Giving birth can be one of the biggest events in a person’s life, and it’s a loaded experience. Everyone has expectations about what a “good birth” looks like, but birth doesn’t always go as planned. For some parents feelings of disappointment, fear, or stress about the events surrounding the birth of a beloved child can transition into something more serious: birth trauma, also known as perinatal PTSD. This condition is a lot more common than you might think.

Our expanding understanding of psychological trauma has highlighted the fact that PTSD is an issue much broader than the emotional aftermath of experiencing combat. Any intense traumatic experience can have psychological ramifications, whether someone has a history of mental health conditions or not, and no matter how well-prepared someone might be. Birth, accompanied with intense physical and emotional experiences, is no exception. But the myths surrounding pregnancy and childbirth can make people uncomfortable when it comes to speaking out, or uncertain about whether what they’re experiencing is normal.

“I just kept replaying every moment from when I first started getting contractions to when I gave birth,” Rebekah Sanderlin told Talkspace.

When she gave birth to her second child, she was living far apart from her family while her husband was on deployment. Nearly everything that could have gone wrong did. She went into labor in the middle of a hurricane, had trouble reaching the hospital, and was treated dismissively by hospital staff at intake. While the actual process of labor and delivery went as smoothly as it ever can, and her child was born happy and healthy, the experience haunted her.

Identifying PTSD

Like many people who develop PTSD, Sanderlin became obsessed with ruminating on the series of events surrounding her delivery, feeling “stuck, like a broken record.” When she compared notes with other new parents, she found that they didn’t share her experiences. Nonetheless, it didn’t occur to her to identify the issue as PTSD until much later.

Doctor Mary Kimmel, the medical director of UNC’s Perinatal Psychiatry Inpatient Unit, has considerable experience working with patients who are struggling with complex and unexpected emotions both before and after birth. Flashbacks, like those Sanderlin experienced, are not uncommon, but her patients also have nightmares, anxiety, hypervigilance, and feelings of being on edge. Sometimes patients arrive with a mix of mental health conditions, including perinatal mood disorders like depression and anxiety. At other times the PTSD presents on its own.

Limited research on this subject indicates it is a very real problem, but the precise number of birth parents who experience it is unclear. Kimmel, however, says it may be as high as 5% of pregnancies. While “trauma” often seems to imply an unplanned, unexpected, scary situation — like an emergency C-section — it can happen in births that are fairly ordinary, too. Kimmel notes that people who feel a loss of control, as though the situation is being rushed and they don’t have an opportunity to actively participate in making choices, can be at higher risk, especially if a sense of helplessness accompanies that emotion.

That observation is echoed by Katherine Clover, who entered a hospital as a home birth transfer after several frustrating days of painful labor. She ultimately needed a C-section, saying: “It was this very scary sense of having no power or control.” Even as she was supported by hospital staff, the rapid transition in her birth plan left her feeling unmoored.

How Therapy Can Help

Clover didn’t identify what she was experiencing until months after the birth, when she sought counseling to help her sift through the complicated emotions that followed her son’s weaning. Coincidentally, she reached a therapist who specialized in postpartum care, something Kimmel says is important.

Therapy allows you to tell your story and have a place to process that story,” says Kimmel, who adds that she loves her job working with parents and families. In some cases, medication can also help patients get stable so they can take their time with clinical treatments.

Sanderlin and Clover are open about their experiences, with Sanderlin reaching out to new parents to let them know they might experience a mix of complicated emotions. The decision to share stories is somewhat unusual, though. Kimmel says it can be “hard to talk about your birth experience,” especially when you “feel you have all these negative emotions.” In a world where birth is supposed to be a beautiful, spiritual, affirming event, people with perinatal PTSD may feel slightly out of step.

In pregnancy there can be a sense that planning for unfortunate circumstances puts a jinx on the experience. Despite this concern, Kimmel notes that there are some steps people can take to mitigate the risks of birth trauma, and Clover says having a specific mental health plan in advance can be highly beneficial. But it’s important to remember that, as with other mental health conditions, it’s not possible to prevent birth trauma. Even a meticulously-planned pregnancy and delivery experience can’t account for everything.

Kimmel says it can be helpful for parents to work with the local hospital to tour the labor and delivery area and meet the staff there. This preparatory step can make it seem less scary and overwhelming on the day of. That goes for home births, too: If something goes wrong, the hospital shouldn’t feel like an unknown frontier for someone who is already worried and unhappy that a birth isn’t going as planned. Getting a neonatal intensive care unit [NICU] tour can also be helpful. Hopefully it’s a tour of a place you’ll never see again. Nonetheless, knowing what it looks like, what babies who need intensive care look like, and who works there can be an anchor of familiarity at a scary time.

Birth plans

Birth plans can also help expecting parents think ahead and regain some measure of control in chaotic situations.

“We need to do a better job of discussing birth with people, and talking about the things that can happen,” says Kimmel, who says that during her medical training as an obstetrical intern, the process of communicating often felt rushed or poorly timed.

Making sure everyone on the care team is on the same page is tremendously helpful, but so is a frank conversation about what will happen in an emergency. If a baby goes into distress, parents need to have confidence in a medical team that doesn’t have time to explain what needs to happen and why. Patients should be able to think, “I’m doing my best, I have a team I trust, they’re doing their best,” says Kimmel.

Acknowledging that pregnancy and childbirth are accompanied by intense emotions is also important. Even people without a history of mental health conditions can benefit from therapy during and after pregnancy to talk about what’s happening in their lives. Those who have a history of PTSD, depression, or other mental health conditions — or traumatic events that might be reopened during birth — should specifically have a mental health plan, argues Clover.

“Have a specific plan,” she said. “Have a therapist already.”

She suggests sourcing local phone numbers to call for help and talking with family members about what to do. “Be kind to yourself,” says Kimmel, something Clover agrees with. Birth trauma “isn’t anybody’s fault, but you can get help and there really is no reason to wait.” It’s better to have this information and not need it than to be in distress and not have it.