We often hear childbirth being described as “magical,” or “transformative,” which might resonate for some people, but what about those whose experiences feel quite the opposite? For many people who give birth, the birthing experience is associated with fear, powerlessness, and lack of control that can have lasting psychological and emotional impacts. Amongst so much euphemistic talk about birth, the lack of discourse around births that don’t go as planned or as hoped, can result in feelings of isolation for those who have experienced birth trauma.
As a perinatal psychotherapist, I’ve had many women sit in my office and tell me that their experience of labor felt like a nightmare, and that they don’t know why. This often results in them reaching for self blame. Some of these women had medically complicated births or births that resulted in serious medical consequences. Others had medically uncomplicated births but felt voiceless, out of control, and unsupported by their medical teams during their labor. All of these women share the experience of birth trauma, although the paths that got them there might look quite different.
What is birth trauma?
Birth trauma is a term that refers to intense emotional and psychological distress during or resulting from a childbirth. Researcher and obstetric nurse Cheryl Beck stated “birth trauma is in the eye of the beholder” (Beck, 2004), meaning that it is based upon the subjective experience of the birthing person, and not the objective medical facts. This is an important lens for looking at birth trauma. Even in a labor that would be considered medically uncomplicated by the medical team, if the birthing person felt fearful, powerless, voiceless, or helpless, they might have experienced a birth trauma.
This type of birth is more common than you might think. In fact, up to 45% of new mothers report having experienced birth trauma (Beck, Watson, Gable 2018). It’s important to note that some people who experience trauma might meet full criteria for the diagnosis of Posttraumatic Stress Disorder, and some might not. Whether or not someone has a diagnosis of PTSD resulting from their birth trauma, they can still be profoundly impacted by trauma-related symptoms.
How does birth trauma happen?
Due to many misconceptions, many patients I’ve worked with have initially struggled to identify their birth experience as traumatic, especially those that had a medically uncomplicated delivery. Through learning about the subjective nature of birth trauma, we can empower birthing people to better understand their experience and recognize their reactions as real and valid. This can help alleviate feelings of shame or failure that are unfortunately very common among survivors.
Given that birth trauma is in the eye of the beholder, it can occur with or without objective medical stress or complications. Birth trauma can (at times) look like real or perceived risk to the life of the mom or baby, a NICU stay, intense physical pain, or unexpected medical intervention. Birth trauma always includes feelings of powerlessness, intense fear, and lack of control. Many times, birth trauma might involve the birthing parent feeling dismissed or unheard by their medical team, having broken expectations for birth, and generally feeling overwhelmed by the experience.
What are the symptoms associated with birth trauma?
Similarly to many mental health struggles, birth trauma can manifest in a variety of ways and might look really different from one person to another. Many people who have experienced birth trauma describe feeling anxious or fearful when thinking about their birth, or feeling depression or profound sadness. Memories of labor might bring significant distress or feel hard to discuss. As mentioned earlier, often people who have experienced birth trauma feel guilt or shame around their birth experience, as though they did something wrong or caused the trauma.
Often those who have been through birth trauma might report hypervigilance which means feeling “keyed up,” or feeling as though you’re constantly on alert for danger. Nightmares and trouble with sleep are also common symptoms, as well as feeling generally anxious and fearful (particularly around the health and safety of their baby). Additionally, another symptom of birth trauma is feeling numb and disconnected from oneself and their baby or partner.
As you can imagine, these symptoms can range from mild to more severe, and can have varying degrees of impact on the birthing person’s life.
Risk factors
It’s important to name that there aren’t any factors that will predict birth trauma, not even life-threatening medical complications. I have worked with women who have experienced extreme medical risk during labor and through the attunement and support of their care team and loved ones did not identify it as traumatic. Conversely, I’ve worked with women who had medically uncomplicated deliveries but experienced childbirth as traumatic as a result of feeling ignored, powerless, and out of control.
There are some risk factors that can make it more likely for someone to experience birth trauma. Feeling intense fear, lack of control, and feeling voiceless or ignored by medical teams can be a risk factor, as well as a general lack of support. Additionally, experiencing intense pain or unexpected medical intervention can be risk factors for birth trauma. Some additional factors that might put someone at a higher risk include a history of PTSD, prenatal depression, or unresolved mental health issues, fear of childbirth (Ayers, 2017) and poverty or lack of resources.
How can you heal?
Although traumatic childbirth can have lasting psychological and emotional impact, the good news is that it doesn’t have to, there is opportunity for healing. Psychotherapy can be a powerful way to heal. With the right therapist, you can begin to understand your birth trauma, learn to cope with the associated symptoms, and begin to heal.
In order to find a therapist who has some experience in this area, look for those with a perinatal mental health certification from PSI, called PMH-C. This indicates that the therapist has advanced training in perinatal mental health, including trauma. At Wildflower Center for Emotional Health, many of our therapists hold this certification already, and others are working towards it.
Birth trauma does not have to impact you forever: with the right support, you will feel better. Check out the resources below to learn more and empower yourself to understand your own birth experience or to better support your loved ones.
Resources for further learning
Wildflower Birth Trauma Support and Resource Guide Free booklet with education and various resources related to traumatic birth
Make Birth Better Downloadable resources addressing topics associated with birth and mental health
Birth Trauma: A Guide for You, Your Friends and Family to Coping with Post-Traumatic Stress Disorder Following Birth This book explains what birth trauma is, what causes it, and its associated symptoms, and how to heal from birth trauma
The Birth Trauma Mama Podcast Podcast hosted by a licensed therapist and trauma survivor
How to Write your Birth Story: A Path to Healing A guide created by March of Dimes to help people process and understand their births
Helplines
National Maternal Mental Health Hotline
1-833-852-6262 – (available 24/7)
Staffed by trained counselors, this hotline can be called or texted for support at any time.
PSI Helpline
1-800-944-4773 (4PPD) – (8 am-11 pm EST)
Provides resources, information, support- not to be utilized for emergencies.
Sources
Ayers, S. (2017). Birth trauma and post-traumatic stress disorder: the importance of risk and resilience. Journal of Reproductive and Infant Psychology, 35(5), 427–430. https://www.tandfonline.com/doi/full/10.1080/02646838.2017.1386874
Beck, C. T. (2004). Birth trauma. Nursing Research, 53(1), 28–35. https://journals.lww.com/nursingresearchonline/abstract/2004/01000/birth_trauma__in_the_eye_of_the_beholder.5.aspxBeck CT, Watson S, Gable RK. Traumatic Childbirth and Its Aftermath: Is There Anything Positive? J Perinat Educ. 2018 Jun;27(3):175-184. doi: 10.1891/1058-1243.27.3.175. PMID: 30364308; PMCID: PMC6193358. https://pubmed.ncbi.nlm.nih.gov/30364308/
