For mothers facing nightmares, fear and guilt after a traumatic birth: the signs, how it differs from postnatal depression, family support and recovery.
"Your baby is healthy, what more do you want?" Many women who hear this sentence in the weeks after giving birth carry a burden inside that cannot be spoken about. Being rushed into an emergency caesarean, a birth that went on for hours in which control slipped away completely, those long seconds when the baby was not breathing, waiting at the door of the neonatal intensive care unit, or a harsh word heard during labour... These can leave a mark. A traumatic birth is when the mother experiences giving birth as life-threatening, frightening, helpless or degrading. Even if the baby is healthy, a deep upheaval can take place in the mother's mind. In this article I look at what a traumatic birth is, the signs through which it shows itself, why it is so hard to talk about and what can be done to heal.
What Is a Traumatic Birth?
Even if a birth went "successfully" from a medical point of view, it can be traumatic for the mother. What matters is not how the birth looks from outside, but how the woman experienced it. A routine intervention for a midwife or doctor may be the moment in which the mother feels "I am dying" or "My baby is dying."
Some examples of birth experiences that can be lived as traumatic are:
- An unplanned emergency caesarean or interventions decided on in haste
- A very long and exhausting labour, inadequate pain relief
- Life-threatening complications for the mother or the baby, heavy bleeding
- The baby being taken to neonatal intensive care immediately after birth
- Not being kept informed during the birth, interventions carried out without asking
- Being left alone, scolded or exposed to belittling remarks
- A previous pregnancy loss or difficult experiences being brought back to life by the birth
There is an important point here: trauma is often fed not only by physical danger but also by a sense of loss of control and loneliness. A mother who is not told what is happening to her and who feels she cannot make her voice heard may experience even a medically uncomplicated birth as traumatic.
Why are some mothers affected more intensely?
Of two women giving birth in the same hospital under similar conditions, one may recover quickly while the other is affected for months. This difference does not show that the mother lacks resilience. Some circumstances that can increase the impact are: previous traumatic experiences, an intense fear of childbirth lasting throughout pregnancy, previous pregnancy losses, not having someone she trusts beside her during the birth, a large gulf between expectations and what actually happened, and not receiving enough support after the birth. For example, a mother who spent months preparing for a vaginal birth and practising breathing exercises may experience not only fear but also deep disappointment and a sense of "I failed" when she is taken for an emergency caesarean at the last minute. Women who had to give birth in an earthquake zone or during a disaster, with limited resources, may also carry an additional burden in this respect.
Signs Seen After a Traumatic Birth
Experiencing intense emotions in the first days after giving birth is very common. However, some signs may last for weeks or even months:
- Reliving: Images and sounds from the birth coming into the mind against your will, nightmares about the birth, the body going on alert at a hospital smell or the sound of a monitor.
- Avoidance: Avoiding hearing the birth talked about, looking at birth photos or passing the hospital where the birth took place; putting off check-ups.
- Constant alertness: Checking many times a night whether the baby is breathing, startling easily, being unable to sleep.
- Negative emotions and thoughts: Guilt ("My body failed"), shame, anger, feeling like a failure as a mother.
- Difficulty bonding with the baby: Feeling distant when looking at the baby because it brings back the birth, which can in turn cause further guilt.
These signs do not on their own amount to a diagnosis. However, if they last longer than a month and noticeably affect everyday life, an assessment by a professional with regard to post-traumatic stress reactions after childbirth is important.
Are a traumatic birth and postnatal depression the same thing?
The two can occur together, but they are not the same. In postnatal depression the foreground is low mood, loss of interest, hopelessness and low energy. After a traumatic birth, the main burden is fear linked to the moment of birth, reliving and avoidance. In some mothers, a traumatic experience can over time also lay the ground for depressive symptoms. I explain the signs of postnatal depression and how to recognise it in detail in the article on postnatal depression.
Why Is It So Hard to Talk About?
In Turkey, birth is usually talked about only as a happy event. During the postnatal period the house fills with visitors, everyone wants to see the baby, gifts are brought and people say "Maşallah" (a blessing to ward off the evil eye). In the midst of this crowd, saying "The birth was terrifying" can feel almost impossible.
There are certain sentences that make it harder for mothers to share their traumatic experiences:
- "Everybody gives birth, are you the first?"
- "What matters is that the baby is healthy."
- "In our day there was none of this, we gave birth at home."
- "You'll forget; by the second one you won't even remember."
Even if these words are said with good intentions, they make what the mother went through invisible. A woman can be grateful for her baby's health and at the same time carry the pain of her own experience; the two feelings do not cancel each other out. However, these messages from those around her can lead the mother to interpret her own feelings as "ingratitude" and to fall silent.
In families where the mother-in-law or the woman's own mother stays in the home, and where the postnatal period is lived within a traditional framework such as the forty days of confinement, it can become even harder for the mother to make room for her own feelings. On the one hand, receiving help is good; on the other, being constantly observed and the pressure to be the "right kind of mother" can add to the burden.
Being glad that your baby is healthy and finding your birth hard can both be true at the same time; speaking about one is not denying the other.
Partners and Those Who Witnessed the Birth
A traumatic birth does not affect only the mother. A partner waiting in the delivery room or outside the door may have faced frightening questions in an emergency, such as "The mother or the baby?" Watching his wife bleed, the baby lie motionless or healthcare staff rushing about can also be traumatic for fathers.
It is socially even harder for men to talk about this experience. They may suppress their feelings with thoughts such as "I have to be strong" or "What she went through is the hard part." Yet suppressed fear can come back as irritability, escaping into work, avoiding time with the baby or sleeplessness. The couple being able to talk about this experience together supports the recovery of both.
Let us say a young couple welcome their baby by emergency caesarean after a long labour. The baby stays in neonatal intensive care for a few days. Once they are home, the mother wakes every night from nightmares, while the father changes the subject whenever the hospital is mentioned. Each stays silent to protect the other. One evening months later, when they finally find the courage to talk about the day of the birth, they realise they had been carrying the same fear in two separate rooms.
How Can You Support Yourself After a Traumatic Birth?
The suggestions below do not replace professional support; however, they can be first steps during this difficult period.
1. Take what you went through seriously
Finding your birth hard is neither a weakness nor ingratitude. Telling yourself "This was frightening for me, and I have the right to feel this way" is the beginning of healing.
2. Write your birth story
When you feel ready, try writing about the birth from your own point of view, in your own words. There may be gaps you do not remember; this is normal. Writing can help memories that sit in fragments fall into order. Stop when it becomes too hard; you do not have to finish it in one go.
3. Ask for information to fill the gaps
Not knowing exactly what happened during the birth can increase anxiety. Some mothers say that going through their birth records with their doctor and getting answers to questions such as "Why was an emergency caesarean performed?" was reassuring.
4. Limit visits
You do not have to host guests every day during the postnatal period. Your partner or someone close to you can help you manage when visits happen and how long they last. Nor do you have to retell your birth story to everyone who comes; saying "I don't want to talk about that for now" is enough.
5. Make sleep a priority
Lack of sleep makes trauma symptoms worse. If possible, sharing the night feeds and creating chances for short naps during the day is important.
6. Make peace with your body again
After giving birth, some women feel anger towards or estrangement from their bodies; they cannot look at their caesarean scar and avoid the mirror. Within the limits your doctor approves, small moments of care such as short walks, a warm shower or gently applying cream to your scar can help you build a safe relationship with your body again.
7. Talk to someone you trust
Sharing your birth experience with a friend, sibling or your partner who can listen without judging you can lighten your load. Talking to other mothers who have had a similar experience can also help you feel you are not alone.
Fear of the Next Pregnancy
Many women who have had a traumatic birth are intensely afraid of a new pregnancy. Some put off this decision for years even if they want a second child, while others are gripped by intense anxiety when they find out they are pregnant. Working with the traumatic traces of the previous birth can make it possible to enter the next pregnancy feeling more prepared and safer. I discuss fears about childbirth during pregnancy and how to cope with them in the article on fear of childbirth.
For the next birth, talking openly with your doctor about your previous experience, reviewing your birth plan together and deciding who will be with you during the birth can strengthen your sense of control.
When Should You Seek Professional Support?
It is important to get support from a professional in the following situations:
- Nightmares, intrusive memories or intense fear relating to the birth have lasted more than a month
- You are finding it hard to bond with your baby and this upsets you a great deal
- You are constantly crying or feel hopeless or worthless
- Thoughts of harming your baby or yourself come into your mind
- You are noticeably avoiding check-ups or going to the hospital
If thoughts of harming yourself or your baby arise, this is an emergency; please call 112 (emergency services) without waiting and let someone close to you know. Whether medication is needed while breastfeeding, and which options are suitable, can only be determined through an assessment by a psychiatrist.
How Is a Traumatic Birth Addressed in Therapy?
The first step in therapy is to create a safe setting in which the mother's experience is listened to without judgement. Many women feel considerable relief when, for the first time, they are able to tell the story of their birth from beginning to end, without interruption and without being met with "But the baby is healthy."
In trauma work based on cognitive behavioural therapy, thoughts that develop after the birth, such as "My body let me down", "I am not a good mother" or "Next time I will die", are examined. The memory of the birth is revisited within a safe framework and at the mother's own pace, with the aim of reorganising it in the mind as an event that belongs to the past. Situations that are being avoided, such as going to the hospital, are gradually faced again.
Part of the work also concerns expectations about motherhood. When rules such as "A good mother bonds immediately after birth" or "A real mother can bear anything" are noticed and loosened, guilt can ease considerably. Where appropriate, the partner may also join one or more sessions; in this way the couple can understand how each of them lived the same day from a different angle and find ways of supporting each other together.
Because leaving the house, leaving the baby or arranging transport can be difficult during the postnatal period, online sessions are a more practical option for some mothers. If you would like information about this, you can take a look at the online therapy page.
Frequently Asked Questions
My birth was medically normal, so why have I been affected so much?
What defines trauma is not how the birth looks in the medical records, but how you experienced it. Intense fear, helplessness or a feeling of being left alone can make even a birth considered normal traumatic. So there is no need to belittle your reaction.
Does a traumatic birth affect breastfeeding?
Some mothers may struggle because the memory of the birth comes back during breastfeeding or because physical contact stirs up intense emotions. This does not happen to every mother. If you are struggling, talking about it with both a breastfeeding counsellor and a mental health professional can help.
Years have passed since the birth — is it too late to get support now?
No. Some women only notice the effect of a traumatic birth years later, during a subsequent pregnancy or at a friend's birth. There is no time limit for working with this experience.
Since the birth, my partner changes the subject whenever the hospital comes up. What should I do?
It is possible that your partner also experienced the birth as frightening. Without pressuring him, you can open the door with a question such as "I was really scared that day — what did you feel?" If you find it hard to talk about it together, seeing a professional can make room for both of you.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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