Your Pregnancy Matters
PTSD after pregnancy: When a doctor becomes a patient
April 9, 2019
I have two beautiful, healthy daughters. I also have a little post-traumatic stress disorder (PTSD) that developed as a result of traumatic pregnancy experiences.
When I share this with people, they’re often surprised because I am a maternal-fetal medicine (MFM) doctor. I see complex pregnancies every day. And PTSD is most commonly associated with emotional pain inflicted on survivors of assault, war, or natural disasters.
However, pregnancy-related PTSD can develop due to the psychological toll of a traumatic pregnancy or birth event such as miscarriage, placental abruption, pre-term delivery, or pregnancies that involve anomalies and complex infant care.
Nearly 10 percent of women with a prior pregnancy complication meet the full criteria for PTSD, and approximately 30 percent meet partial criteria. Many women we see in our MFM office face such complications, making them more likely than an average pregnant patient to develop PTSD.
I’m an MFM doctor, and I was an MFM patient. Both of my pregnancies were complicated by preeclampsia with severe features. As a result, I had two premature births, two NICU stays, and emotional reactions that I still face in certain personal situations today.
My experience with pregnancy-related PTSD
During my first pregnancy, I was diagnosed with preeclampsia at 32 weeks. My daughter was delivered within 24 hours of my diagnosis because our health was at risk. That was scary.
Even though I am a doctor, I was terrified to go to a doctor after that. In fact, I didn’t go back to the doctor again until I got pregnant with my second daughter – a choice I would never advise to patients.
When I finally went back to my doctor, I started worrying as soon as I woke up the day of the appointment. My anxiety skyrocketed the morning of the appointment, and my pulse shot up to 120 beats a minute – almost double what it should have been.
'During my first pregnancy, I was diagnosed with preeclampsia at 32 weeks. Throughout my second pregnancy, I was scared to have my blood pressure taken, fearing that it will be high, and I will have another preterm baby.'
This was an ongoing scenario throughout my second pregnancy. I was scared to have my blood pressure taken. It will be high, and I will have another preterm baby. Trying to compensate, I’d start arriving at the doctor’s office 20 minutes before each appointment to try to calm down.
At 29 weeks of my second pregnancy, I was diagnosed with fetal growth restriction and preeclampsia. I had to stop working; I had to visit the doctor twice a week and take my blood pressure twice a day. At 34 weeks, I was diagnosed with preeclampsia with severe features. My second daughter was born not much later.
Ongoing and chronic symptoms
Making the matter even more complicated, sometimes PTSD symptoms are delayed. The onset of symptoms is typically within a few months of the traumatic event, but in approximately 25 percent of patients, onset occurs after six months.
Some patients recover within a year of the onset of symptoms, but approximately one-third of patients develop chronic symptoms. I’m one of those patients.
My girls are 8 and 6 and, to this day, having my blood pressure taken is a triggering event for me. When I make a doctor’s appointment, it’s the first thing I think about. I immediately flash back to my babies staying in the NICU. I relive the first visit to my doctor at the start of my second pregnancy.
Even writing this article, I can feel my heart rate increase. When I go to the doctor now, I still try to arrive early. I still have to give myself a pep talk to calm down so my symptoms don’t get the best of me.
PTSD After Pregnancy
Post-traumatic stress disorder is most often associated with survivors of assault, war, or natural disasters. But as maternal-fetal specialist Dr. Shivani Patel will tell you, symptoms of PTSD can weigh heavy on moms who had complex pregnancies. She knows from personal experience.
PTSD symptoms in new mothers
We know that risk factors for PPD can be similar to those for pregnancy-related PTSD, such as adverse pregnancy outcomes, having a baby who has to stay in the NICU, or having a history of depression.
Many patients with PTSD develop psychological symptoms:
- Intrusive thoughts
- Flashbacks of the traumatic event
- Emotional fluctuation, such as anger that slides into sadness
Every woman with PTSD has different personal triggers. For example, mine are similar to those I’ve heard from my patients with like experiences:
- Attending office visits
- Being asked standard medical questions
- Discussing my labor and delivery experience
- Getting ultrasounds
- Having my blood drawn
- Thinking about being in the neonatal intensive care unit (NICU)
The more traumatic the experiences, the likelier PTSD will develop. For example, research suggests that women with pregnancy-related blood pressure diagnoses in subsequent pregnancies are at increased risk for post-traumatic stress issues. And women with PTSD may have an increased risk of preterm birth.
Untreated PTSD can lead to difficulties in patients’ social, professional, and interpersonal relationships. To cope, some women turn to unhealthy ways to numb their symptoms, such as using alcohol, tobacco, or other drugs. Medical symptoms can arise parallel to or because of these coping mechanisms, such as high blood pressure, heart disease, and even high cholesterol.
Additionally, taking care of preemies or babies born with congenital abnormalities also might increase the risk of PTSD. Getting help early in any of these scenarios is key.
Getting help for PTSD
Because of my medical knowledge and education, I know I didn’t cause my preeclampsia, which has helped me free myself of feelings of guilt. I also know that having had preeclampsia puts me at increased risk for heart disease and high blood pressure later in life. Therefore, I have additional reasons why I should go to the doctor – not going is not a good choice.
This logical thinking pattern has helped me overcome my mild PTSD symptoms. However, many women can benefit from more substantial support. Patients and doctors are increasingly appreciating the importance of mental health in prenatal and postpartum care. We’ve begun to include mental health screening in our Ob/Gyn visits to look for risk factors for both PPD and PTSD.
When patients report symptoms or we notice that something isn’t right, we can recommend resources to help, including counseling sessions, support groups, medical options, or a combination of therapies.
A diagnosis of PPD or PTSD is not an indication of weakness. Quite the opposite – it’s a recognition that you have been through a traumatic experience and could benefit from another level of care to help you recover, not only for your baby’s well-being, but also for your long-term mental health.