Intended for healthcare professionals

Practice What Your Patient is Thinking

It felt like my birth trauma had been forgotten

BMJ 2022; 377 doi: (Published 10 May 2022) Cite this as: BMJ 2022;377:o1006

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Identifying post-traumatic stress disorder after childbirth

  1. Emma Hayden
  1. emmalhayden76{at}

Emma Hayden describes the psychological impact of a traumatic birth, and her difficulties with finding healthcare support

“You’ve really been through it,” the midwife said after we had finally been discharged from hospital. It was the exact same phrase used by the midwives in the high dependency unit, and was repeated on the transitional care ward. My discharge notes stated that I was “tearful” a lot. In reality, that was an understatement.

My newborn was weighed regularly at home after losing a critical amount of weight in hospital, due to us both being unwell after his birth. I had experienced a massive postpartum haemorrhage after a forceps delivery with episiotomy, and my son was born with a very low Apgar score. It was terrifying, and I felt that I had failed my son at birth and now with his feeding. An awful fear remained with me that I couldn’t keep us safe.

I told my midwife that I kept replaying the birth in my head, and that I had obsessive thoughts, seeing danger everywhere. I could “see” in my head terrible scenarios happening, and felt so ashamed that my mind was conjuring up dark thoughts when I was meant to be in the happiest period of my life.

Fortunately, my midwife was very sympathetic about the birth trauma and referred me fora birth debrief session. I also received breastfeeding support from my health visitor. I was terrified that they would think I was a danger to my baby because of the intrusive thoughts, and was reassured that they didn’t. However, when they stopped visiting, it felt like we had to cope alone, as the appointment for the promiseddebrief took months to come through.

Asking the right questions

My GP focused on my immediate physical recovery, checking my wounds, and asking about my physical health, but didn’t ask how I was coping. I felt reluctant to bring up the psychological impact of the birth.

At the 6-8 week check I worried about volunteering my worsening anxiety and intrusive thoughts. Mostly I was frightened about being truly honest with my GP. I thought they would think that I was failing as a mother, or worse, that I was unsafe to be one. I did say how hard I was finding the physical complications of my birth injury and haemorrhage, but my GP explained that women should not expect to remain the same after giving birth, as if this was all perhaps “normal.” The truth was that the impact of the birth injury alone was very distressing, and resulted in further treatment and more than a year of recovery.

I was offered medication (which I declined at the timebecause of breastfeeding), and counselling was suggested through the Improving Access to Psychological Therapies programme, but I was advised that the waiting list was around 12 months. This felt like an impossible amount of time to wait for help. A leaflet was given to me to self-refer, which I shoved under the pram and it remained there, untouched for months. I did not realise that my referral would have been prioritised during the postpartum period.

I presented to the GP surgery several times after that, with infant colic, reflux, rashes, and colds. My son wouldn’t sleep much at all and was very unsettled; infant allergies were eventually diagnosed, which accounted for many of the symptoms. At the appointment regarding the colic, I was asked whether I had support at home. I explained I had. No more questions were asked about how I was feeling. It felt like my birth trauma had been forgotten by the healthcare professionals and that I should try to do the same. The weeks had now turned into months of anxiety, intrusive thoughts, and hyper vigilance.

Long term consequences

The consequences of not getting the help I needed in those early months were far-reaching. With post-traumatic stress disorder came anxiety and depression, and my marriage was negatively affected by the stress, especially as it was alongside years of fertility treatment to have both of our boys. I worried endlessly that those early months would have adverse effects on my son’s development or on our bond, but thankfully these fears were unfounded. During my subsequent pregnancy in 2020 I developed tokophobia (fear of childbirth) with prenatal depression and anxiety, which were compounded by the isolation of lockdowns and the additional threat of covid-19.

When I gave birth to our youngest son, I was incredibly relieved that I could have an elective caesarean, as advised by the consultant after my first birth to prevent further physical and emotional trauma. The sense of control was reassuring. I felt strongly that a caesarean was the quickest and safest route to deliver my baby, as I was fearful of the unpredictability of labour and vaginal birth after the terror and powerlessness I had experienced during my birth trauma. I am also grateful that I received extensive help and support from my GP, midwife, and specialist perinatal services during my second pregnancy and after the birth. It was important to me to ensure support was in place the second time round. I cannot imagine how hard it would have been struggling with a traumatic birth during the pandemic, especially as a first time parent. I feel for all those in that position, and it is vital that they are offered appropriate support when they first need it.

What you need to know

  • A new mother may not volunteer their feelings about their birth experience, you may need to ask questions to start that conversation

  • Mothers often fear doctors will judge their parenting or involve social services. Be mindful to reassure them about this at the earliest opportunity

  • Listen to the information that your patient is giving and try to ask open questions to elicit more about what they may be saying. For example, if a patient volunteers that they are struggling to sleep, is it because of the baby’s routine, colic, or another problem? If she attends repeatedly, it may be worth exploring the mother’s worries

Education into practice

  • If a patient attends your practice with a physical symptom of a complicated birth, how would you bring up whether they are experiencing any symptoms of emotional trauma?

  • How might you act upon a maternity discharge summary describing a new mother as tearful or low, especially in view of any complications during the birth?

  • How might you change your approach when engaging with a new mother attending the practice after reading this article?

Useful resources

Ensure that you have comprehensive knowledge of the perinatal mental health services in your area, including your nearest mother and baby unit and the perinatal community mental health teams.


  • Competing interests: none.

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