Miscarriage and Post Traumatic Stress Disorder
When we think about Post Traumatic Stress Disorder, we often think about war veterans and those who have endured violent crimes. But there are many other ways in which PTSD can affect victims of other, perhaps less obvious trauma. One of the less recognized forms of PTSD results from the trauma of having a miscarriage. While a period of grieving and sadness is to be expected after losing an unborn child, it's important to recognize when normal grieving ends and clinical PTSD begins.
If a miscarriage happens before week twenty, it's officially called a "spontaneous abortion (SAB)." After the twentieth week of the pregnancy, the medical term is "stillbirth." Numerous studies have shown that about a quarter of all pregnancies end in miscarriage in the early stages. That's a pretty high number. However, stillbirths are far less common, and statistics show that they occur only roughly in 1 in 200 pregnancies.
A miscarriage could occur for many reasons-age, hormonal changes, lifetsyle, improper implantation of the egg, or trauma. And while it's not always possible to know why a late-stage stillbirth occurs, a few common explanations are issues with the placenta or umbilical cord, chromosomal abnormalities, and infections.
Women who have made the conscious choice to have a child begin bonding with that unborn baby very early on. Intense hormonal and physical reactions can be dramatic, as well as the unexpected loss of a baby that the mother has already started to bond with in-utero. The further along the pregnancy evolves, the more potentially traumatic a miscarriage can be. In addition, a miscarriage that occurs in the later stages of pregnancy can be very painful and require major surgery to recover from. Things like breast engorgement and hormonally-induce postpartum depression need to be added to the already debilitating emotional aftereffects.
By far the most common PTSD symptoms that result from miscarriage are depression and anxiety. Other symptoms may include fatigue, sleep difficulties, lack of concentration, loss of appetite, and frequent episodes of crying. The impact of the trauma depends on the inner and outer resources of the new mother, her stress level at the time of event, the strength of her relationship with a partner (if she has one), outside support, the important of her hopes of creating a family, and her level of ability to grieve. Parents who have experienced miscarriages need not only to process their grief but also to resolve their trauma. It's vital that the former mom-to-be recognize that the miscarriage was out of her control and not her fault.
For those trying to navigate how to approach a partner, family member, or friend who has recently experienced a traumatic miscarriage, sensitivity and patience are key.
Here are some appropriate steps to take if you or someone close to you has recently experienced a miscarriage and is struggling to come to terms with it:
Seek counseling. Your doctor is a great place to start. He or she can provide answers to questions that may put your mind and heart at ease, and will also be able to recommend further counseling sources.
Create a support system of friends and family. Being able to talk about it can help profoundly.
Get an evaluation for Acute Stress Syndrome. If the symptoms last for more than a month, seek follow-up testing for PTSD. Research has found that up to 25% of miscarriage victims meet the criteria for PTSD a month after the event.1
Not every woman who suffers a miscarriage will suffer from PTSD. According to the American Family Physician, "Anecdotal evidence suggests that up to ten percent of women meet criteria for ASD (Acute Stress Disorder) within one month of having a spontaneous abortion and that up to one percent meet the criteria for PTSD four weeks after the event." In order for a diagnosis of PTSD to be validated, a victim of miscarriage must experience symptoms for longer than four weeks. ASD, on the other hand, can set in after only a few days.2
Healing does not mean forgetting. Communicate with others, find support groups, educate yourself with books, allow yourself to grieve, and if you find yourself falling into depression, seek the help of a therapist.
Some helpful web sites that address miscarriage and pregnancy loss include:
Miscarriage: Women sharing from the Heart - by Shelly Marks, Marie Allen.
Miscarriage: A Shattered Dream - by Sherokee Isle, Linda Hammer Burns
Surviving Pregnancy Loss: A complete sourcebook for women and their families - by Rochelle Friedman and Bonnie Gradstein
Journal of Family Practice, November 2006 http://findarticles.com/p/articles/mi_m0689/is_11_55/ai_n27059397/
The American Family Physician web site http://www.aafp.org/afp/20000315/1689.html
First published on Psychology Today.