Birth Trauma and Post-Natal PTSD
by George Maxwell
The phenomenon of Male post-natal depression, and the peri-natal mental health of men in general, is a significant public health issue and the work on this site aims to get people to recognise the problem and to increase the opportunity to get help.
But Male post-natal depression often doesn’t occur in isolation. Men can also experience anxiety, stress and trauma related symptoms related directly to the event of childbirth.
This article is the first in an extended series which looks at Childbirth related PTSD, with the aims of helping you or your partner identify and understand the symptoms of PTSD and Traumatic stress.
We will look at what keeps Male post-natal PTSD going and introduce simple self-help techniques to help you manage symptoms before finally talking about the treatment approaches which work best with the problem: Trauma Focused Cognitive Behavioural Therapy (TF-CBT) and Eye movement desensitisation and reprocessing (EMDR).
I’ve included as much information about PTSD in childbirth as I possibly can, so this series is a long one – feel free to click ahead to the sections that are most relevant to you:
This website is generally aimed towards men who are finding things difficult after becoming a parent and as such this article is loosely written with Dads in mind. I do want to make it clear however that PTSD for women in childbirth is still by no means adequately recognised and treated at present and the information I include here will be useful for mums too.
What is Post-Traumatic Stress Disorder (PTSD) ?
Post-Traumatic stress disorder is a clinical term for a specific set of symptoms which can develop following a traumatic life event.
A traumatic event is often defined as when a person experiences a real or perceived threat to their own life, or witnesses a similar threat to somebody else. Common examples of traumatic events include natural disasters, road traffic accidents, illness and physical or sexual attack and abuse.
For somebody to be diagnosed with PTSD it means that they reach a certain “threshold” of having specific symptoms which are defined by one of two diagnostic manuals, the DSM-V and the ICD-10. However, it is also common for people to not quite meet the clinical threshold of PTSD but still be troubled by related trauma symptoms.
The symptoms of PTSD, which will be covered in much more depth shortly, include Flashbacks, feeling persistently anxious and on the look out for danger, nightmares, avoidance of reminders of the event and emotional numbness. All of these symptoms collectively serve to have a significant negative impact upon the individuals overall level of functioning and quality of life.
Post-Natal PTSD and Trauma
Research suggests that a significant number of women will develop trauma symptoms after giving birth.
In the UK, up to 15.7% of women will develop trauma related symptoms following childbirth, with this figure sitting at around 9% in the United States. Clearly, these are significant numbers.
Studies have found that women who go on to develop birth related trauma reported experiencing the following during the childbirth process:
Source: Beck, J. “Birth Trauma in the Eye of the Beholder“, Nursing Research (2004), 54 (1).
But what do we know about the partners who develop trauma symptoms after being witness to childbirth? Research into this area is limited however some studies suggest as many as 5% of partners develop trauma related symptoms after being present at the birth.
Given that as up to 98% of partners attend the births of their children in the UK then this means we are looking at a a considerable, yet largely unacknowledged, public health problem.
A 2014 Study investigated the effects of “near-miss” events in birth experiences (defined as being “Severe life threatening complications in pregnancy that require urgent medical intervention“) upon partners who are witness to the birth.
The study found that partners felt powerless in relation to what was happening to the mother and baby, which led to feelings of shock and distress. Many of the male participants interviewed in the study described the presence of PTSD and trauma related symptoms in the weeks and months following the birth. They also reported a lack of understanding from medical professionals in relation to what they had experienced, and as such, were not encouraged to get appropriate help:
He said to me, he looked me right in the eye, and he said to me, “Mr name,” he says. er “Your wife is the one that went through all the trauma, and everything else. You just need to pull yourself together and be there for your wife.” 3 sec pause And that was it. That for me, I fell into a pit of despair from there. Because of course what am I going to come away thinking, I’m thinking, he’s right, he’s right. What is the matter with me? I’m having all these flashbacks and that. I can’t go to work, what sort of a man am I? I can’t, you know, I need to pull myself together, but equally I, I couldn’t. I, I couldn’t function.
The symptoms of PTSD and Trauma
1. Flashbacks in PTSD
Flashbacks in Post-natal PTSD
One of the most recognisable features of PTSD is the experience of having a “Flashback”.
What is a flashback? A flashback is an extremely vivid re-experiencing of the traumatic event, with features that can make the individual believe that the event is happening all over again.
In a flashback, we can experience many of the elements of the original trauma (sights, sounds and smells, etc.) and our body responds with the same fear-based emotions that we experienced at the time of the event.
Some triggers for flashback memories can be extremely subtle which can make the experience even more fear provoking for the individual, almost as if the flashbacks are coming from out of nowhere.
In post-natal PTSD, it is not uncommon for the individual to experience flashbacks related to the initial “hotspots” of the birth trauma event.
For example, one individual reported that he was experiencing flashbacks to seeing his wife being taken to hospital in an ambulance and of feeling powerless to help.
It wasn’t immediately apparent to the client why he was having these flashbacks. We were able to identify that there were a number of triggers for the flashbacks, including the sound of an ambulance siren, Television hospital drama’s and even the smell of the perfume that the client’s wife had been wearing at the time of the traumatic event.
Nightmares in Post-natal PTSD
Whilst we will all have nightmares occasionally, studies show that people who have PTSD are more likely to have nightmares and to have them much more often.
Nightmares, like flashbacks, are another part of the “re-experiencing” symptoms that occur within PTSD and occur as part of the brains desire to make sense of the traumatic event and process it into long term memory. Of course, this leads to poor sleep, which can in turn lead to reduced functioning for the rest of the day – possibly the last thing we need in the weeks and months following childbirth.
Whilst obviously distressing in nature anyway, nightmares in post-natal PTSD can contribute to already compromised sleep patterns.
Having a new baby means that we can expect to be awoken through the night – combine this with the effect of Trauma-related nightmares and we have the recipe for significant tiredness and fatigue. Over a period of months this can all add up.
The more that sleep is disturbed, both as a consequence of nightmares and situational factors, the less possible it is for the brain to consolidate and process the trauma event, leading to further nighmares and sleep disturbance.
3. Hypervigilance in PTSD
Hypervigilance in Post-natal PTSD
As part of your body’s “better safe than sorry” response to a traumatic event, we often find that people with PTSD will become hypervigilant to signs of danger. What this means is that sufferers can feel constantly on edge, always in fear that another traumatic event is going to happen.
We may observe what we call an exaggerated startle response, where the person is particularly jumpy in response to a related trigger. You might have seen an example of this when PTSD is portrayed on TV – when we see the ex-military serviceman jump to the ground when he hears a car engine backfire.
Hypervigilance may result in the individual appearing irritable or impatient, and can result in changes to behaviour such as checking for danger or working hard to minimise any source of threat.
In childbirth related PTSD, we may notice that the individual with PTSD symptoms is extra vigilant around the child or their partner if they witnessed potential harm nearly come to them.
Hypervigilance may then result in such behaviours as the individual excessively checking on the welfare of the child or their partner. Examples of this include checking on the baby’s breathing throughout the night or rushing with panic in response to every cry.
Hypervigilance can also lead to the individual needing to maintain control of the situation at home, minimising any (even unlikely) potential risks, often at the cost of overall normal functioning.
4. Avoidance in PTSD
Avoidance in Post-natal PTSD
Memories are activated by triggers, and this is also true for flashbacks, which are after all just extra-ordinarily vivid memories of a traumatic event. In PTSD, we will often find that the individual will start to avoid certain places which activate the flashback memory or which the associate the sense of threat with.
What tends to happen however is that, whilst there is one initial trigger that an individual may avoid – say a particular street in which a trauma event occurred, this will gradually generalise to include more broadly associated triggers. So instead of a single street being avoided, pretty soon a whole area is also avoided.
Avoidance contributes to the sense of threat being maintained in that the individual is not given the opportunity to test out whether the particular trigger is always threatening, rather than it being a one-time trauma event. As such, avoidance in PTSD is part of what keeps the problem going.
It is not uncommon for people with severe PTSD to experience avoidance so troublesome that even leaving the home becomes extremely anxiety provoking and difficult.
In post-natal PTSD, it is common for sufferers to experience a sense of threat when exposed to triggers which they associate with the initial traumatic birth event. This can then generalise into more broader areas which can then negatively impact upon the individual’s day to day functioning.
For instance, the hospital in which the traumatic birth took place, may trigger a sense of threat and flashback experience for one individual. However, as the individual avoids the hospital and finds that they don’t feel the sense of threat, the “better safe than sorry” effect of anxiety may kick in further and lead the individual to avoid all hospitals – just in case.
As such, all potential triggers can become a source of perceived threat for the individual, again significantly impacting upon their overall level of functioning.
5. Emotional Numbness
Emotional Numbness in Post-natal PTSD
Emotional numbness refers to the absence of, or reduction in, emotional experience in sufferers of PTSD. Whereas the individual may avoid the emotion of fear by deliberately avoiding situational reminders of the traumatic event, emotional numbness is subtly different – Emotional numbness is an involuntary shutting down of all emotional experience, not just the fear response.
It has been suggested that Numbness occurs as part of the “Freeze” response to threat – “Freezing” is one generally much less often talked about part of the “Fight, Flight or Freeze” response. When the individual has exhausted fight or flight reponses to the threat, numbing kicks in, detaching them from the emotional experience related to the trauma.
We may see the Emotional numbness symptoms of PTSD displayed in the individual as a lack of positive emotion, a feeling of disconnection from other people and activities or a lack of hope for the future.
What does Emotional Numbness look like in Post-Natal PTSD?
We might see the sufferer in this instance feel detached from their partner or their child. In the event of mother and child being delivered well (despite the individual experiencing the event as traumatic) emotional numbing can represent as the individual not being able to interact with the mother and child, or not being able to enjoy the weeks and months following the birth.
We’ve looked here at what Post-traumatic stress disorder actually is, and how a traumatic birth situation can lead to it’s onset in both the mother and partner. The next article explores how our emotional experiences at the time of a traumatic event can contribute to the development of PTSD symptoms.
George Maxwell is an Accredited Cognitive Behavioural Therapist and director of Access CBT UK.
He specialises in the treatment of Male depression in the post-natal period but also has extensive skills in working with PTSD, Anxiety disorders, OCD and Panic. If you would like to arrange individual therapy with him (either face to face or via Skype), or would like to receive information and updates relating to New Dad Depression then feel free to contact him at firstname.lastname@example.org or follow on twitter @newdad_depressn.