This year, nearly 4 million American women will give birth. Most will experience an uneventful pregnancy, but the experience may be more difficult for the estimated 8% of pregnant women who have post-traumatic stress disorder (PTSD). For these women, being pregnant can trigger PTSD symptoms that may have been in remission for years. Though PTSD is often associated with a variety of physical ailments, women who have PTSD may avoid medical care because the thought of enduring a physical examination is too stressful. This is especially true for the 13% of women who have survived sexual assault, and the 27% who have survived childhood sexual abuse.
In general, medical exams can feel invasive, as patients are required to remove their clothes, answer personal questions, allow providers to touch intimate parts of their bodies, and sometimes endure painful treatments. This experience can trigger PTSD symptoms including being flooded with memories of the trauma, flashbacks, terrifying nightmares, or dissociation- a sense that the experience is not real or feeling physically numb and detached from the physical body, or the baby. Because prenatal care is so important to the healthy development of the baby, women who have a history of PTSD should find an OB/GYN or Nurse Midwife who provides trauma-informed care so that they can get the help that they need, not only while they are pregnant, but also during the postnatal period.
What is Trauma-Informed Care?
While not all women who have a history of PTSD will experience a resurgence or worsening of PTSD symptoms during pregnancy, those who do may ultimately have difficulty bonding with their infants and may be at increased risk for postpartum depression. Finding an OB/GYN or Nurse Midwife who provides trauma-informed care can make prenatal care and labor and delivery more tolerable. A trauma-informed healthcare provider will:
Ask permission before proceeding with an exam or a procedure;
Offer a patient control by allowing her to refuse or end an exam or procedure when the patient feels uncomfortable or distressed; and
Provide support by not forcing or insisting that a patient complete an exam or procedure and listening to a patient as they explain why they feel uncomfortable or distressed.
If you are a pregnant woman with a history of PTSD, there are ways to assess whether or not your healthcare provider is working from a trauma-informed perspective.
Is My Provider Trauma-Informed?
Ideally the medical professional that you choose should screen their pregnant patients for a history of trauma. Keep in mind that some providers may not screen for trauma because discussing trauma makes them uncomfortable. Other providers may dismiss a woman’s concerns about trauma because they are not aware that pregnancy, labor, and delivery can trigger PTSD symptoms.
Some women will be aware of their trauma history, and others will not. This is why it is important to pay attention to how the provider communicates before, during, and after a physical exam in order to assess whether or not they provide trauma-informed care.
The following checklist has been adapted from materials that are used to train medical professionals on how to provide trauma-informed care. Make note of the following interactions with the medical provider that you have selected, or are considering, to provide you with prenatal care and assist with labor and delivery.
Before the Exam:
Does the provider offer an explanation of everything he/she will be doing prior to starting the exam?
Does the provider explain whether or not what will be done is standard/routine?
Does the provider ask about any signs of your discomfort that they have noticed?
During the Exam:
Does the provider explain how and why they will touch each part of your body?
Does the provider ask for permission before touching your body?
Does the provider check-in periodically to see if the exam is causing you discomfort or distress?
After the Exam:
Does the provider express thanks for your cooperation?
Does the provider explain the results of the exam in clear, easy to understand language?
Does the provider ask about questions or concerns that you might have?
Other Important Considerations
There is some evidence that having emotional support from partners/spouses, friends, and family members, can help to alleviate some of the stress of PTSD symptoms in pregnant women. For some, having the services of a doula who is experienced in providing trauma-informed care can be a source of additional emotional support.
Learning to manage the intense emotions, changes in mood, anxiety, and trauma symptoms that can emerge during pregnancy for women with a history of trauma can make navigating the pregnancy and the postpartum period more manageable. Weekly psychotherapy can help pregnant women with a history of PTSD feel more in control of their lives, and better able to cope with the physical, emotional, and psychological changes associated with pregnancy.
The Waverly Center for Psychotherapy offers trauma-informed psychotherapy for expectant and new mothers in the Washington, DC metro area. Call (301) 417-5506 for help.