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Part One of Two: EMDR as a Treatment Modality for Post-traumatic Stress Disorder (Childbirth Onset) During a Subsequent Pregnancy

Today’s post, the first of two, is written by regular contributor, Kathy Morelli, and provides some insight into a mode of therapy, EMDR, that can help women deal with birth trauma .  Are you a provider who is trained in EMDR?  Or have experienced it yourself?  Share your thought sin our comments section.- SM

Research by doctoral candidate Claire Stramrood and her colleagues of the Netherlands was published in the March, 2012 edition of Birth, The Patient Observer: Eye-Movement Desensitization and Reprocessing for the Treatment of Posttraumatic Stress following Childbirth.  The researchers were evaluating the possibility of using Eye Movement Desensitization and Reprocessing (EMDR) as a treatment modality for post-traumatic stress disorder (PTSD) (childbirth onset) during a subsequent pregnancy. The researchers worked with three women who experienced traumatic births, were diagnosed with post-traumatic stress disorder (childbirth onset) and were now subsequently pregnant again.

 The researchers hypothesized EMDR could be used to reduce the womens’ symptoms and improve confidence about the current pregnancy and impending birth.

Treatment for PSTD (childbirth onset) (Istock/EleanVizerskaya)

Post-traumatic stress disorder (childbirth onset) is a debilitating condition affecting between 1 – 6% of women in developed countries (Ayers, 2008; as cited in Stramrood et al, 2012). It is important for women of childbearing years to receive treatment in a timely manner to reduce current suffering and to avoid a cycle of pain that might carry over into the next generation.

A traumatic experience during a previous birth can set up a woman’s subsequent pregnancy as a trigger for recurring symptoms. During the subsequent pregnancy, women may experience intrusive flashbacks, high anxiety about the upcoming birth, have an over-riding desire to schedule a cesarean section, have an increased risk for developing a perinatal mood disorder, and experience ambivalence about her unborn baby thus interfering with bonding and attachment before and after the birth (Stramrood et al, 2012).

 

 

What is EMDR?

EMDR is a mindbody therapy designed to help people heal from disturbing events or trauma. Francine Shapiro, Ph.D., developed EMDR in the late 1980s. More than twenty randomized studies have found EMDR to be effective in the treatment of post-traumatic stress disorder (PSTD) and hundreds of case studies report effective relief. The Substance Abuse and Mental Health Services Aministration (SAMHSA) of the U.S. Department of Health and Human Services cites EMDR as an evidence-based treatment for trauma. Because of the highly reactive nature of traumatic client material, EMDR is taught only to licensed mental health professionals.

How is EMDR Integrated into Psychotherapy and How Does it Work?

Psychotherapists integrate EMDR into their client care by designing a structured, goal-oriented treatment plan including history taking, establishment of client safety measures, supportive ego strengthening techniques, identification of traumatic memories, and the reprocessing of the traumatic memories. It is believed that EMDR allows the traumatic memories to be reprocessed so as to actually be stored and retrieved in a different way (Parnell, 2007).

Traumatic memories are stored in the brain’s neuronal pathways differently than non-traumatic memories. They are fragmented, thus recollection of a traumatic event is fragmented and can be intrusive. It is difficult for a person to achieve perspective on an event that is horrific in nature but also cannot be recalled as a whole, inclusive of emotion, image and narrative (Rothschild, 2000).

In addition, the EMDR clinician utilizes the techniques of positive resourcing, positive templates and coping skills, all created directly by and with the client.

The study: Three women’s histories, childbirth trauma experiences, EMDR treatment protocols & results

The three women in the study were all in their twenties and giving birth for the first time.

Patient A

Patient A had complications with hypertension during pregnancy. After a 17 hour labor and an unsuccessful vacuum extraction, she underwent an emergency cesarean section. She said she felt like the whole experience was like a “bruise” and felt like she was unable to “stand up for herself.” She felt disempowered by the experience. She blamed the staff for the birth events. She experienced anxiety, intrusive thoughts and flashbacks when passing the hospital.

After four EMDR sessions, Patient A no longer experienced flashbacks or intrusive thoughts. She reframed her feelings about herself during the birth and felt she did a good job. She was proud of herself for completing the EMDR treatment. She said she did not prefer either a natural or surgical birth, just an experience where she did not feel “psychologically damaged.” Her second child was born by cesarean section and she looks back on the birth of her second child as a positive event.

Patient B

Patient B had life-long hypothyroidism, but then developed painful unilateral hydronephrosis, a painful kidney condition, in week 31 – 39 of the pregnancy. During the delivery, she experienced a tear up to her anus. She could not stand up after the birth for three weeks. She reported still experiencing pain at the suture site two years later and an inability to insert tampons and experience pain-free intercourse. She says the birth was “one big trauma” and could not look at her vulva or vagina since.

After six EMDR sessions, Patient B felt calmer, less alone, and was more confident about her next birth. She had scheduled a cesarean section, but now decided she wanted a vaginal birth. She prepared a birth plan where she stated her desires for the birth. She delivered her second child vaginally, had some tearing and sutures, but did not experience subsequent painful intercourse. She looks back on the birth of her second child as a positive event.

Patient C

Patient C had a traumatic past in that she had personally witnessed the death of two of her brothers due to an inherited cardiac event. She was monitored for cardiac symptoms for the duration of the pregnancy but was healthy. She developed symptomatic pre-eclampsia after the birth and was hospitalized for headache, shakiness and elevated liver enzymes. She says her experience of illness and the medical interventions, while necessary, were traumatic to her because of the negative cardiac family history. She experienced flashbacks, intrusive thoughts and debilitating anxiety.

Patient C underwent five EMDR sessions, dealing with her postpartum experience, the deaths of her brothers, her father’s hospitalization and her medical interventions. After these sessions, she reported no post-traumatic stress symptoms, much less anxiety and generally felt better. She gave birth vaginally. She experienced postpartum hemorrhage and hypertension. She looks back on the birth of her second child as a positive event.

Implications of the study’s findings

All three women experienced post-traumatic stress symptoms for several years before becoming pregnant a second time. After the treatment with EMDR, all three women’s symptoms abated and their emotional suffering was much reduced. Before completion of the EMDR sessions, all three women were asking to schedule cesarean surgery. Afterward all three were less fearful of the upcoming birth experience and were open to attempting to give birth vaginally.

Thus, it appears that EMDR can be used to help some women move through her emotional distress, experience more joy in pregnancy, shift towards confidence towards her unborn baby and the upcoming birth.

In the study, the clinician’s approach was flexible in how s/he integrated EMDR into an overall personalized, clinical treatment plan; the treatment plans were informed by the women’s individualized needs.

Thus, it appears it is important for clinicians to have enough experience with working with trauma to help clients develop feelings of safety, a good working therapeutic relationship and to know how to incorporate EMDR effectively into an overall treatment plan, in order to be effective.

Part Two of this series, scheduled for Thursday will examine some clinical opinions about whether or not it is safe to process traumatic material using EMDR during pregnancy.

References

EMDR Institute, Inc. (2012). Research Overview. Retrieved July 29, 2012 from http://www.emdr.com/general-information/research-overview.html

Parnell, L. (2007). A therapist’s guide to EMDR: Tools and techniques for successful treatment. New York: W.W. Norton & Co.

Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York: W.W. Norton & Company.

SAMHSA National Registry of Evidence-Based Programs & Practices (NREPP) (2012). Eye movement desensitization and reprocessing. Retrieved July 29, 2012 from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=199

Stramrood, C.A.I., van der Velde, J., Doombos, B., Paarlberg, K.M., Willibrod, C.M., Schultz, W. & van Pampus, M.G. (2012). The patient observer: Eye movement desensitization and reprocessing for the treatment of post-traumatic stress following childbirth. Birth, 39(1), 70-76.

Birth Trauma, Cesarean Birth, Childbirth Education, Depression, EMDR, Guest Posts, Kathy Morelli, Parenting an Infant, Perinatal Mood Disorders, Postpartum Depression, PTSD, Survivors of Sexual Abuse, Trauma work , , , , , , , ,

  1. avatar
    Jess Banas
    October 2nd, 2012 at 12:03 | #1

    Excellent! EMDR is a important theraputic tool. I really appreciated this statement:

    In the study, the clinician’s approach was flexible in how s/he integrated EMDR into an overall personalized, clinical treatment plan; the treatment plans were informed by the women’s individualized needs.

    “Thus, it appears it is important for clinicians to have enough experience with working with trauma to help clients develop feelings of safety, a good working therapeutic relationship and to know how to incorporate EMDR effectively into an overall treatment plan, in order to be effective.”

    A very important point and one that needs to be emphasized. EMDR should not be limited by the average statisical data, but led by the patient and should be done by a clinician experiecned in trauma. Note how few sessions it took for a positive outcome!

    Non-invasive, effective, and fast acting!!

  2. October 2nd, 2012 at 12:37 | #2

    Hi Jessica – Thanks so much for the kind words! I enjoyed reading the study and writing this article, as I am an EMDR practitioner and truly LOVE using it…it works so well..of course, not with everyone, but it’s gr8 when it does help out ! take care, Kathy

  3. October 2nd, 2012 at 15:58 | #3

    Thank you for this, Kathy. Well written and informative. I myself tried it following my traumatic birth and it was actually triggering for alot of other previous trauma. I appreciate your caveat that when it works it is beneficial. And I don’t necessarily agree that it is non-invasive. Neural pathways are as personal as one can get, LOL. I really look forward to next installment.

  4. October 2nd, 2012 at 18:59 | #4

    Excellent article Kathy! I have successfully used EMDR to help women after traumatic births and I continue to be amazed and the power of EMDR. It is so wonderful to watch women experience healing so quickly. Thanks for the article and spreading the word that EMDR can help if you’ve have a traumatic birth! Looking forward to the next article! ~Robyn

  5. October 2nd, 2012 at 20:01 | #5

    Fascinating! I was offered this treatment once but never ended up getting it due to my therapist moving. I’ve researched it some, since, but I never realized it’s potential for helping PTSD in pregnant women. Thank you!

  6. October 3rd, 2012 at 03:18 | #6

    Hi Robyn – Thanks so much for your kind words, my dear! I have to credit you for turning me to EMDR as you were so happy with the results. I didn’t believe you at first, and then I researched EMDR, and decided to get the training here in my hometown, NYC with Dr. Laura Parnell. I am so glad I did….I have YOU to thank!
    And keep up your amazing work! Take care, Kathy

  7. October 3rd, 2012 at 03:19 | #7

    Hi Rebekah – So interesting how many people are trained in EMDR around the country (world)! I hope you were able to get the help you needed….thank you for stopping by! – Kathy

  8. October 3rd, 2012 at 03:46 | #8

    Hi Walker – Thanks for sharing your experience with EMDR. I’m sorry to hear it triggered painful past feelings for you. I hope there was a way for your therapist and you to regroup and find another way to promote your healing. As with all psychotherapeutic interventions, there is no intervention that is without risk. Compassionate client-centered vanilla (lol ??) verbal therapy absolutely stirs up the neuronal network; some clients just sit in my office and cry wordlessly, as it is the only place they think about their past and their present situation (access their neuronal network). So therapists are always “touching” the neuronal network and with the brain chemistry; research shows that talk therapy can alter the brain chemistry, like a drug. EMDR is not always the appropriate tool to use; the therapist absolutely needs to use good clinical judgment. And, as you said in your experience, even with clinical discernment, it still may turn out to not be the appropriate intervention for that individual at that place and time. But there is no intervention that is without risk; no provider who is perfect; if something is triggering in the therapy room, then one regroups and uses another approach that is safer for that individual. That’s why I feel very strongly that only licensed mental health professionals should be working with traumatized individuals, and using something like EMDR. Walker, you are such a discerning thinker and bring so much to the discussion, thanks, my friend!

  9. October 3rd, 2012 at 09:34 | #9

    @Kathy Morelli
    So true, Kathy. No intervention is without risk. That is where prevention can do so much. You bring such clinical competency from mental health field to this blog. I am thankful to Lamaze and Sharon Muza for featuring your work.

    Philosophically, we could have a great conversation about what the ecology is between client, therapist, and treatment. So many variables. As a Pragmatist, I firmly believe that reality is relative, multidimensional, in flux and changing.

    One step deeper, as a transpersonalist, I constantly question how do we currently define disease, pathology, etc. for childbearing women. We are still caught in the web of male medical models, and nosology. But I am curious to see where APA goes with new separate category of Trauma disorders in DSM5. Spreads things out, backs things up…gives us some perspective I hope.

  10. October 4th, 2012 at 07:58 | #10

    Excellent work Kathy! I also think that using more than one approach and choosing when and how to use them depending on the individual client, is most useful. I was inspired by David Burns interview on The Psychotherapy Networker recently where he talks about using several approached with his clients. I am sure you know his books about anxiety and feeling good. He is an excellent writer.
    I look forward to reading part two!

  11. October 4th, 2012 at 10:02 | #11

    Hi Irene! Thanks for the read and the comments! Yes, I think it is the sign of experience to be able to clinically agile, to know about and try to match different interventions to individual needs. thanks, Kathy

  12. avatar
    Sarah Allen
    October 4th, 2012 at 10:52 | #12

    Great article Kathy. There are several organizations offering EMDR basic training. Do you know if in the field, any organization is considered the best one to train through. I have been thinking of doing the training as I have both research and clinical experience of working with women who have experienced traumatic birth and think it would be a useful tool to add to my clinical competency but don’t want to waste time and money on inadequate training.

  13. October 4th, 2012 at 11:36 | #13

    Hi Sarah – Gee, I don;t know the rep of all the EMDR schools! One can only teach the real EMDR work if one is EMDRIA approved, so start with that. I know I LOVED my EMDR teacher, Dr. Laurel Parnell. But the two trainers I interviewed in the article get great reviews from their students as well! I think word of mouth (or word of blog/twitter!) is a good way to find a trainer who resonates with you as an individual.

  14. October 5th, 2012 at 19:45 | #14

    Wow–what powerful findings. I don’t know why it just dawned on me that the act of pregnancy is traumatic. I admire those women who forgo pain medication and/or opt for natural birth, but for the vast majority of us, it is extremely intrusive.

    I always suspected that my birth canal was too narrow, but my doctor assured me that I’d be fine. After two days of pushing, and enduring every medical option to activate the process, my son said, “Hell, no–I’m not ready just yet.” When the wonderful nurse (and she was BIG and STRONG) put all her weight on my belly in a last ditch effort to expel my son, I thought I would die. I have a high tolerance for pain–but that was my limit. I remember thinking afterwards, “If it wasn’t for modern birthing AKA emergency-C, I’d be dead.

    I impressed with the composite examples and the rapidity of EMDR.

    Great article, Kathy!

    Thank you :).

  15. October 6th, 2012 at 03:53 | #15

    Hi Linda – wow. thanks for sharing parts of your birth story. Wow. I think most medical interventions are traumatic, even if necessary & delivered with kindness (this is after working in a Cancer Center and seeing the patients there, who had procedures that helped them, but were very difficult), so there are so many interventions at birth, and its in intimate areas, and it one has diabetes (or something that turns the event into life threatening for both mom & babe), it can be quite traumatic….EMDR is a great tool, on the flip side, I have people saying they experienced re-traumatization when being treated with EMDR…I think I will do my next post on that…take care, Kathy

  16. avatar
    Fiona Creina
    October 8th, 2012 at 15:50 | #16

    I decided to take self-hypnosis sessions for childbirth out of curiosity with my third child. After a history taking, the instructor who was a therapist by training recommended EMDR to reprocess my traumatic previous birth. It was really surprisingly effective, just one session, (a very emotional one) just seemed to free me of the negative baggage and allow me to go confidently into the subsequent birth which was a great experience. I am now a student midwife working on a paper on PTSD from childbirth so this post is timely, thanks Kathy!

  17. October 9th, 2012 at 03:54 | #17

    Hi Fiona – thanks for sharing your experiences with birth hypnosis and EMDR. It sounds like you had good experiences with both modalities. Gr8 that you found what works for you. thanks, Kathy

  18. October 9th, 2012 at 06:12 | #18

    Thank you Kathy for the informative articles. I am just beginning my certifications in EMDR and Birth Hypnosis so learning more from someone as experienced as you is very helpful. I wish I had known about these methods after my own births and bouts with PPMD. You are helping so many mothers and birth workers!

  19. October 9th, 2012 at 07:58 | #19

    Hi Susanne – Thanks for the kind words, and good luck in your ventures! take care, Kathy

  1. October 4th, 2012 at 04:01 | #1