Birth trauma – Information for health professionals

Birth trauma is defined as a wound, serious injury or damage relating to the birthing experience. Birth trauma can be physical trauma or psychological trauma, or a combination of both. Both mother and/or the father or non-birthing partner can be affected by birth trauma. In some, but not all cases, a parent may develop postnatal mental health problems from the traumatic events experienced during labour or childbirth. In some instances, traumatic birth can cause on-going distress, impact postnatal mental health and family relationships.

Definitions of birth trauma (physical and psychological trauma)

Physical trauma

Physical trauma or birth injuries can present as: perineal tears, pelvic floor muscle damage, pelvic organ prolapse (POP), pelvic fractures (public bone, coccyx, sacrum) or caesarean wounds. Physical birth trauma may or may not be identified straight away.

Psychological trauma

Some people can experience severe emotional distress after a traumatic birth even though there was no physical trauma, and this can continue long after the birth. Psychological trauma can present as a number of mental health problems including postnatal depression and/or anxiety (PNDA); clinically-important post-traumatic stress symptoms that fail to meet the diagnostic threshold; post-partum post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD) (e.g., obsessive thoughts that can affect our behaviour such as checking on baby constantly or recurring thoughts that impact on enjoyment of daily life).

Risk factors for developing PTSD following birth trauma

Post-traumatic stress disorder (PTSD) refers to a range of symptoms or reactions that can develop if a person has experienced or witnessed a traumatic event. For some people, childbirth can also fit into this category. Both men and women can experience PTSD after experiencing or watching a birth. Post-traumatic stress disorder following birth can happen to anyone, particularly those who have experienced:

• A previous traumatic or difficult birth

• Rape or sexual assault in the past – as birth can remind them of their previous experiences where they felt sexually violated, assaulted or invaded

• Intimate partner violence or other traumas.

Symptoms of PTSD following birth trauma

Post-traumatic stress disorder following birth trauma may present as one or more of the following types of difficulties:

• Re-living the birth/traumatic event through unwanted and recurring memories, including vivid images and/or nightmares. This may cause intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of or discussing the birth or events.

• Being overly alert or wound up which can lead to sleeping difficulties, irritability and lack of concentration, becoming easily startled and constantly on the lookout for signs of danger.

• Avoiding reminders of the event – some parents might find themselves wanting to deliberately avoid activities, places, people, thoughts or feelings associated with the birth or aftercare event because it brings back painful memories.

• Feeling emotionally numb – parents with PTSD following birth may lose interest in day-to-day activities, feel cut off and detached from friends and family, or feel emotionally flat and numb.

Prevention options for PTSD following birth trauma

Prevention of PTSD or clinically important symptoms of PTSD following a traumatic birth can involve a range of approaches including trauma-focussed cognitive behavioural therapy, or pharmacological interventions.

Treatment options for PTSD following birth trauma

Treatment of PTSD or clinically important symptoms of PTSD following a traumatic birth can involve a range of approaches including trauma focussed cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), pharmacological treatments.

Trauma-focused Cognitive Behaviour Therapy (CBT)

This treatment is an evidence-based treatment model to overcome the negative effects of a traumatic experience. Trauma focussed CBT interventions include:

• Cognitive processing therapy

• Cognitive therapy for PTSD

• Narrative exposure therapy

• Prolonged exposure therapy

CBT may be administered in person or online (also referred to as computerised CBT).

Eye movement desensitisation and reprocessing (EMDR)

This is a technique used specifically to treat PTSD by getting the person to recall distressing images while using an external stimulus, such as eye movement or tapping. This treatment works by helping to process distressing memories, reduce their lingering effects and allow the development of effective coping strategies.

Pharmacological treatment for PTSD following birth

Antidepressant medication, particularly selective serotonin re-uptake inhibitors (SSRIs) are helpful for the treatment of PTSD.   Where disabling symptoms or behaviours are present, anti-psychotics can be helpful in addition to psychological therapies to manage those diagnosed with PTSD.