Childbirth is often depicted as the most magical experience in the world, and for some women, it truly is. However, for others, it can be complicated and extremely traumatic, both physically and emotionally. I have personal experience with this, having pressured myself into two home births. The first was extremely traumatic, while the second was magical. I have indeed experienced both ends of the spectrum. The Birth Trauma Association estimates that 1 in 25 women experience some form of birth trauma. This equates to 30,000 women annually, though they suspect the unrecorded numbers are much higher. The long-term effects of birth trauma on millions of new mothers are still largely overlooked, underreported, or undiagnosed.
The event can be traumatizing if the birth doesn't go as planned, and expectations greatly influence how traumatized a woman might feel. There's a lot of information suggesting that medicalization is negative, implying that women have failed if intervention is needed during birth. Additionally, The British Journal of Midwifery suggests that birth trauma is more related to the quality of care received than the physiological process itself. PTSD is often mistaken for PND, so mothers should be informed about the difference. Many mothers may feel their experiences are invalidated. Institutional denial of women's experiences can also pose a problem in post-natal care, which is evident in the lack of women speaking out.
What are the symptoms of Birth Trauma?
Psychological effects during the labour
Powerlessness
Loss of control
Frightened
Panic
Confused
Abandoned
Hopeless
Lonely
Disrespected
Unheard
Disregarded
Disappointment
Feelings of failure
Worthlessness
Pain and physical wounding
Post-partum post-traumatic stress disorder (Symptoms)
Intrusive thoughts re-experiencing of the traumatic event
Flashbacks and nightmares (often involving blood), symptoms of PTSD
Anxiety and panic attacks
Psychological sensation of pain (in her uterus)
Avoiding anything that reminded her of the trauma. This meant refusing to go into hospital and avoiding meeting other women with new babies
Feeling hyper-vigilant, to the point of OCD. Constantly worrying that something terrible is going to happen to the baby
Loss of confidence (stop going out of the house)
Sense of constant fear, shame, guilt, and failure and feelings of not being a “good enough” mother
Feeling low and unhappy, which lead to Post Natal Depression (PND)
Problems bonding with their new-born, and developing either an anxious attachment or an avoidant one
What is the path to recovery?
Each mother will react uniquely, and when dealing with trauma, it is crucial to avoid reactivating past events in the present. As a therapist, it's essential to determine what approach is most suitable for each person. Below are several therapeutic methods that have assisted women in overcoming their trauma.
Talk Therapy
Acknowledging the mother's experience
Listening to the story without judgment
Reinterpreting the narrative
Offering compassion and acceptance by addressing guilt and shame, and moving towards the belief of “I am a good enough mother”
Challenging societal norms around childbirth and the unrealistic expectations placed on mothers
Mindfulness
We all understand that the body and mind are fundamentally connected. Mindfulness aids in grounding, anchoring, and self-regulation techniques to maintain nervous system balance,
Guided Meditation & Visualization - This mindful practice focuses on removing fear, tension, and self-doubt, transforming them into confidence, calmness, and control, e.g., visualizations of mentally and physically letting go.
Controlled Breathing - Grounding techniques to keep your body from entering fight-or-flight mode, allowing you to remain within a window of tolerance, thus enabling the parasympathetic nervous system to maintain stability
Positive Affirmations – The power of positive thinking is crucial; it helps you trust, stay calm and open, and fosters self-compassion and acceptance
CBT
Trauma-focused CBT starts by examining the traumatic memory together, concentrating on the meanings formed at the time and the emotionally intense parts of the memory (known as ‘hotspots’). They will then collaborate to develop new interpretations and revisit the memory together (referred to as ‘reliving’).
This process updates the old traumatic memory with new information that reassures the person’s safety, making the memory feel less overwhelming.
TF-CBT might also involve exposure, such as gradually visiting the hospital where the trauma took place. This can be especially beneficial when avoidance symptoms prevent the person from carrying out their daily activities.
Other CBT approaches, including mindfulness and shame-focused interventions
EMDR
EMDR is a structured therapy that prompts the patient to briefly concentrate on the trauma memory while simultaneously undergoing bilateral stimulation (usually through eye movements), which is linked to a decrease in the intensity and emotion associated with the trauma memories. The experience is still recalled, but the fight, flight, or freeze response from the original event is resolved. This allows the experience to be processed and managed, enabling effective communication between the amygdala (the alarm signal for stressful events), the hippocampus (which aids in learning, including memories related to safety and danger), and the prefrontal cortex (which analyzes and regulates behavior and emotion). Instead of enduring PTSD, where the client is stuck in time, continually reliving the past trauma in the present, EMDR will ‘ground’ a mother in the here and now, reminding them that they are safe.
Somatic Experiencing
Drawing from Dr. Peter Levine's work (2012), Somatic Experiencing aids in stabilizing the mother's nervous system, enhancing her ability to handle challenging and painful emotional and physical experiences. By approaching these aspects of herself from a grounded, stable, and well-resourced position, she can renegotiate energy trapped in the body, leading to its release and liberation, which fosters empowerment, relaxation, and a sense of completeness. In conversation with a midwife who incorporates Somatic Experiencing, she shared with me that:
I build a relationship with the mother and gain mutual trust; I get to know her triggers and her tolerance levels. Working very slowly on the edges, so that the mother´s system doesn´t get overwhelmed, we very gently work to discharge activation and eventually get to the core
In conclusion, Birth Trauma can be incapacitating, and it is crucial to increase awareness, reduce stigma, and provide more assistance. When dealing with PTSD, a new mother is tasked with caring for a newborn, which can either suppress or intensify the trauma. New mothers are often exhausted, and the last thing they want is to search for and fight for referrals. More resources should be allocated for support. I hope this article demonstrates that new mothers do not have to endure this alone, as therapists, we are here to listen, support you, and guide you back to recovery.
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