Mom with baby

You may have heard the term “birth trauma” in relation to injuries to a baby that can occur during labor and delivery. But did you know that new mothers also can experience birth trauma?

According to Prevention and Treatment of Traumatic Childbirth, as many as one-third of new moms report having had a traumatic birth experience. Yet, according to the National Healthcare Quality Report, injuries to newborns — bone fractures, cuts, bruises, bleeding, and more serious issues — occur in only about six to eight of every 1,000 births in the United States.

Defining Birth Trauma for New Mothers

“Birth trauma can occur when women feel a serious threat to their safety and there is a discrepancy between what they envision for the birth of their baby and what they experience,” says Sara Sakamoto, MD, an obstetrician and maternal fetal medicine specialist at UPMC Magee-Womens Hospital. “Unexpected complications and interventions at a time when a woman is most vulnerable can leave a lasting impression that is traumatic to a new mother.”

Birth trauma for mothers can be caused by a variety of events including:

  • Unplanned or emergency C-section
  • Significant blood loss or hemorrhaging
  • Forceps delivery
  • Breech birth
  • Premature labor/delivery
  • Preeclampsia or eclampsia
  • The baby being injured or needing to go to the neonatal intensive care unit (NICU)
  • Pregnancy loss
    Other complications for the baby or mother

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The Mom’s Perceptions Are Key

Cheryl Tatano Beck, a leading expert on birth trauma, describes traumatic childbirth as being “in the eyes of the beholder” — meaning the mom is the one who perceives that the birth was traumatic. Whether or not the lives of the mother or baby truly were at risk, the perception of risk is enough to create birth trauma in the mind of the mother.

Typically, birth trauma occurs more frequently when the mother perceives three things:

  • Things happened suddenly. “For example, labor is progressing normally and then a concern about the mother or baby’s status emerges quickly,” says Dr. Sakamoto. “Or perhaps a serious complication causes a change in the birth plan, without time for caregivers to thoroughly explain what was happening.”
  • The mother felt overwhelmed. “Mothers sometimes feel they were disconnected from what was happening during the birth, due to severe illness or medicines such as general anesthesia,” says Dr. Sakamoto. “Or mothers may feel helpless, out of control, unsupported, or alone.”
  • The situation felt dangerous. “Usually, it involves an event that the mother believes caused her life or her baby’s to be in danger,” says Dr. Sakamoto. “It could have been from a medical emergency or complication, whether real or perceived.”

For some moms, a traumatic birth experience does not leave any lasting scars on their psyche. But for others, it can feed into postpartum depression (PPD) and postpartum post-traumatic stress disorder (PTSD).

Symptoms of PPD and PTSD

Women who have had signs of depression prior to pregnancy and delivery are more prone to developing PPD. But even for those women with no history of depression, a traumatic birth event can trigger PPD. Symptoms of PPD include feeling:

  • Hopeless
  • Sad
  • Anxious
  • Disengaged from the baby
  • Disinterested in self-care
  • That something is “off”

As many as 15 percent of new moms report experiencing PPD or related mood disorders — but many more cases go unreported.

Current research shows that up to 9 percent of new moms develop the more severe postpartum PTSD from their birth trauma, but rates of undiagnosed PTSD may be as high as 18 percent. PTSD symptoms include:

  • Intrusive recollections — nightmares, flashbacks, intense psychological or physiological reactions when reminded of the event.
  • Avoidance/numbing reactions — avoiding thoughts/feelings, locations, or people associated with the trauma; experiencing amnesia about some events; detachment from others; inability to feel loving feelings.
  • Hyperstimulation — difficulty sleeping or relaxing; experiencing irritability or having angry outbursts; trouble concentrating; exaggerated startle response; panic attacks.
  • Functional impairment — distress in social or work situations.

“Both PPD and PTSD can be debilitating for new mothers, so it’s important to recognize the symptoms,” says Priya Gopalan, MD, chief of psychiatry at UPMC Magee. “Both conditions respond well to treatment, so new moms should mention these experiences and feelings to their obstetrician (OB) or primary care doctor during postpartum checkups or physical exams.”

Outreach to Diagnose Is Important

To provide early identification of new mothers who may have experienced a birth trauma leading to PPD or PTSD, Magee Behavioral Health now screens women with a history of depression while they are still in the hospital after giving birth.

For mothers with no prior history, OBs and pediatricians are now assessing moms at their first postpartum follow-up visit and their infant’s first well-baby checkup using a seven-question risk scoring tool. The questions cover birth trauma, domestic violence, drug use, and depression. If they answer “yes” to any of those questions, seven more are asked. “These assessments should be done at regular intervals by OBs, pediatricians, and primary care doctors for the first six months at least, as per national guidelines,” adds Dr. Gopalan.

When a baby has been in the NICU at UPMC Magee a week or more, it can be a traumatic experience for the new mom. Trained social workers visit those mothers to ask if they can screen them for signs of birth trauma, PPD, and PTSD. Moms who show signs of PPD or PTSD are referred for therapy.

Resources Available at Magee

New moms who are identified as having or being at risk for PPD or PTSD are referred to one of Magee Behavioral Health Service’s outpatient treatment programs. For moms with more significant symptoms, UPMC Magee offers intensive outpatient therapy for three hours a day, three times a week, in the Wexford Womancare office.

For moms with more manageable symptoms, UPMC Magee has added outpatient therapy programs to its Womancare offices in Wexford and Bethel Park. But Dr. Gopalan emphasizes that location should not be a barrier to seeking care. “One benefit of being part of a large health system is that we can provide postpartum behavioral health care for women where they live because we have therapists in every community,” she says. “Help is available close to home for any woman who needs it — and we’re only a phone call away.”

If you think a traumatic birth experience has contributed to PPD or PTSD in yourself or a loved one, contact Magee Behavioral Health Services at 412-641-1238.