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Understanding Post Traumatic Stress Disorder after birth 

https://kingstonhospital.nhs.uk/information/understanding-post-traumatic-stress-disorder-after-birth

At least 25 out of every 100 women report their birth as traumatic. And 4 in 100 get Post Traumatic Stress Disorder (PTSD) as a result. For these women, some aspect of their experience meant they felt extremely fearful, helpless or out of control.

Every person reacts to trauma in their own way

stressed woman

What feels traumatic to one person may not feel that way to another. It is certainly not for others to judge what was or was not traumatic for you. What matters most is your individual experiences and what they meant to you personally. A traumatic birth is an emotional shock. It can shake your sense of safety, your confidence as a parent, and your trust in others.

It is completely normal to experience all kinds of thoughts, feelings and sensations afterwards. This can feel confusing and scary. But they do not mean that you are going mad or losing control, or that you are a bad parent. You are simply doing your best to manage the impact of a very tough experience.  

Understandably, it can feel hard to make sense of what has happened and of how you are feeling. The pressure of caring for a new baby makes it even harder. You might also be short of sleep, working out feeding your baby, and adjusting to being a new parent. All of this can naturally make the processing of traumatic experiences more difficult.  

Remember: it is your individual birth experience that matters.

Here we describe: 

People often find that thinking or reading about trauma can remind them of their own traumatic experiences. So, it may be helpful to read this at a pace that feels manageable to you or with the support of someone else. 

Common reactions after trauma 

Re-experiencing the memory of what happened 

After a trauma it is common to re-experience what happened as if it is happening all over again. This is because trauma memories are not put together like other memories. They have not yet had a chance to be properly put in the past. They are still ‘raw’ and unprocessed and easily triggered. 

Vivid images of what happened might replay like a video in your mind (also known as flashback). Or you might re-experience what happened in nightmares

Re-experiencing the memory in this way is usually triggered by something that reminds you of the trauma. That can be something obvious, for example, looking at or holding your baby, or visiting the hospital where you gave birth. Or it may be something more subtle, such as a certain smell, colour, tone of voice or body position. This can mean you suddenly experience strong emotions or bodily sensations without warning. This can feel particularly confusing and frightening. 

If the triggers involve your baby this can feel particularly hard. This can make it difficult to get to know them or bond with them in the way you hoped. 

Dissociation 

Dissociation is your brain’s way of distancing yourself from the stress of what happened. It avoids you getting overwhelmed.  

Sometimes this happens automatically when you are reminded of what happened. Or sometimes it might be a way you have learnt to feel safe. It may also have been a way of coping during the birth itself. 

You might think of it as ‘switching off’ or ‘zoning out’. It can range from: 

  • mild daydreaming 
  • feeling like you are on ‘auto pilot’ 
  • out-of-body experiences  
  • going completely blank and losing touch with where you are.  

Naturally, these experiences can feel frightening. However, it is important to remember this is a normal reaction to extreme stress. It is not a sign of ‘losing it’ or going mad. 

Physical stimulation 

After birth trauma, you may feel overly alert, jumpy and easily startled. Your body is still responding as if it is in danger, being prepared for instant action. This can make it hard to relax and just be with your baby

You may also find that you are overly anxious and protective of your baby. Sometimes people speak about being on ‘high alert’ and needing to check their baby is safe repeatedly, or being on the lookout for danger at every turn. Again, this is because you are doing your best to stay safe. But it can mean you find it difficult to sleep, feel very tense or irritable

Difficulty concentrating 

It is common to have difficulty concentrating, paying attention or remembering things, even if they seem simple. This can be particularly frustrating and upsetting if you are trying your best to take care of your new baby or keep up with your usual responsibilities. 

Strong emotions 

Experiencing strong emotions is common for many people after trauma. All of these are understandable. 

You may feel very scared. Your experience may have left you feeling unsafe, and that life is full of unexpected risks. This can be made worse by your responsibilities as a parent and needing to keep your baby safe. 

You may feel low or depressed. You may feel immense sadness about what has happened and what you have missed out on, for example, not giving birth or meeting your baby the way you hoped. 

It is common to feel shame and guilt. You may feel that your body failed, or that there were ways you should have acted differently. 

Feeling snappy, irritable and/or angry is also a natural response. Your experience has been unfair. You may feel angry with health professionals, your partner or your baby. You may dwell on what has happened which can make it hard to put behind you.  

Your emotions may feel ‘dampened’ and hard to experience. Or you might feel numb. 

Shattered confidence 

Before the trauma, you may have had a generally positive view of yourself, other people and the world. Trauma and your experiences afterwards can shatter this positive outlook. It may leave you feeling changed completely. 

You might find yourself questioning your ability to be a good mother because of your birth experience. It might be more difficult to trust others or look forward to the future. 

Feeling cut off

All these new emotions and behaviours can make it hard for you to enjoy the present moment or feel close to your baby and the people around you. You may have the urge to withdraw from those close to you and your baby. This can leave you feeling alone and isolated. 

Bonding with your baby can be difficult after a traumatic birth. This is because it can be hard to separate your feelings for your baby from your terrifying experience. They may be a painful reminder of what happened or they may not feel like your baby. 

Remember: these are all normal reactions to a very difficult experience.
They are simply a sign you have not yet been able to come to terms with what happened to you. They do not mean that you are a bad parent, going crazy or losing your mind. But they can make everything much harder. 

Ways you may have found to cope 

Trying to cope with the effects of trauma is extremely hard. You are likely to have adopted different strategies to manage how you are feeling. All of these are understandable ways of coping. They do not say anything about you as a person other than you are trying your very best in very difficult circumstances. Whilst these strategies may help get by in the short term, in the longer term they can stand in the way of feeling better.

Avoiding trauma memories 

It makes sense that you would want to try to avoid or distract yourself from upsetting memories, thoughts and emotions linked to the trauma. However, the harder we try to block it all out, the more persistent they become. 

Avoiding memory triggers 

Specific people, places or activities may remind you of what happened or trigger your trauma memories. If so, you are likely to avoid them. This can feel particularly difficult if your baby is a strong reminder, or if avoiding people makes you feel isolated. Avoidance may reduce distress in the short term. But in the longer term it can reduce your confidence as a parent and of managing day to day. It can also make it hard to bond with your baby. 

Extra vigilance and precautions 

You may find yourself scanning for danger, being extra vigilant or taking more precautions than usual. This is completely understandable but it keeps your sense of threat alive, rather than making you feel safe. It can also make it hard to get on and live life the way you want to. 

Dwelling on what has happened and self-criticism 

After trauma, many people dwell on thoughts and questions for a long time. It is natural to want to make sense of what has happened. When your thoughts go round and round in circles with lots of “what if” or “if only” type thoughts, it is called rumination. It can create strong emotions like anger, sadness and guilt. It can also make it harder to come to terms with what has happened. 

Critically comparing your experience to others is common. But it can make you feel worse and fuel feelings of failure. 

What help is available 

Talk to your midwife, health visitor, GP or mental health team to discuss how you can be referred for any of the following help. 

Go to your local Emergency Department (A&E) or dial 999 if you need urgent help with how you are feeling.

Talking therapy 

Talking therapies help you address difficult thoughts and feelings.  

These therapies have been proved to help people with PTSD: 

  • trauma focused Cognitive Behaviour Therapy (tfCBT)
  • Eye Movement Desensitisation Therapy (EMDR).    

These can help you make sense of what happened, put the memories into the past and get on with enjoying life with your baby. These can be accessed via your GP. If you are pregnant or have a young baby you should be prioritised for treatment. 

Medicines 

Medication is not the first option for treating PTSD. But for some people it can be helpful alongside other support, especially if their mood is also very low.  

Speak to your GP if you would like to understand more about the medication options which might help. 

Reviewing your birth 

Most hospitals offer a service to talk through your birth experience. This is sometimes called a ‘Birth Reflections’ or ‘Birth Afterthoughts’ service.  

This can be helpful if you want to better understand what happened and why certain decisions were made. You will also be able to ask questions you may have about future deliveries.  

Contact your maternity unit or ask your health visitor or midwife about what is available locally. 

Peer support 

Connecting with other people who have had a similar experience has also been shown to be very helpful. Here are some organisations dedicated to supporting people after a traumatic birth. 


Birth Trauma Association
www.birthtraumaassociation.org.uk 

Make Birth Better
www.makebirthbetter.org 


Many thanks to Dr Cathy Green and Dr Ellen Craig for allowing us to use the content from their patient leaflet: 

Green C, Craig E. Understanding Post Traumatic Stress Disorder after Birth. Information Leaflet, 2022.

Understanding Post Traumatic Stress Disorder after birth  - Kingston Hospi Download PDF


Contacts

Bridge Team (pregnancy mental health midwife team) 020 8934 2939/3988
Birth reflection appointment with senior midwife (PMA) 020 8934 6434
Contact your GP for advice and referral

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