Complex trauma during the perinatal period

There is strong evidence that mothers who have experienced potentially traumatic events during their lifetime are at greater risk of developing other mental health conditions in the perinatal period. This can then impact her relationships with the infant/partner and those around the new mother, leaving them feeling even more distressed.

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Types of traumas

• Single Incident (acute) trauma, such as a car accident, single incident of physical or sexual assault or natural disaster
• Multiple or repeated (chronic) trauma, such as intimate partner violence, physical, sexual, emotional abuse, neglect
• Childhood/developmental (complex) trauma, resulting from exposure to severe stressors that are repetitive or prolonged, involve harm or abandonment from caregivers, or occur at developmentally vulnerable times in the person’s lifetime such as early childhood  

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What is complex post-traumatic stress disorder (CPTSD)?

Complex post-traumatic stress disorder (CPTSD) can develop as a response to trauma that is intense and/or ongoing. These events can take place due to the occurrence of trauma at any time in someone’s life.  

However, not all people who experience trauma develop symptoms. There are variable responses, and everyone is different in how they perceive and experience the same situation. Some become more resilient, but many find that their emotional and general energy reserves are lower and being able to regulate is more difficult.

In the perinatal period, CPTSD can occur due to birth trauma, routine antinatal checks triggering abuse memories, intrusive medical procedures, activated sexual assault memories, threats of death or unexpected birth experiences, poor social support, intergenerational trauma, impactful family adversity or other sorts of abuse such as intimate partner violence or emerging memories of childhood abuse.  

When someone has experienced trauma, the risk of experiencing further trauma is higher, so there is a greater need to help identify those at risk and devise a care plan to support them at this most vulnerable time.

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Recognising CPTSD

Recognising complex trauma, also known as Complex posttraumatic stress disorder (CPTSD) during the perinatal period is a really important step in the journey to understanding, seeking the right help at this time (trauma informed therapy) and ultimately taking the leap into a healing therapeutic journey.  

“There is growing evidence about what can be done to help women and their families during this important life transition. The perinatal period provides and opportune time to provide help in order to disrupt the potential transmission of difficulties for the next generation…research has revealed that childhood maltreatment, lifetime traumatic experiences, pregnancy stressors, re-traumatising labour experiences, postpartum events and poor social support …contribute to the development of significant mental health problems in mothers”

Australian Child and Adolescent Trauma, Grief and Loss

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CPTSD symptoms

• Flashbacks and nightmares
• Lapses in memory
• Unstable or unintegrated sense of self (recognise many aspects of self but feel they don’t make sense as a whole)
• Finding it difficult to manage emotions  
• Heightened arousal (heightened anxiety, unable to relax regardless of the context)
• Unsettled stomach and other physical complaints  
• Sleep disturbances (beyond the normal disturbances that come with a newborn)  
• Conflict in relationships
• Avoidance of infant, certain people, places or circumstances
• Substance abuse
• Disordered eating
• Avoidance of or aversion to breastfeeding  
• Low self esteem
• Chronic health conditions
• Autoimmune conditions

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Seeking support for CPTSD

Sometimes pregnancy or birth can be a CPTSD trigger for an expectant or new mum. Other triggers include the birth process, exposure of private parts, being naked, smells, or lack of consent for medical procedures and having no control in a situation.

Anyone who feels triggered by these situations may find it helpful to record their feelings and take extra care of themselves as they experience this resurfacing.  

If the symptoms are not subsiding or keep resurfacing, it’s a good time to reach out to a trusted friend and a trauma-informed perinatal mental health clinician who can provide support.

Early identification and intervention will give new or expectant parents a sense of control so they can recover, move forward and be the parents they want to be.

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Other helpful resources

Australian Child and Adolescent Trauma, Loss and Grief Network

Blue Knot Foundation

Birchtree Centre

Article: Current Psychiatry - Complex Post-Traumatic Stress Disorder in the Perinatal Period

Article: Aces Aware - Trauma and Trauma-Informed-Care