is Birth Trauma?
When a woman looks
forward to giving birth to a baby, she may not know exactly how the
birth will go, but she has a basic expectation of respectful and protective
treatment from her partner and from maternity care providers. This
expectation includes the right to understand and to participate in
health care decisions, and a confidence in her own and her infants’
safety. When these things are not present, the results can be severe.
Cheryl Beck, who researches the subject of birth trauma, observed:
with post-traumatic stress disorder attributable to childbirth struggle
to survive each day while battling terrifying nightmares and flashbacks
of the birth, anger, anxiety, depression, and painful isolation
from the world of motherhood…”
In another study,
women in this study, their self-defined traumatic birth was experienced
as violent and abusive. Some described their experiences as torture,
resulting in a profound sense of being disassociated from the childbirth
experience, and alienated from societal regard”
In our culture,
when a baby is born, a woman is expected to be grateful and joyful.
However, when a woman has a birth experience that leaves her feeling
traumatized, she is not only unhappy, but can experience severe emotions.
Stress Disorder (PTSD) was once estimated to only affect 1.5% to 6%
of women. Many researchers and clinicians now feel that the number
of women experiencing trauma following childbirth may actually be
of trauma following childbirth may be higher than previously predicted
because of the way PTSD is diagnosed by mental health providers. Trauma
is generally recognized and diagnosed when all
9 of the criteria for PTSD, as described in the Diagnostic and
Statistical Manual of Mental Disorders IV-TR (American Psychological
Association 2000), are observed.
Further, if a
mother who has experienced birth trauma is good at “avoiding”,
the hypervigilence and perhaps the intrusive symptoms may be kept
at levels that are not detectable by a clinician. Mothers with postpartum
trauma may minimize discussions about their experiences with health
care providers and even avoid health care providers themselves, particularly
those associated with the birth. For so many reasons, a woman suffering
from traumatic stress is often left unheard and untreated by professionals.
Some women may
not fit the DSM criteria for PTSD. However, research that is centered
on the woman’s definition and experience of trauma suggests
that debilitating traumatic stress following childbirth is extremely
common. Some studies suggest that over 30% of women have experienced
multiple symptoms of trauma. Also, research has shown that women who
have a “normal” vaginal delivery also can experience PTSD
or traumatic symptoms.
Trauma is not
currently included in the standard screening for mood disturbances
after the birth of a new baby. Frequently, very competent providers
staying within the current standards of care, will misdiagnose any
disorder as “Postpartum Depression” (PPD) since that is
what their screening questionnaires diagnose. The likelihood is high,
therefore, that some women currently diagnosed with postpartum depression
may actually be exhibiting a traumatic response to their childbearing
When should a
woman suspect that she is suffering from a trauma-based anxiety disorder
and not postpartum depression? Click here
to read through information that will help you identify whether you
may be suffering from PTSD or traumatic stress.
Association (2000). Diagnostic and Statistical Manual of Mental
Disorders IV- Text Revision. Washington, D.C.: American Psychiatric
Beck, C. (2004a).
Birth trauma: In the eye of the beholder. Nursing Research 53(1):
Beck, C. (2004b). Post-traumatic stress due to childbirth. Nursing
Research 53(4): 216-224.
Briere, J., Elliot,
D. (1994). Treating adult survivors of severe childhood abuse and
neglect: Further development of an integrative model. In The APSAC
handbook on child maltreatment (2nd ed.)(2002). Newbury
Park, CA: Sage Publications.
Creedy, D., Sochet,
I., Horsfall, J. (2000). Childbirth and the development of acute trauma
symptoms: Incidence and contributing factors. Birth 27(2):
Jukelevics, N. Understanding the Dangers of Cesarean Birth: Making
Informed Decisions. Westport, CT: Praeger Publishing.
C., Flick, L., Homan, S., et al (2004). Post-traumatic stress disorder
in pregnancy: Prevalence, risk factors, and treatment. Obstetrics
Gynaecology 103(4): 710-717.
Margola, D., Filippi, F. (2006). PTSD, risk factors, and expectations
among women having a baby: A two-wave longitudinal study. J Psychosomatic
Obstetrics and Gynaecology, 27(2): 81-90.
DeRoma, V., Saylor, C. (2004). The relationship between gender and
trauma symptoms: A proposed mediational model. Individual Djfferences
Research, 2(3): 203-213.
Thomson, G., Downe,
S. (2008). Widening the trauma discourse: the link between childbirth
and experiences of abuse. Journal of Psychosomatic Obstetrics
& Gynaecology, Vol. 29 (4): 268-273.
Wijma, K., Soderquist,
J., Wijma B. (1997). Post-traumatic stress disorder after childbirth:
a cross-sectional study. Journal of Anxiety Disorders, 11(6):