds of women going through the emotional challenges of conception, pregnancy, loss, and postpartum. She has been interviewed for, and her written work has appeared on multiple leading sites, including Huffington Post, Fit Pregnancy, Health Line, Help Guide, and more. She has presented at local and national conferences and published in academic journals. Several years ago, she established the annual Bay Area Maternal Mental Health Conference and launched the educational website Mind Body Pregnancy, aimed to inform women, their partners, and their providers about mental health and emotional issues common in the reproductive years.

She began her private practice to help women throughout the Bay Area access reproductive mental health services and is really passionate about helping as many women as possible.