Science & Sensibility

Today, Kathy Morelli shares the second part of her series on EMDR, and exams clinical opinions  on the safety of EMDR as a treatment modality.  You can find part one of Kathy’s post on EMDR here. –  SM

There is a lack of specific empirical research to support the safety or lack of safety about incorporating EMDR into a trauma treatment plan for a pregnant woman.

However, there are many experienced trauma clinicians who work weekly in their practices with pregnant women. I gathered clinical information about this issue from several experienced and distinguished trauma clinicians who work with women, pregnancy and trauma and use EMDR.

Background Research about Maternal Stress and the Uborn

The mom and unborn baby (I will henceforth use the term, uborn, borrowed from Michelle LeClaire O’Neill) are connected via stress hormones, which reach the uborn via the placenta.

There are many studies about the effects of stress hormones on the uborn. In general, the research draws a distinct difference between the impact of moderate amounts of stress and the impact of long-term chronic stress. (For a more detailed discussion of this, see How Much Stress is Too Much Stress in Pregnancy?)

Chronic and extreme stress is characterized as famine, poverty, major natural disasters, domestic violence and other extreme life stressors. Studies show the release of excessive amounts of maternal stress hormones may impact the uborn’s brain development (Johnson, 2012; Mulder et al, 2002). In addition, there may be changes in the blood flow to the uborn and this may impact the development of other organs. The research also indicates there are individualized, mitigating factors on the effects of extreme stress, such as social supports and individual resilience (Johnson, 2012; Mulder et al, 2002).

While there isn’t much specific research about the effects of using Eye Movement Desensitization and reprocessing (EMDR) to treat PSTD (childbirth onset) in the pregnant population, there is a lot of research about using EMDR to treat PTSD in the general population.

What are clinicians’ experiences regarding the safety of using EMDR during a subsequent pregnancy to treat PTSD (onset childbirth)?

In my interviews of clinicians regarding the processing of traumatic material with pregnant women, several guidelines emerged:

•  Little or no empirical research on this issue exists
• Clinician must be experienced in trauma work
• Clinician must use good clinical judgment, as it is not always appropriate to go forward
• Treatment must be tailored to the individual woman and her needs
• Recommend consultation with her physician if there are existing physical issues or if she is in her third trimester
• Processing traumatic material during pregnancy generally does more good than harm

Benefits cited:

• processing attachment trauma (abuse) promotes healthy attachment & bonding behaviors
• enhances enjoyment of pregnancy,
• enhances confidence in healthy birth
• can be used to reinforce positivity about the birth, including what was learned in childbirth classes, such as the Lamaze methods

Julia Wood, M.D., a psychiatrist specializing in women’s issues, has a special focus on trauma and borderline personality disorder. She is Medical Director of Brookhaven Recovery Retreat for Women. Her past position was at the Massachusetts General Hospital Center of Women’s Health. She began by saying, when working with traumatic material with pregnant women, in the absence of empirical research indicative of either benefit or harm to the developing fetus, one must use good clinical judgment.

While at Massachusetts General Hospital’s Center for Women’s Health, she worked with a disenfranchised population: pregnant women under chronic stress due to domestic violence and poverty. Although she believes caution should be used when treating traumatic material with a pregnant woman, she said her overall clinical experiences indicated it was beneficial for her patients to be treated for their psychological trauma during pregnancy.

Dr. Wood stated the mental health support helped her patients process their personal traumatic experiences, be more confident about pregnancy and birth, form a more positive attachment with their babies and learn positive coping skills.

Dr. Wood said she does not favor any particular trauma treatment modality, but stressed that the value of clinical experience when treating trauma is key and good clinical judgment is a necessary component of compassionate and successful treatment.

Heidi Koss, LCSW, Executive Director of Postpartum Support International of Washington State, and an expert clinician in childbirth trauma, says she uses an integrative approach with pregnant clients. She creates an individualized treatment plan, incorporating EMDR and other modalities such as interpersonal therapy, mindfulness and somatic experiencing to help her clients process traumatic material. When using EMDR, she says “….I don’t have them recall all the details of their previous traumatic birth, just enough to access the neural pathways we are targeting in order to calm, to lessen any spikes in cortisol that might impact the fetus.”

Kathleen Reay, Ph.D., who has been teaching EMDR for 12 years, has worked extensively with traumatic material with pregnancy clients. Dr. Reay stresses that good clinical judgment must always be used.

Dr. Reay says she’s never come across any safety issues in her work with pregnant clients and she believes there are extensive benefits to working through traumatic material while pregnant. However, Dr. Reay says that when the mother has a pre-existing medical or physical issue, or if she is in her third trimester, she discusses her work with her client’s physician, before beginning any treatment with EMDR, in order to ensure safety. She also says it’s important to discuss the treatment with the mom, too, assuring her she may stop the session(s) at any time.

Dr. Reay believes the benefits to processing traumatic material during pregnancy are twofold. One, it helps the mom work out her own traumatic attachment issues (perhaps related to abuse) and addresses pervasive emotional dysregulation, thus promoting self-regulation, appropriate regulation of her baby and a secure attachment with her uborn and newborn.

Two, EMDR can be used to strengthen the mom’s own resources and positive attitudes about her upcoming birth, such as positive beliefs that she will be able to get the support shes needs, and EMDR can be used to reinforce whatever birth practice the mom chooses to use, including Lamaze’s Healthy Birth Practices.

Julie Greene is an EMDR trainer with extensive experience with pregnancy and trauma. She has been practicing EMDR since 1998 and teaching since 2005. Ms. Greene says as a trainer as well as a clinician, she stresses caution and safety first. She has extensive experience with using EMDR during pregnancy, and has an integrative approach, using mindfulness in her practice as well.

Like Dr. Reay, Ms. Greene uses EMDR to do resource development with any pregnant client, in order to strengthen inner feelings of self-efficacy and emotional flexibility.

Also like Dr. Reay, her cautionary clinical signals are if the mom was either in her third trimester or experiencing physical difficulties, she first speaks to her client’s physician, in order to assess whether or not to proceed with the trauma treatment.

Generally, her thoughts are the benefits to the baby are usually higher than the risk. Ms. Greene says the best reasons to do EMDR trauma work during pregnancy are when there are issues stuck in the mom’s bodymind related to pregnancy and birth. For example, she says, if the mom is terrified and stressed the entire pregnancy, there is a benefit to the current pregnancy to clear this out of the mother’s system using EMDR.

Or, if the client has traumatic history, such as sexual abuse, locked in her body, this can cause a lot of mental and emotional difficulty during pregnancy. There may be a lot of shame and negative thoughts and feelings about her body, the pregnancy, and fears of becoming a parent. Ms. Greene says EMDR is a good way to release this.

Like Dr. Reay, Ms. Greene uses EMDR to help her clients access and strengthen their internal resources, so they feel and believe they made good decisions that are right for them for their personal birth and parenting experience.

To sum up, when processing traumatic material with EMDR with pregnant women, these clinicians used caution and followed good clinical guidelines, tailoring the treatment to the individual woman, and generally believed the benefits regarding birthing and parenting confidence outweighed the harm.

References

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

Johnson, K. (2012). The effects of maternal stress and anxiety during pregnancy. Retrieved September 25, 2012 from http://bit.ly/QhNyIq 

LeClaire, Michell O’Neill (2000). HypnoBirthing- the original method. Chicago: Papyrus Press.

Mulder, E.J.H., Robles de Medina, P.G., Huiznik, A.C., Van den Burgh, B.R.H. & Buitelaar, J.K., &Visser, G.H.A., (2002). Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Human Development, 70, 3-14.

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

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

Wood, J. PTSD and Childbirth. Retrieved July 29, 2012 from http://www.womensmentalhealth.org/posts/ptsd-and-pregnancy/

 

Kathy Morelli Birth Trauma, Cesarean Birth, Depression, EMDR, Guest Posts, Infant Attachment, Kathy Morelli, Maternal Mental Health, Parenting an Infant, Postpartum Depression, PTSD, Trauma work birth trauma, childbirth PTSD, EMDR, guest post, Kathy Morelli, Lamaze Healthy Birth Practices, postpartum depression, PTSD

It really is a joy and, I believe, imperative to spend time sharing childbirth success stories amongst those of us who dedicate our professional lives to improving childbirth experiences and outcomes for women all around the globe.  This year’s first blog carnival is about just that:  celebrating success while illuminating some ways in which Lamaze’s Six Healthy Birth Practices can and have been implemented in the process of realizing these successes.

Lisa, at Journey Through Lamaze, shared with us a lovely story of one of her recent clients who allowed labor to start on its own, and labored at home long enough before checking into the hospital to find herself fully dilated and ready to begin pushing shortly after admission.  Having begun with Healthy Birth Practice #1, this mama progressed through a non-medicated birth which Lisa describes as, “…the calmest birth I’ve ever been at.”  (Read Lisa’s post to find examples of other Healthy Birth Practices exemplified during this baby’s birth.)

Childbirth Educator, Judith, from Dance While You Cook relates how she incorporates teaching the importance of walking, moving around and changing positions throughout labor (Healthy Birth Practice #2) into her childbirth preparation classes.  Beyond “typical” teaching strategies, Judith shows her students how movement in labor can be effective by demonstration through a labor and birth dramatization. Read her post, and I guarantee you, you will pick up on the renewed energy and empowerment Judith gains each time she conducts this portion of her curriculum.

Many of our carnival contributors wrote about experiencing childbirth from a doula’s point of view.  Wendy from Mom and Little Me wrote about her strong belief in extending Healthy Birth Practice #3 into the prenatal period as much as possible.  It is during the prenatal visits that some of her most effective doula support takes place.  (Follow the link to Wendy’s post to also read about her ambitions for educating “a younger generation on natural childbirth and breastfeeding.”)  Hillary at Infinitely Learning shares with us a lovely anecdote about the birth of one of her doula clients that showed her the importance of holding space and bearing witness to the great journey of another human being, as she describes below:

She was a really independent birther and mostly needed the midwives and me (the doula) there for reassurance during some strong moments, but mostly I just stood Witness. A couple of times I doubted that I was even needed and became self-conscious that I wasn’t doing enough, but when I checked in internally to be guided I heard, “Witness”.

Kate, at Two Bee Birth Services shared the story, as written by the mother, of a successful, un-medicated VBAC.  With a history of multiple medical interventions during previous birth experiences plus some other recent pregnancy-related complications, this mama pursued a vaginal birth in the safest way possible, considering a present and extenuating medical circumstance.  In order to do this, she dedicated herself to avoiding interventions that were not medically necessary (Healthy Birth Practice #4) and succeeded in achieving the VBAC she hoped for.

Providing a fantastic success story that illustrated all six Healthy Birth Practices, in the setting of one birth, “Anthro Doula” Emily at Doula Ambitions simply and beautifully describes the end of one of her first birth experiences as a doula:

Once in the labor and delivery room she crawled up onto the bed on all fours, following her instinct and her urges to push on her own. She changed positions to a squat, leaning against the back of the raised bed, so that she would be able to catch her own baby. (Healthy Birth Practice 5: Avoid giving birth on your back and follow your body’s urges to push!)

This is my favorite part of the story, and my favorite part of any birth so far…
While the baby’s head was crowning, she reached down and felt his head, and she looked up with a face full of wonderment and said, “His head is coming out and then going back in a little!” She was so calm and intrigued, fully experiencing the birth of her first child. Then she pushed out her baby and pulled him up onto her stomach, all the while calm and grinning like mad!

The husband had tears streaming down his face, and the new mother was immensely pleased with herself. Mama and baby stayed together, skin-to-skin, and began to initiate breastfeeding, for the whole first hour.
(Healthy Birth Practice 6: Keep mother and baby together - It’s best for mother, baby and breastfeeding)

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Thank you to all blog carnival contributors for your thoughtful words and illustrative stories which collectively remind us that safe, healthy, fulfilling birth experiences are not an anomaly, but an achievable reality!
**Don’t forget to swing on over to Giving Birth With Confidence to read additional results of this blog carnival!

Posted By:  Kimmelin Hull, PA, LCCE

Kimmelin Hull Blog Carnivals, Doula Care, Healthy Care Practices, Practice Guidelines, Vaginal Birth After Cesarean (VBAC) birth carnival, blog carnival, Dance While You Cook, Doula Ambitions, Doula Care, Giving Birth With Confience, good birth stories, how to achieve a VBAC, Initiely Learning, Journey Through Lamaze, Lamaze Healthy Birth Practices, Mom and Little Me, Two Bee Birth Services