Understanding Birth Trauma and Its Effects on Women

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Birth trauma in mothers is a term used to describe postpartum post-traumatic stress disorder (P-PTSD). According to Postpartum Support International, P-PTSD affects around nine percent of women.

The root cause for this illness is trauma during birth. It is important to note that said trauma can be either real or perceived. What this means is that the birthing experience could have a deep and negative impact on the mother if she perceives something traumatic has occurred, or if something traumatic does indeed occur.

Some examples of situations that can trigger postpartum PTSD include but are not limited to:

• Medical complications occurring to the baby such as newborn resuscitation, newborn being rushed to NICU, prolapsed cord, birth of a damaged baby, and of course stillbirth or infant loss.
• Medical complications occurring to the mother such as emergency C-section, severe hemorrhage, unexpected hysterectomy, loss of consciousness, severe perineal tears, etc.
• Use of vacuum extractor or forceps.
• Premature birth.
• History of sexual abuse or rape.
• Feelings of powerlessness or voicelessness in the decision-making process during labor.
• Lack of support, empathy or communication from the caregivers or medical staff attending the labor.
• Feelings of having been coerced, bullied, scared, or shamed into accepting certain procedures.
• Loss of control or dignity.
• A previous negative birthing experience.
• History of psychological or mental health problems.
• A birth that resulted differently than what was hoped for (i.e. a planned home birth that ended in a hospital transfer; an unmedicated birth that required an epidural; a hospital birth that didn’t happen because it speedily culminated in delivery in the car on the side of a highway; etc.)

Reading the list above we may be tempted to think that some of the reasons presented — mainly, the medical emergencies — seem more “legitimate” or “make more sense” for resulting in postpartum PTSD. This, however, represents a problematic narrative in how we view, judge, score, and value women’s birthing experiences.

It is imperative to remember that each woman’s individual experience is valuable, unique, and can have a long-lasting impact on her life.

Furthermore, it’s necessary to explore our own beliefs and biases on the matter, since lack of support is likely to be the primary reason why mothers who suffer from this illness hesitate to ask for help. By recognizing P-PTSD as a legitimate illness, we can be better equipped to identify its signs and be of help.

What Makes PTSD, PTSD?

For a diagnosis of PTSD to be established, the occurrence of an event considered beyond the range of usual human experience is required. Symptoms involve a triad of responses, including:

• Active avoidance of reminders of the event
• Hyperarousal manifested by general edigness or irritability
• Intrusive experiences consisting of nightmares or images that occur as if the person were to relive the triggering event in real time, or persistently reexperience the traumatic event [1].

In order for a diagnosis of PTSD to be made, these symptoms must last at least one month following the event, and must also cause impairment in day-to-day life [1].

As with the PTSD experienced by war veterans, some other symptoms that may occur as a consequence of P-PTSD include:

• Flashbacks or hallucinations
• Difficulty sleeping
• Anxiety or anxiousness
• A sense of detachment
• Panic attacks
• A heightened startle response
• A sense of threat
• Shame
• Anger
• Fear of harm to oneself or the baby
• General feelings of fear, helplessness or horror.
• Avoidance of reminders of the event including, people, places, sounds, colors, details or thoughts
• Hyper-arousal: difficulty sleeping and concentrating; increased irritability.

P-PTSD has also been linked to instances of sexual avoidance, problems with the process of mother-infant attachment or with parenting, and fear of childbirth [2].

Considering the debilitating symptoms of this disorder, and their effect on the social, occupational, psychological and communicative functioning of the mother with her baby and her family, being aware of the possibility of this disorder occurring after delivery, and recognizing the risk factors, is an important issue [2].

Birth Trauma is Not Postpartum Depression

A clear distinction must be made between P-PTSD and Postpartum Depression (PPD), even though some overlap may be present since both illnesses can display some of the same symptoms. Still, each illness is unique and should be treated individually.

Postpartum depression is more commonly recognized, and those experiencing it will likely encounter some of the following symptoms [3]:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities they used to enjoy
• Intense irritability and anger
• Fear that they are not a good mother
• Feelings of worthlessness, shame, guilt, or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Severe anxiety and panic attacks
• Thoughts of harming themselves or their baby
• Recurrent thoughts of death or suicide

Again, while many of the symptoms overlap with those of Postpartum PTSD, we must recognize each illness is a completely different and individual matter.

A doctor diagnosing for one or both of these illnesses will have a checklist of key elements to help distinguish those suffering P-PTSD from mothers battling postpartum depression.

Can Birth Trauma Be Avoided?

Although there is no surefire way to inoculate a woman against the potential development of postpartum PTSD, some research shows promising benefits of having a loved or trusted person who can encourage the woman throughout her laboring process: explaining what is happening, touching, reassuring, supporting, praising, being continuously present, and advocating for her.

For most women, this tends to be the father of their baby or significant other such as their husband or partner, although this role can also be successfully fulfilled by a relative, close friend, or doula (professional birth coach).

Coaching a Client Survivor of Birth Trauma

Needless to say, the impact of birth trauma — and its potential to deplete a mother’s ability to care for herself — cannot be understated. As coaches, thanks to our close relationships with our clients and how well we get to know them, we can oftentimes be the first line of defense when it comes to help identifying a number of challenges they are experiencing.

If you encounter a client who is suffering or might be suffering from P-PTSD, it is important that you coach from a place of deep compassion.

Remember that this woman is very likely to already be judging herself harshly, and potentially experiencing upsetting thoughts about herself.

As health and fitness professionals, there is no need for any judgment on our part, as this may lead our client to withdraw and shut down. Instead, consider the following guidelines:

Empathize With Compassion

Actively listen to your client. Let her know you empathize with her struggle and that you feel deeply for the pain she is enduring.

Normalize

Normalizing doesn’t mean disregarding your client’s pain as unimportant since she’s “not the only one going through this” — all the opposite!

Normalizing the situation in a gentle and compassionate manner is meant to help her bridge feelings of loneliness and isolation.

For more analytical clients, statistics showing the prevalence of birth trauma in our society may be helpful. In the case of more connection-driven clients, showing them that they are not alone and that you will continue to care, love and support them regardless of the conflict they’re experiencing will be key.

Refer to a Specialized Professional

Ideally, you will have a roaster of trusted professionals in different relevant fields to whom you can refer clients when needed. Making relevant connections with health professionals of different fields will be very beneficial to your client’s well-being and your coaching relationship. Some professionals to keep in mind include:

• Counselors
• Psychotherapists
• Support groups for survivors of birth trauma, such as The Birth Trauma Association
• Local hospital’s mental health unit
• Midwives
• OB-GYNs
• Doulas
• Mom support groups, such as your local chapter of La Leche League

Encourage Connection

One of the most beneficial steps when it comes to addressing birth trauma is for the woman to connect with a group of other women who can understand her deeply because they’ve experienced the same. Finding a support group where she can receive companionship and true empathy will almost certainly represent a step in the right direction. The resources and professionals listed above can help find the correct place.

Invalidating Her Experience: Adding To Her Suffering

Above all, please be mindful to avoid invalidating a woman’s experience.

We invalidate a woman’s experience and accompanying emotions when we make statements that subtract importance and magnitude from what she is feeling:

“You’re lucky your baby is alive and well.”
“Well, that’s all done now.”
“It could have been much worse.”
“Others have it so much worse.”
“It’s time to move on, to get over it.”

In fact, these often-used phrases confirm the woman’s fears: No one understands. No one gets it. I am alone in this. Something must be wrong with me. It is safe to conclude that none of this will be conducive to her seeking further help or resolution, but instead may motivate her to withdraw and shut down further, much to her and her family’s detriment.

Instead, use words of affirmation, empathy and deep support:

“Speaking up is so courageous and the first step into healing.”
“I am here for you, no matter what.”
“I wish I could take your pain away.”
“You are not alone.”
“I admire your strength.”
“You are so brave to be confronting this.”
“Thank you so much for trusting me with this.”
“You are so resilient, I am fortunate to know you.”

Not All Is Lost

The good news in an otherwise harrowing and difficult situation is that postpartum PTSD is treatable and oftentimes reversed when diagnosed appropriately. In fact, women have reported that having the opportunity to talk with someone about their birth experience was helpful in facilitating their recovery [4].

Various avenues for treatment and intervention exist, including cognitive behavioral therapy (CBT), group therapy, psychotherapy, eye movement desensitisation and reprocessing (EMDR), and in some cases, medication.

All in all, we owe it to ourselves as a society to remain mindful of the existence and prevalence of postpartum PTSD, so we can be a more timely and effective impact on our vulnerable mothers’ health and well-being. This will in turn result in more solid and positive bonding experiences for mother and baby, and a positive impact on our society’s family dynamics.

References

1. American Psychiatric Association [APA] 1980. Diagnostic and statistical manual of mental disorders. Washington, DC: Author. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517191/#citeref2
2. Bailham D, Joseph S. Post-traumatic stress following childbirth: A review of the emerging literature and directions for research and practice. Psychology, Health & Medicine. 2003;8(2):159–168. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517191/#citeref5
3. Mayo Clinic, Postpartum Depression, Symptoms & causes https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
4. Gamble, JA et al., A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress, Midwifery, Volume 18, Issue 1, 72-79. https://www.ncbi.nlm.nih.gov/pubmed/11945055

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