Reviewed and updated by Iris Hogan, MSW, LICSW · September 2026
The reality gap between what we dreamed of and planned for and what actually happened can be shocking—or even devastating, to say the least.
Things were not supposed to turn out this way.
The well-thought-out birth plan, or simply the dream that guided how we prepared, may no longer give us any structure for how to move through what is happening now.
And often there isn’t time or space to sit with our emotions about what just happened. Sometimes there isn’t even time to talk about it. The focus has already shifted to: How do we deal with right now?
There may be a baby who needs care. There may be medical decisions to make, feeding to figure out, pain and physical recovery, appointments, sleep deprivation, or an unexpected NICU stay.
Life is already moving forward, whether we have had a chance to catch up with what happened or not.
Sometimes the emotional impact hits right away. Sometimes it doesn’t show up until weeks or months later. And sometimes it isn’t until another pregnancy that we realize just how much of the previous birth we are still carrying.
When the Birth Doesn’t Feel Like It’s Over
Sometimes what happened during birth begins to settle into the past. We can remember it, have feelings about it, perhaps even wish desperately that it had been different, without feeling as though we are still living inside it.
And sometimes that doesn’t happen.
I hear women say things like:
“I can’t stop going over what happened.”
“I should have spoken up.”
“Why didn’t they listen to me?”
“Everyone says I should just be grateful the baby is okay.”
“I can’t look at the pictures.”
“I don’t trust my body anymore.”
“I don’t know how I could ever give birth again.”
Sometimes the trauma shows up in ways that don’t initially seem to be about the birth at all. A mother may panic when she is away from her baby or repeatedly sneak into the baby’s room at night to make sure they are still breathing.
For another mother, it may look almost like the opposite. She feels numb. She knows she cares about her baby, but she can’t feel what she thinks she is supposed to feel. She may be frightened or ashamed that bonding doesn’t seem to be happening the way she expected.
These reactions can look very different from one woman to another. They also don’t automatically mean that someone has PTSD. Postpartum anxiety or OCD, depression, grief and previous trauma can overlap with some of these experiences.
What they can have in common is a sense that, although the birth is over, some part of the experience hasn’t quite become the past.
What Makes a Birth Traumatic?
What makes a birth traumatic can be different for every woman—and for every birth partner.
Sometimes the frightening moment is obvious.
It may be seeing your baby blue. Hearing the alarm in your doctor’s voice when they recommend the next step. Watching what suddenly seems like an enormous number of people flood into the room to help.
Sometimes it is more subtle.
It may be the absence of someone narrating what is happening, leaving your mind to anticipate the worst. A careless comment from a healthcare provider. Feeling that decisions are being made around you rather than with you. Or realizing that you don’t understand what is happening to you or your baby.
And sometimes what is happening in the present connects with something that came before it. The memory of a previous birth that ended in complications. A previous medical experience. Or another time in your life that held some of the same ingredients as this moment: fear, vulnerability, helplessness, or feeling out of control.
This is one reason we can’t decide whether a birth was traumatic simply by looking at what happened medically.
Two people can live through very similar events and experience them very differently. And something that looks relatively routine on paper can still have been terrifying to the person who lived through it.
If you are trying to understand whether what happened to you may have been traumatic, I talk more specifically about traumatic childbirth and NICU experiences on my Maternal Mental Health page.
A Traumatic Birth Does Not Always Lead to PTSD
One of the amazing things about us as human beings is that we can go through an extremely hard birth—frightening, painful, complicated, even experienced as traumatic—and not develop PTSD.
A traumatic experience does not automatically lead to PTSD.
Research reflects this distinction. A large systematic review and meta-analysis of birth-related post-traumatic stress found that PTSD after childbirth affects a smaller proportion of mothers than the proportion who experience significant post-traumatic stress symptoms.
We can be deeply affected by what happened. We may grieve the birth we had hoped for, feel angry, replay parts of it, or need time to understand what happened. And still, with time, the experience can begin to settle into the past.
For some women, though, it doesn’t.
The birth is over, but something about it continues to feel remarkably present.
PTSD isn’t determined simply by whether a birth was “bad enough.” It involves a pattern of symptoms that persists and affects our lives. And because trauma symptoms can overlap with other postpartum mental health concerns, thoughtful assessment matters.
A more useful question may be: What happened, what is still happening now, and how is it affecting your life?
Why Does One Birth Settle Into the Past While Another Stays So Present?
There isn’t one answer.
And it isn’t simply about how medically dangerous the birth was.
Research suggests that what happened matters, but so does how we experienced what happened. Feeling intensely frightened, helpless or out of control, believing that we or our baby might be in danger, not feeling supported, or experiencing an unexpected medical intervention can all be part of the picture.
We also don’t enter the labor room with a clean slate. We bring our old wounds, vulnerabilities, and fears with us.
A previous trauma, a frightening earlier birth, anxiety during pregnancy, or fear about childbirth can all become part of how we experience what is happening now. Sometimes the connection is obvious. Other times, we may not recognize it until much later.
None of this means that someone will develop PTSD. It simply means that the birth we experience today doesn’t happen in isolation from the life we lived before it.
In fact, that is one of the remarkable things about us. People can go through extraordinarily frightening and difficult births and not develop PTSD.
There isn’t a simple equation where a particular kind of birth produces a particular psychological outcome.
Sometimes an extremely difficult experience gradually becomes something we remember:
That was terrifying. I wish it had been different. And it is over.
Other times, we know intellectually that it is over, but our reactions haven’t entirely gotten that message.
A sound, a smell, a medical appointment, a photograph, a sensation in our body—or sometimes something we can’t immediately identify—can suddenly bring the fear back.
The memory isn’t necessarily forgotten. It just hasn’t fully become the past.
Sometimes It Shows Up in the Next Pregnancy
I remember this from my own second labor.
When that first really painful contraction hit, I suddenly remembered just how painful contractions had been the first time. And with it came much more of that first birth experience—things that I certainly hadn’t forgotten, but that hadn’t been in the front of my mind.
My immediate thought was something along the lines of:
Oh yes. THIS. How exactly did I agree to do this again?
For me, this was simply a memory coming sharply back into focus.
When a previous birth was traumatic, however, reminders during another pregnancy or labor can bring back much more than the memory of how much contractions hurt.
A woman may have spent months or even years functioning well and believing that what happened was behind her. Then another pregnancy begins. There are ultrasounds and medical appointments again. Her body changes. Conversations turn toward delivery. Eventually, there is the unavoidable reality that this baby has to come out too.
And the old fear can begin creeping back in.
What if it happens again?
Some women find themselves avoiding thinking about the birth altogether. Others move in the opposite direction and try to plan every possible detail.
If I can choose the right provider, the right hospital, the right birth plan, anticipate every possible complication and make sure everyone knows exactly what I need, maybe I can make certain I never feel that powerless again.
There is nothing wrong with thoughtful preparation. After a frightening birth, understanding our options and having a voice in our care can be enormously important.
But there is a difference between preparing for another birth and trying to make it impossible for anything frightening or unexpected to happen.
No birth plan can give us that guarantee.
Healing Doesn’t Mean Deciding the Birth Was Okay
Healing from a traumatic birth doesn’t mean deciding that what happened was okay.
We don’t have to turn a frightening birth into a beautiful lesson about life. Sometimes something awful happened. Sometimes care could have been better. Sometimes there are real losses to grieve.
And sometimes we are still furious about it.
The goal isn’t to rewrite the story.
What can change is how we carry it.
We can remember what happened without being pulled back into it. We can think about the birth and know, emotionally as well as intellectually:
I am here now. That is over.
The memory may still be sad. We may still be angry. We may still wish with everything in us that it had happened differently.
Sometimes healing is also about making sense of our suffering.
That doesn’t mean finding a reason why something terrible had to happen, or turning it into something positive. It can mean developing a more balanced understanding of what happened and of ourselves within it.
We can name our disappointment with the birth without confusing it with disappointment in ourselves.
I am disappointed with what happened is very different from I am disappointed in myself.
We can begin to separate what was within our control from what wasn’t. We can understand the decisions we made in the context in which we actually made them—in pain, frightened, exhausted, overwhelmed, or trying to take in rapidly changing information.
Making sense of what happened doesn’t make what happened okay.
But it can change what the experience has come to mean about us.
Where EMDR Can Help After a Traumatic Birth
Sometimes talking about what happened, understanding it better, grieving what was lost, and having our experience genuinely heard is enough to help a difficult birth begin to settle.
Sometimes it isn’t.
We may already understand the birth remarkably well. We know why the emergency C-section was necessary. We know the baby survived. We know we couldn’t have predicted what happened. We may even know that we did nothing wrong.
And yet we still panic when we think about another pregnancy. We still see that moment when the baby was blue. Our heart races when we drive past the hospital. We still hear the change in the doctor’s voice.
Understanding something and being able to change our reaction to it are not always the same thing.
This is one of the places where I use EMDR.
Research on EMDR specifically following traumatic childbirth is still developing. Recent research supports trauma-focused psychological therapies, including EMDR, as treatment approaches for childbirth-related PTSD.
If EMDR is unfamiliar to you, I explain the therapy in more depth in EMDR Therapy: How It Helps Painful Memories Feel Like the Past.
EMDR doesn’t require us to decide that the birth was okay. It doesn’t erase the memory, and the goal isn’t to convince ourselves that something frightening wasn’t frightening.
Instead, we identify the parts of the experience that still carry distress—the images, moments, beliefs, emotions, or physical sensations that continue to feel particularly alive—and work with those.
And importantly, the target isn’t always the entire birth.
Sometimes it is one moment.
The doctor’s face.
Seeing the baby blue.
Being wheeled away from the baby.
Hearing, “We need to do this now.”
Being unable to get someone’s attention.
Or the moment afterward when everyone else seemed relieved while you were still trying to understand what had just happened.
As those pieces are processed, the goal is not forgetting.
It is helping what happened become something that happened then, rather than something we continue responding to as though it is happening now.
What Does EMDR for Birth Trauma Actually Look Like?
EMDR doesn’t begin with me asking you to jump into the worst moment of your birth.
We start by understanding what happened and, just as importantly, what is happening now.
What brings the birth back? What moments still carry the most distress? What have you come to believe about yourself because of what happened? Are there parts of the experience you avoid? What happens in your body when you remember it? And what do you need in order to feel adequately prepared to approach the memory rather than overwhelmed by it?
Sometimes the target becomes obvious quickly. Sometimes it takes a while to understand what is actually driving the distress.
It also may not be the moment that looks most dramatic from the outside.
The emergency C-section may dominate the medical record, while the moment that remains most painful for you is hearing someone say something frightening and then walking out of the room without explaining it.
Or perhaps everyone was focused on the baby’s medical crisis while what stayed with you was lying there alone, unable to see your baby and not knowing what was happening.
Once we have identified what needs attention and you are adequately prepared, EMDR allows us to work with the memory and the images, emotions, beliefs, and physical sensations connected with it.
You don’t have to give me every detail of the birth for this work to be possible. Some women want to tell the entire story. Others don’t. We can work with what is distressing without requiring you to recount every painful detail aloud.
If you’re wondering whether you need to be completely “ready” before starting, I’ve written separately about how I think about readiness for EMDR.
And processing doesn’t mean that I tell you what you should think about what happened.
Sometimes what emerges is grief. Sometimes anger. Sometimes compassion for the woman you were in that room. Sometimes a recognition of what really was—and wasn’t—within your control.
Sometimes it is simply:
It’s over.
I survived.
I did what I could.
It wasn’t my fault.
Or something entirely different that belongs to you.
The goal isn’t for you to arrive at the “right” interpretation of your birth.
It is for the experience to become less stuck, and for whatever understanding develops to genuinely fit your experience.
Birth Partners Can Carry the Experience Too
Birth trauma doesn’t only happen to the person giving birth.
A partner may have stood in the room watching someone they love—or their baby—appear to be in danger while having very little ability to do anything about it.
They may remember the alarms, the people rushing into the room, the look on a provider’s face, or watching their partner being taken away. And while everyone understandably focuses on the person who gave birth and the baby afterward, the partner may be left trying to make sense of what they witnessed too.
Partners can also come away from the same birth with very different experiences.
One person may desperately need to talk about what happened while the other wants to put it behind them. One may feel enormous relief that everyone survived while the other is grieving how frightening or painful the experience was.
Neither experience necessarily cancels out the other.
Sometimes part of recovering as a couple is simply recognizing that you were both there, but you did not necessarily live through the same birth.
When Something More May Be Going On
Birth trauma and PTSD are not the only reasons someone may be struggling after having a baby. Postpartum depression, anxiety, OCD, bipolar disorder and other mental health conditions can overlap with trauma symptoms, and sometimes more than one is happening at the same time.
Some symptoms need urgent attention. Seek immediate professional help if you are losing touch with reality, experiencing hallucinations or delusions, becoming markedly confused or disorganized, or having a period of unusually high energy or agitation with very little need for sleep. Postpartum psychosis is a psychiatric emergency.
Thoughts about harm also deserve careful assessment, but not all harm thoughts mean the same thing. Unwanted, frightening intrusive thoughts about something terrible happening to the baby—or even about accidentally or deliberately causing harm—can occur with postpartum anxiety or OCD and are different from wanting, intending, or believing you need to harm your baby.
If you are having thoughts of suicide, believe you may act on thoughts of harming yourself or your baby, or feel unable to keep yourself or your baby safe, seek immediate help. In the United States, call or text 988, call 911, or go to the nearest emergency department.
You do not need to figure out the diagnosis yourself. If something feels significantly different from what you expected, is causing substantial distress, or is interfering with your ability to function, reaching out to your healthcare provider or a perinatal mental health professional is a good place to start.
Things Were Not Supposed to Turn Out This Way
Sometimes there is no getting around that truth.
This was not the birth you imagined. Perhaps it wasn’t the beginning of motherhood you imagined either. There may be things about what happened that you will always wish had been different.
Healing doesn’t require us to pretend otherwise.
We can’t change the birth. We can’t go back and make someone explain what was happening, change the decisions that were made, or give ourselves information we didn’t have at the time.
What can change is the place that experience occupies in our lives.
We can make sense of our suffering without deciding that it needed to happen. The birth can remain important, sad, infuriating, disappointing—or some complicated combination of all of those things—without continuing to feel as though we are still there.
An experience that once felt very much alive can become a memory. An important and perhaps painful part of our story, but increasingly a part of our past.
We can’t change what happened.
But what happened does not have to continue happening inside us in quite the same way.
If you’re struggling after a traumatic birth or NICU experience and would like to explore whether therapy or EMDR might be helpful, you can contact me to schedule a free consultation. I provide online therapy for women throughout Washington State.
Research & Sources
For readers who would like to learn more about the research and clinical guidance behind this article:
Heyne, C.-S., et al. (2022). Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis. Clinical Psychology Review, 94, 102157.
Read the systematic review on PubMed
Horsch, A., et al. (2024). Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment. American Journal of Obstetrics & Gynecology, 230(3S), S1116–S1127.
Read the review on PubMed
American College of Obstetricians and Gynecologists (ACOG). Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum.
Read ACOG’s clinical guidance
American College of Obstetricians and Gynecologists (ACOG). Summary of Perinatal Mental Health Conditions.
Read ACOG’s perinatal mental health resource
Read More
If you would like to understand more about birth trauma and recovery, these three books are included among the Birth Trauma Association’s recommended resources:
Birth Shock: How to Recover from Birth Trauma — Mia Scotland
A compassionate, accessible book focused on understanding birth trauma and the process of recovery.
Why Birth Trauma Matters — Emma Svanberg
A thoughtful introduction to why birth can become traumatic and why women’s experiences of birth need to be heard and understood.
Birth Trauma: A Guide for You, Your Friends and Family to Coping with Post-Traumatic Stress Disorder Following Birth — Kim Thomas
A practical guide for women experiencing post-traumatic stress following birth and for the people supporting them.
For additional information and support, visit the Birth Trauma Association. In the United States, Postpartum Support International also offers birth-trauma support and resources.
A Note About This Article
This article is for educational purposes and is not a substitute for individualized mental health or medical care. If you are experiencing significant distress, have concerns about your mental health after childbirth, or are unsure what kind of support you need, consider talking with your healthcare provider or a qualified mental health professional.
If you are in immediate danger, believe you may act on thoughts of harming yourself or your baby, or are experiencing symptoms of postpartum psychosis, call or text 988, call 911, or go to the nearest emergency department.
Until We Meet Again
Until we meet again — breathe gently, walk slowly, and treat yourself with kindness.
— Iris