‘You’ve got a healthy baby’: A qualitative study of traumatic birth, silencing, and perinatal suicidal behaviour

Abstract Problem: The relationship between traumatic birth experiences and perinatal suicidal ideation and behaviour remains poorly understood. Background: Suicide is a leading cause of maternal death, and birth trauma is common and associated with perinatal mental health difficulties. Yet women’s accounts of how traumatic birth and suicidal behaviour connect are largely absent from the literature. Aims: This study explored: (i) how women with lived experience of perinatal suicidal behaviour described traumatic birth and its aftermath; (ii) how they understood the relationship between traumatic birth and suicidal ideation and behaviour; and (iii) what they identified as harmful, helpful, or preventative in the care they received or did not receive. Methods: Using reflexive thematic analysis within a critical realist orientation, we analysed sixteen semi-structured interviews with women in Australia who had experienced both traumatic birth and perinatal suicidal behaviour, drawn from a larger co-designed family-based study. Findings: Two themes comprising seven subthemes were constructed: the silenced birth and routes into suicidal behaviour. Women described traumatic birth through accounts of obstetric violence, medical emergency, loss of control, and lasting physical injury. Family members and clinicians often minimised or closed these accounts down by focussing on the healthy baby, and many women struggled for years to find language to name their experiences. Participants attributed their suicidal ideation and behaviour to birth trauma as the final harm added to an already heavy load, and to physical birth injury experienced as a loss of function, role, and imagined future. Conclusion: Recognising and validating traumatic birth experiences across maternity, mental health, and primary care services is critical for timely support, trauma-informed and collaborative care planning, improved outcomes, and reduced perinatal suicidal behaviour.