Good question. This is something that comes up frequently when I am talking to people expecting babies. Often there has been something bothering them for a while, one of those lurking mental health issues that makes you a little bit less happy than you could be but doesn’t stop you leaving the house.
Then boom. They find out they are pregnant, the onslaught of hormones and social pressure begins and suddenly the problem has become a lot bigger.
Sometimes this happens because they have been through a previous birth that did not go very well. It is very common to find that the traumatic birth you think you left behind ages ago is actually still bothering you when you find out you are pregnant and face the prospect of going through it all again. Some people don’t even realise their first birth WAS traumatic until the memories are triggered by their first antenatal appointment or a comment from a friend about birth.
Or sometimes a mental health issue that has nothing to do with birth or pregnancy can be made much worse by all the change and uncertainty that is involved with bringing a new life into the world. Relationships change, our bodies change, our routines change and the way we feel emotionally and physically changes dramatically too. At the same time we often lose many of the things that normally keep us feeling good and maintaining positive mental health because we physically cannot do them while pregnant. Add to that the uncertainty about what the changing shape of our family will mean for things like work and career and it is not surprising that many find their mental health taking a nosedive during pregnancy.
Other people have overcome a really difficult time in the past, maybe something from childhood, and they are worried that the strategies they used last time won’t help now their life is about to change so dramatically.
For all these reasons you might start thinking about looking after your mental health during pregnancy. But is it safe to have therapy when you are pregnant?
Can therapy be harmful when you are pregnant?
Firstly, before you consider having therapy AT ANY TIME you should check that the therapist is appropriately qualified and registered with a professional body. For example, as a Clinical Psychologist I have to be registered with the HCPC. This means that I have an ethical code that I have to follow and can be struck off if I don’t. Also, anyone using the title “Clinical Psychologist” has to have studied at a high level and learned how to do therapy safely and ethically. There are different regulatory bodies for other types of therapist such as counsellors and psychotherapists. If they are accredited they should have links to their regulatory body on their website and be able to give you their membership number so you can check. Websites such as Psychology Today and Counselling Directory check this for you.
See my blog post on what is psychological therapy to read more about the different types of therapy and therapist available.
When you meet your therapist they will then help you decide if it is the right time for you to be in therapy. Usually I ask these questions to help work this out:
1. How often are you in distress because of the problem?
2. What are you NOT doing because of the problem?
3. What ARE you doing that you wish you weren’t because of the problem?
4. On a scale of 1-10 (with 10 being the most stressed you could possibly be) how much stress does the problem cause you when it is bad?
If your answers suggest that you are in significant distress now or that your quality of life is significantly worse than it could be I would be likely to suggest that some form of therapy could be helpful during pregnancy.
Why would therapy be harmful?
There is plenty of evidence to suggest that babies are impacted by stress during pregnancy (see here for a review). Therapy that brings up lots of bad memories or that challenges you to think about very distressing things (such as trauma therapy) are often not recommended in pregnancy because professionals worry they will cause stress. More recent research however shows that this is very unlikely. On the contrary, therapy has been shown to help people regulate their nervous system, bond with their unborn baby, plan for parenthood and connect with their support networks. This can help you lay an excellent foundation for your parenting and reduce symptoms of depression and anxiety. You can read a review of the evidence for psychotherapy in pregnancy here.
Also, in my experience people rarely enquire about therapy in pregnancy unless they are already experiencing a lot of distress. For this reason the professional advice has changed dramatically over the past few years to reflect our growing understanding of the importance of parental mental health.
What about EMDR therapy in pregnancy?
We now have evidence to suggest that if you are already in significant distress on a regular basis because of your trauma it may be better to do trauma therapy during pregnancy rather than wait. If your stress levels are already very high trauma therapy is unlikely to make this significantly worse and in the end it will make you feel better. For many of my clients going through therapy in pregnancy allows them to do things like attend antenatal appointments, plan their birth and bond with their unborn child that felt impossible prior to EMDR. Overall therefore there are real benefits for you and baby.
If you'd like to read more about the evidence for the effectiveness and safety of EMDR during pregnancy you can find it here.
Overall, if you are struggling to enjoy your pregnancy due to any kind of mental health problem it is worth contacting a properly qualified therapist to talk through whether therapy would help you now and if so what type would be best. If you are ready to take that step then contact me here.