'Everyone wants me to be happy, but I’m traumatised by the birth'

This article will look at what birth trauma is, how to know if you are experiencing it, and how counselling can help you process what has happened to you or your partner. It’ll also share organisations and services that will help you understand what happened to you, and feel less alone, no matter how long ago your baby was born.

What is birth trauma? 

The mental health charity Mind describes birth trauma as a frightening, stressful or distressing event which is related to giving birth. More recently, the definition of birth trauma has expanded to include the care you or your baby received postnatally and some pregnancy symptoms. 

Birth trauma is subjective, meaning it is the individual’s response that makes a birth traumatic, not the event itself. For example, an emergency caesarean may be experienced by one person as distressing and frightening, whereas someone else may have felt a sense of relief and comfort from the intervention.

Why does birth trauma occur? 

Birth trauma may result from:

• A difficult labour or a long and painful birth, which may have involved interventions that were not sufficiently explained or understood.
• Inadequate postnatal care, such as being left alone in pain after the birth, or a delay in getting to hold your baby, or your baby needing painful, intrusive procedures after birth.
• Experiences in pregnancy, such as extreme pregnancy sickness (hyperemesis) which can heighten some women’s vulnerability to birth trauma.
• Feeling uncared for during labour and birth. Examples reported to the Birth Trauma Association include being laughed at for voicing concerns; not given pain relief when it was requested, or having an intimate examination without having given consent.
• Institutional racism or bias, for example, black and brown skinned women, who are at higher risk for some pregnancy complications, often receive less information on their birth options and can feel less in control of their bodies.
• Care that does not take into account previous experience of sexual abuse or certain mental health diagnoses.

Some people may have kept the events of a birth silent for many years; in fact, birth was only recognised as a possible source of trauma in the late 1990s. Up until then, it was not believed that a birth could be traumatic. If you are soon to become a grandparent, you may find yourself anxious about your child experiencing a birth similar to yours. You may find yourself showing your anxiety by becoming overly involved in decisions around birth or remaining distant. 

What are the symptoms of birth trauma?

There are different ways that birth trauma manifests, and there is much overlap between them, however, birth trauma needs to be treated with specific knowledge and techniques. 

Some people may experience signs of depression, anxiety or obsessive-compulsive behaviours after a difficult birth. For example, a parent whose baby was unwell during or shortly after the birth may be highly anxious at any sign of illness postnatally. They may find themselves not able to sleep for fear that they will miss something, and regularly attend A&E. Whilst these feelings are very challenging, they are different to trauma. 

Some parents may have post-traumatic stress symptoms, which might include individual symptoms such as having flashbacks to an aspect of the birth, or ruminating on something unkind or dismissive that was said during labour, or having nightmares about a procedure.

Post-traumatic stress disorder (PTSD) is an official diagnosis recognised by the National Institute for Health and Care Excellence (NICE). People will be experiencing a range of symptoms from across the following:

• Re-imagining the birth: You may have nightmares or flashbacks to a moment in the birth when you thought you, your partner, or your baby might die.
• Avoiding memories of the birth: You may not be able to look at any photos of yourself or your baby after the birth.
• Being in a hypervigilant state: You feel as if you’re in fight or flight all the time, and are easily startled. You may want to avoid attending hospital appointments or find your heart racing when talking to health professionals.
• Negative thinking: You might obsessively think about why you didn’t do anything to avoid the traumatic event, or you may feel very numb and detached from your baby, your partner, friends and family.

What can I do now if I think I am traumatised from the birth?

There is a lot you can do. Take a look at the suggestions below and pick one that feels achievable:

• Educate yourself on birth trauma - Make Birth Better and the Birth Trauma Association are great starting points. MASIC is the charity to go to if you have experienced a birth injury. 
• Find ways to regulate your nervous system - breathing techniques, relaxing activities such as walking, being in nature or listening to calming or distracting podcasts can all help. There are lots of apps that can help with developing these skills.
• Express yourself - writing, drawing and talking about how you are feeling can help you acknowledge your suffering, as well as noticing what makes you feel better or worse.
• Accept different responses to the trauma - like after a bereavement, you and your partner might be processing the trauma differently. Try and acknowledge the strain on your relationship by giving and receiving small gestures of kindness, such as a cup of tea or a walk together in the park.
• Talk to someone - speaking to friends, family, a health professional, helpline. Birth trauma is common, so you may feel less alone by sharing. If it feels too much for you to speak to someone who knows you or what happened to you, then a counsellor is a really good option. 

How can counselling help with birth trauma? 

Some counsellors will provide NICE-approved treatments for PTSD, such as EMDR or trauma-focused CBT, while others will work with the wider symptoms of trauma using a client-centred approach. This means they will provide the right conditions for you to identify what will help you process and recover from the trauma, and they will support you for as long as you wish them to.

Trauma-informed counselling means that the counsellor will take a phased approach - they are likely to focus on what helps you feel safe and secure before working directly with the trauma. They will be able to support you to learn ways of feeling safe, if you are finding this difficult to achieve on your own. Some counsellors offer rewind trauma processing techniques that do not require the client to reveal the trauma to the counsellor at all, but provide the conditions for the brain to process the trauma so it can be recalled without triggering symptoms. 

Whatever approach you choose, a counsellor can provide you with a safe and confidential space to process what has happened to you. They can guide you in learning strategies that will make the day-to-day more manageable and support you in finding ways of feeling less physically and mentally impacted by the symptoms of trauma.

Some people find that friends and family can’t bear to hear the extent of their feelings, especially when there is a new baby taking up their attention. A counsellor, especially one with specialist training in birth trauma, will not be overwhelmed or unable to cope with hearing what happened to you. The relief of speaking openly can help you start to find your own ways of coming to terms with the trauma, and acknowledge the grief for what you hoped would be a joyous and celebratory time.

What NHS support is available for birth trauma?

The NHS is increasingly recognising perinatal mental health, and this has resulted in improved services for birth trauma. Services vary, Trust to Trust, but you are likely to find the following available in your area:

• Birth in Mind - most hospitals will have a service that enables parents to talk through their birth notes with a midwife or doctor. Community midwives and health visitors can refer parents to this service, or you can sometimes self-refer. Whilst this is a very useful service for some, there is variation in the skill of the staff offering this service, and it is not a replacement for therapeutic support.
• NHS Talking Therapies - will often fast-track new parents who are showing signs of depression, anxiety or obsessive-compulsive disorder. They are most likely to offer short-term cognitive behaviour therapy or group support.

Staff from the above services, along with your midwife, health visitor or GP, will be able to refer you to more specialist services if you are experiencing PTSD symptoms.

Further support:

• The Birth Trauma Association
• Make Birth Better
• MASIC
• Sands
• Bliss