Trigger Warning: In this article I will be referencing traumatic birth stories. There is the potential for you to become triggered if you or someone you love has experienced these things. Please thoughtfully consider whether or not this content will feel validating and supportive or if it will feel too activating at the present moment for you. You can always come back to it at another time.

My clinical speciality is trauma. I’ve treated everything from adult survivors of prolonged childhood abuse to sex trafficking survivors to war veterans. Even as a well-trained traumatologist, there was a whole spectrum of trauma that was not on my radar. I’m talking about birth trauma. Birthing babies is so “natural” and common that the reality of it being potentially very dangerous for both the birthing person and baby is frankly glossed over.

Definition of Traumatic

Let’s take a step back and talk about the definition of trauma. This is important because what is traumatic is actually fairly subjective. What is traumatic to me might not be traumatic to you and that doesn’t mean that I didn’t experience a trauma or that you did. A theme in the definitions is that events may be experienced as traumatic when it overwhelms a person’s ability to cope. Another theme is that something may feel traumatic when it disrupts our belief system (i.e., “the world is generally safe”).

The DSM 5, which is basically the diagnostic bible for psychologists, defines a trauma as “actual or threatened death, serious injury, or sexual violence.” This DSM 5 definition is important because you must meet this definition in order for your symptoms to qualify for a Posttraumatic Stress Disorder (PTSD) diagnosis. However, you don’t have to develop PTSD for something to have felt traumatic. In fact, most people who experience trauma don’t develop PTSD. It’s important to emphasize here that you don’t have to develop PTSD for an event to have been impactful.

My first baby was born in a fast and furious way. I arrived at the hospital 8 ½ cm dilated. Within an hour I was pushing my baby out. Three pushes later, he was here. Except, on that final push, that part where his head was crowning, I felt like something may have exploded. I saw my husband’s face and it was full of terror. I knew something bad had happened. The baby was placed on my chest. This is supposed to be magical (this is what I had heard), but I was very numb. I felt removed from my body. The doctor went to work quickly and the phrases “she’s bleeding too much” and “we have to stop the bleeding” were being thrown around. Next thing I know, I’m getting a shot in the thigh. That wasn’t enough. Next, a pill is being inserted directly into my anus, as it is the fastest way to stop the bleeding due to how quickly it can be absorbed. I caught the nurse’s eye and noticed she was crying a little. I felt terrified and I didn’t know how much danger I was in. Then the doctor went to work sewing me up for close to an hour.

You might find yourself thinking, “Oh, wow. That is really awful.” Or maybe you are thinking “That’s it?” The point here is that it isn’t useful to compare pain and we are each entitled to our experience. It’s important to hold space for each other’s stories, even if they are different from our own.

Below you will find a powerful image by Unfold Your Wings (If you have time check out their wonderful website at The Birth Trauma Tree – UNFOLD YOUR WINGS). This visual outlines birthing people’s experiences that may have felt traumatic (I am not saying these experiences will meet the “trauma” definition characterized by the DSM-5 for a PTSD diagnosis). These experiences are represented in the roots of the tree. The symptoms they may experience because of these events are the branches. Notice that these are not just physical experiences, rather many are emotional one’s.

Postpartum PTSD

Now let’s talk about what it looks like if a person does develop PTSD from a traumatic birthing experience. The symptoms of PTSD can be broken down into four clusters:

Symptoms of PTSD

Intrusion- This is a fancy way of saying thoughts and/or images of what happened keep popping in like an uninvited guest. This might also happen in the form of nightmares. It can also happen in the form of a flashback. A flashback is when you have left the present moment and feel like you are back there in that moment. You might be able to hear the sounds and smell the smells. Intrusion can feel really out of control.

Avoidance- This often shows up as trying really hard to avoid all thoughts, images, and feelings that remind the birthing person of the traumatic experience. For example, they may avoid going to postnatal follow up care visits because the doctor reminds them of what happened. If they’ve lost their baby, the birthing person may find themselves avoiding crying babies or saying no to that invitation to the baby shower.

Hyperarousal- A professor of mine explained this so well so I am going to use Dr. Steve Gold’s explanation here. Dr. Gold had us imagine one of those old school, lever style fire alarms that we all remember from school. Hyperarousal is like that fire alarm is always on. It is great when the fire alarm is going off when there is a fire. It activates our body. Our hearts beat fast, we start to sweat, blood pumps to our major muscle groups and we run to safety. Once the fire is over, the alarm needs to be turned off. PTSD is like walking around with the alarm always going off, even when there is no fire, making it not very useful and making your body very distressed most of the time. It's the loss of control of the lever. Hyperarousal may show up as having trouble sleeping, irritability, difficulties concentrating, engaging in reckless/dangerous behavior, and being easily startled.

Negative alterations in mood and thoughts of yourself, others, or the world- This means that there is a noticeably negative shift in thinking. For example, they might have previously held the belief that, generally speaking, the world is a pretty safe place. After the trauma they might find themselves entrenched in thinking that sounds more like, “danger is lurking around every corner.” This can also show up as a negative shift in how one views themselves. For example, a person may go from believing they are mostly strong and competent to believing that they are mostly weak-willed and incapable.

Signs of PTSD

Now that we know the clinical definition of PTSD, I’ll share some of the very relatable ways about how these symptoms show up for people.

“I’m always on edge.”
“I feel like I can’t handle anything.”
Being short-tempered with their partners and children.
Feel disconnected from loved ones and this can include their baby or other children.
Not wanting to be touched.
Jumpy
Restless
Avoiding sleep because of the nightmares.

PTSD Diagnosis

If you or someone you know has symptoms in each of the four clusters, these symptoms have lasted more than one month, and are impacting their ability to function, then PTSD may be an appropriate diagnosis. As you digest these symptoms you may start to think of many different people you know. Notice that the people you are picturing likely developed PTSD from all sorts of events, from childhood abuse, to intimate partner violence, to war, to a traumatic birth experience, etc. PTSD does not discriminate. It is our bodies' rather ordinary response to an extraordinary circumstance.

Postpartum Treatment

If you or someone you know is experiencing PTSD from a traumatic birthing experience there is help available. Postpartum Support International is a wonderful organization that offers access to free support groups and connects birthing persons to therapists with a certification in Perinatal Mental Health in their local area. I encourage you to take the time to check out this really helpful resource at Postpartum Support International - PSI. If you want to continue your research on the topic check out Birth Trauma Association: Home, as I think it is a helpful site. Since PTSD is my passion there will be many more articles to come on coping with PTSD so stay tuned for even more information on the subject.

For all the mama’s reading out there for whom this really hit home, we see you. Your experience is real and valid. Your pain is justified. Now is the time to reach out for support and begin the healing process.

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Postpartum PTSD: What is Birth Trauma?