For five hours, Sadie Nielsen pushed, enduring the grueling physical and emotional peak of childbirth. Then, at the top of the fifth hour, the trajectory of her experience shifted instantly. Her doctor informed her she needed an emergency C-section, and a nurse warned that her baby might require to go to the neonatal intensive care unit (NICU).
“In that moment, I felt like I couldn’t breathe,” Nielsen, a resident of Eagle Mountain, Utah, recalled. “I felt like my life, essentially, was spiraling out of control.”
Nielsen’s experience is not an isolated incident, but rather a reflection of a widespread yet under-addressed crisis in maternal health. Across the United States, estimates suggest that between 9% and 44% of women describe having a traumatic experience during childbirth. Despite this prevalence, the Utah Department of Health and Human Services notes that birth trauma remains largely unrecognized within standard maternity care.
For many women, the trauma is not only found in the medical emergency itself but in the perceived indifference of the care that follows. Improving birth trauma support requires more than just checking a box on a medical form; it requires a fundamental shift in how healthcare providers screen for and respond to postpartum psychological distress.
The failure of procedural screening
Mental health screenings are a standard part of postpartum care, intended to catch depression and anxiety before they escalate. Although, a study conducted with the Kem C. Gardner Policy Institute suggests that the current approach to these screenings often misses the mark. Many participants felt that the questionnaires were treated as procedural formalities rather than genuine opportunities for intervention.
In 2021, shortly after her first child’s birth and although recovering from the removal of metal sutures from her cesarean section, Nielsen underwent a mental health screening using the Patient Health Questionnaire-9 (PHQ-9). The tool is designed to identify symptoms of depression and thoughts of self-harm, but for Nielsen, the delivery of the test was devoid of empathy.
“I wasn’t able to really answer the questions truthfully or honestly due to the fact that I was just in so much pain,” she said. “I had so much fear, and I felt like where I was at — no one was really caring about what exactly had just happened to me.”
Nielsen described the interaction as feeling as though the interviewer were merely “shooting the breeze” or talking about the weather. This sentiment was echoed by other women in the study, who reported that their feelings were dismissed as the “baby blues” or that they feared admitting to mental health challenges could lead to their children being taken away.
Comparing postpartum screening tools
While Utah recommends the Edinburgh Postnatal Depression Scale (EPDS) for new mothers, the PHQ-9 is also considered a valid instrument. The difference often lies not in the tool itself, but in who administers it and how.
| Tool | Primary Focus | Utah Recommendation Status |
|---|---|---|
| EPDS (Edinburgh Postnatal Depression Scale) | Specifically designed for postpartum depression and anxiety. | Recommended primary tool. |
| PHQ-9 (Patient Health Questionnaire-9) | General depression severity and suicidal ideation. | Recognized as a valid alternative. |
The impact of systemic burnout
The timing of Nielsen’s first birth coincided with the COVID-19 pandemic, a period that placed unprecedented strain on the healthcare system. She believes the chaotic environment and constantly shifting hospital procedures contributed to the lack of emotional support she received.
Nielsen noted that nurse burnout was a significant factor. “When hospitals are not doing their job to support their nurses and train them to assist patients with birth trauma, then the patients suffer even more,” she said.
The lack of integrated support meant that while Nielsen knew she needed anti-anxiety medication to manage her insomnia—sleeping perhaps two hours a night—no hospital staff suggested a referral to a specialist. It was only after returning home and receiving help from her mother that she was able to access the medication and begin her healing process.
Moving toward empathetic care
The contrast became clear during the birth of Nielsen’s second child. This time, the hospital utilized a social worker to conduct the mental health screening. Rather than filling out a physical piece of paper in isolation, Nielsen engaged in a guided conversation.
“She was very empathetic about the things I had experienced before,” Nielsen said. “She asked me serious questions, but in a way that I knew that if I answered them in a way that I needed help this time, that she would follow up on it.”
This shift from a “checklist” mentality to an empathetic dialogue provided Nielsen with something her first experience lacked: a clear path to resources and the feeling of being heard. This distinction is critical, as the study found that support for new mothers often drops off sharply after the initial hospital stay.
Currently, most women receive a single comprehensive checkup six weeks after delivery. For many, this visit is too brief to address deep-seated trauma. Nielsen argues that multiple follow-ups from various sources would prevent women from feeling alone in their recovery.
For women in Utah seeking assistance or more information on recovering from a traumatic birth, resources are available at birthtrauma.utah.gov.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
As healthcare systems continue to analyze the findings from the Kem C. Gardner Policy Institute, the focus in Utah is shifting toward refining the integration of social workers and mental health professionals into the immediate postpartum window. The next phase of improvement will likely involve evaluating the efficacy of increased follow-up visits beyond the standard six-week mark to ensure long-term maternal wellness.
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