Article on PTSD in Pregnancy

What is posttraumatic stress disorder? Posttraumatic stress disorder (PTSD) is a mental health problem that develops in some people who have had a traumatic event or experience. Trauma can be anything that is shocking, scary, upsetting, stressful, or the cause of strong emotions. Trauma may be one event or several events that happened over time. When people with PTSD experience something that reminds them of their trauma, they may feel like the trauma is happening all over again. They may feel panic or anger, or their mind may shut down and get numb. They may feel like fighting or leaving, or they may freeze and do nothing. Feeling (reliving) the emotions and pain of a trauma that happened in the past is one symptom of PTSD. Things that make you have the same feelings you had when the trauma happened are called “triggers.” Other symptoms of PTSD are avoiding things that are reminders of the trauma and always feeling anxious and on the lookout for danger. What kinds of trauma can affect women during pregnancy? Although childhood abuse, sexual abuse, and neglect are the most common causes of PTSD in pregnancy, other trauma can also affect women. A previous miscarriage, stillbirth, death of a child, or traumatic birth can also be traumatic and cause symptoms of PTSD during a later pregnancy. Prior illness, like cancer, or bad medical experiences can also make women scared or anxious during prenatal care or cause fears about labor and birth. Women whose parents were not good role models for parenting can feel sad about their childhood experience with a parent and/or wonder if they will be “good” moms. What does my childhood have to do with pregnancy and becoming a mother? Studies show that abuse and neglect can continue to happen in families for generations. About 1 out of every 5 women have experienced physical, sexual, or emotional abuse or neglect when they were young. For some trauma survivors (people who have lived througha trama), abuse and neglect can have long-term effects, such as depression, PTSD, health problems, and not being able to feel happy. Studies also show that trauma survivors really want to break the cycle of trauma or abuse and its effects. Pregnancy is a very important time to get help if you havea history of trauma or symptoms of PTSD. What feeling or needs do trauma survivors have related to pregnancy and mothering? Many trauma survivors have strong feelings that come up during pregnancy. Some worry about how they will handle labor, birth, breastfeeding, and sleeplessness while caring for their newborn. They may feel nervous about depending on the health care providers involved in their care. Feelings of neediness or anger can be hard to deal with. Sometimes, pregnancy or prenatal care can start or cause PTSD symptoms for trauma survivors. People with PTSD need help dealing with their symptoms in healthy ways and avoiding things that are triggers. It is also helpful for them to have extra support and patience from their family, friends, and health care providers. Some people with PTSD use tobacco, alcohol, or drugs to cope, and they may need help to quit using things that are unhealthy. People with PTSD may also be depressed and need treatment for depression. How do I know if I have PTSD? These questions can help you and your health care provider learn if you have PTSD: 1526-9523/09/$36.00 doi:10.1111/jmwh.12705 Qc 2017 by the American College of Nurse-Midwives 775 In the past month, have you: • Had nightmares about the event(s) or thought about the event(s) when you did not want to? Yes No • Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? Yes No • Been constantly on guard, watchful, or easily startled? Yes No • Felt numb or detached from people, activities, or your surroundings? Yes No • Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? Yes No If you answer yes to 3 or more questions, you could have PTSD and should talk about this with your health care provider. What can I do if I have PTSD? Talk with your health care provider if you havea history of trauma or if you think you have symptoms of PTSD. You and your health care provider can make a plan for how to best avoid triggers and manage your PTSD symptoms. You can also decide together if you could be helped by getting counseling for PTSD. Counselors can teach you strategies to manage symptoms of PTSD. In counseling, you may talk about the past or you may choose not to talk about the trauma. This is your choice. There are also medications that help with PTSD. If PTSD is making it hard to do your normal activities, talk with your health care provider about the risks and benefits of using these medications during pregnancy and breastfeeding. Discussing these questions with your health care provider can help you both decide how to best manage your history of trauma: • Are you having symptoms of depression? • Are you having any trouble quitting using tobacco, alcohol, or drugs? • Do you know what things might trigger you or make you feeling uncomfortable, such as having a physical examination, being in a hospital gown, or feeling like you are not the one in control of things? • What extra support would you like in labor, with breastfeeding, and for learning about parenting? • Who in your family is a safe, supportive person who could be good help to you? • What helps you feel hopeful and excited about being this baby’s mother? How can I talk with my health care provider about my history of trauma? Talking abouta history of trauma is difficult. One way to prepare for this conversation is to put your story into a “3 E’s” format. The 3 E’s are Event, Experience of the event, and Effects. You can fill in these blanks: Event: “What happened to me was .” You don’t have to share details if you don’t want to. Just saying “I have a history of childhood (sexual, physical, or emotional) abuse” is good enough. Experience of the event: “At the time I felt .” Effects: “Now it seems to me I need help with .” Flesch-Kincaid Grade Level: 8.1 Approved October 2017. This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to the Journal of Midwifery& Women’s Health’s approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, the Journal of Midwifery& Women’s Health suggests that you consult your health care provider. This document is UCSF endorsed 776 Volume 62, No. 6, November/December 2017 ¿Cómo podemos apoyar su salud y bienestar? Nuestra esperanza es ser su socio para tener un embarazo feliz, saludable y apoyado. Tener nuestras necesidades básicas satisfechas y los “Cazadores del estrés”, o pilares del bienestar, son algunas de las cosas que ayudan a sobrellevar el estrés. A continuación, se muestran algunas áreas en las que podríamos ayudar; marque una “X” junto a las áreas en las que le gustaría recibir ayuda y podemos abordarlas con usted o ayudarlo a conectarse con recursos adicionales. A) Los recursos para necesidades básicas como alimentos, vivienda, desafíos legales o laborales pueden ayudar a las familias con el estrés Me gustaría apoyo con esto B) Salud mental Me gustaría apoyo con esto C) Las relaciones con otros adultos en su vida, incluida su pareja, son apoyos importantes para usted. Me gustaría un poco de apoyo con esto D) Ser padre de su hijo o de sus hijos mayores: una relación sólida con usted y un entorno estable y acogedor son los cimientos de la salud de por vida y lo protegen contra los desafíos que su hijo pueda enfrentar. Me gustaría un poco de apoyo con esto E) Bienestar general (sueño, nutrición, experimentar la naturaleza, actividad física) Estas cosas nos ayudan a sentirnos bien y mantenernos saludables, y ayudan a nuestro cuerpo a lidiar con el estrés. Me gustaría un poco de apoyo con esto F) Trabajando en cómo lidiar con momentos estresantes en el momento y en nuestras relaciones. Me gustaría apoyo con esto G) Preparación para el trabajo de parto y el parto, como clases, plan de parto, nuestra doula Me gustaría apoyo con esto