Birth-related PTSD may go undiagnosed among thousands of new mothers

Tens of thousands of new mums across Britain may be suffering undiagnosed PTSD following childbirth, according to a University of East Anglia report.

The analysis suggests that emotional and psychological trauma following childbirth may go unrecognised or misdiagnosed during postnatal GP consultations, due to multiple contributing factors.

The warning comes after two damning reports into maternity and neonatal services in England from Baroness Amos and Donna Ockenden, and against a growing concern about maternal mental health.

Post-traumatic stress disorder (PTSD) can develop after a difficult pregnancy or birth and causes symptoms including flashbacks, nightmares, anxiety and persistent negative thoughts.

Now, the UEA team are urging the NHS to equip GPs with better ways to identify new mothers with PTSD to prevent more women falling through the gaps.

‘Tip of the iceberg’

According to recent figures, suicide remained the leading cause of death among women between six weeks and one year after pregnancy in the UK during 2021–2023.

The researchers describe these deaths as the “tip of the iceberg”, arguing that many more women are living with serious mental health difficulties but are unable to access the support they need.

Research shows that around one in 20 postnatal women develop PTSD, which is equivalent to tens of thousands of mothers across the UK.

It usually happens after a traumatic pregnancy or delivery, but it can also happen after a medically uncomplicated birth.

Dr. Megan Foreman, Lead researcher and GP, UEA’s Norwich Medical School

The hidden consequences

“The consequences of untreated birth trauma for women and families can be far-reaching.

“Some women become so anxious that they repeatedly seek reassurance from healthcare professionals for themselves or their baby. Others avoid healthcare services altogether, including during future pregnancies.

“They may also request elective Caesarean sections in later pregnancies to regain a sense of control. Or others may reject recommended medical care or opt for home births, even in high-risk pregnancies, to avoid interventions associated with their previous experience.”

GPs ‘diagnosing in the dark’

“The biggest issue is that GPs are effectively ‘diagnosing in the dark’ because they are not equipped with the information or tools to make proper assessments.”

Although birth trauma is mentioned in national guidance from NICE and NHS England, the new report shows that GPs are not given practical advice on how to measure severity, assess risk or decide who requires specialist treatment.

It also suggests that many healthcare professionals, including GPs, feel they lack the confidence and skills needed to support women affected by birth trauma.

“GPs are also facing growing pressures, staff shortages and limited appointment times, despite being the main gateway to specialist mental health services for new mothers,” said Dr Foreman.

“Some women are also being misdiagnosed with postnatal depression, potentially delaying access to the recommended psychological therapies that are most likely to help.”

The analysis points out that antidepressants are generally less effective for PTSD than specialist psychological interventions and are not recommended by NICE as a first-line treatment for the disorder.

A call to strengthen recognition

The researchers are now calling for urgent work to develop clear guidance in collaboration with women, including a validated assessment tool that could be used by GPs during the routine six-to-eight-week postnatal appointment to help to identify PTSD symptoms.

However, they warn that the process must be handled sensitively.

Dr Foreman said: “Many new mothers attend appointments with their newborns, often combining their own health check with baby examinations or vaccinations. Some may not yet feel able to discuss a traumatic birth experience.

“Asking the wrong questions at the wrong time could leave women feeling unsupported or retraumatised.”

Instead, the authors say any future guidance should be accompanied by better GP training, improved awareness and clear referral pathways into specialist services.

“GPs are uniquely placed to spot warning signs,” said Dr Foreman. “But without better evidence and practical tools, many mothers with childbirth-related PTSD risk being left to cope alone, without the support they need.”

This research was led by UEA in collaboration with City St George’s University of London and the University of Birmingham.

‘Diagnosing in the dark: The childbirth-related post-traumatic stress disorder GP evidence gap’ is published in the British Journal of General Practice.