Understanding birth trauma
Trauma is a word that we hear a lot today in various contexts, though clinically it has a fairly complex understanding. Birth trauma is essentially postnatal/postpartum post-traumatic stress disorder (PTSD), however it is often used as a broad umbrella term for women who have symptoms of PTSD but may not have received a clinical diagnosis. It can include both psychological and physical trauma.
There are four main symptoms of birth psychological trauma:
- Re-experiencing the traumatic elements of the birth through flashbacks, nightmares or intrusive thoughts
- Avoidant behaviours – for example not wanting to return to the hospital where you gave birth, not wanting to share your birth story or hear other women’s birth stories
- Hypervigilance – a feeling of jumpiness, being on high alert and finding it hard to relax. This can include a pervasive feeling that something bad is going to happen to you or your baby
- Developing a negative self-belief associated to your birth – this will be very personal but may include feelings like guilt, blame or shame around the events of your birth
I often explain to clients that trauma is in the eye of the beholder and what may be traumatic for one woman, may not be so for another. Birth trauma doesn’t always or automatically follow dramatic and emergency births. For many women experiences such as a loss of dignity, a sense of not being in control of events or not feeling that their wishes were heard or heeded by medical staff result in PSTD symptoms.
Whilst research into birth trauma is still very much in its infancy, we do know that it is more likely to be experienced when the following occur:
- Lengthy labour or short and very painful labour
- Induced labour
- Poorly managed pain relief
- Feelings of loss of control
- High levels of medical intervention
- Forceps deliveries
- Emergency caesarean section
- Impersonal treatment or problems with staff attitudes
- Not being listened to
- Lack of information, explanation or informed consent
- Lack of privacy and dignity
- Fear for baby’s safety
- Birth of a baby with a disability resulting from a traumatic birth
- Baby’s stay in the special care baby unit or neonatal intensive care unit
- Poor postnatal care
- Previous trauma (such as family violence, sexual assault / rape, previous traumatic birth)
A partner / husband / family member present at the birth can also suffer birth trauma vicariously.
Physical birth trauma may be identified immediately post-birth, but for many women the full implications do not come to light until sometime later. These include, but aren’t limited to perineal tears, episiotomies, pelvic floor muscle damage and pelvic organ prolapse. To manage the healing process, and to gain a full understanding of your physical recovery postnatally I always recommend seeing a trauma-informed pelvic/women’s health physiotherapist.
When a woman’s expectations of birth, what she may have included in her birth plan, or has longed for during pregnancy, aren’t met in the reality of their birth experience many women struggle to make sense of their birth. It is important that we are not only aware of the prevalence and unique experience that is birth trauma, but also engage in birth story retelling with compassion and without judgement as we never fully know how hard it may be for any individual woman to come to terms with their birth.
If you are struggling to navigate the after-effects of your birth, there are a number of websites I encourage clients to access: