Birth trauma after a multiple birth

Having twins, triplets or more can make pregnancy and birth more complex. While many parents have positive birth experiences, some find aspects of pregnancy, labour, birth or the days afterwards overwhelming and in some cases traumatic.

What is birth trauma?

Birth trauma describes the emotional and psychological distress that can happen after experiencing or witnessing a traumatic pregnancy, birth or early postnatal experience.

For some people, these experiences can lead to a diagnosis of Post-Traumatic Stress Disorder (PTSD). Others may experience symptoms such as anxiety, intrusive memories or flashbacks without meeting the criteria for PTSD. These experiences are still often described as birth trauma and are equally valid.

Research suggests that around 4–5% of mothers and around 1% of partners develop PTSD following a traumatic birth. Many more experience symptoms of trauma without receiving a formal diagnosis.

What can make a birth traumatic?

Every person's experience is different. What feels traumatic to one parent may not feel the same to another.

For parents of multiples, there can be many different experiences that contribute to birth trauma, including:

• a long, difficult or very fast labour
• an emergency caesarean birth
• an assisted birth using forceps or ventouse
• significant bleeding after birth (postpartum haemorrhage)
• complications during pregnancy or labour
• miscarriage or stillbirth
• a termination for medical reasons (TFMR), including where one baby dies and another continues to develop
• having babies born prematurely
• spending time in a neonatal unit (NICU)
• being seriously unwell yourself after birth.

You may also find it difficult if feeding your babies didn't go as planned. A traumatic birth can sometimes delay your milk coming in or make establishing breastfeeding more challenging. If you had hoped to breastfeed but couldn't, you may experience feelings of grief, disappointment or guilt.

You might also feel sadness that your birth wasn't the experience you had imagined, or frustration if you feel your care could have been better. These feelings are understandable.

Birth trauma can also affect your relationships, including how connected you feel to your babies, your partner or the people around you.

Is the risk of birth trauma higher with multiples?

Multiple pregnancies carry higher risks than singleton pregnancies, which means parents expecting twins, triplets or more are more likely to experience situations that can be traumatic.

For example:

• your babies are more likely to be born before 37 weeks, depending on your pregnancy
• they are more likely to need care in a neonatal unit
• you are more likely to give birth in hospital
• you have a higher chance of needing an induction, assisted birth or caesarean birth
• there is an increased risk of postpartum haemorrhage
• there is also a higher risk of pregnancy or baby loss.

These additional risks don't mean that your birth will be traumatic, but they can make pregnancy, birth and recovery more emotionally challenging.

Recovering physically while caring for two or more babies can also feel overwhelming, especially if your babies need ongoing medical care or extra support.

Symptoms of postnatal PTSD

The symptoms of postnatal PTSD can vary, but they often include:

• reliving the birth through flashbacks, nightmares or intrusive memories
• avoiding places, conversations or situations that remind you of the birth
• feeling constantly on edge, anxious or as though something bad is about to happen
• blaming yourself or feeling overwhelming guilt about what happened
• struggling to remember parts of the birth
• difficulty sleeping or relaxing
• feeling angry, irritable, emotionally numb or detached
• finding it hard to bond with your baby or babies
• feeling frightened about becoming pregnant again.

If these symptoms are affecting your daily life or aren't improving over time, it's important to seek support.

Is PTSD different from postnatal depression?

Yes. Although some symptoms can overlap, PTSD and postnatal depression are different conditions and may need different treatments.

If you're unsure about how you're feeling, speak to your GP or healthcare professional. They can help you understand what's happening and make sure you receive the support that's right for you.

Where can I find support?

If you think you may be experiencing birth trauma, please know that help is available.

Many hospitals offer a birth reflections or birth debrief service. This gives you the opportunity to talk through what happened during your pregnancy and birth with a healthcare professional, ask questions and better understand your experience. If you haven't been offered this, you can ask your maternity unit.

If you're experiencing symptoms of PTSD or you're struggling to cope, make an appointment with your GP. They can assess how you're feeling and refer you for appropriate support. If you live in England, you may also be able to self-refer to your local NHS Talking Therapies service.

Some parents also choose to access private counselling or therapy through an accredited therapist.

At Twins Trust, we're here for you too. Our online communities connect you with other parents who understand life with multiples, including dedicated support for families with babies in neonatal care and those who have experienced bereavement.

When should I seek urgent help?

If you're feeling overwhelmed, it's important to know that you don't have to cope on your own. If your thoughts or feelings are becoming difficult to manage, or they're affecting your ability to care for yourself or your babies, please seek help as soon as possible.

Contact your GP, midwife, health visitor or maternity team if you're struggling with your mental health. If you or someone close to you is worried that you're at immediate risk of harming yourself or someone else, call 999 or go to your nearest A&E department straight away. You can also contact NHS 111 if you need urgent mental health support and don't know where to turn.

If you're having thoughts of suicide or feel unable to keep yourself safe, please tell someone you trust and seek emergency help immediately. You deserve support, and with the right help, things can get better.

Remember, however you're feeling, you don't have to go through it alone. Recovering from birth trauma takes time, and asking for help is a positive first step.