Only a limited number of research studies have examined treatment outcomes for PTSD following traumatic birth in the postnatal period. There is even less research documenting outcomes for treatment of PTSD during during pregnancy. However, in private practice and maternity settings woman are frequently referred during pregnancy with symptoms of PTSD arising from a previous traumatic birth. The looming birth intensifies the fear of childbirth and the fear of losing control again.
Is it safe to treat PTSD during pregnancy? Professionals are sometimes reluctant to offer treatment because of concerns about the effects of the stress response evoked during therapy upon the unborn baby. Certainly, PTSD treatment tends to first intensify the patient’s distress, before leading to a reduction in symptoms. However, untreated PTSD is by virtue of the condition, is associated with elevated stress which also poses a risk to the infant, as well as a potential risk to the mother’s engagement in the pregnancy and the parent-infant relationship. On the other hand, psychologists know that there are long-term benefits for parent, the parent-infant relationship and the for the infant when PTSD is treated successfully.
The question about whether it is feasible to treat PTSD during pregnancy depend upon constraints such as how much time is available to work through a treatment protocol, Cognitive Processing Therapy (CPT) for PTSD for example generally requires 12 sessions. If the woman is too far into her pregnancy, there may not be time to do this work. The woman also needs to be physically well and able to commit herself to the treatment. It is also prudent to discuss what would happen if the therapy was interrupted mid-way because the woman experienced pregnancy complications and was unable to continue.
Perinatal practitioners know however that pregnancy confers a particular advantage for mental health treatment. The time limit it imposes can be especially helpful. A woman can be highly motivated to ‘set things right’ before the baby arrives, thus creating a unique window of opportunity. Mothers are usually acutely aware that the successful treatment of PTSD will support their relationship with their baby to get off on the right foot. It can also be tremendously healing when a subsequent birth is experienced as having gone well.
In short, it is a matter of clinical judgement whether the clinician feels it is appropriate to commence treatment for PTSD during pregnancy. It is important to consider the risks and benefits of this work, the physical health of the mother, her motivation, and the chronicity of the trauma/s. However, in my experience, this can be deeply rewarding work and lead to markedly different outcomes for parents and their babies.
