Childbirth-Related PTSD: Recognizing and Assessing This Unique Subtype

Amanda Koire, MD, PhD, presented on childbirth-related posttraumatic stress disorder (PTSD), a clinically significant subtype of PTSD that she characterized as frequently overlooked and underdiagnosed in postpartum care.

Koire described the clinical pattern that prompted her interest in the topic: patient referrals who came to her labeled as postpartum depression or anxiety that, upon thorough evaluation, revealed underlying birth trauma manifesting as the mood or hyperarousal dimensions of PTSD. She emphasized that childbirth must be recognized as a qualifying criterion A traumatic index event, and that a subjectively negative delivery experience, regardless of objective medical outcome, constitutes the single greatest risk factor for childbirth-related PTSD.¹ She noted that screening can be initiated simply by asking patients to describe their delivery experience as part of a standard reproductive history.

Koire identified a uniquely invalidating social dynamic surrounding birth trauma, observing that childbirth is one of the only potential traumatic events where disclosing the experience is typically met with congratulations—a response that can deter patients from acknowledging or sharing their distress. She framed trauma-informed care as essential throughout all perinatal clinical encounters, emphasizing the importance of "allowing people to disclose and share in their own time" without pressing for details prematurely.

On treatment, Koire noted that many evidence-based PTSD psychotherapies are feasible in the perinatal population, with written exposure therapy, narrative exposure therapy, and EMDR offering shorter protocols that may be more acceptable to new mothers with limited time.² She also noted that many federally approved pharmacological treatments for PTSD are compatible with breastfeeding, and encouraged clinicians working with perinatal patients to be prepared to address questions about medication safety in this context.

Dr Koire is a psychiatrist in the division of women's mental health and reproductive psychiatry at Brigham and Women's Hospital and assistant professor of psychiatry at Harvard Medical School.

References

1. PTSD and DSM-5. National Center for PTSD. Accessed May 18, 2026. https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp

2. Granner JR, Seng JS. Using theories of posttraumatic stress to inform perinatal care clinician responses to trauma reactions. J Midwifery Womens Health. 2021;66(5):567-578.