The expectations of a mother-to-be of a calm, natural and fulfilling labour and childbirth, surrounded by supportive people with a sense of control and being heard can be central to her emerging sense of herself as a good mother. Should this type of labour or postnatal period not eventuate the new mother can feel less than a good mother, combined with the emotional and physical scars that remain.

Many women who experience PND express feelings of distress following labour and/or childbirth. The degree of distress that they feel is determined by the combination of their experience and what the experience means to them. For some women their labour or childbirth may have required a minor degree of intervention for which they were not prepared, that triggered deep responses related to past experiences or interacts with their personality. Other women can experience extreme levels of intervention and are able to come to terms with it fairly rapidly.

PND has become increasingly recognized as a valid and important postnatal mood disorder but there is less recognition for the trauma that can result from the process of childbirth. A difficult and traumatic childbirth experience has been identified as a potential trigger for the development of Post Traumatic Stress Disorder (PTSD). This can be a response to exposure to events that involve actual death, serious injury or any perceived threat, as a victim or a witness. Childbirth is seen as a trauma of significance to cause PTSD. A woman who has felt traumatised by childbirth may re-experience it as intrusive dreams, flashbacks and stress response to events that symbolise the trauma. She may exhibit persistent behaviours of avoidance and increased arousal.

Risk factors for PND and PTSD associated with childbirth can include: (Swalm)

• poor support from partner, family and or staff during labour
• unplanned pregnancy
• previous stillbirth - Turton et al found that 21% of women with a history of stillbirth experienced PTSD during the 3rd trimester of the next pregnancy
• previous trauma such as childhood sexual abuse - some aspects of labour and delivery might remind her of previous sexual assault
• high trait anxiety resulting in women being more prone to anxious responses
• perceptions of not being in control during labour and not knowing what's going on
• inadequate pain relief can be extremely traumatic
• the mother's fear for the well being of her baby or herself following interventions or a life threatening situation can be very traumatic. These fears and anxieties can interrupt the mother's ability to be available to and bond with her baby.

It is important for professionals and lay persons to have some understanding of the differences between PND and PTSD and how to assess them, because the treatment for the two disorders can be different. Offering a mother with a certain level of childbirth intervention access to postnatal debriefing can be vital for her to come to terms with her childbirth experience.