Often women and their partners have lots of unanswered questions about birth trauma - am I traumatised? Why have I been affected in this way? Here, two of our network members Emma Svanberg and Julianne Boutaleb explain what happens to us when we experience a traumatic birth. 

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Emma is a Perinatal Clinical Psychologist and co-founder of the Make Birth Better Network. Julianne is a Consultant Perinatal Psychologist and founded Parenthood in Mind. You are welcome to contact them if you have additional questions. 

 

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It seems like suddenly there is an awareness that birth trauma exists - that birth can affect women, their partners and families for many months and years after a birth. Recent research (Cook, Ayers & Horsch, 2018) has also suggested that the number of women experiencing a birth trauma is rising. But when we talk about birth trauma, what do we actually mean? 

 

Birth trauma, or Post Traumatic Stress Disorder Following Childbirth, has been acknowledged by clinicians for many years but was only written into the NICE Guidelines in 2014. This saw the inclusion of tokophobia (fear of childbirth), PTSD, antenatal depression and anxiety disorders and a definition of traumatic birth

 

“Traumatic birth includes births, whether preterm or full term which are physically traumatic….and births that are experienced as traumatic, even when the delivery is obstetrically straightforward.”

 

This last fact is crucial - the experience of trauma is completely subjective. 

 

Who Experiences Birth Trauma? 

We know that some women may be more susceptible to feeling traumatised by birth, such as those with a prior history of traumatic experiences, those who have experienced depression early in pregancy, or those who are very fearful of birth. During birth, those who feel out of control during birth are more likely to feel traumatised afterwards. And after birth, those who have little social support are at increased likelihood to feel traumatised. However, we also know that women and their partners can have varied experiences of trauma. Some will meet the criteria for Post Traumatic Stress Disorder (around 1-3% of women), but 20-30% of women will have symptoms of trauma which do not meet diagnostic criteria. 

 

What is Post Traumatic Stress Disorder (PTSD)?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines PTSD as a reaction to a particular traumatic stressor - either directly, through witnessing the trauma or even through hearing about a traumatic event. To meet criteria for a diagnosis, someone will be experiencing: at least one symptom of ‘intrusion’ (such as nightmares, flashbacks, feeling distressed at reminders of the event); at least one symptom of avoidance (such as avoiding returning to hospital, or avoiding thinking about the event - for some this might include avoiding their baby too); at least two symptoms of changes to thoughts and mood (such as feeling flat in mood, or finding it hard to remember aspects of the event) and changes to responses to situations (such as startling very easily, feeling very irritable or being overly vigilant).

 

 

What if that doesn’t apply to me?

While you might not meet the diagnostic criteria for PTSD, many women and their partners may experience traumatic stress, or Post Natal Depression with some symptoms of PTSD. One study Ayers et al (2009) suggested that 35% felt intense fear or horror at some point during their birth. While this website, and discussions of birth trauma in general, focus on trauma symptoms related to the birth itself, individual experience can be much broader than this. Many couples experience symptoms of trauma related to their fertility journey, birth partners may feel vicariously traumatised, previous traumatic experiences might be re-triggered - even our own mothers’ experience of birth can affect our response to our own birth.

 

What is crucial is considering whether you feel that you have been affected by birth, or the circumstances around birth, more than you expected. This might apply to the mother, the birth partner and also staff and other family members. 

 

 

Why do we experience trauma?

One of the strange things about traumatic symptoms, and what we can find the most worrisome, is how ‘out of the blue’ they can feel. We might find that suddenly we just can’t stop talking about the birth (that ‘intrusion’ symptom) or conversely that we won’t even consider thinking about it (that’s ‘avoidance’) - or even that we can’t remember it at all (that’s the changes to thoughts symptom). And we might be extremely worried about the safety of ourselves or our babies (there’s the final symptom of changes to reactions). Going through this, especially when sleep deprived, can feel quite frightening. But there’s a good reason why we react in this way, and we know about this thanks to Chris Brewin (you can read his theory here).

 

Usually, when we process memories we use a part of our brain called the hippocampus - which is like a filing system. It takes an experience, and files it into the appropriate place. But when we go through a traumatic event, our hippocampus goes offline and the amygdala takes over (you can read much more about this in a brilliant book called The Body Keeps the Score).

 

The amygdala - our alarm system - sets off our fight, flight or freeze process. If we freeze (which is often the only reaction we have during birth), we might dissociate in order to deal with what is happening to us - literally we go elsewhere in our minds.

 

This means that our memories become stored in the amygdala, unable to be accessed in the same way as normal memories, and can be triggered seemingly at random when we have a particular reminder. 

 

In this way, symptoms of trauma are often very useful responses to what felt like an unbearable event. You can actually utilise these brain reactions when you are ready to begin the process of recovery - and you can read more about that on our ‘Healing’ page. 

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