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Q: Dear Frank, A support pal wanted to ask if you knew how PTSD changes, progresses, worsens, or improves during pregnancy, how the stress of PTSD impacts pregnancy and the developing baby, and if you knew of any ways to best manage and minimize symptoms during such a time. She has been having nightmares and dealing with PTSD symptoms including panic attacks. She is worried about the health of the baby. At 21 weeks, she has already had several complications, including eclampsia. Part of the nightmares stem from past traumas but at this time she is having nightmares about something bad happening to her baby. The support pal was also wondering if she should try to find a support group for pregnant women with PTSD symptoms or any other kind of trauma support group.
A: Dear Joyce:
I'm glad to hear from a caring mother who wants to protect her baby, and stay as healthy and emotionally secure as possible throughout her pregnancy.
Pregnancy does present challenges for women with PTSD. One study from Hawaii in 2006 reported that PTSD itself did not appear to harm the mother or child, but traumatized women were more likely to smoke, drink, gain excessive weight, become depressed --and these factors placed mother and child at risk: http://psy.psychiatryonline.org/cgi/content/full/48/4/304. The population studied was primarily Asian and native Hawaiian. Their most troublesome traumatic events were sexual and domestic abuse and this was most prevalent in the native families. Obviously, the continuing presence of an abusive family member requires intervention to protect mother and child.
But our support pal sounds more concerned about echoes from the past than current threats. I do hope that she has an understanding and supportive obstetrician. The doctor can be sure that general health is maintained, that there is no fetal distress, and that diet and medications are appropriate. Many drugs used for depression and anxiety are risky in pregnancy. That could mean that a pregnant woman needs to calm herself and maintain her morale without her usual medications.
Most therapists know how to treat these symptoms with cognitive behavioral therapy (CBT) and supportive care. This could be the time to revisit an old therapist or find someone new who offers calm and comfort.
There is an interesting web posting from an EMDR expert who discusses using that technique during pregnancy:
The bottom line is that a therapist who knows the client, has established trust and rapport, and who is confident and competent, can treat a frightening flashback during pregnancy. It does more good than harm by allowing the pregnant woman to have her trauma memory in the office, to learn how to face her past and reduce her anxiety. But I would be cautious about "exposure therapy" (that includes counting and EMDR and other forms of reliving and mastering old traumas) if the symptoms are minor and the procedure can wait until well after delivery. Every situation is different. I think of these treatments as being like elective surgery. You want to choose the time (and the doctor or therapist) carefully.
If your original trauma includes being held hostage -literally or figuratively- you will find it particularly important to have a sense of control and freedom. Let your doctor, nurse and spouse or companion know how important this will be during delivery and recovery.
I have a few PTSD patients with agoraphobia, related to their abuse. I have explained this to their general physicians and surgeons so that hospital stays were as brief as could be, supportive friends were allowed to visit as soon as possible, and medications could be chosen carefully. Some women want to be alert and risk a bit more pain; some want to be assured that pain will be thoroughly relieved. It isn't always easy to explain your needs and preferences to a busy doctor. But it is the doctor's job to know your needs. A therapist might be able to help get the message across.
I found an interesting web conversation among pregnant women with PTSD: http://www.mothering.com/discussions/showthread.php?t=476001 Have a look and see if these ideas and experiences are helpful to you.
There may be no support groups of pregnant women with PTSD, but many women have faced both challenges together. Kindred spirits do help. It makes sense to find support groups of women going through pregnancy, and support groups for women with PTSD. I'd be concerned, however, about taking on additional roles of helping those who have suffered traumas and who could add to your stress at this time. You deserve to be supported and to conserve your physical and emotional reserves.
In sum, we have no proof that PTSD per se is harmful to the mom or the fetus or the baby, once born. But PTSD will be associated in some women with risk-taking behavior. They will not be as careful as they should be about healthy eating, fitness and safety. So if you or someone you love is at risk for these reasons, do your best to take precautions -even to seek respite at a shelter. But for most GFW support pals and readers, the issue will be managing the stress of bad memory and the anxiety and low morale that comes with that territory. Do your best to connect with friends and family and support pals who understand and respect you. Avoid the kind of people who add to your stress. Practice all that you know about good health and serenity. And remember: it is 2010, not some time in the past. You have a lot to look forward to. You are bringing a new life into this world and you have a village of caring people to help. GFW is a village.
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