After Birth, "You Know You Have PTSD, Right?"

Flashbacks. Difficulty sleeping. Panic attacks. These are just a few of the symptoms of post-traumatic stress disorder (PTSD), a condition that can occur when someone has survived a traumatic experience such as war, violence, or a natural disaster. These symptoms are in stark contrast to the feelings of love and accomplishment that we imagine most new mothers experience in the delivery room, but birth can be similarly traumatizing.

“When women feel unseen, unheard, and powerless during the birth process, it often leads to feelings of trauma,” Dr. Sarah Allen, a Chicago-area psychologist specializing in maternal mental health and director of the Postpartum Depression Alliance, tells Romper.

This trauma can be devastating for a new mother. Judy Walters, a mother of two from New Jersey, endured years of flashbacks, persistent thoughts, and regret after her emergency C-section. “While I was in labor, my doctor told me the baby was breech and I would need an emergency C-section (it was later determined that the baby wasn’t breech at all). Immediately, people came rushing into the room, doing things without my permission, and shoving papers in my face that needed to be signed to authorize the C-section. I was crying hysterically through the whole process,” Walters tells Romper by phone.

You know you have PTSD, right?

When the spinal anesthesia wasn’t working, Walters was put under with a general anesthetic. When she awoke, her baby was nowhere to be found and even 21 years later she still so clearly feels the disappointment of not being the first person to hold her baby girl or hear her cry. “I thought about it constantly and even imagined new scenarios where my birth went exactly as I hoped it would. It wasn’t until years later when I entered therapy for unrelated reasons that my therapist told me, ‘You know you have PTSD, right?’”

Once Walters was able to put a name to the feelings that had been plaguing her all those years, she immediately felt some relief. While she does still think about her birth experience from time to time, seeing a therapist who validated her feelings put her down the path to recovery.

What’s difficult about birth trauma,” according to Pam Udy, a Utah-based advocate for trauma free birth who spent 13 years on the board of the International Cesarean Awareness Network, “is that women often don’t associate them with their birth experience.” Without this connection, many women suffer in silence, never getting the help they deserve. Postpartum PTSD is estimated to impact somewhere between 4.6 and 6.3% of birthing people, per a systematic review published in Frontiers of Psychology in 2017, while a 2001 study by Ayers and Pickering found a third of women rated their delivery as “psychologically traumatic.” A recent report by the New York Human Rights Commission intended to focus on pregnancy discrimination found a common theme among those who testified about their treatment of “obstetric violence”: “including abuse, coercion, and disrespect from healthcare providers while they are giving birth.” So the issue is widespread. But there are ways to heal from this trauma.

“The first step,” says Dr. Allen, “is finding a therapist who is familiar with birth trauma. Working with a provider who has experience with both trauma and perinatal mood and anxiety disorders can help to ensure proper diagnosis and treatment.” Dr. Allen’s goal with therapy is to alleviate the self-blame, anxiety, and obsessive thoughts patients have about their birth experience.

One of the most effective tools in a therapist’s belt is simply providing a safe space for a person to talk about her birth. “A therapist can help a woman process what happened by letting her tell her story. She may worry that she will burden her friends and family by talking about what happened, or she may not feel comfortable discussing it with them at all,” Dr. Allen said. In therapy, people have a place to let their feelings out instead of burying them.

Many women tend to focus on all the things that went “wrong,” but a therapist can help them shift their attention to the things they are doing right; the things that are going well. Some women may even choose to meet with their care provider to talk through what happened (this could be re-traumatizing for other women). If you do go this route, Dr. Allen recommends bringing a friend or partner with you for support. Patients who are not ready to vocalize their story may benefit from writing out what happened or using art therapy. In certain cases, medication is also an option, most likely requiring referral to a psychiatrist.

While therapy can help women cope with birth trauma, both Udy and Dr. Allen pointed out the importance of taking time to prepare for birth in such a way as to minimize the risk of suffering a traumatic birth experience. Education about possible interventions, complications, and even the flow of a typical labor and delivery are important for a woman (and her partner or support person) to be aware of.

“You can’t know what you want without knowing all the options. A supportive care provider should willingly answer your questions and make you feel comfortable before and during the birth process,” Udy says If you aren’t getting that vibe from your provider, it’s never too late to find someone new, whether in the same practice or a different one altogether.

At the core of birth trauma is a feeling of powerlessness over the birth experience.

Having a supportive partner, friend, and/or doula can also go a long way. “You need someone who can speak up for you in the delivery room so you can focus on your labor,” Udy advises. In order for that person to know how and when to advocate for you, it can be helpful to have a birth plan, but Dr. Allen warns against being too tied to your “plan.” Going into the birth experience with an idea of how you would like things to go is smart, but babies don’t really care about your plan and they may not cooperate with your wishes. Whether you are preparing for your first birth or a subsequent birth after a traumatic experience, Dr. Allen recommends that pregnant people “schedule a session with a birth trauma-specialized therapist. Bring your partner or support person along before going into a possibly triggering situation so you can best be prepared for what’s to come.”

At the core of birth trauma is a feeling of powerlessness over the birth experience. It is not always possible to entirely avoid this trauma, but people who seek help and work with a therapist are likely to see a noticeable reduction in symptoms. A 2013 study published in Behavior Research and Therapy found that male and female survivors of interpersonal assault who completed between four and 18 cognitive processing therapy sessions saw significant reductions in PTSD symptoms, along with feelings of anger, guilt, and dissociation.

Specific to pregnancy, there are a few things moms-to-be can do to ensure they feel seen and heard throughout the birth experience. If possible, take a birthing class to familiarize yourself with the options you have and obstacles that may come your way during labor. Discuss your wishes with your partner and practitioner — if you don’t feel comfortable with their response, make sure you are all on the same page before baby time. Hire a doula if you would prefer to offload any support and advocacy responsibilities to an objective third party.

Even before giving birth, you are a parent and your baby’s number one advocate. Feel confident in knowing what you want and don’t be afraid to ask for it.

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.