According to SAMHSA, 2014, individual trauma results from an event, or series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical social and emotional, or spiritual wellbeing.
Historically, birth trauma wasn’t categorised as a traumatic event, until 2014 when it was added to the NICE Guidelines. To me that sounds crazy! It makes me feel sad for all of those who would have suffered from a traumatic birth, but this wouldn’t have been recognised, validated, and supported.
We talk about birth trauma, although recently on some training I attended, I heard the term “Perinatal Trauma,” and to me that fits more with the types of clients that I work with. Many women can experience trauma as part of their journey to and through motherhood (we call this the perinatal period). Some women have problems getting pregnant or maintaining a pregnancy, others can find themselves going through a difficult pregnancy due to illness or complications, and others can have difficulties with breastfeeding their babies, leading them to stop earlier than they had anticipated. All these factors along the perinatal journey can be experienced as particularly traumatic, meaning they can affect the individual’s wellbeing in a life-changing way.
I work with many ladies who tell me things like "It wasn't just the birth that was scary, it was the birth and the first six weeks postnatally that completely rocked my world. I was in a constant state of anxiety, and I couldn't sleep for fear something bad would happen." Others are so terrified of their experience that they don't go on to have any further children, or when they do, they spend their pregnancy extremely fearful of history repeating itself.
Facts About Birth Trauma
- Birth trauma can be experienced by the mother/birthing person, the father/partner and any birth worker in the room, including Midwives and Obstetricians.
- Birth trauma may present as anxiety, nightmares, irritability, reliving your birth all the time in your mind, feeling unsafe, scanning for danger in your environment, and avoidance of reminders of pregnancy, birth, and babies.
- Between 25% - 40% of women and birthing people in the UK experience their birth as in some way traumatic.
- Birth trauma tends to be on a scale with Post Traumatic Stress Disorder (PTSD) at the severe end of it. Symptoms of PTSD typically increase about 1-6 months postpartum (when families are not having frequent contact with the maternity system).
- It doesn't matter whether the birth trauma is mild, moderate or severe, it is still something that creates a mental health challenge and even on the mild end, sufferers can feel on a state of high alert a lot of the time.
- Your birth could have been medically and objectively "normal," but you can still go on to experience a trauma response to your birthing experience.
- How you are made to feel as part of your birth experience plays a huge role in the development of birth trauma.
- A few other typical factors that can contribute towards experiencing your birth as traumatic is how you are spoken to during your experience, whether things are communicated to you, meaning you are kept in the loop, and the feeling of being out of control (of your body or of the situation).
- Birth trauma is often mis-diagnosed as Postnatal Depression (see my other blog on PND here).
Many sufferers of the above symptoms have shrugged it off as "normal," or something that they will just "get over." Trauma, unfortunately, isn't something that you can just get over without emotional support and help with an experienced and qualified professional, to help you work through your experience so you can process and come to terms with them. Birth trauma can continue to affect you years after you have had your baby, and unfortunately can affect how you bond with, and relate to, your baby.
Birth Trauma Risk Factors
There are shown to be factors at play that can lead you to be more vulnerable to experiencing birth trauma. These can include:
- Lack of consent
- Interpersonal factors
- Physical birth injury
- Feeling out of control
- Obstetric emergencies/difficulties
- Worry that you or your baby will die
- Having a baby during COVID and lockdown restrictions
The above factors can become parts of a birth experience that can be hard to let go of. Birthing people and those involved in the birth experience can find they become stuck on the worst parts of their experiences (we call these hot spots). Research has looked at the most common hot spots that appear within birth trauma and these were highly related to interpersonal factors, such as the language that was used and the way you were made to feel throughout your birth. The second most common hot spot was related to obstetric complications, and the hot spot that was least common was related to medical emergencies. This just goes to back up the idea that trauma is in the eye of the beholder and even if you have a “text-book” pregnancy, labour, and birth, but were made to feel unsafe emotionally or physically, you can still go on to develop symptoms of birth trauma.
How Has Covid Impacted on The Perinatal Experience?
Covid has changed the maternity system in so many ways. Expectant mothers and their partners haven’t been able to attend appointments together such as hospital scans and postnatal follow ups. Birthing people have also had to be away from their birth partners at the beginning of their labour experience due to the restrictions around Covid. Women have been receiving tragic news about their babies and their pregnancies on their own. Others are having to begin their labour experience away from their partners, which for many has been hard to accept but for those who are expecting a baby after loss or previous birth trauma, this would have been especially frightening for them.
Add on to that the chronic lack of midwifery staff and the ones who are there are exhausted and potentially suffering from compassion fatigue. If you think about what you read earlier about how communication can have such a big impact on birth trauma, midwifes are potentially not communicating or offering the care they want to because of being understaffed. An indirect result of that is a birthing person feeling alone and isolated, which can lead to birth trauma. Visiting hours have been cut, meaning Mum’s who have had surgical deliveries are being left to look after their babies themselves while experiencing physical pain and discomfort. A Mum I am working with currently described how she felt she had failed her baby right from the start by not being able to care for herself, let alone her baby whilst in hospital without her partner.
What Factors Might Protect Against Perinatal Trauma?
One of the biggest factors that have shown to have a reduction in the rates of birth trauma is continuity of care. Research has shown how seeing the same midwife throughout your pregnancy and postnatally can help a birthing person to feel a level of trust and safety with their midwife. Given that women who feel emotionally and/or physically unsafe can develop birth trauma, it makes sense how being under the care of the same midwife can help develop a positive and trusting relationship.
Having lots of support around you can also serve as a protective factor. This can be from friends, family, your health visitor, a doula, and the maternity system. Making use of all the help and support that is offered to you is really important to ensure you have the space to tell your birth story, when you are ready, and to be met with validation, empathy and understanding.
Another factor is knowing your rights! So many birthing people go into their pregnancies/labours and birthing experiences without knowing their rights to the care they should be offered and entitled to. An example is vaginal examinations (VE’s). Birthing people can assume that VE’s are mandatory, however, you have the right to refuse one if, for whatever reason, you chose not to have one. Even if there is a huge risk to you or your babies life, you still have the right to refuse a VE if you don’t want one. Another lady I am working with at the moment was told she had to have a VE, despite saying how much pain she was in and how she didn’t want one. This experience developed into a hot spot for her, so knowing your rights and acting in accordance with them can be a protective measure for you.
To summarise, the more emotionally and physically safe you feel in the perinatal period, the less likely you will be to develop symptoms of birth trauma.
What Help Is Available?
The two recognised and recommended treatments for birth trauma are Trauma-Focused Cognitive Behavioural Therapy, (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).
TF-CBT involves telling your story of trauma, whether birth or perinatal (or both). After this, your therapist should assist you in updating the hot spots associated and the meaning that was developed at the time. For example, you may have felt completely disconnected and alone during certain parts of your birth experience, and this belief continues to be active in the here and now because the experience hasn't been processed. Your therapist can work with you to update/change this belief so you no longer believe that in the present, leading to a reduction in trauma symptoms.
What we see is when trauma hot spots have been updated, birthing people tend to feel less at risk, safer with the world around them, and therefore behave in a more relaxed manner. Their trauma symptoms also reduce/go away.
EMDR is another type of trauma therapy that uses fast eye movements (bilateral stimulation) to help the brain process the experience on a physical, emotional and cognitive (belief) level. This process is replicating REM sleep while you are awake, so it's just using a skill you do already. EMDR is fast and effective, and is a recommended treatment for trauma by the NHS and WHO (World Health Organisation).
Both TF-CBT and EMDR come with the understanding that trauma can affect the way the brain processes memories and therefore the aim is to help the brain process the trauma memory/ies. They both should be available on the NHS, although waiting lists can vary across the country.
Both can be tiring and emotionally difficult to go through, but the outcome of addressing the trauma memories means they no longer are triggered randomly, and you are no longer physically distressed now, when you recall the event.
How Can I Find An Experienced Therapist?
As a Perinatal Psychotherapist, I am experienced at and trained to work with birth trauma. Although I haven’t experienced birth trauma myself, I have a keen interest in the area as well as my clinical experience of helping those presenting with it. You can also have a look at the CBT Register (link below) and the Birth Trauma Association Website, which displays a range of therapists who are trained at working with birth trauma.