Post-traumatic stress can result from life-threatening events such as military combat, violent assault or natural disasters. Women who feared that they or their baby would die or be seriously damaged during labour and birth can also develop severe anxiety.
For many women, giving birth is a normal life event and, for some, it’s joyous and empowering. Other women, however, experience childbirth as frightening and life-threatening. Indeed, about a third of women report that, for them, giving birth was traumatic.
These women experience three or more symptoms of post-traumatic stress disorder (PTSD) in the first few weeks after giving birth.
The symptoms they report relate to re-experiencing birthing, emotional numbing or avoidance and hyperarousal about the birth. Between 2% and 6% of women develop a condition called acute stress disorder. Unlike PTSD, which requires symptoms to be present for at least a month, acute stress disorder can be diagnosed between two days and one month after a traumatic event, and involves more dissociative symptoms (when a person feels disconnected from their thoughts, feelings or memories) .
Factors contributing to the development of trauma symptoms are:
- poor medical care, such as a poorly performed procedure causing unnecessary pain or care inconsistent with the best available evidence;
- poor communication by care providers;
- physically traumatic or emergency birth, such as emergency caesarean section;
- physical damage to the baby, or;
- admission to the special care nursery or intensive care unit.
Previous traumatic childbirth, sexual abuse, intimate partner violence and other traumas also play a role, but many women without known predisposing factors experience birthing as traumatic.
Stories of traumatic childbirth are frequently peppered with accounts of being excluded from decision-making, lack of informed consent, or patronising, impersonal, disrespectful and abusive interpersonal communication. Such treatment by health professionals is associated with feelings of loss of control, but women often blame themselves. They say they should have asserted their rights, should have prepared themselves more fully, and should somehow have known how to avoid the treatment and care they received.
Fortunately, most women are resilient and recover from traumatic childbirth. This is more likely when they have adequate social support (especially from their partner) and are mostly free from other life burdens likely to impede recovery, such as financial stress. But for other women, PTSD can be intractable and have negative impacts on them, their babies and their relationships with others.
Experiencing PTSD or acute stress disorder following a traumatic childbirth can have a negative impact on a woman’s future birth choices. But a recent Coroner’s inquest into deaths of babies born at home to women considered at higher risk of birth complications paid scant attention to evidence that a previous traumatic birth led some women to avoid hospital and medical intervention.
Conversely, some women may request to birth under general anaesthetic and have no awareness of the birth, or avoid pregnancy and birth altogether.
Post-traumatic stress disorder commonly occurs with other psychological conditions. A recent longitudinal study found 65% of women with PTSD also had depression 11 months after giving birth. Emotional health problems after childbirth are burdensome and common. Spontaneous recovery is rare and these problems persist over time.
Even though many women would like more advice and assistance, mental health problems are frequently not discussed or diagnosed and few women receive the help they need. Post-traumatic stress disorder doesn’t just affect mothers. Little is known about the consequences of maternal PTSD for the next generation, but there’s evidence emerging that maternal mood disorders predispose infants to a range of adverse psychological conditions later in life.
Efforts have been made over the last decade to introduce new interventions for women dealing with traumatic birth experiences. Over the last decade, our team has tested a counselling intervention called PRIME – Promoting Resilience in Mothers' Emotions. This intervention aims to support women to express their feelings and enable them to identify and work through distressing elements of childbirth.
Mothers are provided with the opportunity to review the birth and gain a realistic perception of events. The programs focus on developing individual situational supports for the present and near future, affirming that negative events and feelings can be managed and developing a simple plan for achieving this. This combination of strategies diminishes emotional distress, promotes constructive coping mechanisms and allows recovery to start.
Widespread and persistent calls to demedicalise and humanise maternity care have resulted in national commitment to reform maternity services. A key to this reform is rolling out midwifery caseload models of care, in which women are assigned a primary midwife who provides care during pregnancy, birth and early parenting.
Positive, caring interactions with a named midwife can influence how women manage their pregnancy and use available health-care services. And building social support networks is a key feature of woman-centred care and promotes maternal resilience and resourcefulness.
Childbirth can be traumatic for some women and contributes to a range of potentially long-lasting symptoms. Post-traumatic stress disorder can be debilitating for mothers and affect the development of their child. Reducing the level of unnecessary medical intervention in childbirth and reorienting maternity services to put women at the centre of care will help address this.