• When birthing experiences don't go to plan, mothers may be left anxious, angry, traumatised or riddled with misplaced guilt

  • Therapist Helena Cook, who specialises in issues related to parenthood, explores the impact of birth trauma

  • If you are struggling to come to terms with a traumatic birth, find a therapist here 

There are so many hopes and fantasies about giving birth. Women prepare excitedly for birth with a birth plan, music, candles, favourite cushions and other paraphernalia to fulfil their dream of this momentous occasion. While many births do proceed as planned with positive outcomes, this article looks at women who have the opposite experience. This can result in serious trauma, catapulting women into a dark, terrifying, angry and deeply upset place where nothing has happened as it should and robbing them of their dream of how it should have been.

For any woman giving birth is a serious mental and physical shock to the body, often unlike anything experienced before. They cannot control the rhythms and imperatives of the birthing process. There are not enough resources for medical staff to be with them all the time or to explain in detail what is going on, leaving them alone, confused, scared and perhaps in severe pain for long periods of time. Even deliveries that are obstetrically straightforward can be perceived as traumatic, especially if the mother feels there is a threat to her life or physical integrity or that of her baby.     

There is a vast spectrum of adverse birthing experiences affecting mother or baby or both. Many deliveries result in a healthy baby but, of course, trauma is intensified if the baby has complications or disabilities, has to spend time in neonatal intensive care or, even worse, does not survive. When people feel under severe physical threat the automatic emotional response in the brain is that of freeze, flight or fight. There is no place for rational intellectual reasoning. Mothers feel destabilised because, caught up in the throes of labour, they often recall little of what actually happened except perhaps imperative, scary cries of “emergency”, the sensation and sight of excessive blood, the influx of medical staff, being hooked up to myriad machines or being rushed off for emergency caesarean section with no time for anyone to explain what is happening nor why. One mother whose baby was healthy said “My baby was taken away without a word before I even saw her. If it weren’t for my husband being there, I would have sworn that I had never had a baby at all. I just felt despair, emptiness and loss not to have her in my arms.”      

Birth partners can also feel terrified and helpless. It is difficult anyway for a partner to witness the pain of the birth process but much worse to feel excluded and useless, especially when there is an emergency. One father expressed his fear and despair of watching his wife haemorrhaging badly and his new baby whisked away for respiratory treatment – not knowing which of them he should be with nor whether either would survive.  Partners often see what is going on much more clearly than the mother and may have more acute memories to cope with. One Dad was furious that he was left alone with his wife watching a heart monitor that seemed to indicate the baby was in distress while the midwife went off to write up her notes.

The impact of birth trauma

Common psychological responses to birth trauma include depression, difficulties in sleeping, anger, deep sadness, anxiety and panic, flashbacks and nightmares, social withdrawal, difficulties in bonding and caring for the baby or others in the family and relationship difficulties. Some women feel numb and cut-off in an attempt to dissociate themselves from the horrors that they have been through. 

Many mothers find it difficult to share negative birth experiences. They may feel the trauma was their fault or that they were weak and so shame and guilt ensue, leaving them feeling even more isolated and abandoned. It can also result in anger and resentment of the baby and can trigger or exacerbate post-natal depression or a lack of bonding and healthy engagement with the new-born. “I felt like a zombie” said one new mum. “All my NCT class were laughing about their birth experiences over coffee and I felt like I had been in a horror movie and must somehow have deserved such an awful outcome. Sometimes I couldn’t bear to look at or touch the baby and my husband had to stay home to look after her.“       

In some cases birth trauma can result in post-traumatic stress disorder (PTSD). This condition tends to be associated with people in high stress situations such as soldiers, emergency personnel in disaster scenarios, people caught up in terrorist attacks and so on. However it is increasingly recognised that those experiencing traumatic births can exhibit the same kind of symptoms and require specialist treatment. Research shows that some 2% of mothers meet the diagnostic criteria for PTSD but, because it is so often hidden, the occurrence is very probably higher. Symptoms include flashbacks, nightmares, hyperarousal, over-protectiveness of the baby, insomnia, depression, despair leading to thoughts of self-harm or suicide or the opposite defensive mechanisms of dissociation from reality and withdrawal. Sufferers of PTSD often go to great lengths to avoid any associations with the trauma and may feel unable to return to hospital or develop a phobia of routine investigations such as blood pressure checks, blood tests or vaginal examinations.    

Birth trauma can be especially difficult to diagnose, especially if parents go home with a healthy baby with no obvious need for further psychological intervention. More serious symptoms may be buried in the normal stresses and strains of the life-changing experience of having a new-born – lack of sleep, feeling tearful, over-protectiveness, lack of interest in socialising, and the responsibilities to the rest of the family. It is easier to try to forget or suppress terrifying memories. No one wants to go back to that painful and fearful place in the midst of joy of a new baby. Dwelling on those feelings might jinx the happiness or cause some other disaster.

Trauma can often be successfully suppressed for a while. However, it does not go away. Later, aspects of it may emerge for either parent in ways they may not initially recognise such as when there is a different emergency in the family or when their child is hurt, needs hospitalisation or suffers another setback. All the old fears and depression, anger, insomnia and over-protectiveness re-surface – feelings that seem irrational and to have come out of nowhere until the connection can be made with the unresolved trauma, perhaps from long ago. Memories of the trauma typically re-emerge especially acutely during a future pregnancy. This is often when parents finally seek therapeutic help as they find themselves unable to contemplate the fear and perceived risks of another birth. One mother told me desperately that she could not contemplate another terrifying vaginal birth. If she could not be guaranteed a caesarean she would have no choice but to terminate her much wanted second baby.   

What can help those who have suffered birth trauma?

1) Ideally birth trauma needs to be picked up early by midwives, doctors or health visitors to ensure that its negative aspects do not affect the crucial early bonding and care of the new baby and also that it does not trigger post-natal depression.

2) Birth trauma can be helpfully explored in therapy - a safe and confidential place where the mother or couple can be completely open about their negative experiences, fears, anger and incomprehension and can discuss honestly how it has impacted on their relationship with the baby and with each other. Initially some parents are not ready to re-visit or deal with the trauma. They may fear “being put through it again” or that it will somehow poison their relationship with their baby. They want to get on with life. Therapists working with them need to be especially careful not to re-traumatise them. There are recognised techniques to guard against this or parents may decide to wait a while before seeking therapy. However, parents and professionals working with them also need to be aware that unresolved trauma rarely just goes away and can easily be re-triggered in ways that can be debilitating.  
3) PTSD requires early specialist help from a trauma treatment therapist, perhaps one skilled in EMDR (eye movement desensitisation and reprocessing).

4) It can be very useful for parents to have a detailed discussion with a senior clinician or midwife to go back through the birth notes and understand exactly what happened and why certain decisions were taken. This can provide the reasoned intellectual narrative as to what happened and fill in blanks and questions, giving a logical framework to the emotional, fearful and irrational feelings experienced by the parents at the time.

5) Of course, if there are serious concerns that hospital practices were at fault this may prove to be a much more difficult exercise and parents will have to decide whether and how they may wish to pursue a complaint. However, this is all about having the full information and deciding what to do with it rather than being left with the incomplete and hazy memories of the trauma.

6) Some parents with acute anxiety or trauma may find it helpful to have a doula or private midwife to guide them through a subsequent pregnancy and birth. These professionals are accustomed to working alongside NHS medical staff and can provide a continuity of physical and psychological care when it is most needed.

Our default as human beings is to escape pain, danger and unbearable memories. This serves us well in emergency situations where our safety may be paramount. No one wants to re-visit trauma if we don’t have to. However, these memories rarely just go away. We suppress them and they lie dormant until something triggers them, often with greater potency than when they first occurred. Then we feel out of control, overwhelmed by incomprehensible emotions and terrified. This is why we need to seek help to work through these experiences and to come out the other side – as we can do if we take it slowly and with professional help.  We do not have to be defined by birth trauma. It can be something we recall sometimes and perhaps with pain and sadness, but it no longer needs to define ourselves, our relationships nor our children.                                                                         

Helena Cook is a verified welldoing.org therapist in EC1 and N8

Further reading

Living with the loss of a baby: the impact on subsequent pregnancy 

Birth trauma: new mothers with PTSD

Maternal isolation: it takes a village to support a mother

Recognising postnatal depression

Why breastfeeding grief and trauma matter

Understanding trauma and flashbacks