Content warning: traumatic births
Postnatal PTSD, or birth trauma, is a topic that is finally commanding mainstream attention. This is thanks, in part, to the acceleration of the online conversation on this matter, which includes famous faces speaking rawly about their experiences – former Made in Chelsea star Louise Thompson is one such example.
Here, WH contributor Carly Lewis-Oduntan explores the mechanisms behind the condition, and speaks with women who have lived this terrifying reality and who have found a road to healing.
It’s the middle of the night and Karen is sitting in bed, bolt upright. Her heart is pounding as she struggles to get air looping in and out of her lungs. Her clothes, damp with sweat, cling to her body. In the darkness, she looks to her right, catching sight of her baby girl who is sound asleep.
Karen watches her infant's tiny body intently before picking her up, needing to hear a cry for confirmation that she is still breathing. This is not a passing anxious moment. Rather, Karen is having another panic attack. In the months following her second daughter's birth these have become so frequent that she’s lost count of how many she’s had in the last few weeks.
If you are dealing with the aftermath of a traumatic birth, speak to your GP or midwife, who can help you to seek treatment and support
‘I gave birth in May 2019 and I had a very difficult delivery,' the 35-year-old mum of two tells WH. 'At first I was suffering so much physically that the mental ramifications were slightly delayed.
'But as my body started to recover I really began to struggle mentally. I wasn’t sleeping, I was waking up constantly having massive panic attacks, in sweats, and thinking that my baby had died next to me.’
She didn’t know it at the time, but Karen, who lives in Norfolk and is the founder of Tot's Playtime Box, was suffering from postnatal post-traumatic stress disorder (PTSD), also known as birth trauma: a type of anxiety disorder rooted in traumatic events experienced during labour or childbirth.
The root of her problems was this: While in labour, she faced complications caused by shoulder dystocia – when a baby's shoulder(s) gets stuck inside their mother's pelvis, resulting in an intensely difficult birth.
‘All the midwives could do was manually remove her. They pinned my thighs to my chest [known as the McRoberts manoeuvre] to open up my pelvis and then one unhooked my daughter’s shoulder from my pelvis to get her out safely – but in doing that her opposite shoulder pushed into me and gave me a third degree tear. She would have died if they hadn’t gotten her out,’ she explains.
Once Karen arrived home, faced with the hefty responsibility of caring for a newborn and a toddler, she soon realised just how life-altering her injury was. ‘I had to crawl up the stairs, I couldn’t really walk, I couldn’t sit to breastfeed so she had to go onto a bottle. Those first few months of her life, I was house bound.'
It wasn’t until a couple of months later that the signs of PTSD began to creep in, with the most distressing symptoms occurring at night. ‘At its worst I was waking my daughter up seven or eight times a night to check that she was breathing.’ Flashbacks from the birth soon became commonplace.
What does PTSD after birth feel like?
PTSD can manifest differently, in different people. For Karen, though, '[PTSD] is like really intrusive memories. They keep coming into your head, you know you don’t want to think about them but you can’t make them leave.'
It got to the point where even the sound of her daughter crying would trigger her, and she avoided going to baby and toddler groups, fearful that somebody would ask questions about the birth. ‘The more I got triggered the less I wanted to leave the house.’
These are all common symptoms of postnatal PTSD, which Karen was diagnosed with after seeking help via the NHS. It's only relatively recently, though, that labour has been understood as a possible catalyst of the disorder.
When did people start to be diagnosed with postnatal PTSD?
'The concept of birth being something that can cause PTSD is still relatively new,' Dr Rebecca Moore, perinatal psychiatrist and co-founder of Make Birth Better, tells WH. 'It only began to be been discussed over the past decade – before that, there wasn’t a lot of awareness about birth trauma.' She notes that we have a tendency to associate trauma with things that are purely negative and of course birth, even a highly traumatic one, can have an ultimately positive outcome.
'I think another thing is that women are often very good at minimising what they’ve experienced,' she adds.
While anyone who goes through a traumatic birth can experience postnatal PTSD, research shows that people who have had an emergency Caesarean are more likely to develop the condition, as are those who have previously experienced traumatic events.
How many people deal with PTSD after birth?
While not super commonplace, postnatal PTSD impacts a significant pool of people – around 3% to 4% of women in the aftermath of birth is the current estimate. In 2017, academics at City, University of London conducted a review and found that the issue is 'common enough to be a significant public health concern that warrants routine screening and treatment.’
More broadly, that same year, another piece of research found that a third of women who have had a baby describe the experience as 'traumatic.'
It's a topic that is garnering significant attention online. At the time of writing, videos mentioning birth trauma on TikTok have racked up more than 378 million views and the #birthtrauma hashtag on Instagram has more than 78,000 posts. Part of this is thanks to celebrities candidly speaking about their experiences.
Earlier this year, former Made in Chelsea star Louise Thompson and actress Gemma Atkinson opened up about their PTSD after having children, with Louise revealing that she spent five weeks in intensive care following the birth of her son.
What are the key signs of postnatal PTSD?
Look online and you’ll find a lengthy list of criteria that can lead to a diagnosis. But it’s probably most helpfully explained by mental health charity Mind, which note that the signs fall into four groups.
Re-living aspects of the trauma (such as flashbacks and nightmares)
Alertness or feeling on edge (such as being easily startled or panicking when reminded of the trauma)
Avoiding feelings or memories (such as feeling physically numb or detached from your body and being unable to express affection)
Difficult beliefs and feelings (such as that you can't trust anyone, or that nowhere is safe)
How is PTSD after birth treated?
Common treatments for the condition include cognitive behavioural therapy (CBT and eye movement desensitisation and reprocessing (EMDR) which combines side to side eye movements with talk therapy. While medication is not typically prescribed to aid PTSD itself, if you are dealing with signs of anxiety and depression, these may be offered by a GP to soothe symptoms.
What is happening in the brain of someone with PTSD?
So what exactly occurs in the brain when a person suffers from PTSD? 'PTSD affects different regions of the brain,' Dr Moore says. 'There is an area in your brain called the amygdala, which is your alarm system: the home of your fight or flight response.' Perceive something as a threat, whether it's an angry email from your boss or the grip of a nasty memory, and it's your amygdala that starts firing.
'Most of the time, your brain is doing is a dance between your amygdala and your frontal cortex – the thinking, rational part of the brain, which can put the brakes on your more primitive, instinctual reactions.' It's this dance that enables you to walk down the street and know what’s a risk and what’s not: say, hearing a car alarm, feeling momentarily scared, and then telling yourself that you know precisely what the sound is and that you're safe.
So how does this play into PTSD? ‘When you have a trauma – for example, you’re giving birth and you think that you’re going to die – we think what happens is that your frontal cortex completely shuts down. As such, you go into that very primitive, frozen, amygdala-driven state,' says Dr Moore.
Once this existential threat has cleared and you're back home, however, when you are re-triggered by something you perceive as a threat, you can't process it as you would have before: using that interplay of your primal, more animalistic amygdala and your rational frontal cortex.
As such, a person with PTSD can be triggered into strong, physical reactions or extreme anxiousness around anything even tangentially related to the trauma, or to things that shouldn't provoke an intense reaction.
PTSD, it's key to note, can also impact the hippocampus, which is the part of the brain involved in memory processing. When this fails to function properly, recurrent, visceral memories of the trauma, as well as flashbacks, can occur.
How did the pandemic tie into postnatal PTSD?
Like most things, the pandemic has had a major impact on the way that people gave birth and its aftermath. This was the case for Neya, 30, a medical writer from London. She gave birth to her first child during a lockdown in 2020. After having an emergency C-section, she was left on a postnatal ward, numb from the waist down, with no support from hospital staff. Due to the pandemic rules of the time, her partner was instructed to leave an hour after she came out of surgery.
‘No one helped me with getting out of bed for the first time, walking, getting to the toilet or looking after my son. I was having trouble breastfeeding him and I was told that someone would come by in half an hour but I literally never saw them again. The whole situation was really distressing.’
‘I knew [mentally] that something wasn’t right because I’d honestly never felt so fearful, desperate and helpless in my life.' Still, she thought her terror might dissipate after she had some recovery time. 'I got home and I thought maybe I needed some sleep and then I could process everything,' she tells WH.
‘But in the coming months I would spend all my time thinking about what happened at the hospital. I lost my ability to function, in a way. I would just sit all day. I didn’t really go out and I found it hard to bond with my son.'
Neya pins this down on being alone in hospital in the aftermath of the birth, and adds that lockdown restrictions – not being able to see friends and family – as adding to her difficulties. 'After the birth, not being able to see others added to feeling really low and isolated.'
When she did finally speak to a psychologist, she was told that she’d had PTSD in the months following her labour, but that what she was then suffering with was unresolved trauma symptoms. ‘The worst of it [the PTSD] was over at that point,’ she says.
How is PTSD after birth treated?
Much like Karen and Neya, every day there are hundreds of women battling the emotional and physical impacts of birth trauma while having to ‘show up’ every day as parents. Though a harrowing and distressing time, it's key to know that life can and does get better.
‘After a year of therapy I noticed a huge difference. I was able to talk about what happened without feeling anxious, or reliving it all over again,’ says Neya. ‘Now I can think about it and not feel upset. It’s more like I recognise that it was a really awful time and I just leave it at that. I don’t have these really intense emotions tied to it.’
For Karen, a mix of cognitive behavioural therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) therapy on the NHS, before going on to private therapy, has resolved the sharp edges of her symptoms. She also credits starting her business in August 2020 with helping her to heal from some of her past pain.
As far as medical developments go, diagnosis and treatment of postnatal PTSD is still relatively in its infancy, and Dr Moore thinks there are still strides to be made in order to consistently ensure that patients receive the best care.
‘Sometimes what happens is when people pluck up the courage to speak to a GP, they’re told that they’re depressed and given medication, whereas actually they’re traumatised by their birth,’ she says.
‘I think we need to create spaces where people can have time to meaningfully talk about their birth experiences. The more we campaign around it, hopefully it’s something that people will feel more able to talk about – and that goes for professionals as well.'
What should I do if I think I have postnatal PTSD?
If you experienced a traumatic birth and believe you have PTSD, it's important that you speak to someone who can help. The Birth Trauma Association recommends you try:
Your health visitor
Family and friends
Email one of a volunteer supporters at firstname.lastname@example.org
Remember, treatment is available and will be able to help. Reach out for support.
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