Causes of PTSD: Pregnancy loss
Pregnancy loss in all its forms, including miscarriage, stillbirth, ectopic pregnancy and termination for medical reasons (TFMR), 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 loss 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) or C-PTSD, along with other mental health conditions.
How many people develop PTSD following a pregnancy loss?
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. Following medical Termination of Pregnancy, reports of PTSD are as high as 64.5%.
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 and C-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 loss 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 pregnancy loss 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 pregnancy loss?
Early intervention is crucial in helping to prevent the onset of PTSD and C-PTSD symptoms. Good aftercare and grief counselling can be beneficial, particularly after traumatic cases. Although pregnancy 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 pregnancy loss. People who have had clinical depression prior to their pregnancy loss are statistically more likely to develop PTSD or C-PTSD, and therefore extra attention should be paid to how they are coping. Likewise, those who experience more than one pregnancy loss are at an increased risk of developing PTSD or C-PTSD, and this too should be acknowledged.
NICE guidance from 2005 and 2011 recommends the use of trauma focused psychological treatments for PTSD and C-PTSD in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).
For more support and information specifically about pregnancy loss, Tommy’s has some great resources.
- 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
- Daugirdaitė, V., van den Akker, O., & Purewal, S. (2015). Posttraumatic stress and posttraumatic stress disorder after termination of pregnancy and reproductive loss: a systematic review. Journal of pregnancy, 2015, 646345. https://doi.org/10.1155/2015/646345
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Treatments for PTSD
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.