What is Birth Trauma?

For some women, childbirth can be a traumatic event often associated with birth complications or a near miss for maternal mortality.¹ A traumatic birth involves a perceived or life-threatening series of events that result in severe injury or death of the infant or mother. This traumatic experience increases the risk of developing posttraumatic stress disorder (PTSD) after birth and can lead to challenges with attachment between the birthing parent and their infant.^1,2,3

Studies indicate birth-related PTSD impacts around 17% of postpartum parents.⁴ Many others may experience posttraumatic stress (PTS) symptoms after birth but not meet the clinical criteria for PTSD.

Symptoms of birth-related PTSD may include:

• Intrusive involuntary thoughts and memories.
• Avoidance of trauma reminders.
• Changes in arousal and reactivity.
• Difficulty sleeping.⁵

Who is most affected?

The United States remains a persistent outlier compared to other countries in the developed world, with some of the poorest maternal and infant health outcomes. The country is facing a maternal health crisis that Black women are disproportionately impacted, experiencing high rates of birth trauma and obstetric injury and a higher risk of developing postpartum depression, bipolar disorder and anxiety disorders than other women. They are, unfortunately, also more likely to be underdiagnosed than for birth-related mental health conditions than white women and face more systemic and social barriers to accessing maternal mental health care. So, they are at an increased risk of living with undiagnosed and untreated postpartum mental illness and birth-related PTSD.^1,5,6

"At 28 weeks, I had my twins via emergency cesarean delivery. Although this was a necessary medical intervention, nonetheless, the process, watching my sons fight to survive, and the overwhelming array of emotions that came in the aftermath left an indelible mark which was later identified as trauma," Joi, 31 an African American mother who shared her birth story with APA

How can providers better support postpartum patients with birth-related PTSD? Frontline providers should be informed about the impact of birth trauma and PTSD after birth, screen frequently, and have the appropriate treatment and referral resources available. Jennie Joseph, LM, CPM, founder and president of Commonsense Childbirth Inc., notes that many frontline providers lack appropriate maternal mental health referral resources — which is profoundly compounded by the current shortage of mental health providers.

Dr. Layne Gritti, a reproductive psychiatrist in the Greater Cleveland area, reminds us that listening is critical in addressing this issue. The Centers for Disease Control and Prevention (CDC) is working to drive this message home through its Hear Her Campaign, which urges healthcare professionals to really listen to their postpartum patients and facilitate open conversations about their unique needs and concerns. Gritti adds that taking five extra minutes to listen to the patient goes a long way to improve the doctor-patient relationship, which can add to the healing process.

The Hear Her Campaign also has resources for pregnant and post-partum women, including tips on how to talk to your healthcare professional.

Resources

For persons considering pregnancy, currently pregnant, or postpartum

• APA Maternal Mental Health Toolkit
• Postpartum Support International
• Prevention and Treatment of Traumatic Childbirth (PATTCh): resources
• Preeclampsia Foundation: birth trauma resources
• National Maternal Mental Health Hotline: call or text 1-833-943-5746 (1-833-9-HELP4MOMS)
• Centers for Disease Control and Prevention resources for pregnant and postpartum women

For clinicians

• APA Webinar Series: Maternal Mental Health. First webinar will be held May 31, 2023, from 7:00 pm- 8:00 pm EST. Pre-register for each session here.
• APA Maternal Mental Health Toolkit
• National Curriculum in Reproductive Psychiatry

By Madonna D. Delfish, M.P.H