What happens when birth doesn’t go to plan? What do we mean by birth trauma?
What is Birth Trauma?
For all of us the transition to being a parent is a huge life event. For many women and birthing people their birth experience happens just as they hoped and wished for, but for many women their birth experience is not at all what they expected. Partners and staff can also be traumatised by what they witnessed, and other friends and family members can be affected too.
When birth is difficult, this can leave parents starting their journey feeling vulnerable and distressed.
A difficult or traumatic birth occurs when some aspect of birth is felt to be traumatic, distressing, and/or fearful. It doesn’t matter what you found difficult, it’s your birth. If something felt fearful, frightening, scary or out of control then that is your story.
Currently more than 20% of all women find some aspect of their birth traumatic, which equates to around 200,000 women per year. That is a lot of women starting the journey to motherhood feeling difficult and overwhelming emotions. We don't yet have the statistics for partners and staff but we know that they are impacted too. Yet, birth trauma is still not well recognised or identified.
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.
The majority of research has focused on women's experiences of birth trauma. Newer research will tell us about birth partners' experiences, and trauma of staff. However, there is much we don't yet know. We can assume looking at the MMBRACE-UK report 2018 that Black and Minority Ethnic women may be at greater risk of traumatic experiences, and evidence suggests LGBTQI+ individuals may experience increased stigma and prejudice. Those with learning disabilities may also be at increased risk. It is also recognised that parents whose babies spend time in Neonatal Intensive Care may be at increased risk of post traumatic symptoms. Parents who lose their babies during or shortly after birth also have the added trauma of finding few services available to support them.
This page focuses therefore, on women, but we hope to update it as the research becomes more inclusive. Do let us know if you would like us to update our information.
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 pregnancy, 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 4-6% 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. You can watch a video which explains how this works here.
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.