The impact of childhood trauma on pregnancy and childbirth: understanding and preventing traumatic reenactment in maternity care

When you think of childbirth you might imagine personal transformation, joy, and even empowerment. For many parents, this is true. But for individuals with a history of childhood sexual abuse (CSA), pregnancy and childbirth can kick up unwelcome reminders of past trauma. And because trauma healing is not linear, the journey to bring new life into the world can reopen old wounds.

I want to take you on a quest to explore the ways in which maternity care can reenact past abuse, even when care is provided with the best intentions. As a psychologist specializing in perinatal mental health and trauma, I have come to understand how inextricably intertwined a person’s trauma history can be with their experience of pregnancy and childbirth. Understanding this connection is critical for therapists working with women and pregnant individuals during this meaningful period of their lives.

Photo by Glitch Lab App on Unsplash

What do you think happens when the process of childbirth itself—the intimate procedures, the potential for perceived loss of control, the encounters with strangers—feels hauntingly similar to the past experiences of abuse? The answer can be found in a qualitative study conducted by Montgomery et al. (2015), where the experiences of nine women who had been sexually abused as children were analyzed to understand how maternity care can unintentionally mirror past abuse. Despite efforts to provide sensitive care, the study found that certain aspects of childbirth can still replicate aspects of past sexual abuse.

One of the most striking findings of this study was the role of intrusive medical procedures on triggering memories of abuse. For women who had been sexually abused, vaginal examinations—a necessary part of maternity care—could evoke feelings of violation and fear, even when the procedure was done with care. For example, one participant in the study shared that she felt violated during a routine examination, linking it directly to her childhood experiences.

What do you think happens when the process of childbirth itself—the intimate procedures, the potential for perceived loss of control, the encounters with strangers—feels hauntingly similar to the past experiences of abuse?

Pain is an inevitable reality of childbirth, and for women with a history of CSA, labor pain can disturbingly overlap with the emotional and physical pain they experienced during past traumatic events. In the study, several women described how the anticipated and experienced pain of childbirth transported them back to their abuse. One woman expressed fear that her childhood trauma memories would “get into her head” before she gave birth. Another participant reported finding herself unable to breathe during labor and delivery; a response that she later connected to her childhood abuse. In the throes of labor, her body remembered what her mind could not consciously hold. This research suggests that, for sexual trauma survivors, pain management in childbirth is not just about physical relief; it is about creating a space where they can feel safe and in control of their bodies.

It comes as no surprise that control is a central theme in both trauma and childbirth. For sexual abuse survivors, the legacy of their trauma often centers around the loss of control over their bodies. In childbirth, this loss of control can be re-experienced, particularly when medical interventions become necessary. Even pregnancy itself can make expectant parents feel disempowered. One of the participants in the study described feeling like the “baby was taking over” her body. Her words echo the experience of many trauma survivors who feel as though their bodies are once again being controlled by an external force during pregnancy. This loss of agency, combined with the medicalization of maternal healthcare and childbirth, can destabilize the expectant parent.

These research findings highlight why working with survivors during pregnancy requires a clear understanding of their trauma history and a sensitivity to how medical interventions can inadvertently trigger a trauma response. Trauma-informed providers and therapists alike must recognize how the body can remember past trauma. Even when the rational mind knows that a medical procedure is distinct from abuse, the body can respond as if it is the same.

In the throes of labor, her body remembered what her mind could not consciously hold.

What can be done to protect CSA survivors from re-experiencing trauma during pregnancy and childbirth? Building trust between healthcare providers and women with a history of CSA is essential. Montgomery et al. (2015) emphasizes the importance of creating a safe, respectful environment where women feel in control of their care. This might mean allowing them to make decisions about how procedures are conducted or ensuring continuity of care so that they can build a trusting relationship with their provider. Therapists working with pregnant women and individuals can prepare their clients for how pregnancy and childbirth might bring up traumatic memories and equip them with resources to navigate childbirth effectively. Therapists can also help women advocate for themselves during pregnancy and childbirth. They can support them in articulating their needs, setting boundaries, and ensuring that they feel empowered throughout the process. Trauma-informed care is not just about avoiding triggers; it’s about creating an environment where women feel safe, respected, and empowered.

If you’re a provider interested in learning more about birth trauma and recovery, I encourage you to take my Birth Trauma Recovery Training. Together, we can create a community of trauma therapists dedicated to supporting women through one of the most meaningful experiences of their lives.

References:

Montgomery, E., Pope, C., & Rogers, J. (2015). The re-enactment of childhood sexual abuse in maternity care: A qualitative study. BMC Pregnancy and Childbirth, 15, 194. https://doi.org/10.1186/s12884-015-0626-9

We need to start talking about birth trauma

Imagine this: there are two people in labor at the same time at a hospital. Both of them planned vaginal childbirths. But their labors didn’t go smoothly, and the well-being of their babies dictated that both undergo emergency caesarean sections.

Both ultimately delivered healthy babies, but that’s where the similarity of experience ended.

Their postpartum journeys were drastically different: One parent healed from the surgery and went on to enjoy the child’s infancy; the other healed physically but started having flashbacks shortly after leaving the hospital. She couldn’t hold her baby without reliving how scared she felt moments before the baby was first handed to her, after a hastily assembled emergency surgery, where medical staff were so focused on the task at hand that the patient felt like an object rather than the vulnerable, terrified person she was in that moment.

Birth trauma is widespread but cloaked in a stigmatized silence that prevents people from seeking treatment.

For a significant minority of people who give birth, the experience ends up more like the second scenario than the first one: as many as 45% of parents who went through labor -- laboring parents are primarily mothers, but not all people who give birth identify as women -- report that the experience was traumatic (Alcorn, O’Donovan, Patrick, Creedy, & Devilly, 2010). And 9% of people who give birth will go on to develop symptoms of post-traumatic stress disorder (PTSD).

Birth trauma, as defined by Cheryl Tatano Beck DNSc, CNM, is caused by an event or series of events during labor and delivery that involves the birthing person experiencing an actual or perceived threat of injury or death to the parent or unborn child -- or by a birth experience that leaves them feeling stripped of their dignity. Beck writes that “birth trauma lies in the eye of the beholder,” meaning that the parent may experience terror, helplessness, powerlessness, or horror while, from the perspective of medical staff or partners, the labor was uneventful.

Like the physical effects of childbirth, which are regularly underdiagnosed and treated, leaving new parents to suffer for years with treatable injuries, birth trauma is widespread but cloaked in a stigmatized silence that prevents people from seeking treatment. And without treatment, it has the potential to destroy the joy of the postpartum period with shame and self-blame.

By the time patients seek my help, they have been dealing with full-blown PTSD or other mood symptoms for months, even years.

As a trauma therapist specializing in perinatal mood and anxiety disorders, I see this all the time. By the time patients seek my help, they have been dealing with full-blown PTSD or other mood symptoms for months, even years. They talk about feeling like they were assaulted in front of their entire family during nonconsensual cervical exams, or of doctors deploying forceps with such force that they were dragged down the hospital bed. Other experiences that can cause birth trauma include a prolapsed cord, a baby needing the NICU, severe postpartum injury, like tearing or hemorrhaging, and a prior history of trauma, like sexual assault/abuse.

In fact, birth trauma has major similarities to sexual assault: both involve women feeling objectified, violated, stripped of dignity, and unable to escape. And – no surprise – both come with a tragic societal stigma around talking about the experience, which makes millions of people suffering from a common experience feel isolated and alone.

We need to continually push to destigmatize birth trauma to create a culture of nonjudgement and acceptance...

This shame-based silence is a tragedy, because both types of trauma are treatable with trauma therapies, which are especially effective if the trauma event is addressed early. Trauma therapy helps undo the painful sense of aloneness, helping people feel connected, and providing a window for them to reclaim their vitality. When taking care of a newborn, sleep-deprived parents need all the vitality they can harness.

We need to continually push to destigmatize birth trauma to create a culture of nonjudgement and acceptance, allowing sufferers to feel empowered to reach out for help.

If a new parent is experiencing flashbacks, a feeling of numbness, hypervigilance, or detachment, remember: it’s not your fault, and it doesn’t have to be this way. Help is out there.

About Us

At Center Psychology Group in New York, we specialize in providing compassionate and evidence-based therapy tailored to your unique needs. Whether you’re seeking EMDR therapy, Somatic Experiencing, or integrative trauma-informed psychotherapy, our experienced team is here to support you. Learn more about our services and how we can help you on the path to healing. Ready to take the next step in your healing journey? Book a free 15-minute phone consultation here.

5 things moms can do postpartum to support their mental health

(This post was originally published to AfterThird)

The perinatal period – which lasts from pregnancy until a year after childbirth – is a time of great psychological vulnerability, which has only been heightened due to COVID-19.

Approximately one in seven perinatal women will experience depression, anxiety or another significant mood concern. Postpartum depression and anxiety can occur anytime within the first year after the baby is born, but many women who suffer from this condition experience symptoms earlier, during pregnancy. And even before COVID, few of them got help.

“Only 30% of people who should be treated are treated,” said Ann Smith, CNM, the New York City coordinator for Postpartum Support International, which helps parents struggling with perinatal mood and anxiety disorders.

Perinatal mood and anxiety disorders are the most common complication of childbirth in the US, and no one should have to go through it alone.

It’s too early to quantify if more new mothers are experiencing perinatal mood symptoms because of the pandemic, but doctors who work with them say that the increased stressors have taken a toll, even though the movement toward online services has given many of these women easier access to sources of support.

“The biggest anxiety that I’m hearing about from moms is that they know their babies are really fragile when they’re first born and want to make sure they don’t do anything that could expose them to getting COVID-19,” said Priyanka Rao, MD, a board-certified pediatrician and instructor at the C.S. Mott Children’s Hospital in Michigan. In these unprecedented times, we cannot ignore that the psychosocial stressors borne from the COVID-19 pandemic have the potential to heighten the intensity of perinatal mood and anxiety disorders.

While parents adjust to life with a new baby, they are also learning to tolerate uncertainty about the future, the loneliness of social distancing, parenting older children who are attending virtual school, and maintaining partner relationships. Many parents have missed out on the normal rituals after childbirth due to social distancing (like baptisms or brises) and are coping with feelings of loss. It’s normal to feel some level of anxiety about all of this.

But when anxiety becomes excessive, it can interfere with overall wellness and functioning. Some signs that’s happening include:

And no matter how you’re feeling, know that it’s temporary, and that support is available.

When any of these things feel overwhelming, consider seeking professional help, anything from private therapy to support groups that you can now attend from home while maintaining social distancing. PSI, for example, holds support groups every weekday. Or, if those steps feel too overwhelming, talk to your child’s pediatrician, since you’re guaranteed to see them regularly.

“For a lot of families, the only reason they’re leaving the protection and bubble of their home is to come to the pediatric office,” Dr. Rao said. “I’m not a mental health professional or an OB-GYN, but I do know how to help moms connect to resources if I start to notice signs or symptoms that have me concerned.”

Besides reaching out for help, there are things postpartum mothers can do to help stave off depression and anxiety going forward. They include:

And no matter how you’re feeling, know that it’s temporary, and that support is available. Perinatal mood and anxiety disorders are the most common complication of childbirth in the US, and no one should have to go through it alone.

Other resources for new parents include: