Expert / 2 September, 2021 / Dr Ellie Rayner

Understanding Birth Trauma: The Signs, Symptoms And How To Get Help

Birth trauma can arise from many things, and not just the exact type of birth someone ended up with. It can often stem from the way someone was spoken to, the way they were treated, whether they felt supported and included in their care or whether they felt empowered to make decisions right for them. In the UK, around 15-45% of women will report that some aspect of childbirth was traumatic, but the majority of these women do not go on to develop post-traumatic stress disorder (PTSD). Studies have suggested that around 1 in 25 women, so around 4% will be diagnosed with Postnatal PTSD which is many as 20,000 women per year.

What are the symptoms of post-traumatic stress disorder (PTSD)?

Birth trauma occurs when a woman, or birth partner, experience an event(s) during childbirth that leads them to feel traumatised and experience ongoing, persistent symptoms of PTSD. The trauma someone experiences can be very varied and subjective and unique to each individual and can affect everyone differently to varying degrees. Not everyone who suffers a traumatic event will go on to experience PTSD so it is important for everyone to be listened to and treated individually.

There are 4 main features that characterise PTSD:

• Re-experiencing the traumatic event via flashbacks or nightmares
• Avoidance of anything that reminds you of the trauma or discussing it
• Feeling hypervigilant and constantly alert, irritable or jumpy
• Feeling low, unhappy, guilty or blaming yourself.

These symptoms can have a big effect on your life and your relationship with your partner and new baby and you might feel frightened about a future pregnancy or traumatic birth happening again. Whether you are experiences symptoms of PTSD or are feeling generally upset and traumatised by the events of your birth, speaking to someone, and getting support is one of the most important things you can do in the short and longer-term.

Birth Debrief Appointment

Every hospital offers appointments to parents to discuss the events of their labour and birth recognising that many parents may need additional support and information afterwards. These appointments, often called a Birth Debrief, Birth Reflections or Birth Afterthoughts, are an opportunity for you to meet with a healthcare professional and talk about your previous pregnancy, labour and birth and can be particularly helpful if you are feeling upset, worried or traumatised.

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There are three main benefits of these appointments:

Firstly, to understand the events of your pregnancy, labour and birth and why certain things happened. These appointments are usually undertaken by a senior midwife or obstetrician with significant experience so they will be able to go through your previous maternity notes and describe in as much detail as you want why certain things did or didn’t happen, and if there was an opportunity for anything to have been done differently. Sometimes, things may not have occurred exactly as you remembered or the timings are different to what you imagined so for some parents this can be really helpful explaining step-by what happened and why and understanding exactly what occurred.

Talking about birth trauma

Secondly, these appointments can answer any questions or concerns you have. Labour, birth and becoming a new parent can be an incredibly challenging time for many reasons. Some new parents find waiting a period of time after birth helpful. This might enable them to reflect on the events and identify questions they would like to know the answer to, that they didn’t get at the time. It is not uncommon for parents to come with a list of questions that you can work through together and really feel listened to. These appointments can happen any time from 6 weeks to many months or years after birth and the timing of when you feel ready will differ from parent to parent. You may not feel ready to talk about your birth immediately afterwards and this is really normal so don’t worry if this is the case for you.

Thirdly, another benefit of these appointments is the ability to understand any implications for future pregnancies. Events of a previous pregnancy and labour can have implications for a future pregnancy, for example, you may be recommended additional monitoring, or to birth in the hospital setting or to have a planned Caesarean birth. The healthcare professional you see can give you more details specific to your situation, so you are fully informed and know what to expect before becoming pregnant again. They can also direct you towards further information or refer you for additional support if needed.

Every hospital should offer appts like this. In some situations, these appts may be made/offered automatically, but whatever your situation, you can request one if you feel it would be beneficial for you and your partner by speaking to your GP or local maternity team.

Subsequent Pregnancy

Sometimes these feelings don’t emerge until you are pregnant a subsequent time and the reality of approaching another birth occurs. In this situation, it is important to speak to your midwife as soon as possible, so they can effectively manage the condition. Early identification is essential so that access to appropriate secondary care services can be arranged. This can include specialist input from specialist midwives, obstetricians and peri-natal mental health professionals. It is important to know that even if you are fearful of childbirth, you will be listened to, understood and supported in whichever way you need to ensure you have a healthy pregnancy and positive start to motherhood.

How will my future pregnancy be managed?

Depending on the events of your previous pregnancy and how severe your symptoms are will depend on what support or management you are recommended. Your midwife or doctor providing reassurance and education around labour and birth. They’ll explain the different options available, and creating a detailed birth plan together can be enough to reassure many parents and reduce their levels of fear and anxiety. Practising breathing techniques and pregnancy affirmations can also help to manage stress and anxiety and may help reduce some of the fear and pain you experience in childbirth and help you feel more in control. Deep breathing, such as that undertaken during yoga, whether you are pregnant or not can also help reduce your stress and anxiety levels and help you to stay calm.

For some parents, these supportive techniques are not sufficient, and the feelings of fear and anxiety are too great and in this case, your midwife may refer you to an Obstetrician to discuss the pros and cons of other ways to manage your pregnancy around the time of birth such induction of labour or having a Caesarean birth this time.

Getting help for birth trauma

If you are worried that you or a loved one, has any of these symptoms, it is really important you get the support you need as soon as possible and remember you are not alone. GPs, HVs, MWs & Obstetricians are becoming increasingly aware of the importance of early recognition, diagnosis and treatment for anyone with the condition so speak to them if you feel you need additional support. The Birth Trauma Association also provides resources and support for parents who have experienced birth trauma.

Dr Ellie Rayner, Obstetrician and Gynaecologist, Antenatal and Hypnobirthing Teacher and founder of The Maternity Collective.

Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.

Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.

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