“There’s still so much stigma surrounding birth trauma. Women are expected to be content and happy because “all’s well that ends well…” Yet, sometimes they don’t feel content and happy, they don’t feel well. And it’s difficult for some women to voice that because they feel they should be grateful for having such a beautiful bonny baby and because other people’s births were so much more traumatic…”
“There is no consistent psychological definition of birth trauma”, explains Dr Georgina Clifford, trauma specialist and experienced Clinical Psychologist. Dr Clifford specialises in Trauma-focused Cognitive Behavioural Therapy, and is currently working towards a PhD focused on the role of memory in complex Post-Traumatic Stress Disorder (PTSD) at the University of Cambridge.
“Birth trauma is not definite by a strict set of rules or particular experiences. According to Beck (2004) , Birth trauma is ‘in the eye of the beholder'. If someone feels traumatised; if they are re-expereiencing the birth of their baby and feel anxious or fearful then the birth was traumatic.”
When considering a women's perceptions and experiences of a traumatic birth, several key themes can be identified:
- Feeling invisible and Out of control
- No involvement in key decisions about the birth
- Feeling powerless
- Not being treated humanely
- Not asked for consent for people to watch/intervene
- Feeling degraded or violated – ‘like a piece of meat’
- Feeling trapped
- A ‘Rollercoaster of emotions’ – anxiety, panic, low mood
Large population-based studies from Australia and the UK indicate that between 1% and 6% of women will develop symptoms of PTSD following childbirth (Creedy et al. 2000, Ayers & Pickering 2001). However this is likely to be an underestimation as women commonly hide symptoms of PTSD following childbirth.
What is the connection between Birth Trauma and PTSD?
We often associate PTSD with war veterans or people who have been in major accidents or natural disasters. But PTSD can develop from any experience where someone felt overwhelmed by negative emotion. It can develop from experiences such as childbirth where women expect to feel empowered and elated but in reality, felt frightened, powerless, trapped or ashamed.
It is normal and incredibly common for people to re-experience the birth in the few days and weeks afterwards – to have vivid, intrusive memories associated with strong feelings. It’s a sign that their brain is processing something that was scary and overwhelming in some way.
For some people, these vivid, intrusive memories stop after a short period of time and for others, they persist. The memories persist when women try hard to avoid or block them in some way. Usually when things are difficult, people talk to friends and family about their experiences. But so often, when women are back home with their baby, they feel they should be “getting on with it”, “making the most of it” and being grateful for what they have.
When women are surrounded by other mums who seem to be coping so well and enjoying their babies, it’s hard to talk about how much they’re struggling.
How can I recognise symptoms of PTSD?
- The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. “Flashbacks” aren't always visual. They are intrusive memories of what someone experienced during childbirth, essentially a reliving or replay of the experience, so can include sounds, smells and physical sensations.
- Distress, anxiety or panic when exposed to things which remind someone of the birth. The “panic” can manifest itself in lots of different ways, depending on how someone experiences anxiety – it can involve a racing heart, difficulty breathing, tightness in the chest, shaking, sweating, feeling dizzy, light-headed or faint or feeling detached from oneself.
- Attempts to block or suppress difficult or distressing emotions and avoidance of talking about the birth with other people. Also, avoidance of activities or people that remind someone of their experience.
- Intrusive memories and the need to avoid any reminders of the birth will often result in difficulties with sleeping and concentrating. Women may also feel angry, irritable and be hyper vigilant (on the lookout for danger) or jumpy and easily startled.
What might help?
Encouraging women to talk about and allow themselves to think about the birth of their baby and the difficult emotions they experienced. To write out an account of their traumatic birth experience and read over it, if they feel able to.
Feelings of guilt or shame often prevent women from talking to other people about what they’ve experienced, but shutting themselves away can result in low mood, depression and certain beliefs about the birth experience being “stuck”. For example, if a woman blames herself for something that happened during the birth but never speaks to anyone else about it, there's no opportunity for anyone else to challenge it.
What help is available if the symptoms of PTSD won’t go away?
In many cases, intrusive memories of the birth and the related distress and anxiety will alleviate over time. If a woman is not feeling any better a month after the birth of their baby then they might benefit from psychological therapy. PTSD can be treated with trauma-focused Cognitive Behaviour Therapy (CBT) or Eye Movement Desensitisation and Reprocessing (as recommended by the National Institute of Clinical Excellence, NICE).
This type of therapy will enable someone to work with their psychologist collaboratively and to process the memories of their traumatic birth, to express any difficult emotions that arise and to challenge any negative thoughts or beliefs they might have and their experience.
Dr Georgina Clifford is a trauma specialist and experienced Clinical Psychologist who has worked in Psychology since 2003. She qualified with a Doctorate in Clinical Psychology (DClinPsy) from Royal Holloway, University of London and is currently working towards a PhD, studying the role of memory in Complex PTSD at the University of Cambridge. Dr Clifford specialises in Trauma-focused Cognitive Behaviour Therapy (CBT) and has experience and expertise in treating psychological presentations in the aftermath of traumatic experiences, including: accidents; rape and sexual assault; childhood abuse; domestic violence. She has a special interest and growing expertise in working with women who have had a traumatic birth experience and women with Post-Natal Depression.
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