In the most severe cases, trauma related to childbirth can lead to posttraumatic stress disorder (PTSD) in the mother.

At the Paris Women’s Health Congress 2025, Ludivine Guérin, MD, child and adolescent psychiatrist at the Toulouse University Hospital, Toulouse, France, discussed key symptoms and proactive steps to support recovery in affected women and healthcare professionals who may also experience or witness traumatic births.

The birth of a child, which is expected to be the happiest day in a woman’s life, can sometimes turn into a nightmare. This does not necessarily involve a medically catastrophic delivery, yet it can leave a traumatic memory for the mother and sometimes for healthcare professionals. “A traumatic experience of childbirth, at least as perceived by the patient, occurs in roughly one quarter of cases, even when there has been no obstetric trauma,” he said.

From Obstetric Trauma to PTSD

In a session devoted to childbirth-related trauma, Guérin first clarified the relevant definitions. “Obstetric trauma refers to dystocic delivery, which you know well,” she told an audience of perinatal healthcare professionals. “The traumatic experience of childbirth refers to the patient’s subjective perception of her own delivery. Acute traumatic stress is the phase of shock experienced when a trauma occurs in the acute setting, which can then lead to PTSD.”

PTSD requires direct or indirect exposure to serious events. “There must be a threat to physical integrity, accompanied by intense fear, or repeated trauma, such as a childhood marked by abuse,” the psychiatrist explained. PTSD is diagnosed when symptoms persist beyond 1 month, including persistent negative changes in mood and cognition, hyperarousal with irritability, and autonomic stress reactions. “When these symptoms persist and disrupt daily life, we are dealing with full PTSD, but partial forms also exist, in which only some symptoms are present. Even partial forms can have potentially severe consequences in the perinatal period because they can affect the mother-infant relationship and increase the risk for depressive complications.”

The prevalence of postpartum PTSD varies widely among studies. Strictly defined PTSD occurs in approximately 4% of the general population after childbirth. When partial cases are included, the prevalence can reach up to 15%, with a substantial comorbidity of perinatal depression. However, PTSD rates in high-risk groups are much higher, at approximately 19%.

Risk situations include emergency cesarean delivery, postpartum hemorrhage, prenatal disclosure of fetal malformation, and a personal history of childhood abuse. “A history of trauma, particularly childhood or sexual trauma, is a major risk factor for traumatic reactivation during childbirth,” Guérin noted. Severe vomiting during pregnancy is a major risk factor for postpartum PTSD. An obstetric-specific PTSD screening scale is available to help clinicians identify and assess distress after childbirth.

PTSD may also affect fathers, “but this is not well described during the perinatal period,” Guérin added.

What is the typical evolution over time? A 2018 study of 226 women who experienced traumatic childbirth found resilience in 62% of cases, acute stress followed by recovery in 18.5%, and chronic or delayed-onset PTSD in approximately 20%. “What is interesting,” Guérin explained, “is that resilience was associated with fewer affective symptoms, such as anxiety, depression, stress, and heightened emotions during the first 4-6 weeks postpartum. In contrast, chronic or delayed PTSD was statistically associated with prior traumatic experiences and low satisfaction with the care provided in the maternity ward.

What Clinicians Can Do

Guérin advises obstetric care teams to regularly check in with affected women, focus on pain relief, and avoid triggers that may recall traumatic delivery. “What is important is to listen to the patient, validate her emotions, and legitimize her experience,” she said. Attention should also be paid to the partner, and sleep support is essential when insomnia or nightmares occur. Clinicians should consider the value of asking open-ended questions after childbirth. Even a delivery considered clinically “successful” may be traumatic for the patient.

“What is therapeutic and calming, in my experience, is being taken seriously by the midwife, the anesthesiologist, and the clinician who followed the pregnancy, especially when parents feel anger,” she added. Referral to psychological or psychiatric care should be individualized and based on an established network with follow-up after consultation.

Guérin cautioned, “What should be avoided is trivializing the patient’s experience with comments such as ‘but you have a beautiful baby,’ justifying care using medical jargon that is often poorly perceived, or immediately suggesting psychiatric referral.” Introducing psychological explanations too early may also be misinterpreted. Likewise, overly intrusive interviews searching for childhood trauma or preexisting psychological vulnerability are not helpful and may even be harmful at this stage. Psychological consultation should be framed as support to feel well or possibly better, not because things are expected to deteriorate. “Information based on protective factors is far more useful than information based on risk,” she said.

Management includes regular follow-up visits until physical recovery is achieved. Treating anemia and fatigue is also important because both are risk factors for depression and anxiety. Later, visits to maternal and child health services can provide valuable support for mother-infant relationships.

Specialized perinatal psychiatry services, whether outpatient, day hospital, or inpatient, for severe bonding disorders can treat and prevent depression and disturbances in parent-child interactions.

More specifically, antidepressants, such as selective serotonin reuptake inhibitors, may be prescribed for trauma. “Paroxetine and sertraline are compatible with breastfeeding and are particularly recommended for PTSD,” Guérin said. Eye movement desensitization and reprocessing may also be helpful in this regard. In contrast, benzodiazepines are contraindicated after trauma because they may consolidate traumatic memories. Low-dose chlorpromazine may be administered during breastfeeding.

Finally, the resilience of healthcare professionals, particularly midwives, can be overwhelmed, particularly after highly traumatic delivery. This is even more likely when medical errors have severe consequences, when the situation echoes a clinician’s own childbirth experience, or when there are preexisting vulnerabilities. Prevalence studies in obstetrics report partial PTSD symptoms in 15%-50% of healthcare professionals. “It is therefore essential to screen for and treat these symptoms, not only for the health of the clinician but also for the quality of patient care,” Guérin concluded.

This story was translated from Medscape’s French edition.