Birth Trauma: Strategies for Healing and Prevention

This is the second part of a two part series on Birth Trauma. In Part 1, which you can read here, you met Sara who was fearful of becoming pregnant with a second child. Although she was riddled with anxiety, she was unaware she had a real problem: because she’d experienced trauma after the birth of her first child she feared getting pregnant. Although birth trauma is a real psychological condition, with concrete symptoms and a diagnostic criteria, many people internalize their experience, feeling shameful instead of seeking support.

My chance encounter with Sara was pivotal. A few weeks later she reached out asking for a referral to a local therapist. Through our informal talks I was able to help Sara understand how her unique experience left her vulnerable to experiencing a traumatic birth (also called postpartum PTSD), and that it was not only extremely common but treatable.

Sara, like many women I see in my practice, was unaware that her symptoms were worth paying attention to. The most common coping strategy I hear about is the attempt to ignore symptoms- to sweep them under the rug so to speak. But this approach is rarely successful for very long.

Women who eventually enter my office for therapy are typically struggling with one or more of the symptoms addressed in Part 1 of this series- symptoms that interfere with their ability to function at home or at work.  In this article I’d like to offer some recommendations for healing from traumatic birth and/or preventing a subsequent similar experience. 
 

Treatment of Traumatic Birth, or Postpartum PTSD

While many women who experience some symptoms of Postpartum PTSD will resolve their emotional stress with positive support from friends or family members, others will continue to struggle and will benefit from professional help. Recommended treatment for Postpartum PTSD starts with a thorough assessment by a trained mental health provider.

1. It’s critical to be assessed by someone who specializes in maternal mental health for a correct diagnosis to be made.  Therapists unfamiliar with postpartum PTSD might inadvertently recognize the symptoms as postpartum depression or anxiety. Although some of the symptoms are similar, the underlying experience of a birth trauma calls for a different treatment approach.

2. Both medication and therapy are evidence-based recommendations for treating birth trauma. Many therapies work quickly and effectively with postpartum PTSD, such as EMDR, which I offer in my practice. Narrative, group, and body-based therapy can be helpful treatment modalities.

Avoiding a Subsequent Traumatic Birth 

Whether you're anticipating a future pregnancy or currently pregnant, there are many things you can do to reduce the likelihood of experiencing a subsequent birth trauma.

1. Include your partner in this process. While it might seem obvious to some, others may feel isolated by their initial trauma and not realize the important role a partner can play in providing support and mitigating a subsequent traumatic experience.

2. Hire a doula. Simply put, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. If for some reason the birth is not going according to your ideal plan, a doula will intervene during labor with the intention of alleviating the trauma to reduce a woman’s chances of developing PTSD.

3. Take a childbirth education class. It’s important for women (and their partners) to be educated about what is supposed to happen during childbirth and what happens in the body during the birthing process. Childbirth classes also help to inform expecting parents about options during birth including: pain management, birthing positions, and how to cope with complications during birth.

4. Develop a written birth plan with your birth team. Discuss and include the interventions you are open to, those you want to avoid. Explore your back up plan. Remember to plan for the postpartum period and to consider the support that will help ease your adjustment to motherhood, or to mothering an additional child.

5. Talk to someone you trust. Work through any past traumas with a therapist, or at the very least discuss your history with your care providers to best prepare for the experience of labor and birth.  Meeting with a psychotherapist or body worker specializing in perinatal mental health allows you to focus on beliefs, emotions, sensations and andy past experiences that may influence your upcoming birth.
    

Help Is Available

Birth trauma is highly treatable; the first step of course is to recognize there's a problem.  With help you can avoid additional suffering and complications for both mom and baby. In San Diego, Postpartum Health Alliance offers a warmline with trained volunteers as well as a provider directory to locate trained therapists and other birth professionals. Outside of San Diego, Postpartum Support International can connect you with therapists worldwide who specialize in maternal mental health disorders.

Birth Trauma: Is THAT What I've Been Experiencing?

I met Sara and her 4-year-old daughter, Claire, at our local playground earlier this week. Claire instantly gravitated to my 5-year-old son and within moments they were chasing balls together, holding hands and laughing. Having just moved to San Diego from Boston, she was excited to meet us.

Like many mom-conversations go, Sara asked about the age difference between my two kids and how I felt about it. She told me that although her daughter was begging for a sibling and her husband was also ready, she wasn’t prepared to get pregnant again just yet. She was conflicted about her timing tho, noting her age and the pressure she was feeling to have another baby.

I empathized with her situation and shared some of my own personal experience, as well as my professional experience as a psychotherapist supporting women on their journey through motherhood. I offered myself as a local resource given my knowledge of San Diego’s network of reproductive health providers.  

A few days later we met again by the swings. Sara jumped right into the conversation, saying, "you know, I think I could probably use some help from someone like you. I'm pretty sure I suffered from some postpartum stuff and that's what's holding me back from having another baby." She went on to tell me about her difficult pregnancy, challenging labor and unplanned cesarean birth that left both her and Claire in the hospital for several days. The experience was distressing and she was anxious about becoming pregnant again. She had wanted an unmedicated, natural birth and was understandably afraid of having a repeat similar experience with her next child.

I spent some time talking with Sara about how her traumatic birth might be impacting her. As I spoke her face softened and her head nodded. She appeared to feel validated by my explanation: that trauma after birth is REAL.

While many around her would like Sara to move on and be grateful for a happy and healthy child, Sara is still reacting to her birth experience with Claire. Although Claire had suffered no long-term effects, Sara did. And her daughter’s health does not negate Sara’s experience and the anxiety and fear left in the wake of her birth experience. As we talked more, I stressed that it’s not the specifics of the birth that is traumatic, but one’s perception of these events. This is such a key aspect of trauma.
 

What Are The Symptoms of Birth Trauma?

Post traumatic stress disorder (PTSD) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a car accident, a natural disaster, or sexual assault. However, a traumatic experience can be any experience that involves the threat of death or serious injury to you or someone close to you, like your baby (birth trauma or postpartum PTSD). Again, it's your perception of your childbirth that matters most.  It is less important whether the hospital staff were in communication about recommended procedures than your interpretation of what happened.

Common symptoms of women who’ve experienced birth trauma may include:

• Feeling socially isolated
• Difficulty bonding with their baby
• Lonely
• Angry
• Depressed
• Irritable
• Difficulty sleeping
• Anxiety or panic attacks
• Worry excessively about the health of their babies
• Worry that their child might die
• Flashbacks or memories that repeat over and over about medical procedures or the behavior of medical staff.
• Nightmares

Why Some People Experience PTSD Postpartum

It’s not always the dramatic events that trigger childbirth trauma but other factors such as a loss of control, the intimidating, aggressive or difficult attitudes of people around you, not feeling heard, or a lack of informed consent to medical procedures.

Risk factors for Postpartum PTSD include a complex mix of objective factors, such as the type of delivery, ability to feed as planned, etc, and subjective factors like those mentioned above. Additional risk factors include:

• Induction
• Length of labor
• Feelings of loss of control
• Unwanted medical intervention
• Traumatic or emergency deliveries/cesarean
• Lack of support from partner or medical staff
• Impersonal treatment
• Not feeling listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth or loss soon after birth
• Birth of a disabled baby
• Baby’s stay in NICU
• Poor postnatal care
• Previous trauma (childhood, with a previous birth, domestic violence)
• History of anxiety or extreme fear of childbirth
• History of abortion or infertility
   

How common is Birth Trauma?

It’s estimated that approximately 9% of new mothers in Western societies experience full blown post traumatic stress disorder. However, research shows that 25-34% experience subsyndromal symptoms (symptoms that don't meet the diagnostic criteria for PTSD)! So while not meeting diagnostic criteria for PTSD, up to a third of mothers experience symptoms like intrusive thoughts and memories that may stimulate feelings of fear, anxiety or helplessness that interfere with daily life. That's a huge number! 

It's important to remember that while mothers most commonly receive treatment for postpartum post traumatic stress, their partners and even their medical providers may also suffer. 
 

Why You Should Seek Help

There are numerous potential consequences for women who experience a traumatic birth. They may avoid routine follow-up medical care because it reminds them of their childbirth experience. Like Sara, they may fear subsequent pregnancies and are statistically shown to be less likely to have subsequent births.

Those who do have another child are more likely to have an epidural or a scheduled cesarean; they are less likely to breastfeed and more likely to experience challenges bonding and attaching with their newborns. They’re also more likely to experience difficulties in their relationships and sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to suffer from depression, which also impacts bonding and attachment with their baby.

In part 2, we’ll look at ways to avoid the effects of birth trauma and ways to support healing. If you’re not sure you can wait to read part 2, please don’t hesitate to give me a call. I’m a licensed clinical social worker in the Banker’s Hill neighborhood of San Diego, California. I’m passionate about helping families cope with trauma and other challenges after bringing home their baby. You can reach me at 619.780.3277 for your free in-person 30 minute consultation. 

Reducing the Stigma of Maternal Mental Health Disorders

May is Maternal Mental Health Awareness Month. It’s a month to raise awareness for postpartum depression and anxiety and just how prevalent it is—One in seven! It’s a month to educate people about postpartum PTSD and that you CAN in fact be traumatized by your birth. It’s also an opportunity to let our community know that some women are at a higher risk for developing postpartum psychosis (a personal or family history of bipolar disorder increases her risk). Many are surprised to know that up to 80% of new moms experience the baby blues, it’s that common! Perinatal Mood and Anxiety Disorders (PMADs) are the number one complication of pregnancy. 

Advocates are hopeful that by normalizing the prevalence of maternal mental health disorders, more women will understand the differences between the baby blues and postpartum depression. Greater awareness will help people detect when “something’s not right”— with me, my wife, my sister, my daughter, and hopefully lead to more screenings for prenatal and postpartum depression and anxiety. It's estimated that less than 50% of women struggling with a PMAD seek treatment, despite the fact that they're extremely treatable with professional help. Some reports estimate as few as 15% of women who struggle seek treatment, though it's difficult to know for sure since shame and stigma prevent many from reaching out. 

There are many ways to support the mental health of women and their families during the childbearing years. Below are 5 ways that you can help reduce the stigma of maternal mental health disorders and advocate for greater awareness in our community.

5 Ways to Advocate for Maternal Mental Health 

1. Join your local chapter of Postpartum Support International. In San Diego, our chapter is called the Postpartum Health Alliance. I’m proud to volunteer my time as the Outreach Co-Chair and serve as a warmline volunteer. There are loads of ways to help build awareness and educate your community through your local organization.
    
2. Display a Blue Dot—the new national symbol for Maternal Mental Health. You can purchase your magnet or sticker here. Not only are you supporting this important cause with your financial contribution, but you’re letting those around you know that you’re an aware and concerned citizen; It’s a conversation starter that will let more people know about PMADS and the risks to moms and babies who go untreated. 
    
3. Write letters to congress in support of the Bringing Postpartum Depression Out of the Shadows Act of 2015! That will provide grants for screening and treatment for perinatal mood and anxiety disorders. 
    
4. Participate in your local Climb Out of the Darkness hike in June to raise awareness of maternal mental health disorders. These events are coordinated by local volunteers through Postpartum Progress. To join San Diego’s hike, contact Julie Thorpe
    
5. Don’t forget to ask the mothers you love and care for about their mental health: How are you sleeping? How are you eating? How are you feeling? If you're not sure how to address someone you think is struggling, this article provides some helpful strategies. 

If you suspect that you or someone you love has a perinatal mood or anxiety disorder, reach out for help today. Rachel Rabinor, LCSW is a psychotherapist in private practice; she helps women struggling with their transition to and through motherhood in her San Diego office. She also offers in-home counseling and Walk and Talk Therapy. For resources outside of San Diego, contact your local chapter of Postpartum Support International.