What keeps Childbirth PTSD symptoms going?

by George Maxwell    Published on 06/12/2016

In this series so far we have looked at the phenomenon of childbirth related trauma and PTSD and how the symptoms can emerge as part of our response to threat.  This article looks at how PTSD and Trauma symptoms are maintained over time, leaving us to re-experience aspects of the trauma months, and sometimes years later.

What is happening when we develop PTSD?

In the simplest of terms, PTSD is maintained by the intense, almost phobic, fear of a memory. When the memory of an event carries with it so much emotional content that it overwhelms us with fear, we may invest a huge amount of effort in trying not to remember it. This avoidance of thinking about the event means that our brains struggle to deal with the memory properly, leading to the memory remaining “raw” and unprocessed.  This means that whenever our the memory gets activated (i.e., when we remember it), we get the full, emotionally intense version of the memory, as though the event was happening again in the here and now. Take a look at the following example to understand this process further…

Imagine that your brain is like a factory. The main task of this factory is to take all of your sensory experiences (the raw materials) and run these along a conveyor belt, where they are processed and packaged into nice little units which can be stored in our long term memory store for remembering later.

The process involves the brain-factory putting a sort of “date-stamp” on the memory, to let us know that this is an event that happened and it is now part of our story – part of our past. When we want to, we can then go into the long term memory store-room and take out a memory, remember it and forget about it again, knowing that we can remember it again if we ever need to again in future.

Your brain is doing this all of the time and we don’t really ever think about it.

PTSD factory metaphor - normal processing

Normal brain processing

A trauma event is a little different. Whereas our everyday experiences are generally small, ordinary and easy to process without any special effort, a trauma event comes with uncommonly intense (and frightening!) imagery, emotions, sensations and thoughts, all of which require additional processing from the factory to get it into the long term memory store.

That is, the factory needs to put on overtime to process this traumatic experience and get it into the into the long term memory store.

However, because this memory is so out of the ordinary, with all of its unique scary features, whenever the event gets placed on the conveyor belt, we can become overwhelmed by it and shut down the factory.  The processing stops before it is finished.

And so, instead of the memory being processed, date stamped, and packaged into the long term memory store-room, in PTSD we get a raw materials memory, with intense emotion, imagery and sensation at the same intensity as the initial event, as though the event was happening again, in the here and now.

PTSD factory metaphor - halted processing

Our efforts not to think about the event mean it remains unprocessed and raw.

Avoiding memories, maintaining symptoms

Diagram showing how PTSD is maintained

Memories rely upon triggers to activate them. If we see a friend that we haven’t seen for a while, we’re reminded of the good times we’ve had with them. If we smell sun-tan lotion, we might have the memory of being on San Antonio beach in Ibiza or if we hear the opening synths of Rick Astley’s “Never gonna give you up” we’re reminded of that awkward late-1980’s school disco. You get the idea.

When memories have been processed fully, triggered memories like this rarely cause us any difficulties.  I “know” that I’m remembering an event because my brain has had time to contextualise the event into part of my past – that is, it has put a “date-stamp” on the memory.

However, when a current trigger activates an unprocessed trauma memory, we get a memory which hasn’t had the opportunity to be date-stamped and conextualised as being part of my past experience.  We get an overwhelmingly intense re-experiencing of the event as though the event was happening again in the here and now. We call these experiences “Flashbacks“.

Because the Flashback can feel so frightening, people often avoid the things which they believe triggered the memory.

So for instance, if I had a flashback to a traumatic birth experience  the last time I drove past the hospital, then I might deliberately start to drive via a different route, even if it adds 20 minutes to my journey to work.  As a consequence, my fear of the memory then starts to impact upon my day to day functioning (I avoid more and more and I can do less and less) and the memory remains unprocessed, meaning that a flashback can still be triggered by another related trigger; a TV hospital show, for instance.  Take a look at the graphic on the left to see the PTSD maintenance cycle in action.

So – we’ve seen what causes PTSD and trauma symptoms in childbirth, and we’ve now seen what processes keep them going.  But how can we recover from PTSD and Trauma?  The first step is getting to know your symptoms and this is covered in more detail in the next article.