How does conception and pregnancy trigger post-traumatic stress disorder (PTSD) in survivors of rape?

From the Guidelines

Conception and pregnancy can trigger past rape trauma through various psychological and physiological mechanisms, and it is essential to provide trauma-informed care and psychological support to manage these responses. For someone with a history of sexual assault, the physical sensations, medical procedures, and loss of bodily autonomy associated with pregnancy may remind them of their trauma 1. Hormonal changes during pregnancy can also intensify emotional responses and lower psychological defenses, making traumatic memories more accessible. The physical changes to one's body, especially if the pregnancy resulted from assault, can serve as constant reminders of the traumatic event. Additionally, routine prenatal care involving physical examinations may feel invasive and trigger flashbacks or anxiety.

Some key factors to consider in managing past rape trauma during pregnancy include:

• The importance of trauma-informed care from healthcare providers, which can help create a safe and supportive environment for patients with a history of sexual assault 1
• The use of psychological support such as trauma-focused cognitive behavioral therapy or EMDR therapy, which can help patients process their traumatic experiences and manage their symptoms 1
• The potential use of medications like SSRIs in severe cases, though their use during pregnancy requires careful consideration with a healthcare provider 1
• The creation of a birth plan that acknowledges trauma triggers and establishes a support network of understanding individuals, which can help manage difficult emotions during pregnancy 1

It is crucial to prioritize the patient's physical and emotional well-being during this time, and to provide individualized care that takes into account their unique needs and experiences. By providing trauma-informed care and psychological support, healthcare providers can help patients with a history of sexual assault navigate the challenges of pregnancy and childbirth, and reduce the risk of triggering past trauma.

From the Research

Conception, Pregnancy, and Past Rape Trauma

• Conception and pregnancy can trigger past rape trauma in several ways, including:
  • Reactivation of the rape trauma during labor, with feelings of struggle, surrender, and escape 2
  • Re-traumatization after birth, with feelings of being objectified, dirtied, and alienated from one's body 2
• Women with a history of rape are more likely to experience posttraumatic stress disorder (PTSD) during pregnancy and postpartum, with higher prevalence of PTSD diagnosis or symptomatology 3
• Childhood sexual abuse is also associated with higher prevalence of PTSD during pregnancy and postpartum, with one study finding that pregnant women with PTSD had over 5-fold odds of having a history of childhood completed rape compared to counterparts without PTSD 3

Treatment Options for PTSD

• Trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for reducing posttraumatic stress symptoms (PTSS) in children and adults 4, 5, 6
• EMDR has been shown to be better than cognitive behavioral therapy (CBT) in reducing post-traumatic symptoms and anxiety, but there is no difference in reducing depression 6
• TF-CBT and EMDR have been found to be effective and efficient in reducing PTSS in children, with no significant difference in treatment duration or outcome 5

Implications for Care

• Birth attendants should acknowledge that common measures and procedures used during normal birth or cesarean section can contribute to a reactivation of the rape trauma 2
• Healthcare providers should be aware of the potential for re-traumatization during pregnancy and postpartum, and provide sensitive and supportive care to women with a history of rape or childhood sexual abuse 2, 3