Using Stress Reduction Practices Before and During Pregnancy

Trauma-sensitive instruction for all parents-to-be benefits their offspring.

Posted Mar 04, 2018

Parents-to-be may benefit from using stress reduction practices before and during pregnancy.  As discussed in my previous blog posts, “The Importance of Reducing Stress During Pregnancy” and “The Importance of Reducing Stress During Pregnancy: Part II”, a wealth of recent research demonstrates the negative effects of maternal prenatal stress on pregnancy outcomes.  This knowledge contributes to our understanding of how changes in the psychophysiology of a mother-to-be affect the physiology of her prenate during gestation, and in turn, how changes in her prenate’s physiology may also affect the physiology of the mother-to-be.  The relationship between a pregnant woman or girl and her developing fetus is bi-directional and reciprocal (1).

The quality of the maternal-prenate relationship shapes the growth, health and behavior of the developing child during gestation, and over their life span (2).  In light of this knowledge, it is important to consider two questions when learning or teaching stress reduction practices for use in the preconception and prenatal periods.

  • How does the stress response system of a parent-to-be respond to stress reduction practices?
  • How do these responses affect their offspring during gestation?

Trauma-sensitive stress reduction practices benefit prospective parents and developing babies.

Our stress response system is part of our autonomic nervous system (ANS), which becomes unbalanced or dysregulated when we experience chronic or traumatic stress.  Past or recent experiences of stress and trauma may affect an individual’s response to stress reduction practices.

When teaching stress reduction practices to parents-to-be in the preconception or prenatal period, it is important for instructors to observe how these practices are affecting the autonomic nervous systems (ANS) of their clients, and to consider how their pregnant clients’ ANS reactions may be affecting their developing offspring. Parents-to-be can be given the information they need to assess whether the use of a particular practice is supporting regulation of their autonomic nervous system (ANS) or triggering dysregulation of their ANS.

When students share with instructors that they have experienced trauma and may continue to experience traumatic stress symptoms, teachers have an opportunity to offer trauma-sensitive adaptations in their instruction, which can support student ANS regulation in class and during practice at home. 

What do we know about the effects of stress reduction practices during pregnancy?

Several studies have explored the effects of stress reduction practices on parents-to-be. Positive effects of Mindfulness-Based Stress Reduction (MBSR) programs during pregnancy have been demonstrated (3) (4) (5).  These studies did not evaluate the effects of these practices on participants’ offspring during the pregnancy.  Studies on the effects during pregnancy of the combination of yoga and tai chi (6) ), and yoga and massage therapy (7), have also revealed positive impacts on parents-to-be, but did not evaluate the effects of these practices on participants’ prenates.

One study (8) evaluated the impacts of induced maternal relaxation on pregnant women and their fetuses demonstrating significant associations between maternal autonomic measures and fetal physiological markers. The results of this study indicate that maternal experience affects the intrauterine environment and fetal physiology (8).

What do we know about the effects of stress reduction practices on pregnant trauma survivors with PTSD?

The experience of pregnant trauma survivors with PTSD symptoms often differs from that of mothers-to-be who are not trauma survivors.  There is a lack of research on the impacts of stress reduction practices on these mothers and their offspring during pregnancy. This exploration is important, as recent research illuminates the negative impacts of PTSD on mothers-to-be and their offspring and highlights the need for interventions in the preconception and prenatal period that may reduce these negative effects.  

Studies have demonstrated an association between maternal PTSD and risk behaviors in mothers (9); physical complications in mothers (10); lower birth weight (11); shorter gestation (12); and adverse neonatal and neuro-developmental child outcomes (13) (14).

The statistics on the prevalence of violence experienced by women and girls before and during the childbearing years are sobering. Seng et al., (2001) (10) report that 25-50% of women report PTSD symptoms following abuse or assault trauma. The incidence of childhood maltreatment in females is strongly associated with a diagnosis of PTSD in pregnancy (15). One in three women report a history of childhood sexual abuse or physical abuse (16). Childhood maltreatment conveys a twelvefold risk of having PTSD in pregnancy (17). 

The World Health Organization’s report (2013), “Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence” reveals the incidence of violence experienced by women and girls over 15 years old, which may result in traumatic stress symptoms and PTSD. The report states that 35% of females worldwide over the age of 15 have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence.

Concerns about trauma survivors’ reactions to stress reduction practices have been expressed by several practitioners including: van der Kolk (18), Rothschild (19) (20), Treleaven (21), and Emerson and Hopper (22). van der Kolk (18) explains that while trying to meditate, traumatized individuals often report feeling overwhelmed as perceptions, physical sensations, emotions and trauma-related images arise.  Feelings of helplessness and panic may also be activated along with the physiological changes associated with these states. If a woman or girl is pregnant, these changes may also affect the physiology of her developing prenate. The experience of pregnancy itself may trigger ANS dysregulation in survivors of sexual abuse and assault. Directing one's attention to body-based feelings and sensations during mindfulness practices may intensify a pregnant trauma survivor's ANS dysregulation.  

Treleaven (21) describes internal and external signals that mindfulness instructors and students can observe that indicate dysregulation in an individual’s ANS. They are evident when an individual’s ANS is in a hyperaroused or hypoaroused state, outside their optimal “window of tolerance” (Ogden, Minton & Pain, 2006), (23). These signals include the appearance or experience of: “muscle tone extremely slack (collapsed, noticeably flat affect), muscle tone extremely rigid, hyperventilation, exaggerated startle response, excessive sweating, noticeable dissociation (person appears highly disconnected from their body), noticeably pale skin tone, emotional volatility (enraged, excessive crying, terror)” (Treleaven, 2018, pp. 101-102) (21).

Individuals whose ANS has been activated into a hyperaroused or hypoaroused state may also report experiencing flashbacks, nightmares, intrusive thoughts and blurred vision. Interpersonal interactions may also be affected in ANS-dysregulated individuals and can be recognized by disorganized speech, slurring of words and an inability to make eye contact (21). 

Scientific monitoring of the physiological effects on prenates of stress reduction practices may not yet be available to pregnant students, instructors and practitioners, but prospective parents may learn to notice signs of ANS dysregulation within themselves and ways to modulate these states when they arise.  Since we now know there is a relationship between maternal psychophysiology and fetal physiology, modulating maternal ANS dysregulation may support positive outcomes for mothers and their offspring.

It is imperative that practitioners learn to observe signals of ANS dysregulation in all clients, and understand that the practices they are teaching are affecting not only the individual they see in front of them, but possibly an unseen prenate, as they may not be aware of their client’s pregnancy.  

Having the skills to support trauma survivors in modulating ANS dysregulation during stress reduction classes is particularly important for instructors who work with prospective parents. Parents-to-be who experience persistent activation or exacerbation of traumatic stress symptoms in stress reduction classes and practice, could benefit from working with practitioners experienced in trauma treatment approaches that are safe for pregnant mothers and their prenates. Understanding the potential for stress response system reactions to impact mothers-to-be and their developing prenates offers prospective parents and practitioners the opportunity to support healthy outcomes during pregnancy.              

References

(1) Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011). The contribution of maternal stress to preterm birth: Issues and consideration. Clinics in Perinatology, 38(3), 351-384. 

(2) Weinstein, A. D. (2016). Prenatal development and parents' lived experiences: How early events shape our psychophysiology and relationships. New York: NY: W.W. Norton.

(3) Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190-202.

(4) Guardino, C. M., Dunkel Schetter, C., Bower, J. E., Lu, M. C., & Smalley, S. L. (2013). Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy. Psychology and Health, 29(3), 334-349. 

(5) Vietan, C., & Astin, J. (2008). Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: Results of a pilot study. Archives of Women's Mental Health, 11(1), 67-74. 

(6) Field, T., Diego, M., Delgado, J., & Medina, L. (2013). Tai chi/yoga reduces maternal depression, anxiety and sleep disturbances. Complementary Therapies in Clinical Practice, 19(1), 6-10.

(7) Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and prematurity. Journal of Bodywork and Movement Therapies, 16(2), 204-209.

(8) DiPietro, J. A., Costigan, K. A., Nelson, P., Gurewitsch, E. D., & Laudenslager, M. L. (2007). Fetal responses to induced maternal relaxation during pregnancy. Biological Psychology, 77(1), 11-19. 

(9) Morland, L., Goebert, D., Onoye, J., Frattarelli, L., Derauf, C., Herbst, M.,...Friedman, M. (2007). Posttraumatic stress disorder and pregnancy health: preliminary update and implications. Psychosomatics, 48(4), 304-308.

(10) Seng, J. S., Oakley, D. J., Sampselle, C. M., Killion, C., Graham-Bermann, S., & Liberzon, I. (2001). Posttraumatic stress disorder and pregnancy complications. Obstetrics and Gynecology, 97(1), 17-22.

(11) Rosen, D., Seng, J. S., Tolman, R. M., & Mallinger, G. (2007). Intimate partner vioence, depression and posttraumatic stress disorder as additional predictors of low birth weight in infants among low-income mothers. Journal of Interpersonal Violence, 22(10), 1305-1314.

(12) Rogal, S. S., Poschman, K., Belanger, K., Howell, H. B., Smith, M. V., Medina, J., & Yonkers K. A. (2007). Effects of postraumatic stress disorder on pregnancy outcomes. Journal of Affective Disorders, 102(1-3).

(13) LaPlante, D. P., Brunet, A., Schmitz, N., Ciampi, A., & King, S. (2008). Project Ice Storm: Prenatal maternal stress affects cognitive and linguistic functioning in 5 1/2-year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 47(9), 1063-1072.

(14) Yehuda, R., Engel, S. M., Brand, S. R., Seckl, J., Marcus, S. M., & Berkowitz, G. S. (2005). Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to World Trade Center attack during pregnancy. Journal of Clinical Endocrinology and Metabolism, 90(7), 4115-4118. 2

(15) Seng, J. S., Low, L. K., Sperlich, M., Ronis, D. L., & Liberzon, I. (2009). Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care.  Obstetrics and Gynecology, 114(4), 839-847.

(16) Cougle, J. R., Timpano, K. R., Sachs-Ericsson, N., Keough, M. E., & Riccardi, C. J. (2010). Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Research, 177(1-2), 150-155. 

(17) Seng, J. S., Sperlich, M., Low, L. K., Ronis, D. L., Muzik , M., & Liberzon, I. (2013). Childhood abuse history, posttraumatic stress disorder, postpartum mental health, and bonding: A prospective cohort study. Journal of Midwifery and Women's Health, 58(1), 57-68.

(18) van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin.

(19) Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York, NY: Norton.

(20) Rothschild, B. (2017). The body remembers volume 2: Revolutionizing trauma treatment. New York, NY: Norton.

(21) Treleaven, D. A., Trauma-sensitive mindfulness: Practices for safe and transformative healing. New York: NY: Norton.

(22) Emerson, D., & Hopper, E. (2011). Overcoming trauma through yoga: Reclaiming your body. Berkeley, CA: North Atlantic Books. 

(23) Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: Norton.