Trigger warning – description of traumatic birth experience to follow

Hannah is a 30 yo woman who went into labor with her first child at 39 weeks. She had an uneventful pregnancy but was anxious about what her birthing experience would be like. After 4 hours of labor, something wasn’t right. All of a sudden the doctors and nurses started yelling and looked really worried; the next thing Hannah knew, she was in the operating room getting prepped for an emergency C-section. She had no idea what was going on and felt like no one was answering her questions. The last thing she remembers is wondering whether she and the baby were about to die. When Hannah woke up from anesthesia she learned that her baby was in the NICU. Her doctor came to see her and said “you two scared us for a minute there, but everything is fine now!” He told her that they had to do an emergency C-section because the baby’s heart rate was dropping, then left to see other patients. She didn’t have a chance to ask him more questions. Three weeks later, she is having trouble sleeping and feels disconnected from the baby. She doesn’t like talking about her delivery and hates when people mention the hospital in conversation. She’s worried all the time and feels like there must be something wrong with her. At her first postpartum appointment, she tells her doctor what she has been experiencing. He replies, “Yes, it was a difficult birth but you’re both fine now. It’s time to move past it.”

What is a “traumatic birth”?

It’s very common to hear pregnant people talking about their “birth plans” – what they want to happen when they go into labor. Most people think about music, family members, and whether or not they want an epidural. Some people want a vaginal delivery and others would prefer a planned C-section. However, the one thing everyone has in common is that they want a safe experience, where both parent and baby come through safe and sound. 

However, “safe and sound” can mean different things to the doctor and the patient. In Hannah’s case, she thought she was going to die and worried that the baby would die too. She was terrified by the yelling and the fast pace, and didn’t feel like anyone was telling her what was going on as it happened. Her doctor agreed that it had been a high stress situation, but since Hannah and the baby were both fine physically, he considered it a successful delivery. That situation made it hard for Hannah to tell her doctor how much trouble she is having now.

Could I have posttraumatic stress disorder (PTSD)?

PTSD is an anxiety disorder caused by exposure to a traumatic event. Some of the common symptoms of PTSD are:

• Frequent and distressing memories, nightmares, and/or flashbacks of the traumatic event
• Avoiding people, places, and situations that remind you of the traumatic event
• Trouble remembering the traumatic event
• Feeling detached from others and/or having no interest in regular activities
• Irritable, impulsive, and/or self-destructive behavior
• Trouble with concentration and/or sleep

If these symptoms are bad enough that they affect your ability to work, go to school, or keep up relationships with friends and/or family, you might have PTSD. 

How common is postpartum PTSD?

Experts think that between 4-20% of all deliveries may meet criteria for postpartum PTSD. People who report a negative birth experience are most likely to develop postpartum PTSD. Other factors that might be related to postpartum PTSD include: 

• Perinatal depression
• Pre-existing PTSD
• Fear of childbirth
• Unplanned c-section or use of tools during vaginal delivery

Prevention and Treatment

While there is no way to know for sure who will develop postpartum PTSD, you can talk to your doctor about some things that might decrease your chances of a traumatic birth experience:

• Share any fears or concerns you have before your due date
• Have them explain the difference between vaginal and c-section deliveries and what you can expect with each option
• Tell them that you and/or your support person would like all medical decisions explained to you in real time
• See if they have any good therapists they can recommend so you have someone to talk to after the baby comes

If you do happen to develop postpartum PTSD, there are support groups, therapists, and reproductive psychiatrists who can help!