Causes, Health Effects, and How to Begin to Heal

While my pregnancy journey wasn’t what I’d hoped for, I set my sights on the birth, hoping it would be a redemptive experience. Don’t get me wrong, I knew birth could be unpredictable—I’d taken childbirth education classes and researched birth outcomes ad nauseam (I’m a health journalist, after all)—but still, I was optimistic.

I’d assembled an amazing medical team—a caring, affirming midwife practice and a compassionate doula—so I felt confident that my birth preferences would be honored and respected. My ideal scenario was an unmedicated vaginal birth. Sure, I knew it would be the hardest thing I’d ever do, taking me to the edge of what I thought physically possible. But I wanted to dig deep and push ahead (literally) to have an experience I could only describe as a spiritual, transformative rite of passage to motherhood, where I’d emerge on the other side as an empowered new mom with a beautiful, healthy baby in my arms.

Unfortunately, at 34 weeks, I developed preeclampsia—a potentially life-threatening condition that causes high blood pressure and can damage organs in the body. By 36 weeks, my condition had become so severe it landed me in the hospital. While there, my blood pressure skyrocketed, and my liver and kidney functions dropped dangerously low. Things were quickly becoming very unsafe for me and my baby, and I was scared.

After discussing risks, my care team decided a C-section was the safest route. It was a major blow to the idea of my dream birth. But my baby’s health and my own depended on it.

Before surgery, I was given medication to prevent me from having a stroke or a seizure (which can happen when preeclampsia develops into eclampsia). The drugs made me extremely sick and loopy. In the OR, as they pulled my baby out of me and into this world, I was gagging and spitting up saliva.

The memory of seeing my son for the first time is hazy, and I don’t remember much else from those first few days. I didn’t get that magical “golden hour” of bonding with my baby post-birth, or any sweet pics of us snuggling. I could barely even take care of myself. Nurses took over my care for the following 48 hours, down to giving me sponge baths in bed.

I spent a week in the hospital filled with ups and downs of trying to manage my blood pressure, and was finally discharged on a freezing Friday night in January. I bundled up my baby, premature by four weeks, and drove away from the hospital, leaving behind my hopes for a positive birth experience and the person I was just a few days earlier.

When I left the hospital, feeling fragile, shaken, and numb, I didn’t yet have the exact words to describe my birthing experience. Now I know it’s called birth trauma.

“Giving birth has been depicted as one of the most beautiful things a woman can do. For some this may be true, but for others, it’s traumatic.” —Paige Bellenbaum, LCSW, therapist

What is birth trauma?

Birth trauma happens when you go through a distressing event during pregnancy, childbirth, or postpartum that overwhelms your mind or body’s ability to cope, says Farrah Sheehan, MSN, RN, IBCLC, CCBE(BFW), a nurse educator, researcher, and expert on birth trauma prevention and recovery.

“Historically, giving birth has been depicted as one of the most beautiful and glorious things a woman can do; for some, this may be true, but for others, giving birth is traumatic,” says Paige Bellenbaum, LCSW, a maternal mental health advocate, therapist, and founding director of The Motherhood Center in New York City.

Like all trauma, birth trauma is subjective. What may be traumatic to you may not be for someone else. For this reason, there’s a wide range of experiences that can cause birth trauma—including physical, emotional, and interpersonal.

Types of birth trauma

Physical trauma

Physical trauma involves a serious physical injury, or the threat/fear of injury or death, to the birthing person (or the baby), according to the Maternal Mental Health Leadership Alliance (MMHLA).

Some examples include the following, per the MMHLA:

• Emergency C-section or instrumental vaginal delivery
• Feeling overwhelming pain or the denial of pain relief
• Third- or fourth-degree perineal lacerations or tears
• Unwanted or unannounced episiotomy (a surgical cut made at the opening of the vagina)
• Complications with anesthesia
• Manual removal of placenta
• Urinary catheterization
• Unplanned hysterectomy
• Hemorrhage
• Preeclampsia
• Stillbirth/ infant death
• Premature birth
• Fetal distress or harm to baby
• Separation from infant in the NICU

Emotional trauma

Even without physical injury, birth can still feel emotionally (or psychologically) traumatic. It happens when something during childbirth makes you feel unsupported, unsafe, or helpless.

Many events can cause emotional birth trauma, but they often all have one thing in common: It wasn’t at all what you’d expected.

In all its unpredictability, “birth is an innately ‘traumatic’ experience,” says Sheehan. No matter how much you research, learn, and prep for birth, there’s always something unexpected that happens. And if the unforeseen event causes you great distress, it can make you feel powerless. It can also make you question your trust in the world, sense of order, or belief in yourself, she adds.

Care-related interpersonal trauma

Sometimes emotional trauma happens when you’ve been mistreated by your doctor or the health-care system at large. This is called care-related interpersonal trauma. A staggering 1 in 5 birthing people report getting some type of mistreatment during pregnancy or childbirth, per the MMHLA.

Examples of care-related interpersonal trauma include the following, per the MMHLA:

• Feeling disrespected by health-care providers
• Feeling abandoned or alone
• Feeling pushed, rushed, coerced, or not seen or heard
• Feeling that embodied knowledge is disregarded
• Being yelled at, ignored, scolded, or threatened
• Poor communication (lack of proper translation, spotty and inadequate conveyance of important information, partial informed consent, un/misinformed by health-care personnel, etc.)
• Lack of agency; loss of control and participation in decision making
• Medical providers talking about the birth as if the birthing parent were not present

How common is birth trauma?

Unfortunately, all too common. Though research is still limited, there’s a growing body of evidence suggesting that many birthing people have birth trauma. Case in point: As many as 1 in 3 people have developed some trauma symptoms from their birth experience, according to a September 2023 review in Women and Birth.

Other studies estimate this number even higher. For instance, a June 2018 study in the Journal of Perinatal Education noted that almost half (up to 45 percent) of new mothers have reported feeling traumatized by their childbirth experience.

Who’s most at risk? Though it can happen to anyone, certain groups are disproportionately affected by birth trauma. “For those who have a history of trauma or are marginalized or stigmatized in health care (i.e., women with substance use disorder, LGBTQ+ people, Black women, people of color, and people with a history of abuse), the risk for birth trauma is greater,” says Sheehan.

Symptoms and health effects of birth trauma

Birth trauma can be like an earthquake: It shakes the very foundation of your sense of self, and it can come up later in all areas of life like aftershocks. In other words, its effects are far-reaching.

Symptoms can also be different for everyone, says Sheehan, with some people not feeling effects until weeks, months, or even longer after birth.

Here are just a few ways birth trauma can affect your mental health, physical health, and relationships in the short and long term.

Mental health effects

Going through trauma can literally alter the way your brain functions, according to the Jed Foundation. That’s because trauma overwhelms your nervous system’s ability to cope. In order to survive, your brain protects itself and switches into a 24/7 fight-or-flight mode, meaning it’s always on high alert.

It’s no surprise then that birth trauma can result in a range of mental health issues, including anxiety, depression, and in some cases, post-traumatic stress disorder (PTSD).  In fact, “PTSD affects around 17 percent of postpartum parents,” says Bellenbaum.

Symptoms of postpartum PTSD might include the following, per Postpartum Support International:

• Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
• Flashbacks or nightmares
• Avoidance of stimuli associated with the event, including thoughts, feelings, people, places, and details of the event
• Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, or exaggerated startle response)
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

While many birthing people don’t meet the clinical criteria for PTSD, they can still have PTSD symptoms, says Bellenbaum. I fall into this group. Though I don’t have a PTSD diagnosis, I’ve struggled with health anxiety and hypervigilance since my birth experience. It’s been over a year, and to this day, the beeping sound of hospital machines (like the blood pressure monitor) sends my heart racing.

Physical health effects

If you developed a serious physical injury or medical condition while giving birth, healing can be a long and complicated road.

Take third- or fourth-degree perineal tears, for example. These tears cause severe damage to the tissues and muscles of your vagina and anus. Not only are they painful in the days after delivery, but the pain can persist long after birth (especially during sex) and scarring can cause bowel problems like incontinence, according to the University of Chicago Medicine. These ongoing symptoms can majorly affect your quality of life and even your mental health.

Health conditions, like my preeclampsia, can also continue to affect your life post-birth. It took several months to get my blood pressure under control—with medication and under a specialist’s care.

Similarly, stress from birth trauma can have an affect on your health in the long term. For example, Sheehan says that certain mental health issues like stress can be linked to inflammation in the body. It’s true: Prolonged stress can trigger inflammatory responses in the body, and, over time, can contribute to chronic diseases like heart disease, cancer, and arthritis, according to the book Oxidative Stress.

Your body is more susceptible to this inflammation during the postpartum period when you’re not getting much sleep—which is the body’s natural way to repair and mitigate inflammation, adds Sheehan.

Effects on relationships

Not only does birth trauma affect you, but it may also affect your relationships with the people you love. For example, your traumatic experience can make it difficult to bond with or breastfeed your baby, or be intimate with your partner, per the MMHLA. Your partner may even feel traumatized by what they saw and experienced during your labor and delivery.

Give yourself permission to call your experience what it was. If your birth felt traumatic to you, then it was. Period.

How to process and heal from birth trauma

When you’ve been through birth trauma, the world can feel like a lonely, dark, and even scary place. As painful as it can be, there is light at the end of the tunnel. With time, patience, and support, you can begin to recover. Here are some things to help you along the path to healing.

Give yourself permission to call your birth “traumatic”

First, give yourself permission to call your experience what it was. “In the work I do with new mothers every day, I almost invariably have to give them permission to use the word “traumatic” to describe their painful and difficult birth,” says Bellenbaum.

People fear that calling their birth traumatic makes them a terrible parent, she adds. They may wonder, What kind of parent would use that word to describe what is meant to be such an amazing experience?

Others may question whether they even have the right to call their birth traumatic. For instance, if you were fortunate enough to have a healthy baby, and/or you’ve physically recovered from the delivery, you might feel the need to justify your experience or feelings. You might question, am I just overreacting?

No matter what you went through, your feelings are valid. “Trauma is in the eye of the beholder,” adds Bellenbaum. “What feels traumatic to you might not to someone else, but at the end of the day, all that matters is how you felt it.”

If your birth felt traumatic to you, then it was. Period. You shouldn’t have to bury your true feelings or put on a happy face for the world. Healing can only begin when we acknowledge our trauma.

Don’t blame yourself

When something goes wrong during birth, many people feel ashamed. They think, if only I did something different, if only I had prepared more for birth, if only I had spoken up to the doctor.

Some birthing parents even feel as if they failed themselves and their baby. “When the expectation of one’s birth experience is based on what it ‘should’ be like—and it’s not like that at all—a new mother can feel shrouded in disappointment, shame, and guilt,” says Bellenbaum.

With this deep sense of shame often comes self-criticism. You might beat yourself up asking, Why can’t I just be stronger? Why can’t I just focus on gratitude? You may fear other people will judge you, too.

Please stop beating yourself up: Birth trauma wasn’t your fault, and you’re not to blame. Shame and guilt will only keep you trapped in a dark, lonely place and prevent you from healing.

Join a birth trauma support group

Birth trauma is isolating. For me, the alienation was almost as heartbreaking as the trauma itself.

After the initial shock of my birth, I was desperate to connect, be heard, and feel understood. But when I shared my experience, I was frequently met with some version of, “At least you and your baby are both healthy. Now you can move forward.”

“Sometimes, the people we share our stories with can keep the trauma wheel spinning,” says Sheehan. This is certainly true in my case. While talking to others, I learned to keep the less desirable details of my story to myself, and in doing so, suffered in silence.

Even among other new parents I felt like the odd one out. I tried to make connections in several new moms’ groups, but I just couldn’t relate to anyone. Every mom I met had (or at least appeared to have had) a pretty “normal” or routine delivery. This only intensified the loneliness I felt. Sometimes I would think, Am I the only one who feels like this?

Six months post-birth, my therapist recommended I check out a virtual birth trauma support group. It was a small group— just me and two other new moms—but it was a big piece of my healing puzzle. For the first time, I felt like I could truly relate. While we all had different stories, we shared one thing in common: We were grieving a birthing experience we didn’t get to have. We mourned what was taken from us and expressed our true feelings of devastation and rage without judgment.

Since then, I’ve also found a lot of validation in online communities. On Instagram, accounts like @theteaonbirthtrauma and @thebirthtrauma_mama (both run by birth trauma specialists who are survivors themselves) have helped give a voice to what I was feeling and made me feel less alone.

If you’re looking for a support group, you can start by checking out PATTCh (Prevention and Treatment of Traumatic Childbirth), an organization dedicated to creating awareness and knowledge about the effects of trauma on childbearing people. The website has a helpful list of virtual and Facebook groups, as well as other useful resources.

There’s growing evidence that suggests the effects of trauma not only live in the mind, but in the body, too, leaving our nervous systems in states of fight, flight, or freeze.

Tell your story

You may want to forget your birth trauma ever even happened—I hear you. But avoidance won’t serve you. A key to healing is facing all your feelings, and telling your story can be an essential part of that.

“The more women talk about their traumatic birth experience, the less power and hold it has over them,” says Bellenbaum. (To be fully transparent, that’s part of the reason why I’m writing this article.)

Sharing your birth story can also help you reframe your experience to give it new meaning, rebuild your confidence, and regain your identity and sense of self, according to the March of Dimes. One of the best ways to do this is by writing it all down. If you’re not sure where to begin, you can download templates online, like this birth story guide from March of Dimes, for tips on how to write your story.

Of course, who we share our stories with also makes a difference. The effects of trauma may be lessened with the “soft landing of human compassion…a person to deeply listen to your birth story and help you expand on and find meaning in the experience,” says Sheehan. In traditional cultures, this person may be a medicine woman, or another woman regarded as someone who “returned” from the ordeal of birth, she adds. But it can also be someone in your life who holds space for you.

If you want a more structured option, you can try something called “Birth Story Medicine,” says Sheehan. In these sessions, a trained birth story listener guides you through the sharing process and helps you make meaning of your trauma, in hopes that it will help you heal other areas of your life, says Sheehan.

“The idea is, the hardship of birth trauma didn’t break you, but rather presented you with an unexpected opportunity to heal other parts of yourself,” she adds. This falls in line with a philosophy called post-traumatic growth, according to the Journal of Perinatal Education.

Just keep in mind: Post-traumatic growth isn’t meant to negate your pain. Your trauma won’t magically go away. Rather, your traumatic experience can live alongside a new appreciation of life, newfound strength, and spiritual change.

Seek professional help

The emotional burden of birth trauma can become unbearable, even with family and friends to lean on. Despite having a solid support network, and an arsenal of coping skills I’d accumulated over the years, I was drowning. I needed professional help.

Therapy can be an integral part of the recovery process. But finding a skilled and experienced counselor is key. Try to find someone who will not only validate your feelings and experience, but who understands that birth (whether traumatic or not) is an ordeal, says Sheehan.

I was fortunate enough to find a therapist who specializes in postpartum issues and birth trauma (a privilege I am keenly aware of). My therapist has been my lifeline on this journey, but it did take some time and digging to find a clinician with this expertise.

If you’re looking for a mental health professional to guide you in the aftermath of traumatic birth, here are some resources to get started:

• Postpartum Support International (PSI): An organization dedicated to expanding awareness about the emotional changes that childbearing people feel during pregnancy and postpartum. You can search their provider directory to find a qualified perinatal mental health professional in your area. If you need a little more one-on-one support, you can speak to a specialized coordinator to help you navigate the process of finding the right birth trauma-related resources for you.
• PATTCh (Prevention and Treatment of Traumatic Childbirth): Here you’ll find several directories where you can search for a provider who specializes in birth trauma (as well as other helpful resources like support groups, podcasts, and books related to birth trauma).
• The Motherhood Center (based in NYC and virtual): A comprehensive treatment center for new and expecting birthing parents that offers therapy and medication management. Their mental health professionals specialize in perinatal mood and anxiety disorders (PMADs), including postpartum PTSD. They also have reproductive psychiatrists on staff, who can prescribe medication that’s safe and effective to take in postpartum. The center also runs support groups for people dealing with mental health issues in pregnancy or postpartum.

Try somatic therapy

There’s growing evidence that suggests the effects of trauma not only live in the mind, but in the body, too, leaving our nervous systems in states of fight, flight, or freeze. Trauma can manifest in countless physical ways—including muscle tension, body pain, and disturbed sleep.

Enter: somatic therapy. It’s is a relatively new type of treatment that aims to address how our bodies hold and express traumatic experiences. Unlike traditional talk therapies (which focus on our thoughts) somatic therapy centers around the body as the vehicle for healing. The goal is to bring awareness to bodily sensations, and ultimately, to help people feel safe in their bodies while they explore painful thoughts, emotions, and memories, according to Harvard Health Publishing.

Somatic therapy can involve a range of mind-body techniques including acupressure, hypnosis, breathwork, and dance. Other techniques a somatic therapist may use to help release trauma include the following, per Harvard Health Publishing:

• Body awareness: Helps people recognize tension spots in the body as well as conjure calming thoughts
• Pendulation: Guides people from a relaxed state to emotions similar to their traumatic experiences and then back to a relaxed state
• Titration: Guides people through a traumatic memory while noting any accompanying physical sensations and addressing them in real time
• Resourcing: Helps people recall things in their lives that promote feelings of calm and safety, such as special people and places

While there’s still limited research on somatic therapy and trauma recovery, the emerging evidence shows great promise. A small June 2017 randomized controlled study found somatic therapy was an effective treatment for PTSD, per the Journal of Traumatic Stress. And anecdotally, many people claim it can be life changing.

If you’re interested in finding a somatic therapist, you can search for a trained practitioner through the U.S. Association for Body Psychotherapy or Somatic Experiencing International.

Give yourself grace (it takes time)

We live in a “snap-back” society when it comes to healing after birth, but the process shouldn’t be rushed. It can take up to a year to heal emotionally and physically from birth—not the standard six weeks suggested by most doctors, says Sheehan.

“This is not a six-week process, and our culture and medical community does a whole lot of disservice to birthing people by suggesting so,” she adds.

Birth—whether traumatic or not—is a “symbolic death of who we were before,” says Sheehan. We need time to grieve our former selves and heal our bodies and minds. Sheehan likens the process to a metamorphosis, which is messy. Caterpillars completely break down to become a butterfly. In other words, healing is messy, hard work, and it takes time.

One year postpartum, I’m still in metamorphosis. I also see my healing process like my C-section scar. The superficial layers of skin have healed, but below the surface, deeper layers of tissue are still regenerating. In time, they will heal, too. But we’re all on our own unique timeline. I’m trying my best to be kind and patient with myself during the process. I hope you will be, too.

Can you prevent birth trauma?

Sadly, birth trauma can’t always be prevented. On a macro level, there are larger systemic barriers at play, including institutionalized racism which prevents Black women and people of color from getting quality reproductive care. This puts them at higher risk for dangerous, demeaning, or humiliating situations, per the MMHLA.

“The reason why we have alarming rates of maternal mortality in the U.S. is because we haven’t done enough to prevent medical/physical trauma in birth,” says Sheehan. While problems persist system wide, there’s hope. Birth advocates and activists are pushing for change, awareness, and equity for birthing people.

Still, there are things you can do on a personal level to advocate for a positive birth experience, and lower your risk of birth trauma.

Choose your care providers carefully

According to the MMHLA, one of the main contributing factors to birth trauma is patient perception of poor care or communication with their medical team. This means finding the right doctor or midwife is of utmost importance. At the bare minimum, you want someone you can trust, and feel comfortable asking questions or expressing concerns to.

“All people deserve to have compassionate, caring, patient, and skilled health-care professionals at their side during birth… someone who will hold their hand, tell them what is happening when something is scary, and let them know they are not alone,” says Sheehan.

But this is not always the reality. Too many birthing people have felt unheard, dismissed, or downright disrespected (myself included). In fact, I switched providers in my third trimester after my then-OB/GYN wasn’t open or receptive to my birth-related questions.

Again, this poor bedside manner seems to be, in part, a systemic issue. “Our health-care system does little to nothing to train health-care professionals—nurses, doctors, or others—on these skills, so birthing people are left at the mercy of who they get when they walk in the door that day,” says Sheehan.

So how can you pick the right caregiver? Ask family members or friends who’ve given birth who their doctor was, and whether they had a positive experience. While they may not end up being the right provider for you, personal referral is always a good place to start.

You can also turn to apps like IRTH, a “Yelp-like” platform for people of color that has prenatal, birthing, postpartum, (and pediatric) reviews of care from other Black and brown parents.

Once you make an appointment with a potential provider, don’t be afraid to ask questions that are important to you, according to UT Southwestern Medical Center. For example, you might ask about their stance on pain management, how they feel about working with doulas, or request their rate of induction or C-section stats. Through their responses, you can get a sense of their approach to care and how they might react in certain situations. You can also spot possible red flags (like if they’re rushing you or seem dismissive).

Consider a doula

While doctors and midwives play an essential role in your birth, they’re not the only people who can enhance your birth experience. You may also want to consider working with a doula. Doulas are trained professionals who offer physical, emotional, and educational support before, during, and in some cases, after childbirth. Their entire goal is to help you have a safe and satisfying birth.

In fact, “research shows people who work with doulas have better birth outcomes, including a more positive birth experience and fewer complications,” says Bellenbaum.

Even though my birth trauma couldn’t have been prevented, I’m eternally grateful for my doula. Throughout my pregnancy, birth, and early postpartum, she was a warm shoulder to lean on, a fierce advocate, a reassuring cheerleader, a patient teacher, and so much more.

To find a qualified doula in your area, you can use DONA International’s search tool.

Prepare for the unpredictability of birth

On paper, I did all the “right” things to have a positive birth. I educated myself and assembled a team of compassionate medical providers. But still, my birth went south and rocked me to my core. All this to say, there are parts of birth you can prepare for, and others you can’t.

The reality is “we are wholly unable to control the outcome of birth by the things we do to influence birth,” says Sheehan. That doesn’t mean we can’t prepare ourselves at all—we may just need to tweak the way we do it. This may include planning for unexpected events, and developing healthy coping skills in advance.

“We can and should help people prepare for birth and return from it as whole, loved, and new people,” says Sheehan. Remain curious about what could unfold during birth that might be unanticipated, surprising, or even unwanted. Spend time thinking about how you might navigate this scenario.

In the end, you can’t predict what will or won’t happen during birth. But recognizing what’s out of your control and how you might deal with an unforeseen situation can help (hopefully) soften the blow if it does.