When the System Is the Stressor: Why Perinatal PTSD Is Still Being Missed and What Helps

January 13, 2026

Written By: Sarah Donovan, LCPC, PMH-C

Licensed Clinical Professional Counselor | Perinatal Mental Health Certified | EMDR Therapist and Consultant | Registered Yoga Teacher

Perinatal trauma is far more common than most providers and systems of care recognize and far more nuanced than it is often treated. Too frequently, trauma in the perinatal period is misidentified as anxiety or depression alone, leaving both parents and providers frustrated when insight, reassurance, and well-meaning coping skills are not enough.

One of the most important distinctions we explore in our work is the difference between Perinatal Mood and Anxiety Disorders (PMADs) and Perinatal PTSD (P-PTSD). While these conditions often co-occur, they are not interchangeable. Perinatal PTSD is a trauma-based condition rooted in exposure to identifiable threat or loss, not mood dysregulation alone. When the two are conflated, trauma frequently goes untreated and parents are left feeling confused, ashamed, or convinced they are failing at recovery.

Perinatal PTSD can emerge at any point from preconception through pregnancy, birth, and the postpartum period, and typically follows one of three pathways: the reactivation of preexisting trauma, trauma that begins during pregnancy, or trauma related to childbirth itself. Symptoms are often linked to specific perinatal events and may include re-experiencing, avoidance, hyperarousal, and persistent negative beliefs about the self or body. Because these symptoms can overlap with depression or anxiety, perinatal PTSD is commonly overlooked or misdiagnosed.

At its core, trauma is not defined by the event itself but by overwhelm without integration. During traumatic perinatal experiences, such as obstetric emergencies, medical racism, loss of autonomy, or invasive care, survival responses take precedence over reflection. Language centers in the brain go offline, while sensory memory and physiological threat responses remain active. This is why perinatal trauma often shows up later through intrusive images, body sensations, avoidance, or heightened reactivity rather than a coherent narrative.

Understanding this distinction is essential for providing care that actually supports healing, rather than asking parents to think or talk their way out of a nervous system injury.

The perinatal period also coincides with matrescence, a profound developmental transition involving identity, body trust, and meaning-making. When trauma interrupts this process, parents are often left holding split identities—the “grateful parent” alongside the “survivor” who carries shame, guilt, or self-blame for not feeling the way they think they should. Without trauma-informed care, these internal conflicts often deepen rather than resolve.

This is where system-level awareness matters. Medical settings, power dynamics, and lack of informed consent can themselves become the trauma. Ethical, trauma-informed practice requires screening across timepoints, not just once, and responding with approaches that honor how trauma actually lives in the brain and body. Screening is not extra care, it is responsible care.

As clinicians and mothers, Nina and I see these patterns everywhere. Sometimes it’s while reviewing cases together. Sometimes it’s over coffee at Atwater’s. Sometimes it’s on the sidelines of lacrosse games or tumbling classes. Again and again, we’ve found ourselves saying, “We’re seeing this everywhere and it is still not being named.” That recognition is what led us to create this training.

Our work is grounded in somatic, nervous system–informed approaches, including EMDR, movement, art, yoga, and body-based regulation. These are not techniques we simply teach, they are practices we continue to return to ourselves. We know firsthand that insight does not calm a nervous system. Safety does. Regulation does. And sticking with this work, even when it’s slow or uncomfortable, is where healing happens.

Our January 28th training, Perinatal and Maternal Mental Health: Through the Trauma Lens, is designed to help clinicians recognize perinatal trauma accurately, intervene ethically, and expand their trauma-informed practice in ways that fit their scope and setting. Participants will leave with practical frameworks, screening guidance, clinical language, and curated resources that can be immediately integrated into perinatal care—whether you are a therapist, medical provider, or support professional in the perinatal field.

This training is offered collaboratively by Sarah Donovan of Tilted Root Counseling and Nina Davey of Lifted Willow (www.liftedwillow.com). We are not teaching from a place of having “arrived,” but from the shared, ongoing process of healing alongside our clients and our fellow providers—building something intentional, sustainable, and grounded in real life.

👉 Learn more and register here:

https://www.eventbrite.com/e/perinatal-and-maternal-mental-health-through-the-trauma-lens-registration-1795479751269?aff=

About the Author

Sarah Donovan, LCPC, PMH C, is a Licensed Clinical Professional Counselor, EMDR Certified Therapist, EMDRIA Approved Consultant, and Registered Yoga Teacher with over 16 years of clinical experience. She is the founder of Tilted Root Counseling and Therapies in Maryland, where she specializes in perinatal mental health, trauma, and nervous system informed care for women and couples across the lifespan.

Drawing from both clinical training and lived experience, Sarah integrates EMDR, attachment based approaches, and mind body practices to support healing beyond survival. She is deeply committed to advancing compassionate, trauma informed care in the perinatal space and empowering clinicians to meet this work with depth, humility, and sustainability.

Sarah collaborates with her colleague, friend and fellow mother, Nina Davey of Lifted Willow, to provide perinatal and trauma focused consultation, supervision, and continuing education for clinicians nationwide.