Birth Trauma and PTSD

Birth Trauma and PTSD Impacts Mothers

Childbirth often does not go as planned. Sometimes these unanticipated events escalate far beyond minor changes in the birth plan and on to true trauma. Birth trauma refers to an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother or her infant. The birthing woman usually describes feeling intense fear, loss of dignity, helplessness, loss of control, and horror.Birth trauma is far more common than one might think. In fact, up to 34% of women report experiencing a traumatic birth. Determining whether an event is traumatic really is in the eye of the person experiencing it. Two women may experience the same event in very different ways depending on their respective emotional states, how each is treated by the people around her, their own personal histories, or their individual perception of dangers in the moment.

Potentially Traumatic Birth Experiences:

• Emergency cesarean delivery
• Postpartum hemorrhage
• Premature birth
• Infant in NICU
• Forceps or vacuum extraction
• Severe pre-eclampsia
• 3rd or 4th degree lacerations
• Hyperemesis gravidarum (persistent vomiting)

 Survivors of sexual abuse are at an increased risk of birth trauma. She may have greater body comfort issues, experience hypervigilance, fear of invasive procedures, and fear of losing control of her body. The birth experience may trigger body memories of her abuse and lead to dissociation. Considering 1/4 to 1/3 of women are survivors of sexual abuse, this represents a big challenge.Birth trauma results in Post-Traumatic Stress Disorder (PTSD) when the distress after the event leads to significant impairments in the person's ability to function. About 9% of women postpartum experience PTSD. 

Symptoms of PTSD:

• Re-experiencing the traumatic event with flashbacks or intrusive thoughts
• Distressing memories, thoughts, or feelings related to the event
• Recurrent dreams/nightmares
• Avoidance of family, friends, providers
• Persistent and distorted sense of blame or guilt
• Emotional numbness or dissociation
• Anger
• Hyperarousal or hypervigilance, often with exaggerated startle response
• Inability to recall aspects of the traumatic event

There are particular themes in Postpartum PTSD with which many women identify.

1. Perceived lack of caring
   1. Felt abandoned
   2. Stripped of her dignity
   3. Lacking support and reassurance
2. Poor communication
   1. Felt invisible
   2. Preferences and opinions not considered
3. Feeling powerless
   1. Betrayal of trust, not protected by staff
   2. Physically restrained in the operating room
4. Do the ends justify the means?
   1. Repeated message that a healthy baby justifies the traumatic birth

PTSD due to Birth Trauma can have severe consequences for the mother and her family. She is more likely to avoid aftercare and not seek medical follow up. Mother-infant bonding is likely to be more challenging with breastfeeding problems more common. She is at an increased risk of sexual dysfunction, avoidance of future pregnancies, or worsening of emotional symptoms during future pregnancies. This experience can significantly impact the recovery of the mother an affect the course of the entire family.It should be noted that partners and family members are also vulnerable to Birth Trauma. Witnessing a loved one in such a vulnerable and potentially life threatening situation causes the same feelings of fear, horror, and helplessness. They are expected to "be strong" for the laboring woman and baby, but may harbor intense unspoken fears.Resolving the emotional impact of Birth Trauma is essential for long-term healing and emotional bonding in the family. It is important to talk about the experience or write about it and share this with someone who will be compassionate. Honor the pain of this experience and the loss of an ideal delivery. Seek professional help to address symptoms of PTSD. The earlier you seek support and treatment, the less of an impact this experience is likely to have on your life and the lives of your family. You are not alone, and help can make all of the difference.(If you have experienced birth trauma or know someone who has, please see our resource page for a list of services on the west and east sides of Cleveland. Dr Smith's information can be found both on the resource page and below.)Suzanne J. Smith, Ph.D. is a licensed Clinical Health Psychologist working in private practice at Lakefront Psychology in Westlake, Ohio. She received her Doctorate at Ohio University and completed her training at the Cincinnati VA Medical Center and Cleveland Clinic. She worked for more than ten years as a staff psychologist at the Cleveland VAMC. Currently, she provides assessment and treatment for adults experiencing anxiety, depression, personal crises, and relationship difficulties within the comfort of a small private practice setting. She specializes in providing compassionate care for women facing unique challenges throughout the childbearing and child-rearing years. In particular, she strives to support women dealing with pregnancy and fertility issues, loss, as well as transitions in family and personal life.