While childbirth is often a joyful event, it rarely unfolds exactly how we think it will. This causes disappointment or distress among some women, and leaves a small proportion with a diagnosis of postnatal post-traumatic stress disorder (PPTSD).
A negative birth means mothers are more likely to be depressed. This can alter the way they engage with their baby, which can impact on the baby’s development. Women’s relationships with their partners (both sexual and emotional) can also become strained.
Women were more likely to view the birth as negative if they had an instrumental birth (with forceps of vaccuum) or caesarean section.
Partners also increasingly report feeling distressed, traumatised and helpless when things go wrong in labour.
After a traumatic birth, the fear of something similar happening can be so intense some women delay subsequent pregnancies; request caesarean sections or avoid hospitals for future births; or simply never have another baby.
Why doesn’t it go according to plan?
Most women want a normal, vaginal birth and many want to be able to do this without pain relief and any medical intervention.
When expectations of childbirth don’t match reality, women can feel like a failure – and are somehow at fault.
But women are not able to control the baby’s position, whether the baby gets distressed during labour, her blood pressure rising, or the development of diabetes. These factors may require increased monitoring and interventions such as an emergency caesarean section.
When birth does not go to plan, this is rarely a woman’s fault. It is sometimes a failure on the part of the care providers. And sometimes nothing could have changed the outcome.
It doesn’t help to tell women this is “just one day” in their lives and “at least they have a healthy baby”. This dismisses how women feel and risks women getting “stuck” in their trauma. Remember, there is no one definition of trauma: it is whatever the woman says it is.
Women should feel they can talk about it and seek help if they need it.
Trauma-related mental illness
A small proportion of women who experience trauma in childbirth meet the diagnostic criteria for postnatal post-traumatic stress disorder (PPTSD).
PTSD causes persistent, involuntary and intrusive memories, distressing dreams and dissociative (out of body) reactions after a traumatic event. Postnatal PTSD causes intense or prolonged psychological distress after childbirth.
Researchers estimate postnatal PTSD affects between 1.7% and 9% of women who give birth.
Our recently published review of 53 research papers found women are more likely to be diagnosed with PPTSD if they have: a past history of trauma, sexual abuse or domestic violence; complications during the pregnancy, birth, or with the baby (such as the baby needing to be resuscitated); poor or abusive care; and lack of support.