The morning I speak with Liz Elliott, a 37-year-old mom of one from Chicago, it's her daughter Addie's six-month birthday. She just posted a side-by-side photo to Instagram: the shot on the left is one of herself 37 weeks pregnant; on the right, it's her and her daughter smiling in the mirror that morning. The caption reads: "Six months ago today I woke up pregnant and was a mommy by 5 p.m. and today I am holding my six month old." If you saw it, it's the type of photo that you'd likely heart and comment well wishes on.
But for Elliott the photo on the left is heavy. "I took it the morning before it all happened," she says. "Of course, it's such a happy memory, but then I shudder thinking, 'Oh God, this poor girl in this picture had no idea what was going to happen that afternoon."
See, Elliott is one of the upwards of 45 percent of women who feel as though they had a traumatic birth experience. While about 4 percent of women experience post-traumatic stress disorder (PTSD) due to giving birth—18.5 percent for those already at higher risk for the condition—many more simply describe their birth as traumatic.
The problem: For women like Elliott, there can be an enormous amount of shame and guilt surrounding birth trauma (is my trauma justified? Is it truly trauma? Am I entitled to these feelings?)—and it's enough to keep many parents silent with their stories.
"I've never sat down and told everyone all the details of my story," says Elliot. "Even my husband—I have told him a lot, and he was obviously with me that day, but, you know, I haven't told him that sometimes when I'm in the shower, I have flashbacks about the birth."
There's a lot of misinformation out there about birth trauma. And if you feel as though your birth was traumatic, you don't have to silently struggle or feel as though your trauma isn't legitimate. Here is what birth trauma is, its potential effects, and how to cope.
What is Birth Trauma?
Traumatic birth doesn't mean delivering a stillborn or having a panic attack on the delivery table (though it certainly can). "Trauma is in the eye of the beholder," explains Cheryl Tatano Beck, DNSc, CNM, FAAN, a distinguished professor at the University of Connecticut's School of Nursing and one of the leading experts on birth trauma.
"What's most important is how a woman classifies it and experiences it," adds Paige Bellenbaum, LMSW, founding director and chief external relations officer of The Motherhood Center of New York. (Read: What you experience and classify as trauma might not be the same as what another person experiences and classifies as trauma.)
The majority of birth trauma cases that Dr. Beck sees are ones where, as she puts it, "if a typical clinician looked at their record, they would never dream that that woman could have perceived the birth to be traumatic."
Bellenbaum also notes that a lot of people relate to feeling that they had a traumatic birth with their first birth. "I think there's a lot of significance in that because as a first-time birthing woman, we have no idea whatsoever what it's actually going to be like. Oftentimes, women can walk away feeling as though they failed."
Talk to a person who feels as though their birth was traumatic and you'll also find that these births tend to have common core elements, Dr. Beck explains, with the main themes being a lack of caring, a lack of communication, and feeling stripped of their dignity. "[Many report that] once the birth is done, and if the baby's Apgar scores are great, nobody wants to hear about her experience. She gets pushed into the background while everyone celebrates the successful birth."
That was the experience for Elliott, who had what she describes as a "textbook pregnancy." Then, at her 37-week appointment, around 1:30 p.m., her doctor asked her if she had felt the baby move that day and she answered no. A stress test determined that the baby's heart rate had dropped and she was told—with little information—that she needed to head to the hospital. Her husband met her there and doctors rushed her into an emergency C-section.
"I probably had 15 minutes to process the fact that I was having a baby, that something was wrong, that I may not meet my baby, and that I wasn't having the unmedicated birth I had hoped for. I was not in a good place."
Upon delivery, Elliott's daughter was resuscitated and ultimately survived—her cord had been wrapped twice around her neck. Elliott didn't get to hold her baby. "At 5:01 p.m. they were cutting me open, at 5:21 p.m. I had her, and by 5:23 p.m., I was all alone in the room. The baby was gone, my husband was gone, and I was sitting there shaking alone on an operating table."
All throughout Elliott's fear that she wasn't going to meet her daughter, the expedited timeline, and time in a neonatal intensive care unit (NICU), not a single family member asked her how she was. "It wasn't that they didn't care, I think, it was more that they knew to be concerned with my daughter, not me. And in my situation, with my own mother being deceased, I felt very alone." Due to COVID restrictions, she spent days in the NICU alone, healing from a C-section, and struggling with her own memories. With the exception of two good friends who had also recently had their own traumatic births, she felt as though her experience was written off by those closest to her. "It was the worst thing that's ever happened to me for the best outcome," she says. "I expected a lot of support, but I honestly felt so alone and unsupported, and in some scenarios, ungrateful."
The message she got back from friends and family, she says, was mostly along the lines of this: Be grateful for what you have. And she was. But she also felt as though her birth was traumatic.
The Consequences of Birth Trauma
In 2015, Dr. Beck published a study called "The Ever-Widening Ripple Effect." It's a theory of traumatic childbirth that details all of the subtle (and not so subtle) ways birth trauma can impact a person, including PTSD and issues with breastfeeding.
"There is also a scientifically-proven direct correlation between the experience of a traumatic birth and a perinatal mood and anxiety disorder (PMAD)," adds Bellenbaum. "It's one of the leading risk factors that can lead to and contribute to anxiety and depression in the postpartum period."
Dr. Beck calls all of these consequences ripples—"all these different ripples just from a few minutes or a few hours of labor and delivery."
And the ripples can continue. For one: "The anniversary of birth trauma is really difficult for the woman," explains Dr. Beck, but "if you experienced birth trauma, your anniversary is a day of celebration for the baby's birthday." No one asks you how you're doing. And worse? You're told to put on a happy face and celebrate. "Sometimes women describe themselves as 'the great pretender,'" says Dr. Beck (you're smiling because you do want your baby to have the happiest birthday, but inside things are different).
Subsequent childbirth can be another hurdle, she says, with many finding another pregnancy to be full of panic, with the ever-looming question of whether or not the next birth will be traumatic or even healing, says Dr. Beck.
Elliott can relate. "She's the coolest thing I've ever done and I love being a mom," she says of her daughter. "But I don't know that I can do it again. I'm not sure I'm in it. I do know how lucky I am, but I can't shake it. It really broke something inside of me."
Ways to Cope from Birth Trauma
If you feel as though your birth was traumatic, there are ways to feel better. Experts suggest starting with these three:
Process your birth experience
Birth can be a whirlwind with little downtime to take in what just happened no matter what. But if you went through a traumatic birth, you might not feel as though you've had a chance to sit down and truly process the birth—or maybe you don't want to. But when you keep your experience inside, residual trauma can build without an outlet, worsening symptoms. "When we keep trauma inside of us, things can happen down the line that are very triggering," says Bellenbaum. For example, you might have flashbacks or see symptoms crop up every time you have to go to the hospital. Giving yourself space to process your birth—privately in a journal, with a trusted friend, or with a therapist (noting the good parts and the hard parts)—helps pave the path forward, says Bellenbaum.
Find that friends and family aren't allowing you to share your experience? Try saying something like, "I want to share with you that even though it might have appeared to others to have been a breeze, I feel like I just experienced one of the most difficult times in my life and I'm having a really hard time moving past that." You could also add something like, "I know that you want to be helpful. Right now, I just need you listen," suggests Bellenbaum.
See a professional
"In a lot of instances, birth trauma requires clinical intervention and treatment to help people feel better and move past it," says Bellenbaum. This is, of course, particularly true if you notice symptoms of PTSD (you have flashbacks, nightmares, feel emotional numbness at times, avoid things that remind you of the trauma, have a hard time sleeping, feel easily irritated, and more). It's important to find someone who specializes in perinatal mental health with expertise in PTSD from childbirth, birth trauma, or postpartum depression, notes Dr. Beck. Postpartum Support International's provider directory—which curates thousands of specialized professionals all over the world—is a good place to start.
Consider a postpartum doula
Many countries provide free postpartum doula support to birthing people. While the U.S. doesn't, if you feel comfortable having someone in your home and have the means to afford it, a doula not only provides an extra set of hands (to help care for you and the baby) but they are trained professionals who can provide the kind of one-on-one support parents need. Elliott, for one, feels as though she could have benefited from a judgment-free zone and more education—both of which a postpartum doula can provide. "There is a mom that has to take care of that baby and I feel like we fall out of the equation when the baby comes out," she says.