How Birth Trauma Can Impact Your Fourth Trimester Experience—and How to Cope
Written by Guest Blogger Emily Guarnotta, PsyD, PMH-C, Co-founder of Phoenix Health
The Fourth Trimester
The fourth trimester is the time between birth and 12 weeks postpartum. It’s a critical period where a new mother is recovering from birth, both physically and emotionally, and getting to know her new baby. She’s also going through matrescence, which is the process of getting to know herself as a mother, a new role she has never experienced before.
In an ideal world, childbirth goes smoothly with no complications. A mother goes into labor, seeks care from a provider of her choosing, follows their agreed upon birth plan, and a healthy baby arrives. Unfortunately, this is not the reality for around 45% of mothers who experience a traumatic birth. Like other forms of trauma, birth trauma can have a significant impact on a woman’s life, including her transition into motherhood and her experience of the fourth trimester.
Understanding Birth Trauma
Birth trauma is the suffering that you experience after a birthing event marked by fear, anxiety, and/or a lack of support. Often the birth is life-threatening to the mother or baby, but this is not always the case. The experience of trauma is unique to each person. What is traumatic for one person may or may not be traumatic for another person.
Certain events during birth increase the risk of trauma, including:
Having an unplanned or emergency c-section.
The use of forceps or other unwanted interventions.
Any form of injury to mother or baby.
A sense of not being heard or supported during birth.
A NICU stay.
Birth not going according to plan.
Experiencing a traumatic birth increases the risk of developing post-traumatic stress disorder (PTSD). PTSD is a mental health condition that involves symptoms like:
Unwanted thoughts and memories of the trauma.
Avoidance of reminders about what happened.
Feeling more irritable and on-edge.
Feelings of anger, guilt, sadness, or self-blame.
PTSD can happen to anyone that experiences any form of trauma. But mothers with PTSD are at heightened risk of other perinatal mental health conditions, like postpartum depression and anxiety. Experiencing birth trauma, therefore, increases the likelihood that women will experience mental health concerns during the fourth trimester.
How Birth Trauma Affects the Fourth Trimester
The focus of the fourth trimester is physically and emotionally recovering from birth, while also getting to know your baby and becoming more comfortable in the role of mother. If you’ve experienced birth trauma, the fourth trimester may feel even more challenging.
After a traumatic birth, you may feel like you have unresolved trauma. However, there is probably no time to process what has happened. During the fourth trimester, you are caring for your baby around the clock, navigating nursing, sleep deprivation, and physical discomfort. The intrusive thoughts and memories of what happened may come up at the worst times, like when you are trying to sleep.
Birth trauma can make mother-infant bonding especially difficult. Mothers who have had a traumatic birth and develop PTSD have more trouble bonding with their babies. This can be heartbreaking and cause mothers to feel a lot of guilt and shame. They may feel like they are failing in their roles.
Trauma can also cause people to want to isolate themselves. This is a problem because the fourth trimester is when you need a lot of support with physical tasks, like caring for your baby, as well as emotional support and encouragement. If you’re isolated from family and friends, it’s going to be harder to manage the demands of this time.
Tools for Coping with the Fourth Trimester and Birth Trauma
If you’ve had birth trauma, then there are steps that you can take to cope in the immediate weeks postpartum. Nearly half of women experience a traumatic birth, so you’re not alone. Here are some recommended actions:
Acknowledge what you went through
We have a tendency to downplay our trauma, but this almost always makes us feel worse and fuels guilt and shame. If something scary, unexpected, or unwanted occurred during childbirth and you’re feeling distressed by it, then allow yourself to acknowledge what happened. All too often, we judge ourselves for our feelings, which causes more distress. Instead, accept that you had a traumatic experience and allow yourself to feel your emotions.
Use grounding and mindfulness techniques
Mindfulness and grounding are effective tools to reduce distress, anxiety, and symptoms of PTSD. These techniques can help when you are in distress and can also be used as daily practices to help you feel more calm and grounded. You can even squeeze in grounding and mindfulness during your baby’s nap.
There are many different ways to practice grounding and mindfulness, but new mothers may find the following helpful:
Listen to a guided meditation online.
Practice deep breathing by taking a long inhale through your nose for four seconds, holding briefly, and then exhaling through your mouth for six seconds.
Take a walk with your baby and notice what you see, hear, feel, taste, and smell.
Connect with supportive people
Having social support and connection with others can help reduce the risk of perinatal mental health conditions and can help mothers who are suffering recover. If you have supportive people in your life, consider reaching out to them. This can be difficult if your trauma makes you want to isolate. But remember that you are likely to feel better after reaching out.
If you don’t have a good support system, there are some different ways that you can connect with other parents. You could attend a local moms group or mommy-and-me class. You may be able to find one at your local library or by doing an online search in your area.
If you are looking for a safe space to open up about the challenges of motherhood, you could benefit from attending a support group. There are many support groups available through Postpartum Support International and other organizations to connect mothers who have experienced birth trauma. You can also find other trauma-informed support groups on our resources page. It can feel uncomfortable to attend these groups at first, but these are supportive, non-judgemental spaces for people who have all experienced similar things.
The Benefits of Trauma-Informed Treatment
PTSD is a mental health condition that often requires treatment. Just like a broken leg requires a cast, an expert should treat PTSD.
Trauma-informed care is a treatment that considers how a person’s life experiences are impacting their symptoms. Providers who practice trauma-informed care acknowledge the impact of traumatic events and take extra steps to ensure that they are not re-traumatizing their patients.
There are specific therapies available to help mothers who have experienced birth trauma. These include:
Trauma-focused cognitive behavioral therapy (TF-CBT): This type of therapy helps you identify and change your thoughts about the trauma.
Eye movement desensitization and reprocessing (EMDR): EMDR therapy involves processing a traumatic memory while a therapist guides you in bilateral stimulation, such as side-to-side eye movements.
Trauma-focused expressive writing (TF-EW): This form of therapy has you create a narrative about your birth by talking through and writing your thoughts and feelings about the traumatic event, to help you make meaning of your experience.
Final Thoughts
When you are seeking treatment for birth trauma, it’s important to work with a provider who has experience and training in this area. Perinatal mental health conditions like PTSD due to birth trauma are complex, so you will want to work with a provider who has both a background in trauma, as well as perinatal mental health. Some providers are certified in perinatal mental health, which means that they have additional training and experience in this area and have passed an exam. They are also required to continue attending trainings to learn about the most up-to-date approaches when working with perinatal clients. Therapists who have this certification will have the letters “PMH-C” after their name. When looking for a therapist, don’t hesitate to ask about their experience and training, or use the Trauma-Informed Maternal Health Directory.
The fourth trimester is a challenging time for most mothers. When you add having a traumatic birth on top of it, it can be even more difficult. If you’re having a hard time recovering from your birth experience, try to acknowledge your feelings without judging them, use grounding, mindfulness, and other healthy coping skills, and connect with a support system. If you are experiencing symptoms of PTSD or another perinatal mental health condition, then seek trauma-informed care.
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Guest Author: Dr. Emily Guarnotta, PsyD
Dr. Emily Guarnotta is a licensed clinical psychologist and certified perinatal mental health provider. She owns Phoenix Health, a therapy practice that supports anyone experiencing infertility, pregnancy loss, and perinatal mental health concerns.
About the Trauma-Informed Maternal Health Network
Liz Gray, LCSW and Olivia Verhulst, LMHC, PMH-C are the co-founders of the Trauma-Informed Maternal Health Directory. They are clinical psychotherapists with a deep passion for increasing accessibility of trauma-informed care to the maternal health population. They created this specialized directory to connect women experiencing infertility, pregnancy, postpartum, and new parenthood to trauma-informed health and mental health providers.
Search the directory: https://directory.maternaltraumasupport.com/
Interested in writing a guest blog post?
If you are a trauma-informed provider who works with the perinatal population, submit a blog proposal HERE!
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