Birth trauma: the woman’s perception of the birth is key

What is birth trauma?

In addition to physical injuries that occur during the birth process and are referred to as birth trauma, the subjective, traumatic experience of birth can also lead to psychological birth trauma.

What causes trauma during birth?

Psychological birth trauma arises from intensely stressful feelings and reactions during labour. Around 20% of births have a significant impact on a woman’s mental health and well-being, and about 10% of mothers develop stress-related reactions in the first few weeks after delivery.

Common triggers for birth trauma include:

Violence during childbirth

Physical or emotional violence can also play a significant role in birth trauma.

Physical violence

• Rough handling during medical procedures
• Procedures performed without consent (e.g. an unplanned caesarean section)
  

Emotional violence

• Verbal abuse, such as shouting, insults or derogatory remarks
• Ignoring the mother’s wishes and needs
• Exercising pressure or making threats
  

How do women experience birth trauma?

What matters most in the development of trauma is how a woman perceives her birth experience. Rahel shares her story.

Processing a stressful birth experience

Rahel had hoped for a vaginal birth for her second daughter, but when her baby’s heart rate dropped during labour, the doctors decided on an emergency caesarean. It was only later that Rahel fully realised how critical the situation had been – that both her life and her baby’s had been at risk. What still troubles her is what happened afterwards. “I wasn’t able to have my daughter with me after the birth, so we couldn’t bond.” This was a traumatic experience for Rahel. Due to repeated breathing pauses, her baby was transferred from neonatal care to intensive care. Meanwhile, Rahel was unable to be moved due to severe internal injuries. Otherwise, she says, she would have insisted on staying with her daughter. To process her experience, Rahel found it invaluable to connect with others who had been through similar situations, which is why she wanted to join a birth trauma support group.

Preventing birth trauma

Dr Werner Stadlmayr is a consultant in gynaecology and obstetrics, and a specialist in psychosomatic medicine, who uses a range of measures with his patients to help prevent birth trauma. Among other things, he likens the birth process to a long, challenging hike. "At first it may seem overwhelming but, as time goes on, the woman finds her own rhythm, focuses on her breathing and moves forward step by step. She can turn inward. External support is on hand and she’s being cared for."

Address your own wishes and fears

Dr Stadlmayr emphasises the importance of helping women develop and strengthen agency during childbirth. Concerns, fears and uncertainties should be openly discussed, for example. Whether alone or in discussion with others, this allows women to reflect on what might help them during labour and what kind of support they do or don't want. This mental preparation can make it significantly easier for them to contribute to any discussion or decision during the birth.

Involving partners: a valuable source of support

Including the woman’s partner in the process is key. But calmness is called for. Only partners that feel relaxed can offer optimal support. And it's this support that creates a sense of unity, which can be deeply reassuring and healing for both parents.

The relationship between the mother and midwife is also important and, if required, the doctor can help strengthen this bond. Intuitive action is often enough, but sometimes it helps to address the issue directly and engage with both sides, says Dr Stadlmayr.

Start with gentle approaches

He also strongly recommends beginning with gentler pain relief methods tailored to the mother’s preferences – such as a warm bath. If these don’t provide sufficient relief, stronger options like a patient-controlled analgesia (PCA) pump or, as a last resort, an epidural (PDA) can still be considered.

Balancing medical responsibi­li­ty with subjective experience

Dr Stadlmayr highlights the highly subjective nature of birth experiences, which makes it challenging to incorporate birth trauma prevention into medical training. There are no parameters for such highly subjective levels of psychotraumatisation.

"What I experience with patients is one thing. What I do is another. The same action can be interpreted in completely different ways: One woman may find it intrusive, while another may accept and integrate it. The difference often lies in how the action is carried out."

Finding support and processing birth trauma

Trauma means that a gap exists between the event and the sufferer’s current state. What’s missing are the events in between. This is why it's particularly important in therapy to create the narrative by going through the events step by step and understand what happened and why. This process of working through the birth trauma is essential for healing.

There are various support options available for women with the condition.

Psychotherapy

Trained professionals are available to support women dealing with trauma. By offering trauma therapy, they help women process their experiences, integrate healing methods and accelerate the recovery process.

Midwives and birth professionals

Many midwives also provide postnatal care and emotional support. They can be a first point of contact for processing a traumatic birth and can refer women to specialists if needed.

Specialist networks

The Schweizer Netzwerk Verarbeitung Geburt (Swiss Network for Birth Processing) provides addresses of trained professionals who can help women work through their birth trauma.

Support groups

Talking to other mothers who have had similar experiences can be extremely helpful. This is where local self-help groups can provide valuable support. Rahel Rupp, who shared her story, has also set up a self-help group for birth trauma.