Pregnancy and trauma treatment

Is ANY form of EMDR safe in the context of pregnancy?

(Add note re: this was originally focused on EMDR trauma treatment, but applies to other forms as well.)

by Tom Cloyd, MS, MA – Counselor / Psychotherapist – Bellingham, Washington (360) 920-1226 – email: tc (AT) tomcloyd.com (please read about content licensing)

SUMMARY

In EMDR trainings, one is cautioned about doing EMDR trauma therapy with pregnant women. This may sometimes be problematic, but there is a complication which makes therapy postponement a less simple decision than it might appear.

Trauma-treatment may cause prenatal and postnatal
harm

Stress hormones produced when experiencing or re-experiencing trauma (as one does during therapy for trauma) are believed to have negative effects on a number of aspects of prenatal development and postnatal survival. Inhibition of fetal growth, along with prematurity in certain aspects, is commonly reported in studies I have seen. A number of recent studies suggest that stress during pregnancy is almost a toxin to fetal brain development. Other aspects of fetal development, as well as postnatal characteristics of the baby, may also be stress-sensitive. A mere sampling of some recent literature:

Animal studies have shown a clear relationship between stress and poor pregnancy outcome. Chronic prenatal stress in rats has been found to produce earlier development of key indicators of growth (prematurity), and to increase susceptibility to behavioral depression at adult age (Secoli & Teixeira, 1998). A study of pregnant rats (Lordi, et al., 1997) which compared the effects of two kinds of prenatal stress found that both greatly increased postnatal death rate, while the second alone affected growth rate (negatively). When adult, the offspring of stressed mothers exhibited learning and memory impairments. Alteration of these cognitive functions was interpreted as a subtle effect of the hormonal components of the mothers’ stress response upon the neonates’ nervous system development.

Human studies have shown similar findings. In a prospective study of 120 Hispanic and 110 White pregnant women, prenatal stress (state and pregnancy anxiety) was found to relate inversely to length of gestation (Rini, et al., 1999). Hedegaard, et al. (1996), found the same relationship in a study of 8,719 Danish women, while also finding social support to have no buffering effect.  Hansen, et al. (1996) found, in a population based study of 3021 women, clear support for the existence of a fetal stress syndrome with adverse effects on fetal development, including deficient brain development.

Stress induction in the presence of pregnancy appears to be risky at best. But it’s not that simple.

NOT treating trauma may cause greater harm

Pregnant women with active PTSD will usually experience flashbacks, and hyper-responsivity, and hyper-arousal, without psychotherapeutic intervention. What if such intervention could decrease the total amount of stress response produced during a pregnancy, by desensitizing the mother to traumatic memory? How does one make a probabilistic calculation to estimate the degree to which psychotherapy, whose duration can only be estimated at best, will stress the mother LESS than leaving her to experience her pre-intervention PTSD symptoms? As a clinician, are you more liable, in the event of an adverse pregnancy outcome, if you intervene (with trauma therapy) or if you do not?

I don’t know, and I don’t know how to know. Until recently, I have chosen in virtually all cases NOT to do trauma therapy with pregnant women. And I have always found this to be an unsatisfying choice for several reasons. But trauma treatment is not our only option, with EMDR.

Supportive EMDR is safe

EMDR, it will be remembered, is basically a process for inducing rapid learning. If the “lesson” is a positive one, no traumatic stress is induced. Use of Leeds’ Resource Installation protocol is clearly acceptable, due to its focus on targets imbued with positive affect. Should the EMDR processing take a turn toward a negative focus, which certainly can happen with some heavily impacted clients, the processing can be quickly shut down in the standard manner taught in EMDR training and discussed in Shapiro (1995).

Resource Installation is indicated with traumatized women who are pregnant for another reason. There is anecdotal clinical evidence that people with greater personal resources respond less adversely to traumatic flashbacks, etc. In other words, Resource Installation may well have a stress-buffering effect as one of its outcomes. This likelihood would suggest that in all cases where Resource Installation might strengthen an individual who is pregnant it should be done.

Choose to minimize harm

One EMDR clinician has commented that there are many things one might experience during pregnancy that have not been proven safe—including riding a bus! EMDR is just one more such thing. This same clinician, who is medically trained, did EMDR with a woman who was hooked up to a fetal monitor, and no fetal distress was observed at all, during the EMDR processing. Use of a fetal monitor seems to be a relatively popular idea. All uses of which I have heard have indicated that the EMDR did not appear to distress the fetus. We may be worrying about a phantom. There appear to be NO known reports of adverse outcomes from use of EMDR during pregnancy, and a number of clinicians have used it in that context.

If one decides to go ahead with EMDR during pregnancy, it would certainly seem wise to give attention to the practices we usually use to keep the client from re-experiencing the trauma excessively—emotional containment metaphors (Shapiro’s train, viewing the trauma as if on a television, etc.), cultivating clear skill with and confidence in symptom management procedures like the Safe Place exercise, and so on. The experience the client will have during EMDR is subject to pre-treatment modification, so why not take advantage of this?

Let’s not lose perspective, in thinking about EMDR in the context of pregnancy. If, say, two or three sessions of EMDR would bring an end to flashbacks that occur even once a week, there would be a clear net gain, over the period of a full-term pregnancy, and use of EMDR would seem to be indicated and easily defensible.  If EMDR has no effect, then the net increase in trauma-related hormones would still be very small, over a nine month pregnancy. Too, there are cases where a woman is at risk for such behavior as drug-overdoses, which are highly undesirable during a pregnancy. If EMDR can diminish such risks, it would be an excellent clinical option. A number of clinicians have used EMDR with such pregnant clients, and there has been a clear reduction in frequency of high-risk behavior and its processors, in all cases of which I have heard.

EMDR can reduce pregnancy-related anxiety

Many clinicians have appreciated the usefulness of EMDR in attenuating or terminating anticipatory anxiety experienced during pregnancy. This would include such things as concerns about the birthing itself, about the health of the newborn, about birth defects, about the development of the child, about the reaction of other children in the family to the child, about the adequacy of the husband to father, about the mother’s own maternal skills, and so on. Not only might EMDR resolve these anxieties, it could also be used to install positive expectations! The net result? Surely an overall decrease in the anxiety experienced by the pregnant mother, and physical concomitants that might adversely affect the fetus.