Birth trauma (childbirth-related PTSD)
Post-traumatic stress after a birth the parent experienced as threatening to their own life or the baby’s, or as a loss of control or dignity. It brings flashbacks or nightmares of the birth, avoiding reminders of it, feeling on edge, and changes in mood and beliefs that last more than a month. A birth that looked routine on the notes can still be traumatic for the person giving birth.
What drives it
What happened in the room is held as a threat that has not finished, so reminders (the smell of the hospital, a birth on television, the baby’s birthday) set off the body’s alarm. Useful for identification because the parent is often told ‘at least you’re both healthy’, which leaves no room for what the birth was like for them.
How it shows
Work
Losing focus whenever a colleague announces a pregnancy. Unable to watch a training video set in a hospital. Taking a route to work that avoids the maternity unit.
Relationships
Avoiding sex for fear of another pregnancy. Being unable to talk about the birth, or talking about it again and again. Anger at a partner who ‘just stood there’. A partner who saw it and now has their own nightmares.
Self
Notice whether parts of the birth come back as pictures or body feelings you didn’t choose, whether you skip places and talk that remind you of it, and whether you have felt jumpy since.
What tells it apart
Post-traumatic stress disorder (PTSD): Birth trauma is PTSD with childbirth as the event. It may need its own name because the reminders are everywhere in daily life with the baby, and because people around the parent may not see a birth as a possible trauma.
Postpartum depression (perinatal depression): Depression is more likely when low mood and loss of interest lead. Birth trauma is more likely when the birth itself replays and is avoided. The two often occur together.
Grief after miscarriage, stillbirth or neonatal death: When the baby died or was gravely ill, grief and trauma can be woven together. Trauma may be the fit when the replaying centers on the fear in the room, and grief when the longing centers on the baby.
A test
Ask whether, more than a month after the birth, the parent has pictures, dreams or body memories of it that they did not choose, and whether they avoid reminders. Yes to both may point to birth trauma, which the City Birth Trauma Scale can screen for and a perinatal or trauma clinician can assess.
Questions to carry
- Which moment of the birth comes back to me without my asking, and what was happening in my body then?
- Whose words about the birth have I let decide what I am allowed to feel about it?
Go deeper
- Read: The Kazdin Method for Parenting the Defiant Child, Alan E. Kazdin with Carlo Rotella, 2008. Written for parents by a Yale psychologist who spent decades testing parent management training: praise and small rewards for the behavior a parent wants to see, built up in small steps. That approach has many controlled trials behind it with children referred for defiance and aggression, though Kazdin's own 1997 review said questions remained about how large, wide and lasting the effects are. The book itself does not walk through the studies. It carries the Association for Behavioral and Cognitive Therapies' Self-Help Seal of Merit.
How strong the research is
strong. A meta-analysis of 59 studies and 24,267 women (Yildiz, Ayers and Phillips, Journal of Affective Disorders, 2017) put PTSD after birth at about 4.0% in community samples and about 18.5% in samples at higher risk. A meta-analysis of 50 studies from 15 countries (Ayers and colleagues, Psychological Medicine, 2016) found the strongest link was the woman’s own negative experience of the birth, followed by an assisted or cesarean delivery, lack of support and dissociation during labor, and depression in pregnancy. Partners can also develop symptoms, but the studies so far were not built to say how often.
Where it comes from
Susan Ayers and colleagues at City, University of London, including the City Birth Trauma Scale, 2018. DSM-5 PTSD criteria apply to childbirth as to any other event