One in six women who experience an early miscarriage or ectopic pregnancy have symptoms of post-traumatic stress disorder nine months later. As people can experience the symptoms of PTSD for months, it is important that women are able to access psychological support should they need it, say the researchers behind the work.
It is estimated that women have more miscarriages than live births over their lifetime. But the psychological effects are often “brushed under the carpet”, says Jessica Farren, an obstetrician and gynaecologist at St Marys Hospital in London.
Women often don’t tell their friends, family and colleagues that they are pregnant until they have had their 12-week scan. If that scan reveals a miscarriage, they may feel unable to tell people, so miss out on support, says Farren.
She and her colleagues asked 737 women who experienced a miscarriage during the first 12 weeks of pregnancy or an ectopic pregnancy – in which the embryo attaches outside of the uterus, causing pregnancy loss – to fill out mental health questionnaires designed to diagnose anxiety, depression and post-traumatic stress disorder. The questionnaires were sent to the women one month after their pregnancy losses, and then again three and nine months after the losses.
Nine months after experiencing a pregnancy loss, 18 per cent of women met the criteria for a PTSD diagnosis, 17 per cent of women reported anxiety and 6 per cent of women had symptoms of moderate to severe depression.
The figures are “terrifyingly high”, says Farren. “We have a problem on our hands that we haven’t up until now properly acknowledged or looked to treat.”
That was the experience of Samantha* who had an early miscarriage last year. “Initially it was like a bereavement,” she says. “[My husband and I] both felt very connected to that baby and still do. I felt loss, emptiness, scared that I might not be able to have another child (but in some ways relieved that we’d been able to get pregnant)….We both had and still have moments where it hurts.”
Samantha remembers hospital staff mentioning counselling, “but at the time, when I was in the middle of the physical miscarriage, it was too early for me to deal with or know whether that was what I wanted”, she says. She points out that her grieving husband “wasn’t offered anything, or even considered by the health professionals”. Given how busy her local medical practice is, Samantha didn’t consider trying to get an appointment with a doctor.
Ruth Bender Atik, national director of the UK charity Miscarriage Association, hears similar stories. “People get in touch with us all the time to tell us about the difficulties they are having after their pregnancy loss and the difficult emotions they go through,” she says. “Those who really need psychological services can find it extremely difficult to access.”
At the moment, the National Health Service in England doesn’t routinely offer psychological support and counselling to everyone who experiences pregnancy loss, says Farren. “It varies across NHS trusts,” says Bender Atik, or according to “how many staff they have on duty that day, and how alert they are to the needs of women [and their partners]”.
“In an ideal world, there would be some sort of screening [for mental health symptoms] after a miscarriage,” says Farren. There are ways that people who have experienced a pregnancy loss can find support, says Bender Atik. For general support, organisations like Miscarriage Association can help, she says. People who need psychological support should be able to access it through their GP.
Samantha, who experienced anxiety, insomnia and loss of confidence after her miscarriage, is now having counselling offered by a private practitioner. “Talking through things is helping,” she says.
*Name has been changed
Journal reference: American Journal of Obstetrics and Gynecology, DOI: 10.1016/j.ajog.2019.10.102
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