Thousands of Mothers May Be Living With Undiagnosed PTSD After Childbirth
The Science of Birth Fear: new research on reproductive fear, anxiety and trauma, and what it means for you.
By Alexia Leachman, founder of Fear Free Childbirth
This piece talks about post-traumatic stress after birth, and briefly mentions maternal suicide and sexual abuse. If you’re struggling right now, there’s a note on where to find support at the end.
The research at a glance
The analysis: Foreman and colleagues. Diagnosing in the dark: the childbirth-related post-traumatic stress disorder GP evidence gap. British Journal of General Practice, published 28 August 2026.
The UK numbers: Webb and colleagues, City St George’s, University of London. 339 women from eight hospitals in England, Wales and Scotland, surveyed six to 12 weeks after birth.
The referral gap: Moran and colleagues. Journal of Affective Disorders, 2026. A study that followed women for up to two years after birth, looking at which health services they used.
The international picture: Ayers and colleagues, the INTERSECT study. 11,302 women in 31 countries, surveyed six to 12 weeks after birth.
A condition with no agreed way to spot it
A new analysis in the British Journal of General Practice (BJGP) sets out something I suspect many women who’ve been through it already know. When post-traumatic stress disorder (PTSD) follows childbirth, the GP who sees you afterwards has no agreed way to recognise it.
In the authors’ words: “there is no established CB-PTSD assessment tool for use in primary care.” (CB-PTSD is short for childbirth-related PTSD.)
The lead author, Dr Megan Foreman, has put a number on what that might mean. Taking 5% of the births in England and Wales in 2025, and evidence that fewer than half of women with symptoms are referred for specialist help, she told journalists that a figure of more than 15,000 women a year would be justifiable, and that it could be “in the tens of thousands”.
That’s an estimate, and she’s clear that it is. Nobody collects the data that would give us an exact count, which is part of the problem. It’s hard to fix something that nobody is routinely looking for.
Around one mother in 20
The best UK figures come from a survey of 339 women from eight hospitals across England, Wales and Scotland, six to 12 weeks after they gave birth. It found that:
- 40.6% experienced their birth as at least moderately traumatic
- 5.9% met the full criteria for childbirth-related PTSD
The BJGP authors use a slightly lower estimate of 4.7%. Either way, it’s roughly one mother in every 20.
A much bigger international study, INTERSECT, surveyed 11,302 women in 31 countries and found an average of about 7%, with huge variation between countries.
Why it gets missed
The BJGP paper describes several reasons.
The six-to-eight-week check is doing too much. It’s a short appointment meant to cover the mother’s physical and mental health, often with the baby in the room and needing attention too. The authors note that this can make assessing the mother’s mental health difficult.
It gets mistaken for postnatal depression. The paper describes a UK study in which GPs read case studies of women with birth-related PTSD. About half spotted the trauma features, but the most common diagnosis they gave was postnatal depression. The two conditions can overlap, and a woman can have both. They aren’t the same, though, and the paper notes that antidepressants are less effective for PTSD than specialist psychological treatment. If the wrong condition gets named, a woman may get help that doesn’t reach what’s going on, and conclude that she’s just not getting better.
Many women don’t reach specialist care even when they’re struggling. The Moran study found that almost half of women who met the criteria for probable PTSD six months after birth had not been referred for mental health support. And those women were using services. Between six and 12 months after the birth, they were seeing their GP almost twice as often as women without symptoms. The trauma just wasn’t being picked up.
And the stakes are high. The BJGP paper points out that maternal suicide remains the leading cause of death between six weeks and a year after pregnancy in the UK.
The symptom that hides itself
One finding from the international study stood out to me. Of all the PTSD symptoms, avoidance (steering clear of anything that reminds you of the birth) was the least commonly reported. But it was also the best single sign of whether a woman had PTSD.
When you think about it, that makes sense. If the thing you’re avoiding is talking about the birth, you’re unlikely to bring it up in a 10-minute appointment. The researchers suggest avoidance could be a useful flag for who needs a closer look.
A straightforward birth can still be traumatic
Trauma after birth isn’t limited to births that were medical emergencies. A birth can be written up as uncomplicated and still be experienced as terrifying.
The same UK team looked at what predicted PTSD symptoms in their sample. Alongside things like previous trauma and current mental health difficulties, they found that an emergency caesarean and lower satisfaction with the birth were both linked to more symptoms. Across all 31 countries, the INTERSECT researchers found that existing vulnerabilities played a part, but factors related to the birth itself had the strongest influence, and they call for maternity care to pay attention to how women experienced their birth.
So how the birth felt seems to matter as much as what happened medically. The experiences that come up again and again in birth trauma research include feeling powerless, not understanding what was going on, believing that you or your baby might die, and saying something was wrong and not being listened to.
The Birth & Babies Survey
What are pregnancy, birth and deciding whether to have children like for women today? We’re asking, and we’d love to hear from you. The survey is anonymous and takes about 10 minutes, and you can skip any question or stop at any time.
Where this meets fear of the next birth
This is where it connects with my work. Trauma from one birth doesn’t always stay in the past. For some women, it becomes fear of the next pregnancy or the next birth, which is known as secondary tokophobia.
It can show up in different ways. Some women avoid doctors and hospitals because they no longer feel safe. Others can’t stop seeking reassurance. Some ask for a caesarean because it feels like the only way to keep control, while others want to give birth anywhere but the place where it happened last time.
I don’t think those responses should be dismissed as irrational. They may be a woman’s way of protecting herself from something her body still believes is dangerous. That doesn’t mean every decision made from that place is the safest one, or shouldn’t be talked through. It does mean that handing her more information, or telling her she’s worrying too much, is unlikely to help much. Her fear has a history, and it needs to be understood before anything else.
And that history is rarely just the birth. When a woman is frightened of a second birth because of her first, there’s so much going on underneath. It’s all the things that happened around the birth too. How was she spoken to? What was the postnatal period like? How did her mother treat her, in the birth space or afterwards? What about the sister who decided to turn up on the day? How fast did it all unfold, and how out of control did she feel? It’s the entirety of the experience, not just the moment the baby arrived, so we can’t say the first birth was “about” one thing.
What these studies can’t tell us
The 15,000 figure is an estimate. It’s a reasoned calculation that combines a prevalence figure with birth numbers and referral rates, and it covers England and Wales.
The BJGP piece is an analysis, not new research. It pulls together existing evidence and argues for better guidance and tools. It doesn’t test any.
The UK survey was 339 women. That’s enough to be useful, but prevalence figures from one study always come with some uncertainty, which is why the international numbers help.
What needs to change
If you’ve given birth and something doesn’t feel right, you don’t need to wait for someone to ask. It might help to go to your GP with the words already in mind: “I think I might have PTSD from my birth.” These are some of the signs worth mentioning:
- memories of the birth pushing in when you don’t want them
- flashbacks or nightmares
- your body reacting when something reminds you of the birth
- avoiding appointments, places, conversations or people connected with it
- feeling constantly on alert for something bad happening to you or your baby
- feeling detached from yourself, your baby or what happened
If you’re a GP, midwife or health visitor, one appointment at six weeks isn’t enough to catch this. Women need more than one chance to talk about how the birth was for them, and a question about avoidance may find women that a question about mood won’t. The BJGP authors are calling for a proper screening tool for general practice, alongside training and clear referral routes. Until that exists, asking specifically about the birth is a good start. I’m not familiar enough with the detail of the six-week check to redesign it, but for me it would absolutely need to include a psychological profile, not just a question about mood. And make sure you know where to refer women who need more support. Inviting a woman to talk about trauma and then having nowhere for her to go leaves her more exposed than before.
If you support women with fear of birth, when a woman comes to you frightened of a second birth, ask about the first, and about everything around it. What happens when she remembers it? What is she avoiding? Is her fear about what might happen, or is some part of her still living through what did? And look wider than the birth itself. I think most of us carry some kind of reproductive wound, and in my view that’s the first place to look: puberty, her own birth, a miscarriage and sometimes sexual abuse. Where PTSD is possible, work alongside someone qualified to treat it.
A bigger definition of fear-free childbirth
When I started the Fear Free Childbirth podcast, the question behind it was personal: how can a woman have a fear-free birth?
I still care about that question, and women deserve good ways to clear their fear and prepare. But over the years the question has grown for me. It’s become: how do we create a world where women can have a fear-free childbirth?
It shifted because it’s become increasingly obvious to me that a lot of what affects how women feel about birth is outside their influence, and that’s a much bigger problem. In my opinion, whatever is going on in the mental health space clearly isn’t working, because from my perspective mental health is an absolute shit show worldwide. The maternity system women have to deal with isn’t getting better. I think it’s getting worse. And the pressure people are under, with jobs, job losses and money, isn’t changing any time soon.
So when a woman decides whether to have a baby, she’s got a lot to untangle. Can I afford to take time out? What if I stop working and can’t get a job again? What about the relationship? What about my identity as a woman, and how society treats women who are mothers? What about the system I’ll have to deal with? I’ve already got anxiety, so what does this mean for that, when the help I’ve had for my anxiety hasn’t really changed it? All of those things have an impact. And in the time I’ve been doing this work, none of them have been improving.
So the question has to be bigger. It’s about what she can do, and also about what we can do around her to help her. That means looking at maternity care, at consent, at how women are spoken to and at what happens after a birth that went badly for the woman living it, including a system that, right now, has no agreed way of noticing when a birth has left her traumatised.
So much about how the system handles birth trauma makes me angry, starting with the fact that a woman has to go through it in the first place. But what gives me hope is that women are fundamentally strong, and we now have some incredible ways to help people heal from this.
If you’re struggling after a birth, please talk to your GP, midwife or health visitor, and use the words birth trauma or PTSD so it’s taken seriously. If you’re in crisis, contact your GP urgently, call NHS 111 or call the Samaritans on 116 123 (free, 24 hours a day). If you’re outside the UK, contact your local emergency services. Our reproductive trauma section has more on this.
If you’re pregnant again and frightened because of what happened last time, the free Tokophobia Test can help you make sense of it. It’s run by our partner site Fearless Birthing, founded, like Fear Free Childbirth, by Alexia Leachman. Take the Tokophobia Test.
Sources
- Foreman M, Hillman S, Cross J, Hanson S, Parretti H, Ayers S. Diagnosing in the dark: the childbirth-related post-traumatic stress disorder GP evidence gap. British Journal of General Practice. 2026;76(770):426-428. doi:10.3399/BJGP.2026.0269
- Webb R, Uddin N, Constantinou G, Cheyne H, Ayers S. Prevalence of birth trauma and childbirth-related post-traumatic stress disorder in UK women: results from the International Survey of Childbirth-Related Trauma. Women’s Reproductive Health. 2026;13(1):16-27. doi:10.1080/23293691.2025.2545307
- Webb R, Uddin N, Constantinou G, Ayers S. Risk factors for birth trauma and postpartum posttraumatic stress in the United Kingdom. Acta Obstetricia et Gynecologica Scandinavica. 2026;105(6):1163-1172. doi:10.1111/aogs.70236
- Moran PM, Best C, Meades R, et al. Postpartum post-traumatic stress disorder and health service use: a longitudinal cohort study. Journal of Affective Disorders. 2026;400:121171. doi:10.1016/j.jad.2026.121171
- Ayers S, Handelzalts JE, Webb R, et al. International prevalence of childbirth-related post-traumatic stress disorder: INTERSECT study. British Journal of Psychiatry. 2026. doi:10.1192/bjp.2026.10708
- Constantinou G, Ayers S, Webb R, et al. Symptom presentation of childbirth-related post-traumatic stress in 31 countries: the INTERSECT study. Journal of Affective Disorders. 2026;412:122092. doi:10.1016/j.jad.2026.122092
- Handelzalts JE, Ayers S, Webb R, et al. Cross-national risk factors for childbirth-related PTSD: findings from the INTERSECT study. Psychological Medicine. 2025;55:e349. doi:10.1017/S0033291725102298
- Dr Megan Foreman’s estimate was reported in UK press coverage of the BJGP paper, August 2026.
About the author
Alexia Leachman has specialised in tokophobia and reproductive anxiety since 2015, and has personal experience of tokophobia. She is the founder of Fear Free Childbirth and hosts its podcast. She developed the Head Trash Clearance Method, which she uses in her work with women and teaches to perinatal professionals. She is the author of Fearless Birthing and Betrayed By Your Biology and a contributor to Childbirth, Midwifery and the Media. Alexia designs psychometric assessments of reproductive fear, including the Birth Readiness Profile.
Fear Free Childbirth is a publication and is not a substitute for medical or mental-health care. If you’re struggling to cope or in crisis, please contact your GP, midwife or a qualified professional.
Keep reading
- Thousands of Mothers May Be Living With Undiagnosed PTSD After Childbirth - 16th October 2026
- What Happened to Birth? The Statistic That Sent Me Down a Rabbit Hole - 16th October 2026
- Induction and Birth Trauma: What a New Study Found - 12th October 2026
