Postpartum PTSD: Risk Factors & Symptoms

Postpartum PTSD: Risk Factors and Symptoms

I have become especially interested in the phenomenon of Postpartum Post-Traumatic Stress Disorder (PTSD) as of late. I live and work in a community where “natural” choices and Attachment Parenting are both respected and expected by many. Bradley Childbirth Education classes are common. Having a home birth or delivering with a midwife in the hospital are frequently chosen. Breastfeeding is often non-negotiable for new moms just beginning their journey, and non-medicated birth is the preferred option for a large number of women here.

While there is certainly a culture of success (meaning that many women do end up with the births that they had hoped for), there are also the very common realities that take many women off guard: the emergency C-Sections; the “cascade of interventions” during childbirth that may start with induction; the common breast-feeding challenges, the delivery by an OB that was not preferred; the reality of pain in childbirth; the loss of sense of control that can occur for many, many women, especially those who have a prior history of trauma or abuse; the premature baby or baby with medical issues that lands a family in the NICU; and infants lost during childbirth or shortly there after. These things can happen, no matter how “prepared” or with what intentions well-meaning moms and medical providers hold on to.

Often, I see these moms in my office weeks, moths, and sometimes years after experiencing a birth that was in someway “traumatic” for them. I put this word in quotes because we know by now that it is not the specifics of the birth events that can lead a mom to be traumatized, but her perception of these events. On paper, a birth might look “perfect” when, in reality, a mom may be walking away from her experience with some significant post-traumatic stress. Physicians, midwives, doulas, nurses, spouses, partners, and family members may assume that all is fine and dandy for a mom after she delivers a healthy newborn when, in reality, her perception is very, very different.

When looking at the probable “causes” of postpartum post-traumatic stress disorder, this is what we know may contribute to risk:

  • A perception of lack of caring: Moms feel abandoned by providers or partners during their pregnancy or childbirth experience; moms do not feel reassured or supported during childbirth.

  • Poor communication: Moms feel unheard during childbirth and feel that their perspectives around choices were not validated. Moms feel uninformed about choices being made to benefit herself and her baby during childbirth.

  • Feelings of powerlessness: Moms feel unprotected and under-supported by medical/birth staff. Moms feel that they had no control over birth process.

  • A re-triggering of old trauma histories or fears: Moms went into childbirth with intense fear and uncertainty that was not addressed.

  • Does a healthy baby justify a traumatic delivery? Moms feel that attention was on health and well-being of her baby while she went “unnoticed.”

The reality is that postpartum PTSD is not that uncommon. Statistics vary, but the one that I have seen the most is a whopping 9% of women who deliver a baby will go on to develop symptoms of post-traumatic stress after birth. A recent study published in Birth: Issues in Perinatal Care (38:3 September 2011)  broke these symptoms down into three categories.

  1. Intrusion symptoms: Repetitive re-experiencing of the birth trauma through flashbacks, nightmares, distressing recollections of the birth experience, and psychological distress following birth.
  2. Avoidance symptoms: Attempts to avoid reminders of the birth experience such as doctors offices as hospitals, people associated with birth experience (sometimes including the baby), thoughts about the birth experience.
  3. Increased arousal symptoms: Difficulty sleeping, heightened anxiety, irritability, and concentration challenges.

And there can be significant consequences for moms with postpartum PTSD if support isn’t put into place. Moms who suffer from PTSD are less likely to have subsequent births (and are more likely to have an epidural or a scheduled C-Section if/when they do); they are less likely to receive follow-up medical care; they are less likely to breast feed (due to pain, feelings of violation, low milk supply, self doubt and lack of confidence, and/or painful reminders of childbirth); they are more likely to have challenges bonding and attaching with their newborns (again, often due to triggering reminders of events); and they are more likely to experience conflict in their marriages/relationships and experience sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to also suffer from depression.

We know that risk factors such as antenatal depression, lacking social support, previous trauma histories, breast feeding challenges, and physical challenges following childbirth can heighten a woman’s reaction to trauma. But we also know that preventive measures such as well-established stress management strategies, “health promoting behavior” such as healthy sleep, nutrition, and exercise, and opportunities to debrief birth experiences can reduce a mom’s risk for PTSD. In other words, with effort, some of these postpartum PTSD stories can be lessened.

And, why is it important to know whether a mom has Postpartum PTSD? Because in many cases, women are treated for their depression (remember, most women with PTSD will also be depressed), and their PTSD is not addressed. If a mom isn’t asked the right questions and if she does not tell the whole story, she may be in treatment for a long time without the desired relief. A mom with Postpartum PTSD needs support in re-processing the experiences that led her there; in understanding why she developed the reaction that she did; in understanding the role of old and new beliefs that may have led her to her reaction to her birth or that have been created due to her experience in birth. These women benefit greatly from having an opportunity to re-frame and better understand their birth experience for what it was—to them. For many women, specific work around trauma is necessary.

It is a great honor to be given access to a mom’s story during birth, whether it was one that met her expectations or one that was upsetting and “traumatic.” These stories are a woman’s first experience with being a mom to a baby on the outside, and the ones that will often inform her earliest parts of motherhood. What was your birth story?

For support and information on Postpartum PTSD:

Postpartum PTSD & the Concept of Mental Defeat

Mom Recounts How Her Childbirth Trauma Led to Postpartum PTSD

Two Online Communities for Birth Trauma

Trauma and Birth Stress

Solace for Mothers

PTSD After Childbirth

Get the Facts: Post-Traumatic Stress Disorder


Kate Kripke, LCSW 

Tell Us What You Think

  1. Thank you thank you thank you. I'm sitting at work in tears because all of this is exactly what I KNEW I needed even when I didn't have a word for what I was experiencing. I just couldn't get the right people to listen to me … I think I may print this out, highlight the #@$% out of it, and send it to a few people.

    Thank you so much for providing me with some validation.

    • Wow, Kimberly. It sounds like you have endured a horrible experience. And it is very very understandable that each year you become anxious when remembering what you went through. Yours is a great example of how traumatic birth experiences can exist even when the birth itself goes "smoothly". Thank you so much for sharing…

  2. Thank you for this…I suffer from PTSD…while my birth experience was uneventful, it was what happened afterwards that was traumatic for me. I had a severe rash that covered my entire body. It was akin to a burn patient; my entire trunk oozed. It had baffled doctors. They didn't know if it was from the epidural, the anti-biotic, the medical tape…they had no idea.

    I was forced to stop breastfeeding at 2 weeks postpartum to start taking steriods.

    All this while my postpartum depression was already in full swing.

    When I get rashes, I immediately panic.

    The rash began in August and lasted to the late fall (I was on steroids for over a month)…so when this time of year comes, I immediately sink into panic mode.

    This has been going on for 3 years.

    It is hell.

    People don't realize how hard "re-living" your worst nightmare is. People think that you can just "get over it" and move on…Lord I would love to…but there is a switch in my brain that immediately gets flipped in the fall.

    Sigh…this was a novel. sorry.

    • Wow, Kimberly. It sounds like you have endured a horrible experience. And it is very very understandable that each year you become anxious when remembering what you went through. Yours is a great example of how traumatic birth experiences can exist even when the birth itself goes “smoothly”. Thank you so much for sharing…

  3. Thank you for this post. I think I qualify under most points (prepared for natural, vaginal birth but had to be induced and eventually had a C-section.) I can't drive by the hospital, I replay my pregnancy and labor and delivery over and over in my head trying to find anything that I could possibly do differently…..

    But I am getting help for my depression and we do talk about the birth from time to time, but this post still helps me feel justified in my feelings.

    Thank you.

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  5. Thank you for putting into words what so many of us can't say. Plus it feels good to be understood. I always felt like I was set up for PTSD by taking the Bradley Course and was that one student who had a c-section. Now I need even a longer course to 'correct' the birth I thought I was going to have.

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  7. I have been told that very rapid postpartum weight loss is often associated with birth trauma. Is this true? I experienced PPD as well as flashblacks to labor, and lost all my pregnancy weight plus 5lb by day 10 after birth, yet my OB didn’t consider it significant.

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  9. thank you so much for your post. After infertility I got pregnant and had a easy pregnancy followed by a traumatic birth (fetal distress, last minute delivery with vacuum and large tearing/episiotomy while waiting for the emergency csection team to arrive). Now After many months I feel ok again but the postpartum was horrible. I felt beaten up physically and very tired psychologically but very few people understood it. Moreover coming from infertility it was like expressing what I was going through was ‘being ungrateful’ or people would just dismiss with a ‘you wanted it, don’t be a wuss’. Thank you again for your post, now O am back on my feet again but it is so important to find that somebody can understand my feelings without judging and help other be more compassionate.

  10. I had an all natural c-section. Meaning no time to be numbed or be put out. My daughter survived is what matters. I on the other hand literally felt something in my brain snap.

  11. So nice to read this. In the netherlands they disregard everything. Making you feel like an idiot. My daughter was born butt first and after delivery ( that almost went wrong) I lost more than 3 liters blood. They forgot half my bloodtransfushion and send me home not even able to walk. Had problems with breastfeeding. Kept going and after 7 week finally succesfUll. I got good help after 6 months,those doctors saved me. My meds did wonders.It has been 4 Years but I am still suffering a little bit. I function and I am happy but something is Just not right I can feel it. I am thankfull for just being alive. Hope one day I will heal. Oh sorry for the typo’s… I’m dutch .

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  13. My birth story can be found on my blog:
    It is labelled “Adelaide,” My journey with postpartum PTSD is found under: “The Aftermath: Postpartum Survival”.

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  16. This is what I’ve been looking for. Thank you. I’ve been thinking I was alone on this. My emergency C-section and the near loss of our son hit me 6months after he was born. I have nightmares every night and every day-I relive almost losing him and it feels the fear is growing.

    I live near Annapolis. Is there anyone who can help in this area? I want to talk to someone and get through this.

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