Today, we’re speaking to Dr Megan Foreman, a GP and NIHR Clinical Lecturer based at the University of East Anglia.
Title of paper: Diagnosing in the dark: the childbirth-related post-traumatic stress disorder GP evidence gap
Available at: https://doi.org/10.3399/BJGP.2026.0269
Transcript
This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.
Speaker A
00:00:00.320 - 00:00:58.460
Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm the Senior Research Editor here at the Journal. Thanks for taking the time today to listen to this podcast.
In today's episode, we're speaking to Dr. Megan Forman, who is a GP and NIHR Clinical Lecturer based at the University of East Anglia.
We're here to discuss the recent analysis piece that she and her team have published in the September issue of the Journal and it's titled Diagnosing in the Dark the Childbirth Related Post Traumatic Stress Disorder GP Evidence Gap. So, hi, Megan, it's really nice to meet you and thanks again for joining us here to talk about this article.
I suppose, to start with, could you explain a little bit more about what you mean by birth trauma and childbirth related PTSD? And I suspect that these are probably terms that GPs are not as familiar with that we should be.
Speaker B
00:00:59.310 - 00:01:46.360
Yeah, thank you. So birth trauma is a broader term and that can be.
So we're talking here about psychological birth trauma rather than physical birth trauma in the context that we're using it in. We're talking about people who have had a difficult, potentially a pregnancy experience or a birth experience.
That's not just looking at birth itself. That can cause ongoing mental health issues and psychological concerns when we talk about PTSD after pregnancy and birth.
So what's often referred to as childbirth related ptsd, those are people who meet diagnostic criteria for PTSD as a result of a trauma that was related to their experience from pregnancy or birth. So birth trauma is a broader term and then PTSD is a specific diagnosis.
Speaker A
00:01:46.520 - 00:02:14.480
And we were talking just before we started about the wider reach of this work and how, um, it's been picked up more in the mainstream media. But you've also had people telling you about their stories as well.
And what I find quite sad in a way is that there have been a number of reviews around inadequate care in women's health.
And I'm really struck by some of the poor outcomes that you mentioned in the article, like high suicide rates in women postnatally as well, which is really shocking, actually.
Speaker B
00:02:14.880 - 00:03:14.130
Yeah, I mean, you mentioned the people who I've spoken to.
So I've had a really involved patient participation group with the work that I've been doing, and they've talked about their own experiences, even in situations where they've had really extreme birth complications. So, for example, a neonatal loss or severe physical injury, even in those circumstances, may have struggled to access support.
I've also been contacted by a member of the public since the paper was published and since there was media interest in this, talking about her own experiences of birth almost 30 years ago and difficulty in dealing with that going forward. So it clearly is a big issue.
It's also important to say that even if a birth looks straightforward medically on paper, it's still possible to develop birth trauma symptoms and indeed ptsd. So it doesn't have to be a birth with serious complications or a poor outcome for somebody to develop these symptoms.
Speaker A
00:03:14.620 - 00:03:37.180
Yeah, and I think that's one of the things that really struck me in the article, is that birth trauma is very subjective and that these issues can happen like, just like you're saying, just after what might appear to have been or appears to be a medically uncomplicated birth. And I think that's probably really important for GPs to understand in terms of what this will look like when women present to their gps as well.
Speaker B
00:03:37.260 - 00:04:27.610
Yes.
And I think an important consideration is that when women keep referring to women, but I include in that people with other gender identities who have a baby, but when women go into pregnancy, they come to pregnancy with all of their past experiences.
And we know that people who have had difficult previous experiences, so for example, intimate partner violence, previous adverse childhood experiences, substance abuse or pre existing mental health problems, these people are particularly at risk of developing PTSD after birth. And it can be something that develops after what looks like a normal birth on paper.
So it's really important that we consider birth trauma and PTSD in people, even when it appears that the birth is straightforward and that we still are inquiring about these symptoms to make sure that they're identified.
Speaker A
00:04:27.850 - 00:04:40.970
And we'll come back onto sort of inquiring about symptoms. But what might a woman with childbirth related PTSD look like when she presents to her gp?
Are there any clues that we should be looking out for, aside from asking questions about it?
Speaker B
00:04:40.970 - 00:06:08.320
Well, one of the issues with PTSD is that one of the symptoms that women often experience is avoidance.
So people can find that either talking about their birth experience or visiting a healthcare setting can retrigger their symptoms and can be really distressing.
So a particular issue with PTSD that isn't necessarily an issue with other perinatal mental health problems is that people can be incredibly reluctant to talk about their experience and that can be with both with family members, friends and healthcare professionals. So it's something that we really need to be vigilant for.
But in terms of the symptoms that people describe, essentially there are four symptom clusters. So the first would be hypervigilance so feeling constantly on edge, a constant fear that something bad is going to happen to themselves or the baby.
I mentioned the avoidance, avoidance of anything that reminds them of the birth, because it can bring back very extreme, intense physical symptoms. Reliving the birth is another symptom that, that often differentiates it from anxiety and depression.
So that can be symptoms like flashbacks and nightmares. And again, the flashbacks can be triggered by reminders of the birth experience. And then the last thing is alterations in mood.
So that can be low mood, but it can also be things like disproportionate feelings of guilt. And so mood disturbance is a feature as well.
But really, for a diagnosis of ptsd, a person would have to have symptoms from all of those symptom groups.
Speaker A
00:06:08.720 - 00:06:35.280
And I suppose in primary care, GPs sometimes can be in a bit of a practice gap. So primary care really has a role in assessing and coordinating this care.
But I think that sometimes we're not really sure how to do that, especially when there are other people involved, like the health visitor or the midwives and things. So what do you think that looks like in practice at the moment?
So I think probably what you're going to describe is that there's a sense of fragmented care in this area.
Speaker B
00:06:35.750 - 00:07:56.120
Yeah, I completely agree. And I mean the guidance.
So, for example, the nice guidance on antenatal and postnatal mental health, it suggests that if, if another healthcare professional is concerned about mental health symptoms, that they should be sending people to see their gp. And obviously there's. There's perhaps this expectation that women will also be offered a six to eight week postnatal appointment.
So GPs will be seeing women at these points. But absolutely. Care can be fragmented. Sometimes concerns either aren't picked up or aren't passed on. Communication between services can be limited.
I know certainly from my own experience, often the information we get in a discharge summary, for example, can be very cursory, which can also make it difficult then to really to preempt you maybe having more problems. Another issue. So we know from research evidence that GPs often mistake postnatal PTSD for depression.
So there have been research studies that have demonstrated that this is a common problem. Part of the issue is the overlap with depressive symptoms.
So, for example, if you look at the Edinburgh Postnatal Depression Score, it does include symptoms of hypervigilance and mood, so it can easily be mistaken for other conditions. And this can be really problematic because the guidance on the treatment of PTSD and depression are quite different.
Speaker A
00:07:56.470 - 00:08:24.550
And I guess just thinking about treatment, so one of the Issues I wondered about was the access to secondary care services, and this isn't always straightforward.
And talking about sort of gaps in care, I wonder if some women are falling through a gap here in terms of not potentially fitting criteria for NHS talking therapies because of their symptoms, but not quite at the stage where...
