Commentary: How PTSD changed the way I care for pregnant women

By Shivani Patel, M.D.

Appointments with my doctor make me nervous. That’s highly ironic because I’m a doctor, a maternal-fetal medicine specialist who regularly deals with high-risk pregnancies. But ever since developing preeclampsia during my first pregnancy eight years ago, the thought of having my blood pressure taken triggers flashbacks and anxiety.

The silver lining is that my experience has changed the way that I care for patients.

I was diagnosed with preeclampsia at 32 weeks after my blood pressure rose and I experienced headaches and blurred vision. The condition, which affects upwards of 10% of pregnant women, can lead to seizures and kidney or liver damage and is a leading cause of maternal and fetal death. My daughter was delivered via caesarean section within 24 hours of my diagnosis and stayed in the newborn intensive care unit for 5 1/2 weeks. The whole experience was frightening.

Afterward, I was terrified to go to a doctor and have my blood pressure taken. In fact, I avoided seeing a doctor for two years, until I got pregnant again — something I would never advise my patients to do.

On the day of my first prenatal care visit for the second pregnancy, I started worrying as soon as I woke up. My anxiety skyrocketed and my pulse shot up to 120 beats a minute — almost double what it should have been. Having my blood pressure measured on that day, and throughout my pregnancy, was especially terrifying.

At 29 weeks, I was told that my baby was not growing normally and was once again diagnosed with preeclampsia. I had to stop working, see my doctor twice a week, and take my blood pressure twice a day. By 34 weeks, my preeclampsia had become severe and I had another C-section to deliver my second daughter. But because I had shared my anxieties from the first C-section with my medical team, they implemented small changes that made the experience better for me.

Today, my daughters are healthy young girls, but having my blood pressure taken still triggers flashbacks. I always arrive 20 minutes early for doctor’s appointments so I have time to calm myself down.

PTSD is most commonly associated with the kinds of trauma experienced by survivors of assault, war, or natural disasters. But it can also develop from a traumatic pregnancy or birth event like miscarriage, preterm delivery, or pregnancies that involve complex infant care.

While postpartum depression is more commonly diagnosed in new mothers, pregnancy-related PTSD is becoming more widely recognized and the subject of research. Nearly 10% of women with a prior pregnancy complication meet the full criteria for PTSD, and approximately 30% meet partial criteria. Symptoms such as anxiety, depression, or flashbacks typically occur within a few months of the traumatic event. And though some women recover within a year, about a third develop chronic symptoms. I am one of them.

My experience has made me more aware of the fears and anxieties my patients may be carrying from previous pregnancies. Now when I meet a woman who is having another child, I ask her to describe her past pregnancy. Sometimes what appears on paper to have been a normal birth may have been traumatic for her.

Research has shown that pregnant women with PTSD are more likely to have preterm births. By listening to my patients, I can make adjustments in their care plan to try and avoid situations that may trigger anxiety. If symptoms of PTSD are affecting a patient’s life, I can recommend a psychiatrist or support group for help.

Pregnant women with PTSD are more likely to have preterm births. By listening to my patients, I can make adjustments in their care plans such as avoiding situations that may trigger anxiety. When symptoms of PTSD affect their lives, I often share my own experience and can recommend a psychiatrist or support group for help.

Pregnant women should be upfront and honest with their doctors about their past medical experiences. But the onus is really on doctors to try to gauge whether a patient had a traumatic birth experience and may be experiencing PTSD. Women are often reluctant to share fears or anxieties – or may just not realize what they are feeling – and need a physician’s help to uncover those feelings. This is yet another instance in which a patient’s emotional well-being can play as big a role in care as her physical well-being.

Dr. Shivani Patel is a maternal-fetal medicine specialist and Assistant Professor of Obstetrics and Gynecology at UT Southwestern Medical Center in Dallas. This article was published by STATnews, The Dallas Morning News, Fort Worth Star-Telegram, Houston Chronicle, Corpus Christi Caller-Times, Amarillo Globe-News and Motherly.