Don’t stress me out: Posttraumatic stress disorder (PTSD) and pregnancy

• My fear and anxiety about my soon to be first child is overwhelming on a daily basis… Some days I am angry, some days sad and other days I panic.
• My stress and depression levels were higher than normal
• I get scared when I go anywhere or see someone, even when I keep social distance.
• We planned to have an amazing support team and the rug was pulled from under us.
• I realize this is uncharted territory, but I haven’t felt supported as a first time mother.¹

These were the feelings of pregnant people going through the pandemic. It was an unprecedented event and as MotherToBaby Specialists we faced the anxiety of expectant parents as they tried to get reliable information and deal with their fears, anxieties and frustrations. Fortunately, as time went on, the infection did not seem to increase the chance of birth defects, but now there is the question of the emotional toll it took on pregnant women.

Post-traumatic stress disorder (PTSD) is a state of persistent mental and emotional stress that occurs after a stressful or extremely traumatic event. Unlike PTSD which decreases over time, PTSD symptoms do not fade. PTSD symptoms fall into the following four categories and can vary in severity:

1. Penetration: may include disturbing thoughts or painful memories, flashbacks, nightmares
2. Avoidance: may involve avoiding thinking or discussing the event or their feelings. avoiding things that remind them of the event (people, places, activities).
3. Negative changes in thinking or mood: may include a lack of memory of details about the event. negative thoughts and feelings about themselves or others. feeling numb or withdrawn from others. loss of interest in activities.
4. Changes in physical and emotional reactions (arousal): it may include being irritable and having angry outbursts. self-destructive behavior; having trouble concentrating or sleeping.

In general, PTSD occurs more often in women than in men, and in the pregnancy population more than the non-pregnant population. According to some studies, 3% to 19% of pregnant women experience PTSD.² When it comes to psychiatric disorders during pregnancy, postpartum PTSD or postpartum PTSD is considered the third most common mental health disorder after depression and nicotine addiction.³

If left untreated or undertreated, PTSD can have long-term effects not only on the pregnant person but also on her relationships with other people, especially family, and interfere with bonding with her child and breastfeeding she may have long-term effects on the child. Pregnant people with untreated PTSD are more likely to experience adverse birth outcomes, such as gestational diabetes (diabetes that develops during pregnancy), preeclampsia (severe high blood pressure), low birth weight (birth weight < 2500 grams, 5 .5 kg) and premature birth (before the 37th week of pregnancy). Also, disturbingly enough, PTSD is strongly associated with attempted or committed suicide and substance abuse, two leading causes of maternal death in the United States.³

We know that the pandemic has been a stressful situation for the whole country and especially for pregnant women, but what have been the long-term effects, particularly in terms of PTSD. In general, risk factors for postpartum PTSD include, but are not limited to, fear of childbirth, prenatal health concerns (preeclampsia, birth defects), lack of emotional/social support, depression, and anxiety. During the pandemic the primary concern was the risk of infection to themselves and their child before and after birth. Also, birth plans had to be changed due to hospital restrictions. They didn’t have the social support they expected or planned for with their doulas, partners, family or friends. Lack of social support was not only a problem during labor, but remained after birth due to stay-at-home orders. In addition, expectant parents may have had to deal with other problems amplified by the pandemic, such as unemployment and the loss of a loved one. The sense of safety and community was greatly affected during the pandemic, and then expectant parents had to navigate a new world while just being parents, as expressed by pregnant people above. All of these factors can create a traumatic birth experience and increase the potential for PTSD.

There have been many studies investigating the effects of the COVID-19 pandemic during pregnancy. While the studies may have differed in their approach to reviewing this topic, the results generally indicated that childbirth during the pandemic had many effects on the pregnant population and that PTSD was quite common. Also, rates of PTSD were higher among pregnant blacks and Latinas than whites and lower socioeconomic status (ie, less education and income).

Recommendations:

There is a call for screening for PTSD during pregnancy and after to make sure no one falls through the cracks. It is suggested that providers who had patients deliver early in the pandemic follow up to make sure they are coping well. Not everyone with PTSD will need counseling, but pregnant women should be aware of their options.

“Trauma is perhaps the most avoided, ignored, underestimated, denied, misunderstood and untreated cause of human suffering,” said Peter Levine, PhD, a trauma expert. For pregnant women, if your symptoms are affecting your quality of life, talk to your health care professional so you can get the help you need. As MotherToBaby information experts we can connect you with the resources that can promote your health and well-being. We provide information about medications used to treat PTSD as well as anxiety, depression, and exposure to stress during pregnancy and breastfeeding. We are just one important resource that new and expectant parents can rely on for confidential information. Contact us today or visit our Resource Center at Mental health during pregnancy and breastfeeding.

There are resources available to help you.

International postpartum support:

National Maternal Mental Health Hotline: 1-833-943-5746 (1-833-9-HELP4MOMS)

Bibliographical references:

1. Kinser PA, Jallo N, Amstadter AB, et al. 2021. Depression, anxiety, resilience and coping: The experience of pregnant women and new mothers during the early months of the COVID-19 pandemic. J Womens Health (Larchmt). May; 30(5):654-664.
2. Padin AC, Stevens NR, Che ML, et al. 2022. Screening for PTSD during pregnancy: a missed opportunity. BMC pregnancy delivery. 14, 22 (1): 487 June.
3. Khsim IEF, Rodríguez MM, et al. 2022. Risk Factors for Post-Traumatic Stress Disorder after Childbirth: A Systematic Review. Diagnostics (Basel). 26 Oct 12(11):2598.
4. Sharp, Rachel. “100+ PTSD Quotes to Help Survivors Cope With Trauma”. Declutter the Mind, February 27, 2021. https://declutterthemind.com/blog/ptsd-quotes/. Accessed 22 April 2023
5. Shuman CJ, Morgan ME, et al. 2022. Associations between postpartum PTSD symptoms and stressors associated with the COVID-19 pandemic. J Midwifery Womens Health. Sep. 67(5):626-634.
6. Benzakour L, Gayet-Ageron A, et al. 2022. Traumatic childbirth and birth-related posttraumatic stress disorder in the era of the COVID-19 pandemic: A prospective cohort study. Int J Environ Res Public Health. Oct 31; 19(21):14246.