Birth Trauma: What Are We Missing?

Unresolved birth trauma can lead to clients presenting with depression, anxiety and attachment issues – years, and even generations, after the event. As we mark Maternal Mental Health Awareness Week and World Maternal Mental Health Day, Kate Foster, a psychotherapist and former manager of an NHS perinatal counselling service, explains why therapists shouldn’t confine our curiosity about birth experiences to the perinatal period.

[main copy] Birth trauma has tended to stay in the shadows, leading to a lack of effective treatment. But a growing body of evidence clearly shows its prevalence, and that it has a devastating impact on parents and families. Reported statistics indicate that perinatal PTSD affects three to four per cent of all women after birth, 15 to 19 per cent of women in high-risk situations and up to 39 per cent of women whose babies die. I believe the real figures are much higher, as many cases of birth trauma continue to go unrecognised.

Birth trauma isn’t just about the birth itself – it’s also the events around the birth, from the journey of pregnancy through to the postnatal experience. For instance, a recent report by the Maternal Mental Health Alliance outlines the additional mental health stresses that the pandemic has added to women and families, such as raising anxiety levels, restricting access to services and reducing contact with family and friends.

The focus of perinatal services is often on the short term, typically within one year after birth. I believe this misses many potential women and families who would otherwise benefit from treatment. In my own practice, I see many clients who present after the first year, following which they are not classed as a perinatal mental health case.

I have become increasingly aware that many clients presenting with depression and other mental health issues in fact have issues related to birthing experiences. Significantly, clients may themselves have been parented by ‘traumatised’ mothers and fathers. The effect on the baby and the attachment relationship is well documented, with traumatic birth more likely to lead to an insecure attachment relationship. Birth trauma creates a ripple effect that impacts everyone in the circle.

Birthing experiences tend not to factor in the assessment processes in which counsellors and psychotherapists are trained, which can result in connections to on-going mental health issues being missed.

I would recommend that all therapists hold curiosity around clients’ experiences of birth, and their parents’ experiences. This curiosity can reveal generational family traumas, such as stillbirth, and their lasting impact on families. It can uncover compromised attachment processes behind presentations of depression, when clients who describe their depression as ‘always being there’ share a family history of parental birth trauma. It can help anxious clients, who feel that the world is an unsafe place, connect this to an experience of a life-threatening situation around birth – one that may have happened long ago, but has never been treated.  

Organisations such as Make Birth Better hold regular training on this subject, and their website contains valuable information and resources for all affected by (or working with) birth trauma. The theme of this year’s Maternal Mental Health Awareness Week is ‘Journeys to recovery’. In my work, I have learnt that, for many families, the journey to recovery from birth trauma continues long after the ‘perinatal’ year has passed.