May is Maternal Mental Health Month, a time to raise awareness about the importance of caregiver mental health, especially around the perinatal period. We asked Hilary Waller, LPC, to share her experience using EMDR therapy during the perinatal period.

Go With… Exactly What She Needs: EMDR Therapy for Perinatal Mental Health

Guest Blog Post by Hilary Waller, LPC

It’s the best-case scenario. A healthy baby is born. Not too big, so mom didn’t experience tearing during birth. Not too small, so there aren’t concerns about the baby’s weight. Baby arrived at 39 weeks following a labor and delivery that almost exactly met mom’s expectations, and breastfeeding has been easy. Family and friends reach out from near and far, offering support, resources, food, and love. 

For mom, though, life is still difficult. She is healing from 9 months of pregnancy, the effort of labor, and the physical trauma of delivery. She is swollen and sore, trying to learn how to care for both her vulnerable and reliant newborn and her own unrecognizable and tender body. Everyone looks to her for answers and solutions – “Should you feed the baby? What time do you want to have dinner? Did your mom say she is planning to visit?” – but she is exhausted, disoriented, and profoundly sleep-deprived.

Remember, this description is the best-case scenario. Worst-case scenarios can include an emotionally or medically traumatic birth, profound and debilitating symptoms of postpartum depression, anxiety, and other mood disorders, or the death or near-death of a baby. For some time, EMDR therapy was believed to be contraindicated for pregnant and postpartum patients. It is becoming increasingly clear, however, that EMDR therapy is an increasingly supported and highly effective treatment for mild to severe perinatal symptoms and trauma (Ferguson & Darby, 2025; Tesler Stein et al., 2026).

EMDR conceptualization for perinatal clients

Hallmarks of the perinatal period include a rewiring of the brain that prioritizes the needs of a new baby, increased chaos within the home as family members adjust to the baby’s arrival, mood disruption due to hormonal and psychosocial changes, and sleep disruption due to infant care needs (Barba-Müller et al., 2019; Paternina-Die et al., 2024). Perinatal clients must navigate a unique confluence of decreased biological and psychosocial capacity and significantly increased demand placed on the individual. It is important to remember that the perinatal period is not just a stressful time; it is a time when the nervous system is required to work on behalf of not one but two individuals while simultaneously healing from pregnancy and birth in the face of complete exhaustion.  And again, this is referencing best-case scenarios, which don’t account for medical complications, perinatal trauma, symptoms of perinatal mood and anxiety disorders, and systemic resource limitations that might burden new parents today.

Due to these unique aspects of the perinatal period, EMDR therapy requires careful clinical planning and attention on the part of the clinician and requires trust, focus, and effort both within and between sessions on the part of the client. Ideally, sessions require privacy, concentration, focus to foster safety, and time to practice engagement in distress tolerance activities that the client will begin implementing between sessions if mood or sleep disruption occurs following EMDR therapy reprocessing. We place great importance on helping our clients maintain presence within their window of tolerance. Attending to safety and security needs is crucial to success with any EMDR client, but can be of even greater importance when working with perinatal clients due to the vulnerable nature of this life stage.

Despite the typical challenges of affect stability, access to self-care, and privacy, in my work with hundreds of birthing people whose perinatal experiences run the gamut from best-case to unimaginably tragic-case scenarios, I consistently find EMDR’s standard protocol fitting for the perinatal period. The trick is simply to learn to “go with that” in a way that enables responsivity to unique vulnerabilities of the perinatal period and considers the integrity of EMDR therapy.

EMDR case example 

Zoe (name changed to protect privacy) came to therapy when she was four months postpartum. While she did not describe her perinatal experience as traumatic and denied a history of trauma, like many new mothers with postpartum depressive symptoms, Zoe reported persistent negative thoughts about herself in the context of motherhood. When given a list of NCs to consider, Zoe immediately related to the theme of responsibility and the NCs “I am failing” and “I am a bad mom.” Just reading these words from a handout was so upsetting that Zoe was immediately brought to tears and heaving sobs, stating example after example of her perceived failures. Despite her loving and reassuring support system and baby who was thriving by every measure, Zoe could not shake the intuitive feeling that no matter what her thinking brain, family, friends, and pediatricians told her, she truly was a terrible mother.

Zoe sought my help after reading online that EMDR could be helpful for postpartum women. However, she believed EMDR therapy was only a treatment for PTSD (which she did not have) and worried about the intensity of therapy. She was unsure how EMDR therapy would translate for her needs and life as a new mom. I reassured Zoe that EMDR can be a helpful treatment for women with her symptoms and that the standard processes of EMDR therapy can be adapted to meet the needs of new parents. She scheduled an initial session.

Sessions one and two

 I gave Zoe the option to bring her baby, Sammy, to her intake session, acknowledging that arranging childcare can be a barrier to attending sessions. I invited her to feed her baby by breast or bottle (based on her preferences) and to bring anything that might increase her comfort. Sammy spent most of the session snoozing in a car seat carrier while Zoe and I built rapport and initiated Phase One. Zoe decided to bring Sammy to session two as well. At the conclusion of session two, Zoe and I agreed to begin Phase Two resourcing in session three. Again, Zoe was reassured that bringing Sammy would be fine and that we could work around his needs.

Sessions three and four

In session three, Sammy drank his bottle and fell asleep in Zoe’s arms. Rather than starting Phase Two right away, I encouraged Zoe to tell me about her week while Sammy napped. First, Zoe complained about Sammy’s recent sleep regression and the challenges she had finding the right formula for him to drink. After a few minutes though, I saw her eyes brighten as she described her efforts to make him belly laugh. This was the material I hoped to find. Instead of teaching resources such as Container and Calm Place, I used Zoe’s recent experiences with Sammy, including the current pleasurable experience of holding him as he slept, as content for resource development and installation (RDI). At session close, Zoe reported feeling excited to notice moments that could be used for RDI moving forward.

Session four felt different, as Zoe arrived frazzled, trying to wrestle a fussy Sammy into a baby carrier. Zoe tried to get settled and focused, but twenty minutes into the session, she was still pacing my office trying to soothe Sammy. Zoe started to verbalize her self-critical narrative. Rather than using a cognitive tool or reassurance, I shared with Zoe that walking can serve as a method of bilateral stimulation. Together we paced the room and talked about Zoe’s week. Eventually I taught her to use the butterfly hug while tapping on Sammy’s back as he tried to settle in the carrier (while this method did not bring Sammy relief in this session, often babies will settle in response to this type of butterfly hug; I did not set this expectation for Zoe, but did encourage her to integrate this skill as a method of soothing herself and Sammy). At session close, I validated Zoe’s hard work and provided handouts on the butterfly hug and the container exercise. I encouraged her to review the butterfly hug and prepare for the container exercise at the outset of her next session.

Session five

Sammy and Zoe arrived for a fifth session, regulated and calm. Now experienced at practicing Phase Two exercises in the office and at home, Zoe expressed confidence in moving forward with the container exercise. I encouraged Zoe to do her best to concentrate on developing her container and reassured her that attending to Sammy if he became fussy would not undo the progress she was making. With a fully undistracted and well-resourced (at baseline) client, the container exercise might only take a small portion of a session. With Zoe, the exercise moved more slowly to accommodate Sammy, but by session close, Zoe had developed a container, a calm place, and identified a nurturing figure. She was ready to move on to the reprocessing phases of EMDR.

Sessions six through ten

Over the course of sessions six through ten, we adapted to the logistical and developmental realities of the perinatal period:

  • Childcare: Zoe and I agreed that securing reliable childcare would be imperative for reprocessing sessions. While engaging in the reprocessing phases of EMDR therapy with a baby in the room is not impossible, it can be understandably difficult for a new parent to ‘turn off’ their sense of parental attunement to tend to the content of the session. By freeing the therapeutic space from infant cues, we created open space for reprocessing. Zoe and I also decided to extend our sessions from 50 minutes to 90 minutes during reprocessing to reduce the frequency at which she would require childcare. Extended sessions can also be helpful for perinatal clients to support more complete processing and re-stabilization at session close, an important consideration given the parental responsibilities to which Zoe returned following sessions.
  • Self-care between sessions: At the outset of our sixth session, we discussed Zoe’s plans for self-regulation between sessions. Zoe decided to use her container and calm place before bed at night. Having practiced RDI and the butterfly hug with Sammy present, Zoe felt confident in using these resources while engaged in childcare responsibilities. She also prepared her husband by talking with him about the possibility that she might need additional emotional support or rest between reprocessing sessions. Finally, Zoe downloaded a journaling app so that she could have access to hands-free journaling by dictating if needed.
  • Target selection and pacing: Prioritizing the client and their perinatal needs is essential in the reprocessing phases and can be especially confusing for recently trained EMDR therapists learning to work flexibly within the protocol. Target selection and pacing are key mechanisms through which therapists can exercise clinical flexibility. Zoe learned about the three-pronged approach of the AIP model at the outset of our work. Recognizing that past targets may need to be revisited in future sessions, Zoe chose to prioritize recent targets in hopes of addressing the daily emotional dysregulation that reinforced her negative self-perception in motherhood. Processing recent targets both allowed us to focus on issues most directly impacting Zoe’s relationship with her baby and to mitigate risk for overactivation during a period of limited capacity due to Zoe’s perinatal state.

Reprocessing sessions progressed smoothly until Zoe presented for session eight, frustrated with her husband in response to an argument about sleep training. Managing disagreements like this is common in perinatal therapy as clients are regularly confronted with new feelings and challenges related to role and relational transitions. I offered Zoe the option to pause reprocessing for the session, schedule an additional follow-up session for reprocessing, or to manage time in the extended session to make room for both verbal processing and resuming work on her unfinished target. Zoe decided to process her anger verbally. When she felt some relief from her acute distress, I reflected to her how the disagreement might relate to the recent targets we were reprocessing. Often, acute in-the-moment issues arising for perinatal parents fit the broader target sequence and provide new and relevant material to integrate into the work already in process. Addressing these issues with flexibility to follow the client’s lead can support the client’s overall goals.

By the close of session ten, Zoe felt that her reprocessing needs were met. She reported increased overall regulation day to day, a significant decrease in symptoms of depression as evidenced by self-report and measures on the PHQ-9 and Edinburgh Postnatal Depression Scale, and a feeling of satisfaction with her therapeutic experience. We completed our EMDR therapy work over the course of two more sessions and were ready to move on to new goals. Attunement to the nuances of the perinatal period is central to the development of trust and rapport in work with perinatal clients. Zoe’s case highlights how EMDR therapy can effectively meet the unique needs of the perinatal client.

EMDR as compassionate healing for perinatal clients

All new parents, even in the best-case scenario, are faced with the profound task of navigating a brand-new and often overwhelming world, while experiencing immense bodily, emotional, and identity-oriented shifts. When applied with attunement and flexibility, EMDR therapy provides a compassionate pathway for healing during a uniquely vulnerable stage of life. For clinicians who want to integrate EMDR into their work with perinatal clients, it is key that we honor the complexity of early clients where they are, and by going with exactly what they need.

 

Hilary Waller, LPC, is a psychotherapist specializing in reproductive and parental mental health. She trained at The Postpartum Stress Center and Touchstone Institute, and provides psychotherapy services and professional training within the specialty of reproductive mental health disorders. She has authored and co-authored several books and articles on the subject. 

 

References 

Barba-Müller, E., Craddock, S., Carmona, S., & Hoekzema, E. (2019). Brain plasticity in pregnancy and the postpartum period: Links to maternal caregiving and mental health. Archives of Women’s Mental Health, 22, 289-290. https://doi.org/10.1007/s00737-018-0889-z

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10‑item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782

Ferguson, B. & Darby, S. (2025). Early eye movement desensitisation and reprocessing (EMDR) therapy for traumatic birth experience: Treatment for maternal postpartum post-traumatic stress disorder (PTSD). Evidence-Based Nursing. https://doi.org/10.1136/ebnurs-2025-104465

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ‑9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Paternina-Die, M., Martinez-Garcia, M., de Blas, D. M., Noguero, I., Servin-Barthet, C., Pretus, C., Soler, A., Lopez-Montoya, G., Desco, M., & Carmona, S. (2024). Women’s neuroplasticity during gestation, childbirth and postpartum. Nature Neuroscience, 27, 319-327. https://doi.org/10.1038/s41593-023-01513-2

Tesler Stein, M., Sinclair, M., & McMullen, S. (2026). EMDR and perinatal mental health. In D. P. Farrell, S. J. Schubert, & M. D. Kiernan (Eds.), The Oxford handbook of EMDR therapy. Oxford University Press. https://doi.org/10.1093/oxfordhb/9780192898357.013.11

 

 

 

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Additional Resources

If you are a therapist interested in the EMDR training:

If you are EMDR trained:

If you are an EMDRIA™ Member:

 

Date
May 8, 2026

Contributor(s)
Hilary Waller, LPC

Topics
Pregnancy/Perinatal

Audience
EMDR Therapists

Language
English

Content Type
Blog/Blog Post

Access Type
Open Access

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