Causes of PTSD: Miscarriage/Early pregnancy loss
Early pregnancy loss in all its forms, including miscarriage and ectopic pregnancy, can be a hugely traumatic and upsetting time for those who experience it. In the UK, there are an estimated 250,000 miscarriages and 10,000 ectopic pregnancies (in which an embryo starts to grow outside the uterus) every year.
The sense of loss, the experience of death, the pain and trauma endured in the miscarriage itself, the feelings of hopelessness and despair, the guilt-ridden questions of ‘what if’, plus the medical interventions that may follow, can all lead to the development of post-traumatic stress disorder (PTSD), along with other mental health conditions.
How many people develop PTSD following a miscarriage?
Research conducted by Imperial College London in a survey of 113 people who had suffered a miscarriage or ectopic pregnancy, found that four in 10 of them were reporting symptoms of PTSD in the three months after their miscarriage. They were also suffering from moderate to severe anxiety, distress and depression.
The people researched were commenting on experiencing intrusive or unwanted thoughts, as well as regularly re-experiencing the feelings associated with losing their pregnancies. For some of them, this involved nightmares or flashbacks, while others were avoiding anything that may remind them of their miscarriage. For nearly a third of them, their symptoms were impacting their work life, while 40% felt it impacted their relationships with their friends and family.
As psychiatrist Gail Saltz M.D. explained to SELF.com, “A wanted pregnancy stirs many fantasies of the child and the family-to-be, even at the earliest phase. This fantasy is very real and very wished for, so loss of the pregnancy, even at three months, feels like the loss of the would-be child and the would-be family.”
How PTSD can manifest
PTSD may manifest itself in a number of ways, from sadness to nightmares, social withdrawal to flashbacks, physical sensations like nausea or trembling, to repetitive distressing sensations. Those affected may wonder why the miscarriage happened to them, if they could have done anything to stop it, and can lead them to feeling guilty, ashamed or somehow responsible. The reality is that miscarriage is by-and-large unavoidable, and often doctors can’t always explain why it happens.
Is there anything that can be done to help prevent PTSD following a miscarriage?
Early intervention is crucial in helping to prevent the onset of PTSD symptoms. Good aftercare and grief counselling can be beneficial, particularly after traumatic cases. Although miscarriage and baby loss can feel like a very taboo subject, speaking out– to doctors, friends and family – can all help to make those suffering feel less alone, and also help to alleviate the onset of any mental health problems.
For GPs and pregnancy units, it’s important they are trained to look out for these symptoms, and to also practice empathy and understanding when meeting people (and their partners) who have experienced a miscarriage. People who have had clinical depression prior to their miscarriage are statistically more likely to develop PTSD, and therefore extra attention should be paid to how they are coping. Likewise, those who experience more than one miscarriage are at an increased risk of developing post-traumatic stress disorder, and this too should be acknowledged.
NICE guidance from 2005 and 2011 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).
- Farren, J., Jalmbrant, M., Ameye, L., Joash, K., Mitchell-Jones, N., Tapp, S., Timmerman, D., & Bourne, T. (2016). Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ open, 6(11), e011864. https://doi.org/10.1136/bmjopen-2016-011864
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