Anxiety and Depression

Perinatal Trauma

BY DR. HO YILING

7 November 2022  |   5 min read

Perinatal trauma, sometimes also known as birth trauma or postnatal posttraumatic stress disorder, refers to medically-related traumatic stress experienced by mothers during or after childbirth. Childbirths can become traumatic when women fear that their lives and/or their baby’s lives become threatened during the birthing process. Sometimes, this distress can also emerge or persist even after the child is born. Affected women may report varying intensities of traumatic stress symptoms, with some meeting the full diagnostic criteria for posttraumatic stress disorder (PTSD).

Risk factors

It is estimated that perinatal trauma affects up to 45% of new mothers (Beck et al., 2018). Factors that may increase the risk of perinatal trauma include medical complications that occur during childbirth, or other subjective experiences of childbirth that may increase one’s sense of helplessness, fear, loss of control, or loss of dignity. Women who have had prior exposures to other traumatic events or mental health difficulties may also be at higher risk of experiencing traumatic stress from pregnancy or childbirth complications (Dekel et al., 2017).

Examples of these risk factors include:

Medical Complications Subjective Experiences of Childbirth Trauma & Mental Health Histories
  • Emergency caesarean section
  • Induced labour
  • Painful or prolonged labour
  • High level of or intrusive medical interventions
  • Stillbirths
  • Birth of baby with disabilities resulting from the birth process
  • In-utero losses or babies born with high needs and require immediate intensive care
  • Lack of information around medical interventions
  • Interactions with medical staff that may result in one feeling dismissed or unheard
  • Lack of privacy
  • Fear of childbirth for self and/or baby
  • Needing to adapt to unexpected changes in procedures during labour
  • History of childhood sexual abuse
  • History of domestic violence
  • Previous traumatic birth experiences
  • Perinatal anxiety
  • History of depression
  • History of PTSD

Traumatic stress symptoms

Women affected by perinatal trauma often report feeling a range of emotions, such as feeling misunderstood, lonely or depressed. It is also not uncommon for women to feel guilty or responsible for their traumatic birth experiences. Other common traumatic stress symptoms from perinatal trauma include:

  • Having uncontrollable intrusive memories of the traumatic birth, flashbacks or nightmares
  • Becoming more vigilant of the baby’s safety and one’s surroundings
  • Feeling irritable, tense or easily startled
  • Feeling sad, hopeless or anxious
  • Difficulties remembering the birth experience
  • Avoiding external reminders e.g. places like the hospital, people, conversations, objects, or situations that remind one of the traumatic experience

Women who have had prior exposures to other traumatic events or mental health difficulties may also be at higher risk of experiencing traumatic stress from pregnancy or childbirth complications.

Some may believe that becoming new parents or having a new baby can make up for the traumatic childbirth experience; or make it easier for affected mothers to focus on the baby and not on the traumatic memories. However, this may not be the case for some affected women. Instead, they may feel anxious about having another baby, or become more vigilant about their baby’s health; to the point where their relationship with their family or ability to carry out daily tasks may be impacted. A review study by Cook and colleagues (2017) found that perinatal trauma may affect some aspects of child development, i.e. lower birth weight, reduced rates of breastfeeding, with other researchers also suggesting an impact on mother-infant attachment, increased infant cortisol levels, and eating or sleeping difficulties. It is therefore recommended that women who experience the above mentioned traumatic stress symptoms for longer than a month after childbirth consult with a trained mental health provider.

Treatment and therapies

Treatment for perinatal trauma usually involves trauma-focused therapies like cognitive processing therapy (CPT), trauma-focused cognitive therapy, or eye movement desensitization and reprocessing therapy (EMDR). These therapies aim to help one understand their personal triggers, increase their capacity to cope with difficult emotions, reduce the intensity of traumatic memories, and develop more balanced thoughts and beliefs around the traumatic birth experience.

It is also worth noting that some traumatic stress symptoms may present similarly to that of postnatal depression. Some affected women may also experience postnatal depression and perinatal trauma. However, as these two conditions are distinctly different, they require specialised interventions. Visit The Massachusetts General Hospital Center for Women’s Mental Health website (www.womensmentalhealth.org) for more resources on maternal mental health.

This article is contributed by KK Women’s and Children’s Hospital. This article was first published on Trauma Network for Children’s Quick Bytes Newsletter and is republished with permission.

The Stay Prepared – Trauma Network for Children (TNC) programme is a joint collaboration between KK Women’s and Children’s Hospital (KKH) and Temasek Foundation. It aims to enhance the psychosocial capability of the Singapore community to support children and youth after crises or traumatic events. For more resources, visit the Trauma Network for Children Website at www.childtraumanetwork.sg.

Reference

Beck, C. T., Watson, Su., & Gable, R. K. (2018). Traumatic childbirth and its aftermath: Is there anything positive? The Journal of Perinatal Education, 27(3), 175-184.

Cook, N., Ayers, S., & Horsch, A. (2018). Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. Journal of Affective Disorders, 225, 18-31.

Dekel, S., Stuebe, C., & Dishy, G. (2017). Childbirth induced posttraumatic stress syndrome: A systematic review of prevalence and risk factors. Frontiers in Psychology, 8, 560.