Understanding Trauma of the Perinatal Period

Estimates show that upwards of 20% of the population is impacted in some way by issues surrounding pregnancy and birth, including:

• Traumatic birth

• Perinatal trauma 

• Infertility 

• Pregnancy loss

• Stillbirth

• Postpartum Depression

• Postpartum Anxiety

For a very long-time women’s suffering around pregnancy complications and birth trauma were invisible and ignored.  More recently, society has begun to recognize the widespread prevalence and significant impact of these experiences.  We have learned that support may be needed at any stage of the pre or post-natal experiences, from the challenges of getting pregnant, pregnancy loss, complicated or unexpected birth experiences, to post-partum trauma, anxiety, or depression.  

In general, trauma therapists have seen an overall increase in referrals for perinatal trauma since the COVID pandemic.  During COVID a light was shone on the impact of perinatal challenges on mental health and finally more women began seeking support (but still a fraction of those who need it).   It’s important that this message of support continues to spread, and we encourage women to get the support they need through what may likely be one of the most challenging times of their lives.   

About Perinatal Trauma, Pregnancy Loss, and Infertility.  

Perinatal trauma is a term used to describe traumatic experiences that women go through around and during the birth experience.  This can include traumatic childbirth where Mom and/or Baby are in danger, experience significant complications, or have severe medical issues.  These experiences often have a theme of fear and tackling the unexpected or unknown.  Studies (BioMed Central) (World Health Organization) have shown that around 20% of women experience some form of mental health issue during the perinatal period, with trauma being a significant contributing factor. 

Pregnancy loss is more common and more impactful than most realize.  According to studies (BioMed Central) (World Health Organization), between 10-20% of recognized pregnancies end in miscarriage, and 1% in stillbirth.  These experiences are frequently linked to symptoms of depression, anxiety, and PTSD.  The experience of pregnancy loss takes an emotional toll, which is often influenced by societal expectations and the invisibility of grief, leading to feelings of isolation and inadequacy. 

Infertility research (BioMed Central) (World Health Organization) suggests that it affects about 10-12% of couples.  The stress associated with infertility can be temporary or chronic, and impact a wide range of mental health issues, such as depression, grief, anxiety, and shame.  The experience of infertility often involves a cycle of hope and disappointment, invasive medical procedures, and significant financial sacrifices, which all contributes to the emotional burden.  

AREAS OF IMPACT and FOCUS FOR HEALING

Issues of infertility, pregnancy loss, and perinatal trauma are not necessarily considered “single incident trauma,” meaning that, more often than not, the trauma is complicated and multifaceted.  Treatment approaches need to consider all aspects of impact to reduce symptoms of depression, anxiety, or trauma:  

Where to focus treatment: 

1. The EMOTIONAL TOLL of the experiences.  

This focus is on the emotional experiences of parents during any and all traumatic moments, including those of loss, disappointment, fear, panic, self-blame, terror, or hopelessness.  For many women, there will be numerous points of disturbing emotion throughout the experience.  Treatment may include trauma reprocessing (such as EMDR) to assist with the desensitization of these memories, as well as to shift to a more adaptive perspective of the events and their meaning. 

2. Shifts in IDENTITY or sense of self.  

Often experiences of perinatal trauma, infertility, or pregnancy loss will lead to a questioning of identity (our beliefs about ourselves and understanding about who we are).  During and following pregnancy loss or still birth, for example, we may question whether we can consider ourselves a “mother” and how to integrate memories around the pregnancy experience into our self-narrative.  Other common, maladaptive shifts in identity may include a sense of betrayal or distrust of the body, self-blame (something I did or to cause these complications), and/or an overall sense of being devalued as a woman.  These shifts in identity can result in shame and a sense of being isolated.  

3. MEDICAL TRAUMA including emergency or unexpected procedures, significant shifts from birth plan, or negative experiences within medical systems and with providers.  Negative medical experiences include traumatic components such as, not having a voice/choice, not being included in decision making, being told contradictory things by different providers, lacking trauma-informed practices or policies, insufficient options, and mistakes made.   Since mothers and babies (particularly those with complications) will need ongoing medical check-ups and care, this medical trauma can continue to negatively impact these experiences for years following birth.  

4. LOSS OR DISCONNECTION IN RELATIONSHIPS.

Experiences of infertility, pregnancy loss, and perinatal trauma often contribute to a sense of isolation or disconnection from others.  Women often describe this as not being seen or no longer being understood by those around them.  The trauma is often minimized by society with an implied expectation that grief should be minimal and private, leading to increased isolation and lack of belonging.  To make matters more difficult, for those who have experienced one of these complications, trauma triggers are everywhere.  You really can’t go anywhere, read anything, or watching anything without constant exposure to parenting, babies, pregnancy, or children.  Though some express shame around these triggers, they are completely reasonable considering the pain and suffering one has undergone in these experiences.  

THERE IS HOPE.  

Therapy, such as Eye Movement Desensitization and Reprocessing (EMDR), can address all 4 aspects of impact – emotional toll, medical trauma, shifts to identity, and relationship factors.   

Therapy can help…

• Reduce the emotional distress associated with the traumatic memories

• Help integrate the experience into a more adaptive self and world perspective

• Reframe negative beliefs and perceptions associated with the traumatic events

• Reduce symptoms of isolation, depression, anxiety, panic, and PTSD

• Help clients to achieve a more connected, integrated, and positive sense of self

Now more than ever, therapists are able to access and participate in education and advanced training on how to treat people experiencing pregnancy loss, infertility, and perinatal trauma, leading to better outcomes! 

Seeking support?  Look for a therapist who explicitly works with women’s issues and/or perinatal trauma.