Unseen Trauma: Recognizing and Understanding Childbirth-Related PTSD

What comes to mind when you think of events that can be the cause of post-traumatic stress disorder (PTSD)? Maybe you think of soldiers in combat, a terrorist attack, a terrible car accident, or a sexual assault. But have you also thought of birth as an event that can trigger PTSD?

Birth PTSD is different from other forms of PTSD in that, unlike other trauma-related events, birth is an index event that is socially generally viewed as positive. Childbirth is often celebrated as a joyful event, the beginning of a new chapter in life. But for many women, this event can also be a source of profound psychological trauma. Antepartum vulnerability factors for birth PTSD include belonging to an at-risk population (this variable is defined differently in studies), depression during pregnancy, fear of childbirth, poor health or complications during pregnancy, previous PTSD, and counseling during pregnancy. Risk factors at the time of birth include negative subjective experience of childbirth, operative delivery, lack of support, and dissociation (e.g., Ayers et al., 2016; Heyne et al., 2022). Childbirth-related PTSD can be a serious condition that affects both mothers and their families (e.g., Garthus-Niegel et al., 2018).

Research shows that approximately 30% of women who give birth describe the experience as traumatic (Ayers et al., 2009) and that up to 12% of mothers and 1% of fathers experience significant post-traumatic stress disorder (PTSD) symptoms after childbirth. Of these, 5% of mothers and 1% of fathers subsequently developed PTSD (Heyne et al., 2022).

Perception and lack of recognition of childbirth

Despite growing literature on the prevalence of childbirth posttraumatic stress disorder (PTSD) and its effects on mothers and families, there is a lack of research on perceptions of childbirth PTSD and whether people recognize those experiencing it as victims of this event.

In A study that was recently published in the Journal of Anxiety Disorders We took a first step toward filling this gap by testing how people perceive PTSD from childbirth compared to trauma caused by other index events (Kahalon & Handelzalts, 2024). We found that when we presented people with brief descriptions of a woman experiencing PTSD symptoms, the woman in the story was least likely A prevalence of PTSD has been found in women who suffer from the disorder when the traumatic event indicating birth is the result of childbirth, compared to descriptions of women who suffer from the same symptoms but as a result of other events indicating the trauma, such as sexual assault or a traffic accident. This lack of recognition was found both in the general public and among mental health professionals, who are less likely to diagnose PTSD when childbirth is the trigger.

Why does that matter?

Failure to properly recognize post-traumatic stress disorder (PTSD) from childbirth can have significant consequences. Without proper recognition, mothers may not receive the emotional or medical support they need. This lack of support can delay recovery, as recognition and social support are critical to healing from PTSD. Even mental health professionals can miss PTSD from childbirth, leading to misdiagnosis and inappropriate treatment.

Why is post-traumatic stress disorder (PTSD) in childbirth underrecognized?

We are currently working to understand the mechanisms underlying this lack of recognition. We believe that one of the main reasons why birth PTSD is under-recognized is due to the generally positive perception of childbirth. Society often views childbirth as a happy event, making it difficult to accept that it can also be traumatic. Furthermore, media representations of PTSD often focus on military or combat experiences, limiting awareness of other PTSD triggers, including childbirth. Another challenge is the overlap in symptoms between birth PTSD and other common postpartum experiences. For example, sleep disturbances and anxiety are common after childbirth, leading to potential misdiagnosis or dismissal of symptoms as normal postpartum problems.

What can we do?

Knowing that birth-related PTSD is under-recognized suggests that raising awareness about birth-related PTSD is essential. A high level of social support can have a significant impact on PTSD symptoms and recovery. Changing the way society views birth trauma can lead to better support systems and more effective treatment options. Educating both the public and healthcare providers about birth-related PTSD is crucial to improving recognition and support.

Join the conversation

• Have you or someone you know experienced trauma during childbirth? What was your experience with recognition and support?
• Do you think societal views on childbirth influence trauma recognition? How can we change this?
• What steps can be taken to improve awareness and support for PTSD in childbirth among healthcare providers and the public?

References:

• Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The etiology of posttraumatic stress after childbirth: A meta-analysis and theoretical framework. Psychological medicine, 461121-1134. doi:10.1017/S0033291715002706
• Ayers, S., Harris, R., Sawyer, A., Parfitt, Y., & Ford, E. (2009). Postpartum posttraumatic stress disorder: An analysis of symptom presentation and sampling.Journal of Affective Disorders, 119(1-3), 200-204.
• Garthus-Niegel, S., Horsch, A., Handtke, E., Von Soest, T., Ayers, S., Weidner, K., & Eberhard-Gran, M. (2018). The impact of postpartum posttraumatic stress and depressive symptoms on relationship satisfaction: A prospective population-based study.Frontiers in Psychology, 91728.‏ https://doi.org/10.3389/fpsyg.2018.01728
• Heyne, C.S., Kazmierczak, M., Souday, R., Horesh, D., Lambregtse-van den Berg, M., Weigl, T., … & Garthus-Niegel, S. (2022). Prevalence and risk factors for birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis.Journal of clinical psychology, 94102157.
• Kahalon, R., & Handelzalts, J. (2024). Research on the underrecognition of birth-related posttraumatic stress disorder among the public and mental health professionals.Journal of Anxiety Disorders102897.