Originally posted October 6, 2012.
This originally appeared in Science and Sensibility
Part One: Research review: Evaluating EMDR as a Treatment Modality for Post-traumatic Stress Disorder (Onset Childbirth)
Research by doctoral candidate Claire Stramrood and her colleagues of the Netherlands was published in the March, 2012 edition of Birth. 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.
The researchers hypothesized EMDR could be used to reduce the womens’ symptoms and improve confidence about the current pregnancy and impending birth.
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 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 dis-empowered 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 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 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 will examine some clinical opinions about whether or not it is safe to process traumatic material using EMDR during pregnancy.
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.