Shining a light on PTSD after child birth

Agnieska has come in for her postnatal check with her baby. The baby check is fine, but you have noticed Agnieska has been quite subdued throughout. You gently enquire how things are at home - ‘OK’. Is she getting enough support? ‘Yes’. She appears flat and seems low in mood.

What’s going on? Is she depressed? Or could we be missing something else? The unintelligible maternal discharge letter makes some reference to a delayed second stage, but otherwise makes no comment that there had been any problems with the birth. Could her birth experience be relevant, and could Agnieska actually be suffering from childbirth-related PTSD?

Question. What is the leading cause of maternal death in the postnatal period? VTE? Sepsis? Wrong - it’s suicide. The 2025 MBRRACE (Maternal confidential enquiries into deaths), which reviewed data from 2021-2023, had some stark findings. In the postnatal period (from 6 weeks to 1 year after delivery), suicide was the leading cause of death (18%). 

Whilst I’m sure most of us are well attuned to looking out for signs of postnatal depression, how good are we at considering childbirth-related PTSD (CB-PTSD)? I suspect less so. This was highlighted in an excellent BJGP article last month (Diagnosing in the dark: the childbirth-related post-traumatic stress disorder GP evidence gap - BJGP 2026; 76 (770)).

What is CB-PTSD and why is it important?

The BJGP nicely summarises that a diagnosis of CB-PTSD ‘requires the presence of a traumatic event or events related to pregnancy, birth, or the postnatal period, accompanied by symptoms of re-experiencing, avoidance, hypervigilance, and negative cognitions and mood for at least 1 month’. Importantly, we need to remember that birth trauma is subjective - what the medical profession may deem a ‘medically uncomplicated birth’ may not be the experience of the mother.

CB-PTSD can have a devastating effect on the mother, her ability to care for her child, and the wider family. The MBRRACE report highlights CB-PTSD as one of a number of contributors to maternal suicides. But this is only the tip of the iceberg, with many more women suffering with CB-PTSD.

The obvious time to assess for CB-PTSD is the 6-8 week postnatal check, but BJGP highlights the challenges we face assessing for CB-PTSD in this appointment - there’s a lot to do in this consultation, and it’s doubly tricky to assess the mother’s mental health if her baby is voicing disgruntlement at having their baby grow whipped off for the baby check. Alongside these symptoms of CB-PTSD may overlap with other mental health problems, and there is no validated screening tool. Importantly, antidepressants may have limited effect in CB-PTSD.

So, what can we do to assess for CB-PTSD and support mothers who may have it?

Many mothers find disclosure of birth trauma (or mental health problems in general) difficult. Whilst no validated screening tools exist for CB-PTSD, there are two very simple open questions we can ask. Anyone who has been on our excellent Women’s Health course, run by Dr Steph DiGiorgio, will be familiar with these:

• How are you finding being a mum (again)?
• Tell me about the birth.

These simple questions are a great way to start to explore any difficulties the mother may have had during/after the birth and possible symptoms of CB-PTSD. What do we do if we think the mother has CB-PTSD, will be largely dependent on your local services. The BJGP article bemoans the lack of support for primary care in this area, that we are constantly being asked ‘to do more with less’, as well as highlighting limited access to specialist services. Ideally, women with CB-PTSD would have access to a perinatal mental health team, but many fall below the threshold for referral. However, there is more we can do as GPs. Refer to your local talking therapy services (many will prioritise women who are pregnant or in the postnatal period). There are some excellent resources below we can direct mothers to. Offering follow-up and continuity, to allow the mother to divulge information when she is ready.

Agnieska gets very tearful when you ask her about the birth but does want to discuss it more. Far from a straightforward birth, she had a terrible time. A slow second stage led to her finally requiring augmentation (‘they couldn’t get the drip in for ages’); she really struggled to manage the contractions and ended up with an episiotomy. ‘I never thought it would be that bad’. She’s getting flashbacks and feels constantly on edge. But she feels better for talking about the birth, as she’s found it difficult discussing it with her husband. You suggest she self-refer to talking therapies (making clear she is post-natal so should get prioritised) and signpost her to some of the resources below. You both recognise more time is needed to explore her mental health and book a follow-up appointment, suggesting she comes without her baby next time to allow for a quieter consultation, focused on her needs.