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Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v9.i2.2022.67-75 

Original Article 

Investigating the impact of eye movement 
desensitization and reprocessing (EMDR) in 
reducing birth trauma symptoms 
Silvia Wetherell
Saybrook University, California-United States 

Abstract 
Background: Childbirth-related traumatic experiences are an overlooked area of 
psychological suffering, often leading to Post-Traumatic Stress Disorder, 
Perinatal Mood and Anxiety Disorders, and difficulties in bonding between 
mother and baby. This study aimed to evaluate the effectiveness of Eye 
Movement Desensitization and Reprocessing as a brief psychological 
intervention in reducing Birth Trauma symptoms. 
Methodology: Using a prospective experimental longitudinal design, 12 women 
residing in Singapore with Birth Trauma symptoms received three 90-minute eye 
movement and desensitization (EMDR) sessions over two weeks on average. 
Participants were assessed through two trauma self-report questionnaires and 
underwent a brief Autonomic Nervous System (ANS) assessment. 
Results: Post-treatment assessment showed significant differences in mean 
trauma scores with a 76% reduction on the Modified Perinatal PTSD 
Questionnaire (z = -3.061, p = .002) and 70% reduction on the Impact of Event 
Scale-Revised (z = -3.061, p = 0.002). Skin conductance response changes from 
baseline to stressor reduced by 4% but were not statistically significant (z = -.863, 
p = 0.39). 
Conclusion: Brief EMDR has shown promise as an effective treatment for Birth 
Trauma. Larger controlled randomized studies are required to evaluate the 
effectiveness of EMDR compared to a placebo control group. 

Keywords 
Post-Traumatic Stress Disorder, PTSD, Birth, Postpartum, EMDR, GSR, Skin 

Conductance 

Citation: Wetherell S. Investigating the 
impact of eye movement desensitization 
and reprocessing (EMDR) in reducing 
birth trauma symptoms. APP. 2022; 9(2): 
67-75 

Corresponding Author Email: 
silvia@moremindful.me 

DOI: 10.29052/2412-3188.v9.i2.2022.67-75 

Received 20/10/2022 

Accepted 06/11/2022 

Published 01/12/2022 

Copyright © The Author(s). 2022. This is 
an open-access article distributed under 
the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 

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Introduction 
Childbirth is a watershed moment that can 
trigger profound changes for the mother, 
with lasting repercussions for the whole 
family. While birth can be a joyful 
experience for many women, as many as 
33% of women describe their birth as 
traumatic1. Of these, 2-8% of women in 
community samples and up to 19% in high-
risk samples develop Postpartum Post-
traumatic Stress Disorder2–4. An adverse 
childbirth experience and associated trauma 
symptoms can contribute to maternal 
distress and postpartum depression5 and 
adverse health outcomes for the infant6. 

Birth Trauma is defined by the woman's 
appraisal of the birth as traumatic. It 
involves trauma responses such as re-
experiencing, avoidance, negative affect, 
and hyper-arousal7, which may not meet all 
PTSD criteria according to the DSM-V8. 
Causal or contributing factors for Birth 
Trauma include an emergency Caesarean 
section, forceps or vacuum delivery, poorly 
managed pain, unanticipated 
complications, and concern for the baby's 
life1,5,9. A prior history of trauma, 
psychiatric disorders, poor support during 
childbirth, and mode of delivery can 
increase women's risk of developing trauma 
symptoms in the postpartum period, which 
may progress to diagnosable PTSD7. 
Prenatal depression and a higher-risk 
pregnancy can also increase vulnerability to 
developing postpartum PTSD9. Beyond 
those factors, the literature shows high co-
morbidity between Birth Trauma and 
postpartum depression (PPD)10. 

Evidence-based psychological interventions 
for Birth Trauma include EMDR and 
trauma-focused cognitive behavioral 
therapy11. Despite the U.K.'s National 
Institute for Clinical Excellence (NICE) 
guidelines recommending EMDR as one of 

the preferred interventions for Birth 
Trauma12, there is little research to support 
the effectiveness of EMDR in this 
population. The evidence on which such 
guidelines are based is not drawn from 
studies of perinatal populations, so they do 
not reflect the unique differences in the 
etiology of trauma in postpartum women13. 
EMDR is a psychological intervention 
developed by Shapiro14 in the late 80s15 that 
has shown great effectiveness in treating 
trauma symptoms and PTSD16–19. During 
EMDR treatment, the client brings up the 
most distressing moments of the traumatic 
memory, then is asked to track saccadic 
visual targets, and may hear bilateral tones 
and sensory tapping14. The individual is 
encouraged to allow disturbing images, 
thoughts, feelings, sensations, and self-
beliefs to arise during this bilateral 
stimulation phase of EMDR treatment14. 
The bilateral stimulation technique starkly 
differentiates EMDR from other types of 
psychotherapy to treat trauma in 
individuals. Shapiro hypothesizes that the 
bilateral stimulation triggers a physiological 
state which helps process traumatic 
memories, "moving the disturbing 
information – at an accelerated rate further 
along the appropriate neurophysiological 
pathways until it is adaptively resolved14. 

Evidence supporting the use of EMDR in 
trauma treatment includes findings by 
Bisson et al.16, who, in a systematic review 
of 36 randomized controlled trials, found 
that EMDR was an effective intervention in 
reducing trauma symptomatology. 
Furthermore, a recent meta-analysis of 
PTSD treatments17 concluded that EMDR 
and TF-CBT were the most effective in 
reducing trauma symptoms and sustaining 
those gains at follow-up. The evidence for 
EMDR as an effective trauma intervention 
has led to it being recommended by 
national and international guidelines and 
organizations20–23.  



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Despite NICE recommendations24, only two 
case studies and one more extensive 
controlled study have been conducted to 
examine the potential effectiveness of 
EMDR therapy in treating Birth Trauma25–27. 
In a small study of EMDR for Birth 
Trauma26, all four participants reported a 
reduction of post-traumatic stress 
symptoms after treatment, as measured by 
the Traumatic Events Scale. Three 
participants showed maintained gains at a 
three-year follow-up. A separate pilot study 
with three pregnant women with 
unresolved Birth Trauma found that it was 
an effective intervention to reduce trauma 
symptoms based on interviews with a 
health psychologist26. Finally, a controlled 
study by Chiorino et al.25 compared EMDR 
to treatment as usual for postpartum PTSD 
symptoms, with one single session 
delivered in the maternity ward. The 
authors found that most women showed 
significant improvement in trauma 
symptoms after one session, compared to 
one treatment session as usual (78.9% 
EMDR vs. 39.9% TAU). The authors 
concluded that "a brief EMDR intervention 
could be a viable and promising tool in the 
early treatment of post-traumatic stress 
related to traumatic childbirth" (p.795).  

Increased psychophysiological reactivity, 
such as elevated galvanic skin response 
(GSR), has been shown to correlate with 
trauma symptoms and PTSD28. EMDR has 
also reduced GSR in traumatized 
individuals in as little as one session29.  

Methodology 
The study took place in Singapore with 
referrals from midwife-led clinics, perinatal 
support groups, and allied health 
professionals. This investigation received 
Institutional Review Board Approval from 
Saybrook University, which followed the 

Declaration of Helsinki rules and met the 
required rules of Singapore's Personal Data 
Protection Act.  

Entry Criteria 

• Adult women who had given birth to a
live infant in the past 18 months
considered their delivery traumatic.

• Significant trauma symptoms were
measured by cut-off scores on one of two
screening tools.

• If on medication had been on a stable
dose for at least four weeks and required
to remain on the same regimen until the
conclusion of the study, and if receiving
counseling had been in counseling for at
least six weeks and would not initiate
any other type of treatment until the
conclusion of the study.

Exclusion criteria 
• Pregnant

• Experiencing a severe medical condition,

• Scored over 20% on dissociative
symptoms as assessed by the
Dissociative Experiences Scale30

The study comprised a pre-assessment, 
three 90-minute EMDR sessions, and a post-
assessment two weeks following the 
conclusion of treatment. Participants 
completed the three-session treatment 
within an average of two weeks. 

Measures 
The screening instruments measured 
psychological and psychophysiological 
symptoms associated with trauma, and they 
were easy to administer and validated for 
use with a postpartum population. The 
investigator also conducted pre- and post-
treatment Autonomic Nervous System 
assessments measuring galvanic skin 
response. 



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Participants completed several self-report 
measures, including the following. 

a) Modified Perinatal PTSD Questionnaire (M-
PPQ) is a 14-question, self-report screening
instrument on a 5-point scale to identify
childbirth and perinatally related trauma
symptomatology31. The screening tool
addresses birth experience regarding
intrusive thoughts or re-experiencing of the
birth, avoidant behaviors, and
hyperarousal. As reported by Callahan et al.
(2006), it has good internal consistency (α =
0.85) and test-retest reliability (r = 0.92). It
has been validated to measure PTSD in the
parents of infants32 and significantly
correlates with the Impact of Event Scale to
screen for trauma symptomatology. A cut-
off score of 19 is usually recommended for
referring women to treat trauma symptoms.

b) Impact of Event Scale-Revised (IES-R)33 is a
22-item self-report screening tool that can
be used post-delivery to measure symptoms
of avoidance, intrusions, and arousal
following a traumatic event. Items are rated
on a 5-point scale from 0 ("not at all") to 4
("extremely"). According to Ayers7, the IES-
R has been widely used in postpartum
studies, has high internal consistency (α =
0.96), and has a good correlation with the
PTSD checklist (r = 0.84). The cut-off score
of 33 had the highest probability of
predicting PTSD34.

c) Participants underwent a brief 12-minute
Autonomic Nervous System (ANS)
assessment using a skin conductance
sensor, monitoring galvanic skin response
(GSR) as a baseline, in response to a mild
stressor, in response to a trauma-related
stressor and while recovering from both
stressors. Adding such a measure was to
objectively evaluate changes in this
physiological correlate of sympathetic
nervous system activation28. Percentage
change from baseline to trauma stressor
was used to calculate significance from pre- 
to post-assessment.

d) Finally, participants were asked to complete
the Edinburgh Postpartum Depression Scale
(EPDS)35 as a secondary outcome measure.
The EPDS is a 10-item self-report screening
instrument for symptoms of depression and
anxiety during pregnancy and in the
postpartum period. The EPDS has been
found to have high test-retest reliability (α =
0.92), 86% sensitivity, and 78%
specificity36,37.

Procedure 
Following written consent and pre-
treatment assessments, participants 
received three in-person 90-minute EMDR 
sessions and a post-assessment two weeks 
after treatment completion. Participants 
completed the EMDR intervention within 
two weeks on average. Treatment was 
conducted by the principal investigator, a 
counselor with certification in perinatal 
mental health, Level I and Level II trained 
in EMDR by the EMDR Institute, with six 
years of experience using this therapeutic 
modality. EMDR sessions followed the 
protocol by Shapiro14, which included 
identifying a specific target moment from 
the traumatic birth. The participant was 
then asked to focus on the emotional 
disturbance while simultaneously tracking 
the investigator's fingers moving side to 
side or receiving bilateral tapping on the 
knees.   

Result 
Comparison of pre-and post-treatment 

results of psychological questionnaires 

showed reductions in all measures: 76% in 

the M-PPQ, 70% in the IES-R score, and 4% 

on the baseline to trauma stressor 

percentage increase. Using the SPSS 

statistics program (38), non-parametric 

Wilcoxon signed-rank tests pre- to post-

intervention outcome measures showed a 

statistically significant reduction in the M-

PPQ (z = -3.06, p = .002) and also the IES-R 



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(z = -3.06, p = .002). Galvanic skin response 

changes from baseline to stressor reduced 

by were not statistically significant (z = -

0.86, p = .39). The secondary outcome 

measure of the EPDS also showed a 

considerable reduction of 51% which was 

statistically significant (z = -3.06, p = .002).

Table 1: Descriptives of Pre- and Post-Treatment Values. 

Variables Mean±SD 

95% Confidence Interval for 
Mean 

Lower Bound Upper Bound 

IES-R PRE 40.67± 15.95 30.53 50.8 

IES-R POST 12± 9.5 4.57 16.04 

M-PPQ PRE 40± 9.08  34.23 45.77 

M-PPQ POST 9.42± 6.13  5.52 13.31 

GSR % INC. PRE 18.89± 28.48  0.79 36.98 

GSR % INC. POST 14.95± 99.88  -48.51 78.41 

EPDS PRE 15.42± 6 11.6 19.23 

EPDS POST 7.58± 3.8  5.17 10 

Figure 1: Bar Graph of Pre- to Post M-PPQ Score Changes. 

0

5

10

15

20

25

30

35

40

45

M-PPQ

Changes in M-PPQ Scores

Pre-EMDR Post-EMDR



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Figure 2: Bar Graph of Pre- to Post IES-R Score Changes. 

Table 2: Results of Wilcoxon Signed-Rank Test). 

 Variables Z Asymp. Sig. (2-tailed) 

M-PPQ -3.06 0.002 

IES-R -3.06 0.002 

Skin Cond. -0.86 0.388 

EPDS -3.06 0.002 

Discussion 
Both main outcomes measures post-
treatment scores showed a significant 
clinical change in the direction of 
functionality. Scores reduced on the M-PPQ 
from a mean of 40 pre-treatment to 9.4 post-
treatment, below the recommended clinical 
cut-off score of 1937. Scores on the IES-R 
reduced from a mean score of 40.7 pre-
treatment to 12 post-treatment, below the 
recommended PTSD clinical cut-off score of 
3332. Every participant in the study had a 
reduction in self-screening trauma 
questionnaires to the below cut-off for both 
M-PPQ and IES-R. The significant score
reduction for both self-screening 
instruments confirms that trauma 

symptomatology was significantly reduced 
through the brief EMDR intervention. An 
underpowered sample could explain the 
lack of significance regarding GSR changes 
with a small effect size. Additionally, 
participants were not screened for any other 
existing or complex trauma, which could 
have confounded these psychophysiological 
results. Finally, evidence has recently 
highlighted a subtype of PTSD whereby 
individuals may show reduced 
physiological arousal to aversive trauma-
related stimuli38. 

Regarding the secondary outcome measure 
of postpartum depression and anxiety, the 
EPDS showed a significant clinical 

0

5

10

15

20

25

30

35

40

45

IES-R

Changes in IES-R Scores

Pre-EMDR Post-EMDR



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reduction from a mean score of 15.4 to a 
mean score of 7.6 post-treatment, below 
recommended clinical cut-off score of 1139. 
This reduction in symptoms of PPD 
possibly reflects improved mood due to the 
reduction of trauma symptomatology. Time 
since traumatic childbirth ranged from 2 to 
17 months, with a mean of 9.75 months. 
Only four of the participants had an infant 
under six months of age. Considering the 
research supporting the marked reduction 
of trauma symptomatology in the five 
months following the traumatic incident39, it 
is possible that the women participating in 
the study would be less likely to have 
experienced spontaneous remission since 
most had delivered at an average of 10 
months prior to commencing the study.  

The findings from this pilot study indicate 
that EMDR shows promise as an effective 
and brief intervention for Birth Trauma. 
Self-report questionnaires clearly show a 
marked post-treatment reduction in trauma 
symptomatology, with none of the 
participants meeting cut-off scores for PTSD 
following the intervention. There is also the 
vital matter of acceptability and tolerability 
when working with women in the 
postpartum period considering the many 
obstacles to women seeking mental health 
support in the postpartum period40. 
Strengths of this study include the short 
duration of the intervention to minimize 
time-lapse effects on trauma symptom 
reduction and the use of validated outcome 
measures for this population. Limitations 
include a small sample size and a single 
psychophysiological measure to measure 
stress responses in individuals. 

Conclusion 
Brief EMDR significantly reduced trauma 
symptoms in postpartum women with Birth 
Trauma. Additional psychophysiological 
measures such as heart rate and peripheral 

temperature are recommended in future 
Birth Trauma studies. Future research 
recommendations include randomization to 
a control group with a credible sham 
intervention, larger sample sizes, EMDR 
through videoconferencing, and 
replicability studies.  

Acknowledgment 
The authors would like to acknowledge all 
the mothers fighting postpartum birth 
trauma.  

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