Birth trauma and PTSD: symptoms, treatment and support

Birth trauma is an everyday phrase for distress that follows a frightening or distressing childbirth. When symptoms become persistent and disabling they may meet the criteria for post-traumatic stress disorder (PTSD). The NHS describes PTSD as a mental health condition caused by very stressful, frightening or distressing events, which medicines and therapy can help manage.

The NHS includes a difficult birth, or your baby dying, in its list of causes. NICE guidance on PTSD says clinicians should be aware that childbirth-related events such as intensive care admission or neonatal death can be associated with PTSD. The NHS adds that you may have experienced the traumatic event yourself, seen it happen to someone else, or heard about it happening to someone close, which means partners and others present at a birth can also be affected.

The main symptom, according to the NHS, is repeated distressing thoughts about the traumatic event, experienced as flashbacks, vivid or intrusive images or thoughts, and recurring dreams or nightmares. Other symptoms of PTSD in adults can include:

• Avoiding people or places that remind you of the event.

• Not being able to fully remember the traumatic event.

• Negative thoughts or beliefs about yourself, and not doing things you used to enjoy.

• Problems with relationships, and feeling disconnected from yourself and the world around you.

• Difficulty controlling feelings, or not experiencing emotions at all.

• Being more irritable or angry than usual, low mood, and difficulty sleeping.

• Feeling very anxious and looking for danger all the time (hypervigilance).

• Repeated headaches, tummy problems or pain with no physical cause.

The NHS describes postnatal depression as a common condition that can start during pregnancy, soon after birth, or up to a year after the baby is born. Its symptoms include low mood, finding it hard to enjoy anything, feeling hopeless or unable to cope, guilt, being a bad parent, anxiety, difficulty bonding with the baby and thoughts of suicide or harming yourself or your baby. It says feeling down for a few days after birth is common, known as the baby blues, and usually goes away within 2 weeks.

PTSD and depression can occur together, and they are treated differently, so an assessment is worthwhile. The NHS describes re-experiencing of the event, such as flashbacks and nightmares, as the main symptom of PTSD. If you think you may have postnatal depression, the NHS advises speaking to a GP, midwife or health visitor, and says it is important to get help even if you only have some of the signs.

The NHS says to see a GP if you think you have symptoms of PTSD, or if you have been diagnosed and treatments are not helping. If you are 18 or over (or 16 or over in some areas) you can refer yourself directly to an NHS talking therapies service without a GP referral. A GP will ask about symptoms and refer you to a mental health specialist, such as a talking therapies service or a psychiatrist, who will ask about mood, behaviour, health and family history.

If you are in crisis or in danger, the NHS says to seek urgent help for mental health, and to call 999 or go to A&E if you cannot keep yourself or someone else safe. The NHS notes that in the perinatal period, which runs from pregnancy to 12 months after birth, support may come from a GP, a talking therapies service or a specialist community perinatal mental health team.

The NHS says PTSD usually gets better for most people, but symptoms can be more severe and last longer for some, and that a GP and mental health specialist will create a treatment plan. Treatments include trauma therapy such as trauma-focused CBT, eye-movement desensitisation and reprocessing (EMDR), and medicines, usually an antidepressant. NICE guidance for adults says to offer individual trauma-focused CBT to people who present more than a month after a traumatic event, and EMDR to adults who present more than 3 months after a non-combat-related trauma.

The NHS says not to stop PTSD medicine unless a doctor tells you to, even if you feel better, and that some medicines are not safe in pregnancy. On postnatal depression it says many antidepressants are safe to use while breastfeeding and that you should tell your doctor if you are breastfeeding so a suitable medicine can be chosen. The NHS also says that you may be scared your baby will be taken away if you ask for help, but this is very rare, and your care team will support you to care for your baby.

The sources used here do not set out advice on planning another pregnancy or birth after trauma. If you are considering one, discuss it with your midwife or GP.

The NHS suggests talking to someone about how you feel, such as a friend or family member or through an online support group, and keeping a diary to spot triggers for flashbacks. A mental health professional can help you learn and practise skills to manage symptoms such as flashbacks. For postnatal depression the NHS suggests asking for practical help with shopping, chores and childcare, regular exercise even if only a short walk, local support or parent groups, as much rest and sleep as possible, and avoiding alcohol or drugs to cope.

NHS talking therapies and perinatal mental health teams provide trauma-focused treatment, and waiting times vary by area. Private psychologists and psychiatrists can offer quicker assessment. Check that the therapist is trained in trauma-focused CBT or EMDR, how many sessions are planned, and how a private provider will liaise with your GP, particularly if medicine is also being considered.