Miscarriage Resources

by Band Back Together | Jul 8, 2018

What is a Miscarriage?

A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. The majority of miscarriages occur within the first 13 weeks of pregnancy. Miscarriage is the most common form of pregnancy loss with as many as 15-25% of all clinically recognized pregnancies ending in miscarriage. After 20 weeks, a fetus is technically viable outside the womb; a pregnancy loss at this point is considered a stillbirth.

Contrary to popular belief, sex and exercise will not cause a miscarriage.

If you have suffered a miscarriage, YOU ARE NOT TO BLAME. Please remember that. 

Symptoms Of Miscarriage:

If any of the following symptoms occur during pregnancy, it is important to call your doctor as soon as possible. Possible symptoms of miscarriage may include:

• Lower back pain, or abdominal pain that is dull, sharp, or cramping.

• Tissue or clots passing through the vagina.

• Brown or bright red vaginal bleeding (with or without cramps)

• A sudden decrease in signs of pregnancy.

• White-to-pink mucus from the vagina.

Types Of Miscarriage:

Threatened Miscarriage – any vaginal bleeding during early pregnancy without cervical dilation or changes in cervical consistency. Mild cramping may occur; however, usually, no pain exists. No tissue or fetal membranes have passed through the vagina. Threatened miscarriages are very common – about 25-30% of pregnancies have some amount of bleeding; less than half of all threatened miscarriages lead to a true miscarriage. 

Inevitable Miscarriage – an early pregnancy that has vaginal bleeding and dilation of the cervix. Generally speaking, the vaginal bleeding is heavier than with a threatened miscarriage and the pain is greater.

Incomplete Miscarriage – a pregnancy that has vaginal bleeding, dilation of the cervix and passage of the fetus and other products of conception. Often the cramps are extremely painful and the bleeding from the vagina is heavy. While a complete miscarriage may not have occurred, the miscarriage is inevitable.

Complete Miscarriage – a full miscarriage; all products of conception have been passed through the vagina, and the mother notes that the amount of bleeding and pain have diminished. The cervix is closed and high. Ultrasound examination reveals an empty uterus.

Missed Miscarriage – the presence of a nonviable intrauterine pregnancy that remains in the uterus without bleeding, abdominal pain, passage of tissue or cervical changes. A missed miscarriage is generally diagnosed by the absence of fetal heart tones or by an ultrasound.

Chemical Pregnancy – a pregnancy lost shortly after implantation. May occur so close to normal menstruation that many women do not realize they are pregnant.

Molar Pregnancy – a genetic error during fertilization leads to growth and proliferation of abnormal tissue within the uterus. Molar pregnancies don’t usually contain an embryo, but will often have more severe pregnancy symptoms. A molar pregnancy is diagnosed via ultrasound.

Blighted Ovum (also called anembryonic pregnancy)- a fertilized egg implants into the uterine wall, but fetal development does not occur. Often ultrasonography will reveal a gestational sac (with or without a yolk sac) without fetal growth.

Chances Of Having A Miscarriage:

Most women of childbearing age have between 10-25% chance of having a miscarriage.

Women under 35 = 15% chance of miscarriage.

Women between 35-45 = 20-35% chance of miscarriage.

Women over 45 = up to 50% chance of miscarriage.

Why Do Miscarriages Occur?

Typically, the cause for miscarriages is idiopathic, meaning that no cause can be easily identified.  In the first trimester of pregnancy, chromosomal abnormalities of the embryo are the most common cause of miscarriage.

Other causes of miscarriages include:

• Hormone imbalances
• Improper implantation of the fertilized ova into the lining of the uterus
• Maternal infections such as the German measles, CMV (cytomegalovirus), mycoplasma pneumonia, etc.
• Structural abnormalities of the uterus including fibroids, endometriosis, abnormal growth of the placenta, and poor muscle tone in the mouth of the uterus
• Cervical incompetence
• Chronic maternal infections, including polycystic ovarian syndrome, poorly controlled diabetes, renal disease, Lupus, untreated thyroid disease, maternal hypertension, and antiphospholipid syndrome.
• Drinking, smoking or recreational drug use (especially cocaine)
• Advanced maternal age
• Trauma to the mother

Treatment For Miscarriages:

The number one goal of medical professionals is to prevent and/or treat complications of the mother while allowing the body to do what it needs to do. Common complications include loss of blood (hemorrhage) and infection. If the body passes all of the fetal tissue, generally no medical intervention is necessary, although medications may be given to prevent excessive blood loss or assist the body during the process.

If the body does not manage to pass the fetal tissue properly, medical intervention may be required. The medical procedure practitioners use when fetal tissue is improperly passed is called a D&C, which stands for “dilation and curettage.” This is a relatively minor surgery during which a doctor enlarges the cervix (dilation) and removes (curettage) any residual fetal tissue from the uterus. A D&C is generally performed in an outpatient surgery center or hospital and under sedation. A D&C is also performed for other medical issues besides miscarriages, such as to remove uterine fibroids or polyps, to control irregular menstrual bleeding, and to rule out endometrial cancer.

Bleeding and pain should be monitored. Any changes or signs of infection (chills, nausea, vomiting, and fever) should be reported to the doctor immediately.

A miscarriage should always be reported to the doctor so that potential complications can be ruled out.

Following a miscarriage, do not use a douche, have sex, or insert anything into your vagina until your doctor says it is okay. The waiting period is typically about 6 weeks.

Prevention Of Miscarriages:

Unfortunately most miscarriages occur for reasons we can’t identify, which makes prevention and prediction of miscarriage very difficult; however, there are things that can be done to give any pregnancy the very best chance:

• Get adequate prenatal care.
• Follow the advice of your doctor or midwife.
• Take steps to control high blood pressure (called “preeclampsia” in pregnancy).
• Avoid alcohol, nicotine, and recreational drugs.
• Discuss all prescription drugs with your doctor or midwife.
• Avoid or cut down on caffeine intake.

Emotions Following A Miscarriage

Emotional responses of individuals who have experienced a miscarriage vary. Many grieve the loss of pregnancy just as they would grieve the death of a living person, which means that they may experience shock and denial followed by feelings of guilt, depression, and anger before finally feeling acceptance. If you have experienced a miscarriage, give yourself time to grieve your loss. Seek support from friends, family, bereavement groups, and/or a therapist to aid you in healing emotionally.

It is important to note that men and women may react differently to the loss of a pregnancy, which can further complicate a relationship. Men do not consider themselves to be a father until they hold their baby for the first time; because of this, it is not uncommon for a man to feel confused about how to react to pregnancy loss or to experience the loss to a lesser degree than a woman.

In addition, men tend to grieve more privately, and their grief may be funneled into projects or the examination of facts and information surrounding the pregnancy. Women, on the other hand, feel a connection to the pregnancy earlier and tend to be more outwardly emotive regarding the loss. No matter how your partner reacts, it’s important to stay communicative and be respectful of their feelings and any differences in how they grieve.

Women who have suffered miscarriage are susceptible to postpartum depression. It can be difficult to differentiate between grief and depression, but typically if the symptoms are severe and impinge upon one’s ability to function for a prolonged period of time, professional help should be sought.

How To Help A Loved One Who Has Miscarried:

As with any loss, a miscarriage can be hard for friends and family to navigate. Knowing what to do or say can be hard. Here are some tips:

• Take cues from your loved one: because everyone grieves differently, try to take your lead from her to determine how she’s taking the loss and what she needs.
• Listen: she may want to talk about thoughts and emotions, or she may need to talk about the pregnancy and baby. Listen carefully, focusing on what she’s saying (not on what you’re going to say) and showing you’re paying attention by making eye contact, nodding, gestures, etc.
• Choose your words carefully: don’t tell her she can try again or that it was “meant to be” – these cliches, while common, aren’t always comforting. Don’t criticize or offer advice; listen to how she talks about the miscarriage and go from there.
• Be genuine: don’t tell her you know how it feels or what she’s going through unless you actually do – even though you mean well, this can come off as very offensive. As well, it’s okay to be honest and say, “I don’t know what to say. I’m so sorry for your loss.”
• Consider sending a card: this can be a good way to reach out and let a loved one know you’re thinking about her and sorry for her loss.
• Don’t be afraid to check in: continue asking her how she’s doing and give her the opportunity to talk about her thoughts and feelings. As well, don’t leave out Dad: he’s grieving, too, so make sure to ask how he is doing.

Additional Miscarriage Resources:

Parents or other family members who have experienced the loss of a baby between conception and the first month of life can receive a free March of Dimes bereavement kit by contacting the Fulfillment Center at 1-800-367-6630 or using this link.

Grief Issues Special to Miscarriage – Miscarriage Support Auckland, Inc. is based in New Zealand and provides information about miscarriage issues.

Share – This organization provides mutual support for bereaved parents and families who have suffered a loss due to miscarriage, stillbirth, or neonatal death. SHARE provides newsletters, pen pals, and information regarding professionals, caregivers, and pastoral care.

HopeXchange – Information, support, and hope after pregnancy loss.

Unspoken Grief – A site dedicated to being open, honest and raw about healing after miscarriage, stillbirth or early infant loss.

Still Standing Magazine – an online magazine focusing on encouraging women, men, and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family, and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Still Birthday – Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss

Page last audited 7/2019

Maple Syrup Urine Disease (MSUD) Resources

by Band Back Together | Jul 8, 2018

What Is Maple Syrup Urine Disease?

Maple Syrup Urine Disease (MSUD) is a very rare genetic metabolic disorder that is usually diagnosed in newborn infants characterized by deficiency of certain enzymes (branched-chain alpha-keto acid dehydrogenase complex) required to break down (metabolize) the three branched-chain amino acids (BCAAs) [Leucine, Isoleucine and Valine] in the body. The result of this metabolic failure is that all three BCAAs, along with their various byproducts, accumulate abnormally throughout the body. In the classic, severe form of MSUD, the plasma concentrations of the BCAAs begin to rise within a few hours of birth. If untreated, symptoms begin to emerge, often within the first 24-48 hours of life. Those with MSUD are unable to correctly process certain types of amino acids and proteins, which results in a sweet, maple syrup smell to show up in urine as amino acids build up to unhealthy levels in the body.

The “non-specific” symptoms include lethargy, irritability, and poor feeding, followed soon by focal neurological signs such as abnormal movements and increasing spasticity, and shortly thereafter, by convulsions and deepening coma. If untreated, progressive brain damage is inevitable and death ensues usually within weeks or months. The finding that is unique to MSUD is the emergence of a characteristic odor, reminiscent of maple syrup that can most readily be detected in the urine and earwax and may be smelled within a day or two of birth. If untreated, maple syrup urine disease can lead to seizures, coma, and death.

MSUD is thought to affect 1 in 185,000 newborns globally, although there is a higher occurrence of MSUD in Mennonite populations where it occurs in approximately 1 of every 380 infants.

MSUD is an inherited genetic disorder acquired when both parents carry the recessive gene. If one parent carries the disorder, the child may become a carrier without displaying any symptoms of MSUD.

Maple syrup urine disease is often classified by its pattern of signs and symptoms. The most common and severe form of the disease is the classic type, which becomes apparent soon after birth. Variant forms of the disorder become apparent later in infancy or childhood and are typically milder, but they still lead to delayed development and other health problems if not treated.

The disorder can be successfully managed through a specialized diet. However, even with treatment, both affected children and adults patients with MSUD remain at high risk for developing episodes of acute illness (metabolic crises) often triggered by infection, injury, failure to eat (fasting), or even by psychological stress. During these episodes there is a rapid, sudden spike in amino acid levels necessitating immediate medical intervention.

There are three or four types of MSUD: the classic type; intermediate type, intermittent type, and possibly a thiamine-responsive type. The various sub-types of MSUD have different levels of residual enzyme activity, severity, and age of onset. MSUD is commonly tested in newborns so that it may be caught early.

What Are The Sub-types Of Maple Syrup Urine Disease And Their Symptoms?

Diagnosis and Risks Associated With Maple Syrup Urine Disease:

Most infants with MSUD are identified through newborn screening programs. Tandem mass spectrometry, an advanced newborn screening test that screens for more than 30 different disorders through one blood sample, has aided in the diagnosis of MSUD. However, some infants who have mild or intermittent forms of MSUD may have totally normal amino acids after birth and can be missed by newborn screening. In areas in which the screening test is not available, a diagnosis of MSUD may be based upon the classic symptoms of the disorder.

Treatment for Maple Syrup Urine Disease:

Additional Maple Syrup Urine Disease Resources:

MSUD Family Support Group is a nonprofit organization that offers support and resources for those with MSUD and their families.

CLIMB (Children Living with Inherited Metabolic Disorders) is the National Information Center website in the UK and has incredible resources for those in the UK

Chiari Malformation Resources

by Band Back Together | Jul 8, 2018

What is Chiari Malformation (CM)?

Chiari Malformation is a disorder of the brain affecting at least 1 out of every 1000 people in the world. In the simplest terms, it is a condition where the cerebellum (the bottom part of the brain) squeezes out into the spinal canal. Chiari is almost exclusively diagnosed via MRI of the brain, but other types of scans may detect the disorder as well.

Chiari malformations are structural defects in the base of the skull and cerebellum, the part of the brain that controls balance. Normally the cerebellum and parts of the brain stem sit above an opening in the skull that allows the spinal cord to pass through it (called the foramen magnum). When part of the cerebellum extends below the foramen magnum and into the upper spinal canal, it is called a Chiari malformation (CM).

Chiari malformations may develop when part of the skull is smaller than normal or misshapen, which forces the cerebellum to be pushed down into the foramen magnum and spinal canal. This causes pressure on the cerebellum and brain stem that may affect functions controlled by these areas and block the flow of cerebrospinal fluid (CSF)—the clear liquid that surrounds and cushions the brain and spinal cord. The CSF also circulates nutrients and chemicals filtered from the blood and removes waste products from the brain.

Many people are born with the disorder but have no symptoms until adolescence or adulthood because of growth or progression of the herniation. Others can develop it from trauma or from a lack of spinal fluid.

The most severe forms of Chiari Malformation are detected at birth and may result in significant brain damage and disability.

What Causes Chiari Malformation?

CM has several different causes. Usually, these CM are caused by structural defects in the brain and spinal cord that occur during early fetal development. This can be the result of genetic mutations or a maternal diet that lacked certain vitamins or nutrients.

This is called primary or congenital Chiari malformation (by far the most common type of Chiari) It

Secondary (or acquired) Chiari Malformation occur later in life if the  spinal fluid is drained excessively from the lumbar or thoracic areas of the spine either due to traumatic injury, disease, or infection.

What Are Some of the Symptoms of Chiari Malformation?

Headache is the hallmark sign of Chiari malformation, especially after sudden coughing, sneezing, or straining. Other symptoms may vary among individuals and may include:

• neck pain
• hearing or balance problems
• muscle weakness or numbness
• dizziness
• difficulty swallowing or speaking
• vomiting
• ringing or buzzing in the ears (tinnitus)
• curvature of the spine (scoliosis)
• insomnia
• depression
• problems with hand coordination and fine motor skills.

Some individuals with CM may not show any symptoms. Symptoms may change for some individuals, depending on the compression of the tissue and nerves and on the buildup of CSF (cerebrospinal fluid) pressure.

Infants with a Chiari malformation may have difficulty swallowing, irritability when being fed, excessive drooling, a weak cry, gagging or vomiting, arm weakness, a stiff neck, breathing problems, developmental delays, and an inability to gain weight.

Diagnosis of Chiari Malformation:

Currently, no test is available to determine if a baby will be born with a Chiari malformation, but as Chiari malformations are associated with certain birth defects like spina bifida, children born with those defects are often tested for CMs. However, some malformations can be seen on ultrasound images before birth.

Many people with Chiari malformations have no symptoms and their malformations are discovered only during the course of diagnosis or treatment for another disorder. The doctor will perform a physical exam and check the person’s memory, cognition, balance (functions controlled by the cerebellum), touch, reflexes, sensation, and motor skills (functions controlled by the spinal cord).  The physician may also order one of the following diagnostic tests:

• Magnetic resonance imaging (MRI) is the imaging procedure most often used to diagnose a Chiari malformation. It uses radio waves and a powerful magnetic field to painlessly produce either a detailed three-dimensional picture or a two-dimensional “slice” of body structures, including tissues, organs, bones, and nerves.
• X-rays use electromagnetic energy to produce images of bones and certain tissues on film.  An X-ray of the head and neck cannot reveal a CM but can identify bone abnormalities that are often associated with the disorder.
• Computed tomography (CT) uses X-rays and a computer to produce two-dimensional pictures of bone and blood vessels. CT can identify hydrocephalus and bone abnormalities associated with Chiari malformation.

How Are Chiari Malformations Classified?

Chiari malformations are classified by the severity of the disorder and the parts of the brain that protrude into the spinal canal.

Chiari malformation Type I

Type 1 happens when the lower part of the cerebellum (called the cerebellar tonsils) extends into the foramen magnum.  Normally, only the spinal cord passes through this opening.  Type 1—which may not cause symptoms—is the most common form of CM.  It is usually first noticed in adolescence or adulthood, often by accident during an examination for another condition.  Adolescents and adults who have CM but no symptoms initially may develop signs of the disorder later in life.

Chiari malformation Type II

Individuals with Type II have symptoms that are generally more severe than in Type 1 and usually appear during childhood.  This disorder can cause life-threatening complications during infancy or early childhood, and treating it requires surgery.

In Type II, also called classic CM, both the cerebellum and brain stem tissue protrude into the foramen magnum.  Also the nerve tissue that connects the two halves of the cerebellum may be missing or only partially formed.  Type II is usually accompanied by a myelomeningocele—a form of spina bifida that occurs when the spinal canal and backbone do not close before birth.  (Spina bifida is a disorder characterized by the incomplete development of the brain, spinal cord, and/or their protective covering.)  A myelomeningocele usually results in partial or complete paralysis of the area below the spinal opening.  The term Arnold-Chiari malformation (named after two pioneering researchers) is specific to Type II malformations.

Chiari malformation Type III

Type III is very rare and the most serious form of Chiari malformation.  In Type III, some of the cerebellum and the brain stem stick out, or herniate, through an abnormal opening in the back of the skull.  This can also include the membranes surrounding the brain or spinal cord.

The symptoms of Type III appear in infancy and can cause debilitating and life-threatening complications.  Babies with Type III can have many of the same symptoms as those with Type II but can also have additional severe neurological defects such as mental and physical delays, and seizures.

Chiari malformation Type IV

Type IV involves an incomplete or underdeveloped cerebellum (a condition known as cerebellar hypoplasia). In this rare form of CM, the cerebellum is located in its normal position but parts of it are missing, and portions of the skull and spinal cord may be visible.

Treatment for Chiari Malformation:

Treatment for Chiari Malformation is varied. Most patients are first treated by a neurologist, with medications being used to reduce headaches or other symptoms. Many patients are able to be managed without surgery; however, if medication does not work or the cerebellar herniation gets worse, surgery is usually recommended to provide more room for the herniated brain structures.

Outcomes from surgery vary widely depending upon the patient, the severity of the herniation, and the damage done before surgery.

Some CMs do not show symptoms and do not interfere with a person’s activities of daily living. In these cases, doctors may only recommend regular monitoring with MRI imagining. When people experience pain or headaches, doctors may prescribe medications to help ease symptoms.

Surgery

In many cases, surgery is the only treatment available to ease symptoms or halt the progression of damage to the central nervous system as surgery can improve or stabilize symptoms in most people. More than one surgery may be needed to treat the condition.

The most common surgery to treat Chiari malformation is posterior fossa decompression which creates more space for the cerebellum and relieves pressure on the spinal cord. The surgery involves making an incision at the back of the head and removing a small portion of the bone at the bottom of the skull (craniectomy). In some cases the arched, bony roof of the spinal canal, called the lamina, may also be removed (spinal laminectomy). The surgery should help restore the normal flow of CSF, and in some cases it may be enough to relieve symptoms.

Next, the surgeon may make an incision in the dura, the protective covering of the brain and spinal cord.  Some surgeons perform a Doppler ultrasound test during surgery to determine if opening the dura is even necessary.  If the brain and spinal cord area is still crowded, the surgeon may use a procedure called electrocautery to remove the cerebellar tonsils, allowing for more free space.  These tonsils do not have a recognized function and can be removed without causing any known neurological problems.

The final step is to sew a dura patch to expand the space around the tonsils, similar to letting out the waistband on a pair of pants.  This patch can be made of artificial material or tissue harvested from another part of an individual’s body.

Infants and children with myelomeningocele may require surgery to reposition the spinal cord and close the opening in the back.  Findings from the National Institutes of Health (NIH) show that this surgery is most effective when it is done prenatally (while the baby is still in the womb) instead of after birth. The prenatal surgery reduces the occurrence of hydrocephalus and restores the cerebellum and brain stem to a more normal alignment.

Hydrocephalus may be treated with a shunt (tube) system that drains excess fluid and relieves pressure inside the head.  A sturdy tube, surgically inserted into the head, is connected to a flexible tube placed under the skin.  These tubes drain the excess fluid into either the chest cavity or the abdomen so it can be absorbed by the body.

An alternative surgical treatment in some individuals with hydrocephalus is third ventriculostomy, a procedure that improves the flow of CSF out of the brain.  A small hole is made at the bottom of the third ventricle (brain cavity) and the CSF is diverted there to relieve pressure.  Similarly, in cases where surgery was not effective, doctors may open the spinal cord and insert a shunt to drain a syringomyelia or hydromyelia (increased fluid in the central canal of the spinal cord).

Chiari Malformation and Associated Conditions:

There are a number of other conditions that often occur when a person has CM. These may include:

Hydrocephalus is an excessive buildup of CSF in the brain. A CM can block the normal flow of this fluid and cause pressure within the head that can result in mental defects and/or an enlarged or misshapen skull. Severe hydrocephalus, if left untreated, can be fatal. The disorder can occur with any type of Chiari malformation, but is most commonly associated with Type II.

Spina bifida is neural tube defect in which there is incomplete closing of the backbone and membranes around the spinal cord. In babies who are diagnosed with spina bifida, the bones around the spinal cord do not form properly, causing defects in the lower spine. While most children with this birth defect have such a mild form that they have no neurological problems, individuals with Type II Chiari malformation usually have a myelomeningocele, and a baby’s spinal cord remains open in one area of the back and lower spine.  he membranes and spinal cord protrude through the opening in the spine, creating a sac on the baby’s back. This can cause a number of neurological impairments such as muscle weakness, paralysis, and scoliosis.

Syringomyelia is a disorder in which a CSF-filled tubular cyst, or syrinx, forms within the spinal cord’s central canal.  The growing syrinx destroys the center of the spinal cord, resulting in pain, weakness, and stiffness in the back, shoulders, arms, or legs.  Other symptoms may include a loss of the ability to feel extremes of hot or cold, especially in the hands.  Some individuals also have severe arm and neck pain.

Tethered cord syndrome occurs when a child’s spinal cord abnormally attaches to the tissues around the bottom of the spine. This means the spinal cord cannot move freely within the spinal canal. As a child grows, the disorder worsens, and can result in permanent damage to the nerves that control the muscles in the lower body and legs.  Children who have a myelomeningocele have an increased risk of developing a tethered cord later in life.

Spinal curvature is common among individuals with syringomyelia or CM Type I.  The spine either may bend to the left or right (scoliosis) or may bend forward (kyphosis).

Additional Chiari Malformation Resources:

American Syringomyelia and Chiari Alliance Project – Non-profit organization dedicated to research and support

Chiari and Syringomyelia Foundation – Non-profit group committed to finding a cure for Chiari malformations, syringomyelia and other cerebrospinal fluid disorders

Canadian Chiari Association –  a non profit registered charity organization whose goals are to spread awareness of this condition and to help mobilize the medical community in the fight against chiari.

Last audited 7/2018

Stillbirth Resources

by Band Back Together | Jul 7, 2018

What Is A Stillbirth?

Stillbirth is defined as fetal death after 20 weeks of pregnancy. Stillbirths happen in approximately one in every 160 pregnancies, at seemingly random times. Stillbirth is used as a distinction between the miscarriage or live birth.

Losing a baby to stillbirth is a tragic and tender time when all hopes and dreams are born, only for those hopes and dreams to be shattered upon delivery. The body recovers from the birth, but the heart is forever injured.

How is Stillbirth Diagnosed?

Most stillbirths occur prenatally – stillbirths are relatively infrequent during labor and delivery. Often a woman notices her baby is not moving as usual and may suspect that something is wrong.

Once a woman suspects that there is something wrong and calls her doctor, a fetal death is confirmed (or denied!) via ultrasonography. Sometimes, these images may explain what caused the stillbirth.

What Happens After Stillbirth Diagnosis?

After it’s determined that the fetus has, in fact, died, the health care team will work with the woman to discuss options for delivery. Some women may, for medical reasons, need to deliver immediately.

If not medically necessary, couples are often given the option of when they want to deliver their baby – waiting for labor does not usually pose any problems for the mother.

A couple can wait to go into labor naturally with their baby; labor usually begins within 2 weeks of a stillbirth. If labor does not begin within two weeks, most doctors push to induce their patients because there is a risk of blood clots for the mother after that time.

Most couples, however, opt to have labor induced after they’ve learned that their baby has died. A vaginal suppository is inserted into the cervix, if it has not begun to dilate naturally. Then, an IV drip of synthetic oxytocin, which stimulates uterine contractions, is begun.

Barring any problems with labor and delivery, most women can deliver vaginally.

Why Does Stillbirth Happen?

There are many known causes for stillbirth; however, not all stillbirths have a known cause. Here are some common causes for a stillbirth:

Birth Defects – According to the March of Dimes, 15-20% of stillborn babies have at least one birth defect; 20% of these have chromosomal problems, such as Down Syndrome. Others have birth defects caused by genetics, environmental, or unknown causes.

Placental Problems – According to the March of Dimes, placental problems cause 25% of stillbirths. Placental abruption (the placenta peels away partially or entirely from the uterine wall prior to delivery) results in heavy bleeding that can threaten the life of the mother and fetus. It may cause fetal death due to lack of oxygen. Women who use cocaine or smoke cigarettes while pregnant are at increased risk of placental abruption.

Poor Fetal Growth – Fetuses that grow too slowly are at an increased risk for stillbirth. According to the March of Dimes, 40% of stillborn babies have poor growth. Women who smoke cigarettes or have high blood pressure are at increased risk for small babies. If poor growth is noted prior to fetal demise, a woman will be closely monitored by her OB-GYN.

Infection – Maternal, fetal, or placental infections appear to cause 10-25% of stillbirths, according to the March of Dimes. Some infections, such as genital and urinary tract infections and certain viruses, may go undiagnosed and asymptomatic through a pregnancy until they cause complications like stillbirth or preterm birth.

Chronic Maternal Health Conditions – According to the March of Dimes, 10% of stillbirths are related to chronic health conditions of the mother. These include high blood pressure, diabetes, kidney disease, and thrombophilias. These conditions may lead to placental abruption or poor fetal growth. Preeclampsia also increases the risk for a stillbirth, especially in subsequent pregnancies.

Umbilical Cord Accidents – 2-4% of pregnancies involve umbilical cord accidents, such as knots in the cord or abnormal placement of the cord into the placenta. Umbilical cord accidents can deprive the fetus of oxygen.

Other stillbirths may be caused by maternal trauma (like a car accident), pregnancy longer than 42 weeks, Rh Disease (incompatibility of maternal and fetal blood), and lack of oxygen during a difficult delivery.

Risk Factors for Stillbirth:

• Maternal age over 35

• Maternal Obesity

• Multiple gestation (twins or triplets)

• African-American Ancestry

• Malnutrition

• Smoking

• Drug and alcohol abuse

How Do I Reduce My Risk for Stillbirth?

A woman should schedule a visit with her doctor before she gets pregnant to allow the doctor to identify and treat any maternal conditions before pregnancy to reduce risks during pregnancy. This is also a time when a woman should share all medications, including herbal supplements, with her doctor to identify and discontinue any potentially harmful medications.

Women who are obese should consider losing weight prior to conception. A doctor or other health care provider can help a woman develop a weight loss plan before pregnancy. No woman should try to lose weight during a pregnancy.

Women shouldn’t smoke, use street drugs, or drink alcohol during pregnancy because these can increase the risk of stillbirths.

I Had a Previous Pregnancy End in Stillbirth – Can it Happen Again?

Understandably, those who have suffered a stillbirth are worried about subsequent pregnancies also ending in stillbirth. The risk for those who have had a previous stillbirth is lower than those who have not. For example, placental problems and cord accidents are unlikely to occur in another pregnancy.

If the stillbirth was due to maternal health complications or genetic disorders, the risk of a subsequent stillbirth may be higher. These couples should visit a genetic counselor and discuss the risks of pregnancy complications, including stillbirth.

Doctors carefully monitor any woman who has had a previous stillbirth for any signs of fetal problems – this may assure the woman that all steps necessary for prevention of another stillbirth are taken.

Can We Prevent Stillbirths?

Stillbirth rates, since the 1950’s, have declined dramatically. This is due to better management of certain conditions – high blood pressure and diabetes. Rh disease can be prevented by administering a dose of immunoglobulin at 28 weeks to an Rh- mother carrying an Rh+ fetus.

Women who have high risk pregnancies are monitored more carefully by their doctors during late pregnancy. Women who are carrying high-risk pregnancies are often told to do a “kick count” starting around week 28 of pregnancy. If a woman counts less than ten kicks an hour for two hours or if she feels the baby is moving less than usual, she should call the doctor for additional testing.

Any bleeding during pregnancy should be reported to the doctor immediately. Vaginal bleeding during the second trimester may indicate placental abruption, and an emergency c-section may save the baby.

Since stillbirths are often a complete mystery, there are very few ways to eradicate them entirely; however, with proper prenatal care and monitoring, some stillbirths may be prevented.

How Do I Handle the Grief of a Stillbirth?

Any couple who has lost a baby due to stillbirth needs time and space to grieve. A pregnant woman and her partner have already bonded with their child, well before it is born, so having a stillbirth means that most will feel an intense, pervasive loss when their baby dies. Grief is a very unique process, and each parent may feel the loss differently. Some common emotions are anger, sadness, denial, shock, numbness, depression, despair, and guilt.

Often a woman and her partner cope with a stillbirth differently, which may create tension within the relationship. These couples may benefit from seeing a grief counselor together so that they can be there for one another at a time when they are both in desperate need.

Many stillbirth parents find strength from joining a stillbirth support group. These groups are full of people who understand the unique grief journey that accompanies a stillbirth. This may help each person feel less alone.

How Do I Help a Loved One Who Has Suffered a Stillbirth?

• Follow their lead – everyone grieves a loss – any loss – differently. If you find out how your loved one is coping and what they need from you, it can help you figure out how to respond. Acknowledge your friend’s feelings. Maybe they’re not the reactions you’d have, but they are hers and she is allowed. A little, “I understand why you feel this way” can go a long way. Don’t be afraid to ask questions or talk candidly about the loss with your friend.
• Don’t ever say these things: “You can try again.” “There must’ve been something wrong with the baby.” “At least it happened now.” Even if these are all true statements, they’re about the most unsupportive thing you can say to someone who is grieving.
• You probably DO NOT know how your friend feels, so don’t say so. When you say, “I know how it feels…I lost my cat once,” you’re minimizing the loss your friend just experienced. There’s nothing more hurtful than being told that someone else “gets” their pain when they truly cannot.If you weren’t informed of the stillbirth by the parents, be careful what you say. It’s wonderful to want to be supportive and send love and condolences, but if the couple hasn’t officially told many about their loss, they may feel their confidence has been betrayed. Let them come to you.
• Send a card – just a simple card saying that you are sorry and available if your friend wants to talk. Those sort of words can be extremely comforting when someone is brokenhearted over the loss of their unborn child.
• Follow up – grief is an ever-evolving thing, coming in all sorts of stages and waves. What may be comforting one week may be not the next. So keep calling. Keep emailing. Keep sending notes and letters. Your friend will appreciate it.

Additional Stillbirth Resources:

Now I Lay Me Down To Sleep: a non-profit network of professional photographers around the country that will come to the hospital and offer free professional portraits to families who have lost a baby.

International Stillbirth Alliance: a non-profit coalition of organizations dedicated to understanding the causes and prevention of stillbirth. The group seeks to raise awareness of stillbirth, promote the prevention of stillbirth through international collaboration, and help provide appropriate care for parents whose baby is stillborn.

Empty Cradle, Broken Heart: Surviving the Death of Your Baby -by Deborah L. Davis, PhD: This book has wonderful information on issues such as the loss of multiples, stillbirth, miscarriage, ectopic pregnancy, and infant loss. There is a special chapter for fathers, and it’s an exceptional book for doctors, nurses, grandparents, and others to read to help them offer comfort to the grieving parents.

Still Standing Magazine – an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Still Birthday – Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss.

Page last audited 7/2018

Post-Traumatic Stress Disorder Resources

by Band Back Together | Jul 7, 2018

What is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is severe anxiety disorder that may develop as a result of exposure to a terribly frightening, life-threatening, or otherwise highly unsafe experience (i.e. trauma). This event may involve the threat of death to oneself or someone else. It could be a sexual or physical assault, unexpected death of a loved one, an accident, war or a natural disaster. Post-traumatic stress disorder is a lasting consequence of such stressful ordeals.

Many people who have experienced such traumatic events will have reactions that include anger, shock, fear, guilt, and nervousness. These reactions are common and dissipate over time. However, for someone suffering from PTSD, these feelings increase and often become so strong that they prevent the person from living a normal life.

Who Gets Post-Traumatic Stress Disorder?

Everyone handles traumatic events differently – just as each person handles fears, threats and stresses in a unique way. That means that not every person who witnesses or experiences a traumatic event will develop post-traumatic stress syndrome. Also, the support and help a person receives following the traumatic event influences the development of PTSD and the severity of symptoms of the disorder.

While PTSD was once known as something that happened to war veterans, it is now known that post-traumatic stress disorder can occur in anyone following a stressful event. The likelihood for developing PTSD depends upon many things, including:

• The intensity of the trauma and how long it lasted
• If you lost someone close to you
• How close you were to the event
• The strength of your reaction
• How in control you felt about the traumatic event
• The amount of help and support you got after the traumatic event

What Are The Risk Factors For Developing PTSD?

There are risk factors for developing PTSD, though. They include:

• Those who have had previously traumatic experiences – especially in early life.
• Those who have a history of physical, sexual or substance abuse.
• Those who have a history of mental illness, including depression and anxiety.
• Those who have a lack of support after trauma.
• Traumatic events are more likely to cause PTSD if they involve a severe threat to one’s life or personal safety – the more prolonged and extreme, the greater the risk for development of PTSD.
• Those who have suffered childhood abuse are at greater risk for development of post-traumatic stress disorder.
• Victims of physical and/or sexual trauma face the greatest risk for development of PTSD.

What Are The Symptoms of PTSD?

Symptoms of PTSD often begin within three months of the traumatic event, although they can take years to surface. The severity and duration of post-traumatic stress disorder varies from person to person – some recover within six months while others suffer many years.

PTSD can negatively impact everyday functioning at work and at home, as it often disrupts the normal course of a person’s day and makes it difficult to sleep, eat, or focus on a task.

The symptoms of PTSD are grouped into four categories:

Reliving: PTSD sufferers re-experience the stressful or traumatic event in some way. These can include thoughts and memories of the trauma, nightmares, intrusive thoughts, and flashbacks. Someone with PTSD may also feel distress when they are reminded of the trauma, such as an anniversary of the event.

Avoidance: People who have PTSD may avoid places, people, or other things that remind them of the event or trauma. This may lead to feelings of detachment and isolation from loved ones and friends, as well as a general loss of interest in once-pleasurable activities.

Increased Arousal: People who have post-traumatic stress disorder may become exquisitely sensitive to normal life experiences. This is also known as hyper-arousal. Symptoms of hyper-arousal may include being easily startled, emotional outbursts, difficulty concentrating, increased blood pressure, muscle tension, and/or nausea and vomiting.

Feeling Emotionally Numb: It may be very hard for someone who experiences PTSD to express and feel their emotions. This is a way to cope with memories, but can feel very discomfiting for both the person with PTSD and their loved ones.

Other symptoms of post-traumatic stress disorder include:

• Drug or alcohol abuse
• Problems holding a job
• Relationship troubles, including divorce and domestic violence
• Feelings of hopelessness, shame or despair.

Can Kids Have Post-Traumatic Stress Disorder?

Anyone at any age can develop post-traumatic stress disorder. Their symptoms may be similar to those listed above or can be different. Older children experience symptoms similar to adults. Here are some other symptoms children with PTSD may have:

• Young children may have trouble being separated from parents or caregivers
• Children may have trouble sleeping
• Previously toilet-trained children may suddenly start having accidents or have difficulty using the bathroom.
• Children ages 6-9 may act out the traumatic event through drawings, stories and play. They may also develop anxieties or fears that do not seem to be related to the traumatic event.

Is Post-Traumatic Stress Disorder Common?

PTSD is more common than once believed. It’s estimated that about 5.2 American adults suffer from PTSD each year, and 7.8 Americans will suffer it at some point in their lifetime.

PTSD can develop at any age – including childhood.

Women are more likely to develop PTSD than men, although that may be due to the fact that women are more likely to be the victims of domestic violence, sexual assault and rape than men.

How is Post-Traumatic Stress Disorder Diagnosed?

If the symptoms of post-traumatic stress disorder are present, a complete medical history and physical exam will be performed. If no physical illness is found, a general family practitioner will refer the patient to a mental health professional for a more thorough examination.

A mental health professional will perform a specially designed interview to ascertain whether PTSD is present and how severe the symptoms may be. From there, the therapist and person with PTSD can work together to develop a treatment plan to work on managing the symptoms of the disorder.

How is Post-Traumatic Stress Disorder Treated?

The goal of treatment for PTSD is to reduce the physical and emotional symptoms, improve daily functioning and help the person better cope with the event that triggered the disorder. Treatment for PTSD often involves therapy, medication or both.

Medication – Often, those who have PTSD are prescribed antidepressants to control the feelings of anxiety associated with the disorder. Other medications that may be prescribed are mood stabilizers and tranquilizers.

Therapy – Therapy teaches a person who has PTSD to learn skills to manage symptoms of the disorder and learn to cope with the event and fears that triggered the disorder.

Coping With Specific Post-Traumatic Stress Disorder Symptoms:

PTSD has very specific and very debilitating symptoms. Here are some ways to cope with these symptoms:

Intrusive memories, thoughts or images:

• Remind yourself that they’re just memories.
• Remember that while these can be overwhelming, the reminders often dissipate over time.
• Remind yourself that it’s normal to have memories of the traumatic event.
• Talk about these things with someone that you trust.

Sudden feelings of panic or anxiety:

PTSD often leaves us with our hearts pounding, feeling light-headed or spacey (often called by quick breathing.) If this is something that happens, remember:

• These reactions aren’t dangerous – you wouldn’t notice if you had them while exercising.
• These feelings may come with scary thoughts, which is what may make them so upsetting. These scary thoughts are not true.
• Try to slow down your breathing.
• These awful sensations will pass.

Difficulty concentrating or focusing:

• Slow down – give yourself time to focus upon what it is you need to do.
• Make “to-do” lists every day.
• Break big tasks into smaller doable chunks.
• Plan a realistic amount of tasks to do in a day.
• You may be suffering depression – if so, talk to your doctor about your symptoms.

Trouble feeling or expressing positive emotions.

• Remind yourself that this is a common reaction to trauma, not something you’re doing on purpose.
• Don’t feel guilty for something you can’t control.
• Continue engaging in activities you like or used to like. Even if you don’t think you’ll enjoy it now, once you get into it, you may find yourself feeling pleasurable feelings.
• Take really small steps to tell your loved ones you care – write a card, leave a gift, send an email, call them to say hi.

Flashbacks:

• Keep your eyes open – look around and see, really see where you are.
• Talk to yourself. Remind yourself that you’re here, that you’re safe. The trauma is long-since over and you are in the present.
• Get up and move around. Take a drink of water or wash your hands. Interrupt the flashbacks with movements.
• Call someone you trust and tell them that you’re experiencing a flashback.

Irritability, anger and rage:

• Before reacting, take a time out to cool off and think.
• Walk away from the situation.
• Exercise every day – exercise reduces tension and relieves stress.
• Talk to your doctor about your anger.
• Take anger management classes.
• If you blow up at family or friends, find time to talk to them and explain what happened and what you are doing to cope with it.

Nightmares about the trauma:

• If you wake from a nightmare in a panic, remind yourself you’re reacting to a dream. The DREAM is responsible for the panic, not any current danger.
• Get out of bed, regroup, and orient yourself to the present.
• Try a pleasant and calming activity like taking a bath or listening to soothing music.
• If someone is awake, talk to them.
• Tell your doctor that you’re having nightmares.

Difficulty falling or staying asleep:

• Keep a regular bedtime schedule and routine.
• Avoid heavy exercise for a few hours before bed.
• Use your bed only for sex and sleeping.
• Don’t use alcohol, tobacco, and caffeine – these hurt your ability to sleep.
• Don’t lie there in bed thinking or worrying. If you can’t sleep, get up and do something quiet like drinking herbal tea, or warm milk. Read a book or do something else quietly.

How Do I Manage PTSD At Home?

Recovering from PTSD is a gradual, ongoing process that can take many months or years. The memories of the trauma will never disappear completely, although in time they will become manageable. Here are some ways to cope with residual complications from PTSD:

Recovery – Remember that recovery is a process, not an event, that happens gradually. Having an ongoing response to stress is normal. Healing doesn’t mean forgetting the event or removing all pain while thinking about the event – healing means learning to cope with the symptoms.

Learn – learning about trauma and PTSD in response to a traumatic event as well as some common signs and symptoms may help you to realize you’re not alone, weak or crazy. It helps to know your problem is something shared by many, many others.

Relax – sometimes, relaxation techniques can be helpful for people with PTSD. These activities include: muscle relaxation exercises, breathing exercises, meditation, prayer, spending time in nature, yoga, listening to quiet music. In others, however, these may increase distress at first. If that happens, simply try relaxation techniques for smaller periods of time, or mix them with other activities like listening to music or walking.

Don’t Isolate – The urge to pull back and isolate is very strong in those who have PTSD. It’s easy to feel disconnected to everyone around you, withdrawing from loved ones and social activities. It’s very important to have support from others while you recover, so resist the urge to isolate.

Join a Support Group – find a support group for people who have experienced similar types of trauma in your area. Being around people who understand what you are going through is priceless when it comes to recovery. It can remind you that you are not alone and provide you with invaluable information and tools for making a recovery from PTSD. If there are no local support groups, try online.

Don’t Self-Medicate – While you’re struggling with traumatic memories and painful emotions, the urge to use alcohol and drugs can be overwhelming. It’s a temporary fix. And unfortunately, these substances worsen PTSD in the long run, as they worsen symptoms like emotional numbing, social isolation, anger and depression.

Overcome Helplessness – trauma leaves you feeling vulnerable and powerless. It’s easy to forget that you do, in fact, have both coping skills and strengths. One of the best ways to overcome these feelings is to help other people. Donate time, money, help friends, or take other positive action. Taking positive action directly refutes the feelings of helplessness common in PTSD.

How Do I Help A Loved One With PTSD?

Be Patient and Understanding – Recovery from PTSD takes time – even if a person is actively trying to get better. Be patient with the pace (slow as it may be) and offer a kind ear. Someone with PTSD may need to talk about their trauma over and over – this is part of the healing, and while it can be frustrating to hear, don’t tell your loved one to “move on,” or “stop talking about it.”

Don’t Pressure – Sometimes, it can be very hard for someone with PTSD to talk about their trauma. For some people, it may make the situation worse. So never, ever force someone into discussing their trauma. Simply let them know that you are there if they’d like to talk.

Try to Prepare for PTSD Triggers – many people who have PTSD will have triggers around the anniversary of the trauma, certain sights, sounds, or smells. If you’re aware of what these triggers are, you can offer support and help to calm your loved one.

Don’t Take It Personally – Some of the more common PTSD symptoms can hurt your feelings. These may include anger, withdrawal, and isolation. If your loved one seems distant or irritable, remember this probably has nothing to do with you.

Be There – sometimes the biggest help for someone who is suffering from PTSD is to have a partner, friend, or other loved one simply be there for them. Do simple favors. Offer unconditional love. Don’t push. Simply be there for them.

It’s Not “In Their Head” – being the partner of someone with an invisible illness can be very stressful. You may wonder why they don’t just “get over it.” The thing is – PTSD is a real illness, and your loved one may already feel as though they’re going crazy. Don’t add to it by making your partner feel badly for having these emotions or guilt them for “not getting over it.” It’s not as simple as that.

Help Yourself – if handling the flashbacks, the anxiety, the numbing, and the rest of the PTSD symptoms are becoming too stressful for you, seek help for yourself. No one ever said you had to go through this alone. Seeing a therapist or attending a support group yourself can ease the burden tremendously.

What is Complex Post-Traumatic Stress Disorder?

Repeated traumatic events (such as long-term abuse) can result in what is known as Complex Post-Traumatic Stress Disorder (it may also be called Disorders of Extreme Stress Not Otherwise Specified or DES-NOS).

The current PTSD diagnosis doesn’t quite capture the severe psychological harm that occurs with prolonged, repeated trauma. Complex PTSD is somewhat different from typical PTSD as repeated traumas can cause the individual to question their own self-concept and alter adaptive abilities; in other words, the individual’s ability to distinguish between safety and danger is compromised. There is talk of adding Complex PTSD, with new criteria, to the DSM-IV.

According to the National Center for PTSD, symptoms of Complex PTSD may include:

Changes in emotions and the ability to regulate them. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.

Changes in consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body.

Changes in how one thinks of themselves. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.

Changes in how the victim sees the perpetrator of the trauma. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.

Changes in interpersonal relationships. Examples include isolation, distrust, or a repeated search for a rescuer.

Changes in one’s system of values and meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

Post-Traumatic Stress Disorder During The Holidays:

People suffering from Post Traumatic Stress Disorder (PTSD) may have a more difficult time during the holidays for any number of reasons:

PTSD sufferers can suffer setbacks at the anniversary or during the season the anniversary of the traumatic event occurred. For example, if someone has PTSD because of being molested by a family member during the holidays, the holiday season may bring back the memories and make it difficult to relax and enjoy the holiday. If a veteran remembers spending a horrible holiday seeing other members of their unit killed, the holiday season may be difficult to make it through. Sometimes, those suffering from PTSD do not understand why or cannot explain why they are irritable or cannot enjoy the holidays.

Family members try to make the holiday special and may end up feeling angry instead when the person with PTSD is not willing or able to participate in holiday events.

Holidays and family functions can make the PTSD sufferer feel like an outsider. They may feel uncomfortable joining in the celebration and, as a result, end up feeling alone and isolated. Although family members may try to include the person with PTSD, if the event brings back memories or makes him or her uncomfortable, being pushed into participating can make the feelings of isolation even more uncomfortable.

PTSD sufferers may have survivor’s guilt. The traumatic event that caused the PTSD may be one in which other people perished. This may create guilt and cause them to wonder why he or she survived and others did not. Holidays may increase these feelings. Family members, with good intentions, can create even more guilt by either ignoring the situation or calling attention to it. The survivor must be able to grieve in his or her own way and family members must be respectful of that grief.

Large crowds or events with alcohol can be problems for people with PTSD. He or she may feel unsafe in places with many people or large crowds. Trips to the mall or large family gatherings may bring about such uncomfortable feelings the sufferer may instead avoid all situations that involve crowds.

People with PTSD have a larger chance than the general public of having problems with alcohol. Holiday parties often include alcoholic beverages and this may be a big problem, especially if triggers are around.

No matter what the reason, the holiday season is often difficult for people with PTSD, but there are a number of things they can do to help manage their PTSD during this holiday season:

Understand Your Triggers – Knowing what your triggers are and having techniques to cope with triggers can help you to make it through family gatherings or shopping trips.

Develop Coping Strategies– Anxiety coping techniques, such as deep breathing or removing yourself from the situation for a few minutes can help.

Prepare Yourself – Be prepared for situations that may come up. You may want to write down some of your coping strategies. When a stressful situation arises, you can take out your notes and use the strategies. Sometimes during a stressful situation, you can forget what helps. Having it written down can help calm you down.

Accept You may Need to Leave – If your anxiety becomes difficult or impossible to handle, excuse yourself and leave, even if just for a few minutes. Sometimes leaving for a few minutes may enable you to relax and return for the rest of the event. Other times, your anxiety may require you to leave the event. Whichever it may be, leaving is an option and those people that care about you will understand.

Prepare First – When accepting a social invitation, ask the host or hostess questions to help you be more prepared. How many people will be attending? Who will be attending? By knowing about the event, you can prepare yourself for possible triggers and knowing in advance can help you cope with the triggers.

Create a Support Network – Finding someone that understands and is willing to provide you with support is a wonderful feeling. Bring a friend with you to events you find to be scary or may contain triggers for PTSD. Knowing there is someone that understands what you are feeling and will be watching for signs of anxiety can help and make coping with the situation easier.

The holidays are a time of spirituality. No matter whether you celebrate Christmas, Hanukah or Kwanzaa, the meaning behind the holiday is love and peace. Family celebrations are meant to accentuate these feelings. However, holidays do not need to be celebrated only with family gatherings. Finding your own way to celebrate can make the holidays meaningful. Take time to volunteer at a local hospital or by providing food baskets to those that need them. Sometimes, reaching out to others that are in pain can help to relieve your own pain.

Additional Post-Traumatic Stress Disorder Resources:

Anxiety Disorders Association of America – promotes the prevention, treatment, and cure of anxiety and stress-related disorders through advocacy, education, training, and research.

Sidran Institute  Traumatic Stress Education and Advocacy – non-profit organization that helps people understand, recover from and treat those who have PTSD, dissociative disorder, and disorders that coexist with those disorders.

International Society for Traumatic Stress Studies – an international, interdisciplinary professional organization that promotes advancement and exchange of knowledge about traumatic stress. This knowledge includes understanding the scope and consequences of traumatic exposure, preventing traumatic events and ameliorating their consequences, and advocating for the field of traumatic stress.

The National Center for Post Traumatic Stress Disorder – US Department of Veterans Affairs website. A wealth of information for families of veterans as well as anyone else who suffers from PTSD and/or related anxiety disorders.

Make The Connection – A support community run by the US Department of Veterans Affairs, geared towards helping connect military personnel with others who can help and resources to get them help with issues that arise upon coming home from a deployment.

Page last audited 10/2018