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woman struggling with postnatal ptsd

Mother and Baby Aren’t ‘Doing Fine’. How to Deal with the Effects of a Traumatic Birth

How often do we hear the phrase ‘Mother and baby are doing fine’ compared to how often we hear the opposite? The answer is, rarely. 

Until recent decades, we have been without a definition for birth trauma and postnatal post-traumatic stress disorder (PTSD). The enormity of the emotional impact of childbirth on women’s mental and physical health has been underestimated, gaslit and swept under the carpet by dividing it off as ‘women’s problems’. Just because of the sheer number of births that happen around the clock, there is an assumption that birth is a normal part of life (as if there were only one way to experience childbirth!). 

Dare we even mention the massive underinvestment in women’s health. Society can too often dump Mums with a ‘get on with it’ attitude. 

What are the impacts of birth trauma and postnatal PTSD?  

Mental health charity,  Mind, describes what birth trauma is:

“Birth trauma happens when we go through a frightening, stressful or distressing event which is related to giving birth. It can develop into postnatal post-traumatic stress disorder (PTSD), which is a type of anxiety disorder.” 

It’s also important to notice that postnatal PTSD can be experienced by both the mother and the father, or birth partner.

How many mums are affected?

Without wanting to raise fear of childbirth in the minds of prospective mums everywhere, (and to remind you that while reading this, childbirth is considered to be generally safe in the UK), research shows that about 4-5% of women develop PTSD after giving birth. This is equivalent to approximately 25,000-30,000 women every year in the UK. Mums are living through, and reliving what they describe as horrendous or frightening experiences during or after childbirth. Feeling fear and helplessness over the lack of control that happened when they gave birth is also common.

And the problem has been left unaddressed for some while. In the UK there has been a shortage of midwives due to underfunding to help give support for birth trauma. 

How do you get PTSD from childbirth?

Postnatal PTSD was officially only recognised in the 1990s, defined as an event where a person “witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.

Previously, PTSD was only seen as being “something outside the range of usual human experience” by the American Psychiatry Association. Therefore, childbirth had been considered to be a too-common human experience to qualify for particular attention.

What does postnatal PTSD and birth trauma look and feel like?

Because of the range of maternal health problems that can be experienced,  it might be hard to spot the signs of birth trauma and subsequent postnatal PTSD immediately, and to tell them apart.

In the initial timeframe after birth, you may be adjusting to parenting, experiencing sleep deprivation, and coping with big hormone changes along with some of the more normal physical changes that happen to your body post-birth.

The overall signs and symptoms of birth trauma can include reliving events from your birth that caused trauma, avoidance of emotions, and feeling overly alert or on edge. You may be going through a range of strong negative feelings, or have particular beliefs about what happened including paranoia or isolation, or you may blame yourself for what happened.

Other feelings you may experience could include disappointment with the birth experience or the way that the birth was handled. You may have felt a lack of support during birth or a lack of control or involvement in the birth that made you feel panicked or traumatised afterwards.  If you have given birth before, you might find that previous negative experiences may emerge.

Ultimately, negative feelings surrounding the birth can affect you for a long time. They can impact your relationships, including your relationship with your new baby and influence how you feel about yourself.

What is considered to be a ‘normal birth experience’?

You might be surprised to hear that many things you may find frightening can be considered ‘normal’ within the range of childbirth.

Your expectation of what birth is going to be like is also important to acknowledge in relation to considering what is perceived as ‘normal’. Failed expectations of a particular event during birth for one person, may be perceived by another as a positive outcome or experience.

Human bodies evolved when our species started to stand upright. The hips narrowed and  skulls enlarged meaning that babies had to rotate more to fit the birth canal, and for some modern-day humans, that has meant birth is more physically difficult, whereas for others it is relatively ‘easier’. It’s also important to understand that every birth varies and that difficulties during birth  can be influenced by the individual and their day-to-day lifestyle. You can explore these considerations by talking to your midwife.

The range of birth experiences is wide, and medical procedures and treatments to increase the safety of birth for women in ‘high income countries’ have moved on since the 1700s. As a result, a lot of births can be highly medicalised to include surgical procedures and medicines, thereby going against the somewhat purist definition by the WHO of a ‘normal birth’;

“spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously [without help] in the vertex position [head down, facing the rear] between 37 and 42 completed weeks of pregnancy. After birth mother and baby are in good condition.”

We know that for some of you, (for example, black women are four times more likely to die giving birth), birth may have higher risk than for others 

At Kari we are keen to support mums to feel empowered and so our take on a ‘normal birth’ is the one that you feel in control of the decisions for, with the correct level of care in place to protect your mind and body, as well as the health of you and your child. Things can change very quickly in childbirth and what starts off ‘by the book’ and following the preferences you have outlined in your birth plan, can change quickly 

You may have gone through something where you didn’t know what the process or outcome would look like. The things that could be traumatic to you might include emotional aspects as well as physical things that happened such as:

  • Unexpected or shocking things that happened during the birth
  • A long, painful delivery
  • Interventions such as forceps or ventouse
  • Fear for yours or your baby’s life
  • An unplanned or emergency caesarean section 
  • Emergency medical treatment for you or your baby
  • Perineal injuries (known as OASI Obstetric Anal Sphincter Injury) or 3rd and 4th degree tears.)

The care you should expect to receive in a normal situation

There are procedural requirements that have to be met by your healthcare team;

  • To have the risks and consequences of birth choices and actions explained to you objectively so that you can make an informed decision
  • To be told what you want to know, not what the doctors think you should know
  • To be offered a cesarean section if the risk of vaginal birth means there could be problems
  • To be able to consent to treatment or to withdraw consent for you and your baby
  • To be told the reasons that a particular treatment is being recommended, without having pressure put on you
  • To be allowed reasonable adjustments, as included in your birth plan, if you have a disability
  • To be listened to and taken seriously when you ask for care (e.g. to have pain relief topped up, if clinically sound)
  • To have things explained again if you didn’t understand them. It should be easy to ask questions

If you feel that these were not met, there is a complaints process that you can find out more about through PALS, by speaking to your GP, or through the hospital.

What the healthcare system is doing to help

Recently, things have started to look up with interventions in this neglected situation starting to be made. As we can see below, how far and how quickly these changes happen are also something of a postcode lottery:

What help is on hand right now

If you know that you had a traumatic birth, speak to your midwife or health visitor as soon as possible. You may not feel ready to go over your birth experience for months, or even years but even if you find that you need help because of birth trauma several years down the line, it is also available to you.

6 to 8-week postnatal check This is a separate appointment to the 6 to 8-week baby check, which focuses on the mother’s physical and mental health and general wellbeing. The appointment uses open questioning and provides an important opportunity to identify women with postnatal mental or physical (including pelvic health) concerns. Currently, some women within the UK report not receiving this check. This appears to be in the process of automation within the NHS, but if you haven’t received a notification of this appointment, it’s worth asking your healthcare team.

Requesting a birth debriefMidwife-led Birth Reflections, or Birth Afterthoughts is an NHS initiative you can access through the NHS Trust that you gave birth with. You will sit with an experienced midwife and they will talk it through with you using your maternity records (which are kept for 25 years) as a reference to explain.

Speaking to the midwife will help you to gain perspective about the birth so that you can see that although it was traumatic, your experience may not be unusual, and you are likely to gain a deeper level of understanding about what happened.

You may have questions like ‘could it have been prevented?’ You’ll find that you have to address difficult emotions and you’ll have to do some work processing the psychological aspects such as not having had control over certain things.

They may sometimes refer you for counselling or look for other problems such as   depression.

If your birth trauma includes baby loss, you may be placed on the National Bereavement Care Pathway programme with Sands.

Bliss are a charity who help parents and families of premature or sick babies by offering practical and emotional support when your baby is in the neonatal unit, or when you go home.

Treatment for PTSD may include talking therapy, Cognitive Behavioural therapy (CBT), medication, or eye movement desensitisation and reprocessing (EMDR); a therapy that uses eye movements to dampen the power of the memories and the emotions linked to them.

Remember, help is on hand, don’t suffer in silence

Whatever the reason that you’re not feeling great for any period of time after birth, there is help available for you, even if you can’t put your finger on why it is that you don’t feel ‘quite right’.

Kari is here to help you find the way forwards so that you and your baby ‘are doing just fine’.

Organisations that can help

Evidence Based
This article has been reviewed by our Kari Health Experts and Editorial Board to ensure accuracy and reliability of the information presented. However, please note that the content provided is for informational purposes only and should not replace advice from your medical professional.

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