Can a Traumatic Birth or NICU Stay Cause PTSD?
September is NICU Awareness Month, which is as good a reason as any to say something I don't think gets said enough.
A hard birth can be a trauma. A NICU stay can be a trauma. Not "stressful." Not "a lot to process." Trauma, in the clinical sense, with symptoms that can last for years if nobody treats them.
I’m a trauma therapist who treats PTSD every day. I’m also the proud sister of an incredible NICU nurse who tells me stories regularly about stressful experiences, incredible infant survivals and devestating infant losses.
But first, I'll start with my own birth story, partly because it's a good example of how low the bar actually is for what a person can experience as “trauma.”
My birth story was not the worst one. It still shows up.
With my oldest, I'd hoped for an unmedicated birth. I hadn't prepared enough for that, and when the time came I asked for an epidural.
The needle went through the epidural space. The doctor briefly mentioned afterwards that this could lead to something called a spinal headache and to let someone know if that happens.
Labor itself wasn’t what I expected. I was shaking uncontrollably even though I wasn't cold, and I was throwing up, though after a full pregnancy of hyperemesis that part wasn't a surprise. My husband at the time was in nursing school with a major exam, so he couldn't stay overnight at the hospital as he needed to study for an upcoming test. My mom stayed with me instead.
Before they'd let me go home, I had to prove I could walk down the hall. They even put my baby in the nursery at the far end to motivate me.
About four days later, the spinal headache started. The hospital told me I'd need a blood patch, and suggested I wait until the ER was less busy, since I'd be there a while either way. So we waited, and called periodically to check.
That next day is the part I still see clearly. Standing up was unbearable, so I stayed in bed and my family brought the baby to me to nurse. I crawled to the bathroom rather than stand. My sister helped me hand express enough milk for one bottle. When they finally told us the ER wasn't busy, my mom drove me, and my sister stayed with the baby.
I watched my son take his first bottle over FaceTime from a hospital room in the ER.
I want to be clear that I know this isn't the worst birth story. I've sat with clients whose births were far more frightening than mine. I have friends who nearly died and have sat with moms who did lose their baby. By those standards I was lucky, and I know it.
And yet, more than a decade later, I still remember all of it and it showed up often when I was pregnant and giving birth to my second child.
What makes a birth traumatic?
Not the medical severity, or at least not only that.
What tends to make a birth traumatic is some combination of real or perceived threat to you or your baby, helplessness, pain you weren't prepared for, and the feeling that you weren't being heard or weren't in control of what was happening to your body.
That's why two women can have nearly identical charts and walk away with completely different experiences. One felt informed and supported through something hard. The other felt like it was happening to her.
Estimates suggest up to a third of women describe their childbirth as traumatic. That doesn't mean a third develop PTSD. But it does mean this is not a rare, unlucky thing that happened to you specifically.
How common is trauma after a NICU stay?
More common than most parents realize.
A meta-analysis pooling 56 studies and just over 6,000 parents found post-traumatic stress in roughly 40 percent of parents within a month of their baby's admission, and anxiety in about 42 percent. What struck me most was what happened later. Between one month and a year, post-traumatic stress was still around 24 percent. More than a year out, it was about 27 percent.
It doesn't just fade because your baby came home healthy.
And this holds for fathers and partners too. There's less research on them, which is its own problem, but what exists says they're carrying it as well.
Why don't we call it trauma?
Because of the sentence almost every mother says some version of:
"I should just be grateful my baby is okay."
I understand that. Your baby is okay, and you are grateful, and that gratitude is completely real. Here's the problem. Gratitude and trauma are not opposites. You can be genuinely thankful your child is healthy and still have a nervous system that logged those days as a threat.
When the only acceptable emotion is gratitude, everything else goes underground. And feelings that go underground don't resolve. They just stop getting talked about.
The NICU version of this is even stronger, because the comparison is right there in the room. There's always a baby in worse shape down the row. So you tell yourself you have no right to be struggling.
You do.
Why does this come back during the next pregnancy?
A previous difficult birth is a known risk factor for trauma symptoms in a later pregnancy. The perinatal trainings I've attended teach exactly this, and it's what happened to me. The second time around, the memories from the first one came back up.
For some women it shows up as dread as the due date approaches. For some it's a full reluctance to have another baby at all. I went through a stretch of not being sure I wanted to, because the pregnancy and birth had been that hard on me.
The other pattern I see: birthdays. There are women for whom their child's birthday is also the anniversary of the day they nearly died. That's a strange, lonely thing to carry while you're frosting a cake.
What actually treats birth trauma?
The same things that treat other trauma, because this is trauma.
EMDR and Cognitive Processing Therapy both have strong evidence behind them, and both work well here. CPT tends to be a good fit when you're stuck on the meaning of what happened, the self blame, the "I should have advocated for myself," the "I should be over this." EMDR tends to be a good fit when the memory itself still feels physically present, when a hospital smell or an alarm sound puts you right back there.
Which one makes sense depends on you, and it's something you'd decide with your therapist rather than before you walk in. We assess first and build a plan rather than assigning everyone the same protocol.
One thing I'd look for, whoever you see: someone who knows trauma treatment and has at least a working understanding of maternal mental health. A therapist who doesn't understand what a NICU stay or a complicated delivery actually involves will spend your sessions getting up to speed. And a therapist who understands birth but isn't trained in trauma treatment may listen supportively for a year without the symptoms shifting.
You want both.
If you need support right now
If you're having thoughts of ending your life, call or text 988 for the Suicide and Crisis Lifeline.
The National Maternal Mental Health Hotline is available 24/7 at 1-833-TLC-MAMA (1-833-852-6262), in English and Spanish.
Postpartum Support International runs more than fifty free online support groups, including one specifically for NICU parents and one for parents who have experienced pregnancy or infant loss. Their helpline is 1-800-944-4773, and you can call or text it. It's for support and resources, not emergencies, so use 988 or 911 in a crisis.
Trauma Therapy Online, in Columbia and Lee's Summit, MO
If you've been carrying a birth or a NICU stay that you've never really talked about, that's treatable. It doesn't require years of therapy, and it doesn't require you to decide first whether your experience was "bad enough."
Trauma is what our practice does. We see clients in Columbia and Lee's Summit, and throughout Missouri with online therapy, which tends to be a lot more realistic when you have a baby at home.
Call 573-328-2288 for Columbia or (816) 287-1116 for Lee's Summit and our client care team will help you find the right fit.
Whenever you're ready for effective care and lasting change, we're here.
About the Author
Jessica Oliver, MSW, LCSW is the founder and clinical director of Aspire Counseling.
Trauma is the center of her clinical work. She has advanced training in EMDR and in Cognitive Processing Therapy, and she has sat with a lot of women who spent years assuming their birth experience didn't count as trauma because their baby came out fine.
She writes about this one from both chairs. The story above is her own, and she is aware that it is far from the hardest birth story out there. That is rather the point.
She leads a team of therapist who specialize in trauma therapy, some of whom particularly enjoy working with new moms and have experience helping moms who experienced traumatic births. She believes moms deserve to have their story acknowledged, understood and to work through what happened.
Sources:
Pooled prevalence of anxiety and post-traumatic stress among parents of babies admitted to neonatal units: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713115/
Acute and post-traumatic stress symptoms in mothers and fathers following childbirth: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783161/
