Traumatic birth and post-traumatic stress disorder

Feeling upset or distressed by what happened when you were giving birth may mean you’re experiencing birth trauma. Every person’s experience is different, but trauma can be triggered by both physical and emotional experiences. It might be that your birth was long and intense, that you had an unplanned intervention, that you weren’t looked after or listened to in labour, or perhaps there were concerns about the safety of you or your baby (Shaban et al, 2013).  

Whatever your experience, it is important that you are listened to and that you can express how events made you feel (Reed et al, 2017). Often people assume that if you and the baby are healthy, you will be happy. You’re not alone if you’re finding it difficult to put into words the impact that your traumatic birth has had on you (Elmir et al, 2010). 

Effects of traumatic birth

Traumatic birth affects people in different ways. It can take some time to come to terms with what has happened too. 

Many parents find it difficult to bond with their baby to start with as the baby is a constant reminder of the trauma they have experienced. It might also affect relationships with partners. 

If you notice these symptoms continuing for longer than around four weeks after the birth, then you could be suffering from post-traumatic stress disorder (PTSD). Around 4-6 per cent of women will develop PTSD after birth (Dekel et al 2017). You’re more likely to get PTSD if you suffered from anxiety or depression in pregnancy or suffered previous traumatic experiences. It’s also important to remember that PTSD can develop weeks, months or even years after the birth. 

Symptoms to look out for

According to the Birth Trauma Association, there are four main symptoms of postnatal PTSD. These are: 

• Re-experiencing the traumatic event through flashbacks, nightmares or intrusive memories. These make you feel distressed and panicky. 
• Avoiding anything that reminds you of the trauma. This can mean refusing to walk past the hospital where you gave birth or avoiding meeting other women with new babies. 
• Feeling hypervigilant: this means that you are constantly alert, irritable and jumpy. You worry that something terrible is going to happen to your baby. 
• Feeling low and unhappy (“negative cognition” in the medical jargon). You may feel guilty and blame yourself for your traumatic birth. You may have difficulty remembering parts of your birth experience. 

Because of the stress of living with PTSD, you or others may notice that you are: 

• feeling anxious and fearful a lot of the time, 
• keeping very busy to avoid intrusive thoughts, 
• finding it difficult to sleep, 
• feeling angry, upset, aggressive, irritable or detached, 
• getting involved in destructive behaviours, such as excessive drinking, using drugs or forming a new relationship, 
• not feeling connected to your baby and/or 
• afraid of getting pregnant again. 

PTSD and postnatal depression

It’s worth remembering that while the symptoms of PTSD and postnatal depression (PND) might be similar, the two illnesses are different. It is important that PTSD is recognised as such and not treated as PND, although the two can go hand in hand.

Impact on birth partners

Birth partners may also feel traumatised after witnessing a distressing event, sometimes even if the woman who gave birth is feeling well. Although there’s not much research into this area, it’s thought that as many as 5% of partners develop trauma symptoms after witnessing a birth. 

Partners who witness stressful events and numerous medical procedures during the birth sometimes feel out of control and fearful of what is happening as they can’t help (PTSD 2018a). Read more about support for partners when it comes to a difficult birth here. 

Getting help and support

Talking

Although talking about what happened can feel like the most difficult thing in the world, it could help you to process the events. If you feel ready, you might like to consider who you feel comfortable opening up to – it could be your partner, a friend or a relative.

Alternatively, you might feel you would like to talk through what happened with someone who works in pregnancy and birth but is not directly related to the situation. This might be your midwife or GP. They should offer you the chance to talk about your experience and will have spoken to others with similar experiences before. So don’t be afraid to talk to them.

Most NHS Trusts offer a birth reflections service where you meet with a midwife or maternity support worker to go through your notes and explain the events. 

Going to a birth reflections service can be useful in terms of understanding why particular decisions were made or unplanned interventions occurred. Yet although some women find it helpful, it is unlikely to resolve established symptoms of PND or PTSD (PTSD, 2018b). It is important that you only do this when you feel ready to, even if this is months or years later.

You might find it useful to contact a support group and gain peer support from others who have experienced PTSD. The Birth Trauma Association or PANDAS are good ones to try (British Trauma Association 2022, Pandas 2011).

Emergency help

If you need to talk to someone urgently, please contact Samaritans (UK: 08457 90 90 90 or ROI: 1850 60 90 90) or SANEline (0845 767 8000). You can also call your GP surgery for advice, during out of hours you should hear a recorded message giving advice as to who to call. NHS 111 is also available 24 hours a day.

Learning relaxation techniques

Understanding how to cope with your thoughts and triggers using mindfulness, breathing awareness or meditation could help you to feel calmer.

Psychological therapies

The National Institute for Health and Care Excellence (NICE 2014) recommends cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EDMR) (Birth Trauma Association 2022a) to treat post-traumatic stress disorder after childbirth. Evidence shows that both of these methods work well.

CBT is a form of talking therapy where you will be encouraged to find ways of coping with the trauma as well as thinking about the traumatic situation in a different way. It is different from counselling in that it focuses on the incident rather than other events in your life (Birth Trauma Association, 2018b). EMDR practitioners use a combination of eye movements, taps and sounds to retrain the way your brain is processing the memory of the birth.

Medication is not usually given to treat PTSD. But if you are also suffering from anxiety or depression, you may be offered anti-depressants.

This page was last reviewed in July 2022

Further information

At NCT, we offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby. We aim to help parents prepare for birth and the events that may unfold. We are not here to promote one approach over another, or to provide clinical advice or support, but to share evidence-based knowledge and support parents to find and access the services they need.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Our support line offers practical and emotional support with feeding your baby: 0300 330 0700.

The Birth Trauma Association (BTA) is a charity that supports women who suffer from birth trauma. The website has lots of information, parent case studies and support.