I was diagnosed with PTSD after giving birth to my son. What everyone should know about birth trauma

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CW: This story discusses birth trauma and features NICU images which may be difficult for some readers.

A baby is supposed to cry when he's born.

A shrieking newborn is placed lovingly onto its mother's chest while the room erupts in a chorus of cheers and tears.

It's supposed to happen — but it doesn't always.

When my son Max was born, the room was eerily silent. The only voice I heard was my own, asking in a panicked voice, "Why isn't he crying?" After 48 hours of labour and two hours of pushing, Max was in my arms for less than 20 seconds before he was rushed away, turning a deep shade of blue, my husband following behind. My life with birth trauma began at that moment.

I watched the door expectantly, assuming the worst was over. I imagined Max in another room being weighed, measured and wrapped snugly in a blanket, ready to make his way back to me. When my husband appeared in the doorway without Max, everything began to feel as though it was in slow motion. I felt myself slowly separating from my body, watching the scene as a spectator.

Where was my baby?

Instead of being taken to a recovery room, I was taken to the neonatal intensive care unit (NICU) to see my baby in an incubator. He was covered in wires, a feeding tube, and his face was barely visible with his CPAP machine (continuous positive airway pressure machine) to help him breathe. There were questions about his heart and his lungs, questions about my health and my pregnancy.

That night in the recovery room, my husband and I listened to the other parents tend to their crying babies.

"This wasn't supposed to happen," I repeated, over and over.

Over the next week I would learn that Max was born with an unknown infection that had caused sepsis. Blood tests, blood cultures and lumbar punctures all failed to give us answers. After eight days in the NICU, we were cleared to bring Max home. While it should have been a happy occasion — and in many ways it was — my mental health was deteriorating.

What is birth trauma?

Birth trauma refers to any physical or emotional distress experienced during or after childbirth. In some cases, birth trauma can be the result of an injury sustained by the mother or baby, undergoing an emergency C-section, experiencing complications during delivery or the baby requiring medical attention after delivery.

It can also occur when mothers and pregnant people aren't provided the level of care they expect from hospital staff, or if their labour and experience with childbirth wasn't what they hoped for.

"All birth trauma is physical because it boils down to our nervous system, which is making the choice for us as to whether something is traumatic or not," says Teela Tomassetti, a registered provisional psychologist and birth trauma specialist. "Birth trauma is anything that exceeds the nervous system's ability to cope, whether that’s before, during or after the childbirth experience."

A 2018 study in the Journal of Perinatal Education reported that up to 45 per cent of new mothers report experiencing birth trauma, with many reporting long-lasting impacts of post traumatic stress disorder (PTSD).

After Max was born, friends began reaching out to share their deliveries and NICU experiences. Their stories involved NICU stays longer than ours, and emergency deliveries before their babies were full term. While I was grateful for their messages, I began to feel a deep sense of shame. Was I overreacting? Why couldn't I be as strong as they are?

Experts say birth trauma is an extremely personal experience. Tomasetti points to Cheryl Beck's research to help explain the subjectivity of birth trauma. In 2004, Beck, a distinguished professor at the University of Connecticut School of Nursing, published a study on post-traumatic stress disorder and new mothers to better understand the "essence" of birth trauma. "Birth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians," the study concluded.

"I think it's important to take that to another level and say like, just because it's in the eye of the beholder doesn't mean that it's a choice that somebody is making," says Tomassetti, in the midst of her doctoral research through California Southern University. "Instead, our nervous system is just responding and doing its absolute best in those moments to decide how to help us survive."

What are the symptoms of birth trauma?

Symptoms of birth trauma vary — and they vary in onset.

Many people who develop PTSD after childbirth experience flashbacks, vivid dreams, anxiety, panic attacks, intrusive thoughts, may feel the need to keep busy and become hypervigilant in caring for their child. Some may be irritable or angry, while others may feel completely cut off from their feelings and surroundings.

Tomasetti says once the need to be in "survival mode" wears off, it can take people weeks, months or even a year to present with symptoms of trauma.

Almost immediately after Max was born, I began having nightmares that made it impossible to sleep. I became obsessed with the idea that if I could be the perfect, most attentive mother in the NICU, the staff would realize that even though I had "failed" to have a healthy baby, they could trust me to care for him. I decided to stop eating so that I could spend more time with Max in the NICU, and when I did experience panic attacks, I hid behind the nursing screen and cried quietly so nobody would notice.

In the weeks that followed, my family and I began to worry I was developing postpartum depression. I knew that I was high-risk given my history of depression, and throughout my pregnancy I had anticipated requiring extra support and therapy — a privilege I am aware of. But something didn't feel right; I didn't feel a sense of dread or despair. I felt like I was grieving a birthing experience I didn't get to have.

I cried often. I cried because I felt as though something had been taken from me: the first, sacred moments between mother and child that I had dreamt of throughout my entire pregnancy.

"The research shows that too often people [with birth trauma] are misdiagnosed with postpartum depression," Tomasetti says, adding that depressive symptoms are part of birth trauma. "Sometimes [birth trauma] is missed because people think 'Oh, it's just a new parent. They're just overwhelmed.' No, we should ask more questions about their physical childbirth experience. That's where you're going to find the true answer to, 'Is this PPD or is this birth trauma?'"

Living with birth trauma

Learning to live with birth trauma has been a long process. My son is my greatest joy and I am so unbelievably grateful to be his mother. My feelings towards his birth exist outside of my feelings for him, and I'm careful to make that distinction whenever I speak about my experience.

In the days after he was born, some friends and family would hear that Max was in the NICU and begin sentences with, "Well, you should just be grateful that…"

I felt deeply ashamed that someone would think I would be anything but grateful that my son received exceptional care, that he was able to fight off infection, that there are no long-term effects that we know of, that I live in a country where I wasn't bankrupted by a NICU stay or had to return to work weeks after he was born.

It wasn't until I began learning about birth trauma through therapy and became a part of online birth trauma communities that I realized that my shame and guilt were keeping me in a silo that prevented healing. My gratitude couldn't take away the reality that PTSD was impacting my first time experience as a mother, no matter how much I desperately wanted it to.

I'm aware that many people are living with fertility issues, that many people experience pregnancy loss or infant loss or their own life-threatening birth trauma. There is a constant qualifying process that many people with birth trauma feel as though they must go through to justify their feelings, because we feel in constant fear of looking ungrateful or discounting someone else's experience. But there is no healing unless we talk about birth trauma.

How to treat birth trauma — or help someone dealing with it

Tomassetti says eye movement desensitization and reprocessing (EMDR), narrative therapy and "unpacking" and "holding space" for someone's experience in compassion-focused therapy can be beneficial to treating birth trauma. When it comes to how family and friends can support people with birth trauma, Tomassetti recommends avoiding statements that can be dismissive or invalidate feelings and experiences.

"We should resist saying things like 'Oh, that's normal' or 'every birth is hard' or even interjecting about your own experience," she says. "I think one of the best tools that we have in our kit for supporting people… is to just be quiet and to hold space for their story and not feel like you have to interact with your own opinions and questions. We should validate and say, 'That sounds like it was really scary for you' and 'I'm sorry that you went through that and that shouldn't have happened.'"

Tomassetti says you can also ask the person what you can do for them or what they feel could be helpful to them. Most of the time, birth trauma survivors just appreciate someone "sitting and listening" to their experience.

My son is currently 18 months old, and even though it's gotten better, I still struggle with PTSD. Therapy and medications have been helpful in allowing me to grieve the delivery and postpartum experience I didn't get to have, as have speaking to other birth trauma survivors in online communities.

There are tons of helpful online resources for birth trauma survivors, like Tomassetti's Instagram account "The tea on birth trauma," which has been extremely valuable for validating my feelings throughout my maternity leave and return to work.

While the community is extremely supportive and helpful, birth trauma education needs to extend to those beyond survivors and become part of the public discourse of maternal health. There is an entire aspect of pregnancy and childbirth education that's reactive, rather than proactive. We need to prepare pregnant women for what they could face emotionally, the same way we prepare them physically with what their body will go through during and after childbirth.

I often wonder what kind of mother I could have been without birth trauma. It crosses my mind when I'm playing trucks with Max or when we're cuddling before bed time. I will always wonder what could have been, and might even feel some sadness, but at least now there's no guilt or shame whenever my thoughts wander down that path — and for now, that's good enough.

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