Article

Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors

June 2000
Birth 27(2):104-11

June 2000
27(2):104-11

DOI:10.1046/j.1523-536x.2000.00104.x

Source
PubMed

Authors:

Debra K Creedy

Griffith University

Ian M. Shochet

Queensland University of Technology

Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = 0.351, p < 0.0001) and the perception of inadequate intrapartum care (beta = 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms. Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

Article

Full-text available

Sep 2023
MIDWIFERY

Introduction: Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. Research aim: The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. Methods: A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. Findings: More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). Conclusions: This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

PSYCHOLOGICAL BIRTH TRAUMA: A BIBLIOMETRIC ANALYSIS OF HIGHLY CITED ARTICLES

Article

Full-text available

Jan 2022

Aim: Psychological birth trauma has negative psychological effects on the mother during pregnancy and postpartum period. The purpose of this study is to determine the basic properties of 100 studies on psychological birth trauma on the Web of Science database with the most citations by using the bibliometric analysis method. Methods: A retrospective bibliometric analysis was used. The data were obtained from the Web of Science database. The top 100 studies with the highest numbers of citations were included in the study.

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

Article

Full-text available

Jul 2022

Objective Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes. Methods In the prospective-longitudinal Maternal in Relation to Infants' Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations. Results A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birth-related traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems. Conclusion Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted. Implications Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

Mode of birth and development of maternal postnatal post‐traumatic stress disorder: A mixed‐methods systematic review and meta‐analysis

Article

Full-text available

May 2022
BIRTH-ISS PERINAT C

Background Post‐traumatic stress disorder (PTSD) affects approximately 3% of women in the postnatal period, but less is known about risk factors for PTSD than other postnatal mental illnesses. This review aimed to analyze the literature on the impact of mode of birth on postnatal PTSD. Methods Searches were undertaken of CINAHL, the Cochrane Library, MEDLINE, PsycINFO, and Scopus for studies investigating the link between mode of birth and postnatal PTSD in high‐resource countries from January 1990 to February 2021. Quantitative and qualitative data were collected and synthesized. Meta‐analysis was performed with four of the studies, and the rest were analyzed narratively. Results Twelve quantitative studies, presenting data on 5567 women, and two qualitative studies, with 92 women, were included in the review. Most studies found a significant relationship between mode of birth and maternal PTSD symptoms. Meta‐analysis found cesarean birth was more closely associated with PTSD than vaginal delivery (VD) (P = 0.005), emergency cesarean birth (EmCB) more than elective cesarean birth (ElCB) (P < 0.001), instrumental vaginal delivery (IVD) more than spontaneous vaginal delivery (SVD) (P < 0.001), and EmCB more than SVD (P < 0.001). Women who developed PTSD after EmCB felt less in control and less supported than those who did not develop it after the same procedure. Request for repeat ElCB appeared more common among women with pre‐existing postnatal PTSD, but this may subsequently leave them feeling dissatisfied and their fears of childbirth unresolved. Conclusions Modes of birth involving emergency intervention may be risk factors for the development of postnatal PTSD. Ensuring that women feel supported and in control during emergency obstetric interventions may mediate against this risk.

The Birth of a Story: Childbirth Experiences, Meaning-Making, and Postpartum Adjustment

Article

Full-text available

May 2023

The present study investigated how meaning-making around a birth experience predicts relationship quality and parenting stress across the transition to first-time parenthood, a time that many new parents find stressful and challenging. Childbirth experiences may set the stage for these challenges, and how new parents make meaning of childbirth could play a role in their subsequent postpartum adjustment. Meaning-making processes (sense making, benefit finding, and changes in identity) were coded from birth narratives collected from 77 mixed-sex biological parent dyads (n = 154 individuals) shortly after the birth of their first child. Parents reported on their relationship quality during pregnancy and at 6 months postpartum, and on their parenting stress postpartum. Mothers’ greater sense making and benefit finding buffered longitudinal declines in their own relationship quality, and maternal sense making also buffered declines for fathers. Fathers’ greater sense making and benefit finding predicted lower levels of their own parenting stress, whereas mothers’ greater sense making and benefit finding were linked with higher paternal parenting stress. Finally, fathers’ discussion of changes in identity predicted lower levels of parenting stress in mothers. These results suggest the importance of meaning-making following childbirth for couples adjusting to parenthood and highlight the value of studying meaning-making processes dyadically. Clinicians may be able to support new parents by facilitating their coconstruction of meaning during their shared birth experience and transition to parenthood.

Investigating the impact of eye movement desensitization and reprocessing (EMDR) in reducing birth trauma symptoms

Article

Full-text available

Dec 2022

Silvia Wetherell

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 when compared to a placebo control group.

Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women

Article

Feb 2023
J WOMENS HEALTH

Introduction: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences-Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123).

Cesarean Delivery and Mental Health

Chapter

Full-text available

Dec 2022

A delivery by cesarean can be a cause of development of mental illness, especially posttraumatic stress disorder or the profile of the disorder for a percentage of women. Despite the global increase in cesarean deliveries, there is a paucity of adequate research into posttraumatic stress disorder after cesarean delivery and at many times is associated with other mental disorders of the postpartum period. The purpose of this research is to identify if there is a link between the type of cesarean delivery and posttraumatic stress disorder among postpartum women. Our sample consisted of 162 women who underwent a cesarean section in a public University Hospital in Greece and consented to participate in the study. The results show a high prevalence of postpartum posttraumatic stress disorder (31.7%) and profile postpartum post-traumatic stress disorder (14.3%) in women after emergency cesarean delivery with additional risk factors of preterm delivery, inclusion in Neonatal Intensive Care Unit, lack of support from the partner, and lack of breastfeeding.

Postpartum Depression in COVID-19 Days: Longitudinal Study of Risk and Protective Factors

Article

Full-text available

Jun 2022

COVID-19 impacted the childbirth experience and increased the rates of postpartum depression (PPD). We assessed the longitudinal effects of the pandemic on the rates of PPD and evaluated the PPD causes and symptoms among women who delivered during the first COVID-19 quarantine in Israel. The participants completed online questionnaires 3 (T1) and 6 months (T2) following delivery. We used the ‘COVID-19 exposure’ questionnaire, while PPD symptoms, situational anxiety, and social support were evaluated with the EPDS, STAI, and MSPSS questionnaires. The mean EPDS scores increased between T1 and T2 (6.31 ± 5.6 vs. 6.92 ± 5.9, mean difference −0.64 ± 4.59 (95% CI (−1.21)–(−0.06)); t (244) = −2.17, p = 0.031), and the STAI scores decreased (45.35 ± 16.4 vs. 41.47 ± 14.0, t(234) = 4.39, p = 0.000). Despite the exposure to an increased number of COVID-19 events (3.63 ± 1.8 vs. (6.34 ± 2.3)), the impact of exposure decreased between T1 and T2 (8.91 ± 4.6 vs. 7.47 ± 4.1), p < 0.001). In the MSPSS, significant differences were noted on the family scale between the T1 (6.10 ± 1.3) and T2 (5.91 ± 1.4) scores; t (216) = 2.68, p = 0.0008. A regression analysis showed three statistically significant variables that correlated with increased EPDS scores: the MSPSS family subscale (F (1212.00) = 4.308, p = 0.039), the STAI scores (F (1212.00) = 31.988, p = 0.000), and the impact of exposure to COVID-19 (F (1212.00) = 5.038, p = 0.026). The rates of PPD increased for women who delivered during the first COVID-19 lockdown. Further research is warranted to help reduce PPD among these women.

Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis

Article

Apr 2022
CLIN PSYCHOL REV

This systematic review and meta-analysis aimed to determine mean estimates of prevalence rates for fulfilling all diagnostic criteria of posttraumatic stress disorder (PTSD) or at least showing significant levels of posttraumatic stress (PTSS) in relation to the traumatic event of childbirth. For the first time, both mothers and fathers were included in the synthesis. Studies were identified through systematic database search and manual searches, irrespective of language. Meta-analyses of 154 studies (N = 54,711) applied a random-effects model to four data sets, resulting in pooled prevalence rates of 4.7% for PTSD and 12.3% for PTSS in mothers. Lower rates of 1.2% for PTSD and 1.3% for PTSS were found among fathers. Subgroup analyses showed elevated rates in targeted samples (those with a potential risk status) most distinctly for maternal PTSS. The significant amount of heterogeneity between studies could not be explained to a satisfactory degree through meta-regression. Given the substantial percentage of affected parents, the adoption of adequate prevention and intervention strategies is needed. As this field of research is evolving, attention should be broadened to the whole family system, which may directly and indirectly be affected by birth-related PTSD. Further studies on paternal PTSD/PTSS are particularly warranted.

Wybrane doświadczenia pierworódek związane z porodem jako źródło informacji dla przyszłych matekSelected experiences of primiparous women related to childbirth as a source of information for future mothers

Article

Full-text available

Jun 2024

Currently, 68 percent of Polish women declare that they do not want to have children, 13 percent of mothers regret having children, and over 6 percent experience parental burnout. A woman’s decision to become a mother is not an easy one and is influenced by many factors. One of these factors can be considered the experiences of mothers close to the woman. The aim of the research was to determine what perinatal experiences and beliefs about childbirth first-time mothers can share with other women. Data were collected from 99 women (aged 22–36; M = 28; SD = 3) who had given birth to their first child in the last 26 months through structured interviews. They were asked about selected difficulties related to childbirth, conditions for natural childbirth, to retrospectively assess the level of knowledge about selected aspects of childbirth, and to evaluate the intensity of selected beliefs about it. 72 of the participants gave birth naturally, 12 through unplanned cesarean section, and 15 through planned cesarean section (including 2 „on demand”). Only one of the participants experienced a complication-free natural childbirth, received exhaustive medical information from the staff, full and adequate support from her partner, and gave birth to a child who scored 10 points on the Apgar scale. Eight women giving birth naturally and seven after a cesarean section declared very positive feelings about childbirth, five declared very negative feelings, and the intensity of both positive and negative feelings was within average limits, with moderately higher positive feelings noted. First-time mothers had the lowest level of knowledge regarding the effects of artificial oxytocin (pain, risk), which was administered to as many as 42 participants. The highest level of knowledge was related to possible complications. The strongest belief was that natural childbirth is a better way for a child to come into the world than cesarean section. The weakest belief was that cesarean section is a better way of childbirth for the child than natural childbirth.

“We don’t really address the trauma”: Patients’ Perspectives on Postpartum Care Needs after Severe Maternal Morbidities

Article

Full-text available

Jun 2024
MATERN CHILD HLTH J

Objectives This qualitative study explored experiences of 15 women in New York City who suffered physical, emotional, and socioeconomic consequences of severe maternal morbidity (SMM). This study aimed to increase our understanding of additional burdens these mothers faced during the postpartum period. Methods Qualitative analysis of in-depth interviews (n = 15) with women who had given birth in NYC hospitals and experienced SMM. We focused on how experiences of SMM impacted postpartum recoveries. Grounded theory methodology informed analysis of participants’ one-on-one interviews. To understand the comprehensive experience of postpartum recovery after SMM, we drew on theories about social stigma, reproductive equity, and quality of care to shape constant-comparative analysis and data interpretation. Findings Three themes were generated from data analysis: ‘Caring for my body’ defined by challenges during physical recuperation, ‘caring for my emotions’ which highlighted navigation of mental health recovery, and ‘caring for others’ defined by care work of infants and other children. Most participants identified as Black, Latinx and/or people of color, and reported the immense impacts of SMM across aspects of their lives while receiving limited access to resources and insufficient support from family and/or healthcare providers in addressing postpartum challenges. Conclusions for Practice Findings confirm the importance of developing a comprehensive trauma-informed approaches to postpartum care as a means of addressing SMM consequences.

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies

Article

Full-text available

Mar 2024
PLOS ONE

Background The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families’ well-being. Many reviews have attempted to understand the complexity of women’s and their partners’ birth experience; however, it remains unclear what the key dimensions of the birth experience are. Objective To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women’s and their partners’ childbirth experience. Methods Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews’ quality, extracted data and analysed it using thematic analysis. Findings Four key dimensions of women’s and partners’ birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. Conclusions The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Association between postpartum depression and postpartum hemorrhage: A systematic review and meta‐analysis

Article

Full-text available

Mar 2024
ACTA OBSTET GYN SCAN

Introduction Postpartum depression (PPD) is a growing mental health concern worldwide and has detrimental effects on the social and cognitive health of both mothers and infants. This review was performed to assess the risk of PPD in women with postpartum hemorrhage (PPH) and to identify potential moderators. Material and methods The review protocol was registered in the PROSPERO database on June 17, 2023 (registration number: CRD42023432955). Two researchers independently performed a literature search of the PubMed, Embase, and Web of Science databases for articles published before May 25, 2023, with no filters and no language or location restrictions. Study quality was evaluated using the Newcastle–Ottawa Scale. The primary outcome was the odds ratio (OR) and 95% confidence interval (CI) of PPD in women with vs. without PPH. We performed sensitivity analyses and meta‐regression analyses to resolve heterogeneity. Meta‐regression analyses included the effects of age, maternal smoking, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, and cesarean section. Results In total, seven studies involving 540 558 participants met the eligibility criteria and were included in the meta‐analysis. Women with PPH were at increased risk of PPD compared with women without PPH (OR 1.10; 95% CI 1.03–1.16), and heterogeneity was low (I² = 23%; τ² = 0.0007; p = 0.25). Moreover, the results of the sensitivity analyses showed that the I² value decreased from 23% to 0% after excluding one particular study, which may have been a source of heterogeneity. In the meta‐regression analyses, the OR of PPD was greatly affected by maternal smoking (OR −0.26; 95% CI −0.30 to −0.22; p < 0.001). However, we did not observe any effects for maternal age, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, or cesarean section. Conclusions Women with PPH must be closely monitored because they have a higher risk of PPD than women without PPH. Early recognition and management of these patients will improve treatment outcomes, maternal health, and newborn development.

Older mothers and their difficult adult children: a life course exploration

Article

Full-text available

Mar 2024

Judith Smith

Adult child to parent violence is a growing international social problem that needs to be better understood to develop clinical interventions. An exploratory study on the antecedents of early life adversity on adult child to parent violence/elder mistreatment was carried out using secondary analysis. Directed content analysis (E. Purkey et al., 2022) was used based on life course theory with a data set of older mothers all > 57 years old (Author 2021, 2022). Measurement of instances of child abuse, domestic violence, and birth trauma among abused older mothers was conducted. All the older women had reported being negatively affected by their adult children’s problems and 56% reported being physically attacked. A case example is presented to illustrate how repeated incidents of abuse or neglect in early life might explain an older woman’s inability to take actions for her own safety.

Assessment of Postpartum Posttraumatic Stress Disorder Symptoms Secondary to Childbirth at Delivery and 10 Weeks Postpartum

Article

Full-text available

Apr 2023

Childbirth is recognized as a potential traumatic event and can lead to postpartum posttraumatic stress disorder (PTSD).1 Postpartum PTSD may carry significant morbidity with negative ramifications on parent-infant bonding, marital relationships, comorbid psychiatric illnesses, and future reproductive decisions.1 Emergency cesarean section, medical complications of mother or baby, high subjective distress, and presence of dissociation are risk factors with the highest predictive values for postpartum PTSD.2 However, as deliveries without medical complications can also be perceived as traumatic, identifying women at risk for postpartum PTSD remains a challenge. The current study aimed to evaluate the feasibility of assessing the presence of trauma at delivery and progression of symptoms at 10 weeks.

Changes to women’s childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

Article

Full-text available

Dec 2023
ARCH WOMEN MENT HLTH

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women’s planned birth and actual birth experiences during COVID-19 was associated with women’s postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06–1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29–1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77–0.97]; p = 0.014). Changes to women’s childbirth plans during the COVID-19 pandemic were common and associated with women’s postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.

Adverse Childbirth Experiences - Results of an Online Survey of Woman During Their First Year Postpartum

Preprint

Full-text available

Oct 2023

Background: Scientific research on the topic of "adverse childbirth experiences" is still lacking to date. Although most women experience the birth of a child as a positive event, various studies indicate that about one third of all women subjectively describe their experience as negative. A birth that is perceived by the mother as a negative or adverse experience is associated with various mental illnesses, such as for example, an increased risk of developing post-traumatic stress disorder (PTSD) or postpartum depression. Objective: In addition to exploring the subjective frequency of the categories of incidents which lead to an overall perceived adverse childbirth experience, the present study examines some additional factors such as the timing of these incidents, the persons involved, and the correlation between the number of adverse incidents experienced during childbirth and postpartum depression or elevated posttraumatic stress disorder (PTSD) scores. Methods: As part of an online cross-sectional survey embedded in a longitudinal study (LABOR - Longitudinal Analysis of Birth mode and Outcomes Related) from 29/01/2020 to 25/03/2020, women within their first year postpartum were asked to self-report about their sociodemographic factors, reproductive history, and their subjectively perceived adverse birth experiences. In addition, postpartum depression and PTSD scores were recorded (depression: EPDS; PTSD: PCL-5). The incidents contributing to these adverse childbirth experiences were recorded using four main categories: 1.) Physical, 2.) Psychological/verbal, 3.) Neglect, and 4.) Disruption of the mother-infant relationship. Furthermore, the participants were asked about the timing of the incidents and the persons involved. Finally, descriptive analyses as well as group comparisons were performed via ANOVAS. Results: n = 1079 mothers participated in the survey. Approximately half of the respondents (49.9%) reported experiencing no adverse incidents during childbirth; however, n= 539 (50.1%) reported subjectively experiencing at least one negative incident. Of these individuals, 30.9% (n = 333) reported the incident as being physical in nature, 30.0% (n = 324) subjectively experienced neglect, 23.1% (n = 249) experienced adverse psychological or verbal abuse, and 19.1% (n = 206) perceived that the mother-infant bonding was negatively impacted (multiple responses were possible). Most of the incidents subjectively perceived as adverse predominantly occurred directly during delivery. There were significant differences in the groups of women without any negative incidents during the childbirth experience and those with at least one adverse incident during childbirth with regards to subsequent postpartum depression (F (4, 1067) = 29.637, p < .001, ƞp² = .09) and PTSD scores (F (4, 1067) = 118.142, p < .001, ƞp² = .31). Women with two, three, or four perceived negative incidents during childbirth also had significantly higher depression and PTSD scores than the women who reported only one negative incident occurring during the overall birthing experience. Conclusion: In the present sample, approximately 50% of the women subjectively report having experienced adverse incidents during childbirth. These encounters were associated with increased postpartum depression and PTSD scores. Due to the study being a purely cross-sectional study, no conclusions can be drawn regarding the causality of these factors. Future studies should examine the potentially reciprocal associations between premorbid psychological distress, adverse birth experiences, and postpartum mental illness in a more nuanced manner in order to allow for long-term solutions.

“Women Friendly”: A Childbirth Preparation Intervention in Israel for Women with Symptoms of Post-Traumatic Stress Disorder

Article

Full-text available

Sep 2023
Int J Environ Res Publ Health

Pregnant women with symptoms of post-traumatic stress disorder (PTSD), who have experienced traumatic events such as sexual abuse and traumatic births, are particularly vulnerable to experiencing extreme fear of childbirth complications during labor and traumatic deliveries. In this commentary, we review the literature on this group of women and their specific needs during pregnancy and childbirth. We present a childbirth preparation intervention for pregnant women with PTSD symptoms, “Women Friendly”, designed in Israel and gradually becoming available in the community and Israeli hospitals. This intervention is intended for women with high levels of fear of childbirth who are unmotivated or unable to undergo traditional psychotherapy that focuses on exposure to and processing of past traumatic event(s). It is based on birth-oriented thinking, principles of positive psychology, and trauma-informed care. In addition to the five sessions offered to pregnant women, medical staff are provided with 19 training sessions on the “Women Friendly” approach. Qualitative and quantitative research should examine the effectiveness of this intervention. Should results be encouraging, this intervention could be more widely implemented in Israel and abroad and applied in broader contexts, such as gynecological check-ups and medical examinations, interventions, and surgery.

Maternal childbirth-related posttraumatic stress symptoms, bonding, and infant development: a prospective study Maternal childbirth-related posttraumatic stress symptoms, bonding, and infant development: a prospective study

Article

Full-text available

Sep 2023
J REPROD INFANT PSYC

Background: Childbirth-related posttraumatic stress symptoms (CB-PTSS) including general symptoms (GS, i.e., mainly negative cognitions and mood and hyperarousal symptoms) and birth-related symptoms (BRS, i.e., mostly re-experiencing and avoidance symptoms) may disrupt mother-infant bonding and infant development. This study investigated prospective and cross-sectional associations between maternal CB-PTSS and mother-infant bonding or infant development (language, motor, and cognitive). Method: We analysed secondary data of the control group of a randomised control trial (NCT 03576586) with full-term French-speaking mother-infant dyads (n = 55). Maternal CB-PTSS and mother-infant bonding were assessed via questionnaires at six weeks (T1) and six months (T2) postpartum: PTSD Checklist for DSM-5 (PCL-5) and Mother-Infant Bonding Scale (MIBS). Infant development was assessed with the Bayley Scales of Infant Development at T2. Sociodemographic and medical data were collected from questionnaires and medical records. Bivariate and multivariate regression were used. Results: Maternal total CB-PTSS score at T1 was associated with poorer bonding at T2 in the unadjusted model (B = 0.064, p = 0.043). In the adjusted model, cross-sectional associations were found at T1 between a higher total CB-PTSS score and poorer bonding (B = 0.134, p = 0.017) and between higher GS and poorer bonding (B = 0.306, p = 0.002). Higher BRS at T1 was associated with better infant cognitive development at T2 in the unadjusted model (B = 0.748, p = 0.026). Conclusions: Results suggest that CB-PTSS were associated with mother-infant bonding difficulties, while CB-PTSS were not significantly associated with infant development. Additional studies are needed to increase our understanding of the intergenerational consequences of perinatal trauma.

Cognitive therapy for PTSD following birth trauma and baby loss: clinical considerations

Article

Full-text available

Sep 2023

Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes. Key learning aims (1) To recognise and understand the development of PTSD following childbirth and baby loss. (2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD. (3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth. (4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.

Overlap between birth trauma and mistreatment: a qualitative analysis exploring American clinician perspectives on patient birth experiences

Article

Full-text available

Apr 2023
Reprod Health

Many people giving birth in the United States experience poor health outcomes, and there is a wide racial disparity, with people of color more likely to experience poor outcomes. In recent research, birthing people reported that they were mistreated during their labor and delivery, including being shouted at, scolded, or threatened. Mistreatment accounts were more frequent among women of color. Previous research has looked at patient reports about their birth experiences to explore whether their descriptions of psychological trauma include overlap with mistreatment, but no other studies have looked at descriptions of birth trauma from the perspectives of medical clinicians. The objective of this study was to explore whether maternity care providers’ descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted list. This study analyzed the content of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with obstetricians, family physicians, midwives and labor/delivery nurses. In the interviews, participant descriptions of patient birth trauma fit into all seven mistreatment categories. Participant descriptions included examples of patients receiving medical procedures or treatments without first giving consent, nurses avoiding the rooms of patients who do not speak English, and other forms of mistreatment. Participants were not asked specifically about mistreatment, but they described birth trauma by giving examples of mistreatment, which suggests that some healthcare providers may use the phrase “birth trauma” when talking about “mistreatment.” This study shows a need for further research into mistreatment, including routine “every- day care” that may include mistreatment

Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum

Article

Full-text available

Jan 2023
ARCH WOMEN MENT HLTH

There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2 years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2 years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6 months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6 months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2 years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2 years postpartum, particularly among women who experience greater labor/delivery complications.

Antenatal Fear of Childbirth as a Risk Factor for a Bad Childbirth Experience

Article

Full-text available

Jan 2023

Giving birth is one of the most impressive experiences in life. However, many pregnant women suffer from fear of childbirth (FOC) and experience labour in very different ways, depending on their personality, previous life experiences, pregnancy, and birth circumstances. The aim of this study was to analyse how fear of childbirth affects the childbirth experience and to assess the related consequences. For this, a descriptive cross-sectional study was carried out in a sample of 414 women between 1 July 2021 and 30 June 2022. The Birth Anticipation Scale (BAS) was used to measure fear of childbirth and the Childbirth Experience Questionnaire (CEQ-E) was applied to measure satisfaction with the childbirth experience. Fear of childbirth negatively and significantly predicted the childbirth experience. In addition, women who were more fearful of childbirth were found to have worse obstetric outcomes and a higher likelihood of having a caesarean delivery (p = 0.008 C. I 95%). Fear behaved as a risk factor for the birth experience, so the greater the fear, the higher the risk of having a worse birth experience (OR 1.1). Encouraging active listening and support strategies may increase pregnant women’s confidence, thus decreasing their fear of the process and improving their childbirth experience.

Traumatic Childbirth and Birth-Related Post-Traumatic Stress Disorder in the Time of the COVID-19 Pandemic: A Prospective Cohort Study

Article

Full-text available

Oct 2022
Int J Environ Res Publ Health

Background: Birth-related post-traumatic stress disorder occurs in 4.7% of mothers. No previous study focusing precisely on the stress factors related to the COVID-19 pandemic regarding this important public mental health issue has been conducted. However, the stress load brought about by the COVID-19 pandemic could have influenced this risk. Methods: We aimed to estimate the prevalence of traumatic childbirth and birth-related PTSD and to analyze the risk and protective factors involved, including the risk factors related to the COVID-19 pandemic. We conducted a prospective cohort study of women who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022 with an assessment within 3 days of delivery and a clinical interview at one month post-partum. Results: Among the 254 participants included, 35 (21.1%, 95% CI: 15.1-28.1%) experienced a traumatic childbirth and 15 (9.1%, 95% CI: 5.2-14.6%) developed a birth-related PTSD at one month post-partum according to DSM-5. Known risk factors of birth-related PTSD such as antenatal depression, previous traumatic events, neonatal complications, peritraumatic distress and peritraumatic dissociation were confirmed. Among the factors related to COVID-19, only limited access to prenatal care increased the risk of birth-related PTSD. Conclusions: This study highlights the challenges of early mental health screening during the maternity stay when seeking to provide an early intervention and reduce the risk of developing birth-related PTSD. We found a modest influence of stress factors directly related to the COVID-19 pandemic on this risk.

COMMENTARY Vaginal Birth After Cesarean Section: Ethical Considerations for Midwives

Article

Full-text available

Jan 2014

Vaginal birth after cesarean section (VBAC) and decisions regarding the safest mode and place of delivery can be contentious in contemporary obstetrics. The choice of birthplace adds additional layers to ethical concerns, particularly for midwives, who are often the only care providers attending birth outside the hospital setting. Current guidelines and evidence, drawing largely on obstetrical literature and the hospital environment, recommend hospital birth for anyone with a prior cesarean section. However, despite guidelines and care provider recommendations, a small proportion of women will continue to request midwife-attended homebirth. Ethical debates about VBAC have largely been inattentive to the desires of these women and the unique situation of midwives who may be presented with such requests. We will explore the ethical nuances of choice of birthplace for women planning a vaginal homebirth after cesarean section (HBAC). Analysis suggests that there may be implications to denying choice and some burden on midwives to continue to provide care for women planning HBAC, even when homebirth may not be considered the safest option.

Vaginal Birth after Cesarean Section: Ethical Considerations for Midwives

Article

Full-text available

Jan 2014

The development of a prediction model for arrest of labour to be used at regular check-ups, during 36 or 37 gestational weeks, for primiparas: a retrospective cohort study

Article

Full-text available

Aug 2022
ARCH GYNECOL OBSTET

Purpose An emergency caesarean section (CS) has more complications than a planned CS. The arrest of labour is a major indication for an emergency CS. This study aimed to develop a prediction model for the arrest of labour to be used in regular check-ups at 36 or 37 gestational weeks for primiparas. Methods This was a retrospective cohort study conducted at a single institution in Japan using data from January 2007 to December 2013. Primiparas attending regular check-ups during 36 or 37 gestational weeks, with live single foetuses in a cephalic presentation were included. The outcome was the incidence of labour arrest. Candidate predictors included 25 maternal and foetal findings. We developed a prediction model using logistic regression analysis with stepwise selection. A score was assigned to each predictor of the final model based on their respective β coefficients. Results A total of 739 women were included in the analysis. Arrest of labour was diagnosed in 47 women (6.4%), and all of them delivered by emergency CS. The predictors in the final model were a Bishop score ≤ 1, maternal height ≤ 154 cm, foetal biparietal diameter ≥ 91 mm, pre-pregnancy weight ≥ 54 kg, maternal haemoglobin concentration ≥ 11.0 g/dl, and amniotic fluid index ≥ 13. The area under the receiver operating characteristic curve was 0.783. Conclusion We have developed the first model to predict arrested labour before its onset. Although this model requires validation using external samples, it will help clinicians and pregnant women to control gestational conditions and make decisions regarding planned CS.

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study

Article

Full-text available

Jun 2022

Although cesarean section (CS) has become a common method of child delivery in recent decades, the choice between general anesthesia (GA) and neuraxial anesthesia (NA) for CS must be carefully considered. Depending on the type of anesthesia used in CS, a major outcome observed is the occurrence of postpartum depression (PPD). This study investigated the association between PPD risk and the anesthesia method used in CS by using data from three linked nationwide databases in Taiwan, namely, the National Health Insurance Research Database, the National Birth Reporting Database, and the National Death Index Database. After propensity score matching by baseline depressive disorders, maternal demographics, status at delivery, infant’s health, maternal diseases during pregnancy, and age of partner, we included women who had natural births (n = 15,706), cesarean sections with GA (n = 15,706), and cesarean sections with NA (n = 15,706). A conditional logistic regression was used to estimate the odds ratios and 95% confidence intervals (CIs) of PPDs, including depression, sleep disorder, and medication with hypnotics or antidepressants, under anesthesia during CS. The prevalence rates of combined PPDs were 26.66%, 43.87%, and 36.30% in natural births, CS with GA, and CS with NA, respectively. In particular, the proportions of postpartum use of hypnotic drugs or antidepressants were 21.70%, 39.77%, and 31.84%, which were significantly different. The aORs (95% CIs) were 2.15 (2.05–2.25) for the included depressive disorders, 1.10 (1.00–1.21) for depression, 1.03 (0.96–1.11) for sleep disorder, and 2.38 (2.27–2.50) for medication with hypnotics or antidepressants in CS with GA compared with natural births. Women who underwent CS with GA had a significantly higher risk of depressive disorders and a higher need for antidepressants for sleep problems than those who underwent CS with NA. The risks of PPD were significantly associated with the anesthesia method, especially GA. Our results can assist physicians in carefully considering the appropriate anesthesia method for CS delivery, particularly with regard to postpartum drug abuse and drug safety.

Perception of Traumatic Childbirth of Women and Factors Affecting

Article

Full-text available

Mar 2022

Backround: Mothers' perceptions of labor, their perspectives on the birth process and the events they experience in this process, and the meanings they attribute to them may differ. Aim: This study was conducted to determine women's perception of traumatic birth and the affecting factors. Design and Methods: The study was conducted between Feburary 1 and April 10, 2021. A nonrandom sampling method, the snowball sampling method, wasused in the study. Data were collected using The Trauma Perception Scale for Regarding Birth. Findings: The difference between the Perception of Trauma Related to Birth Scale scores according to age, education level, employment status, social security, income level, family structure, duration of marriage, number of births, number of children and receiving prenatal care is statistically significant. (p<0.05). Conclusion: Midwives and nursings have important duties in order to improve the perception of traumatic birth, which affects women so much, and to leave its place to positive birth experiences.

How does early cognitive behavioural therapy reduce postpartum depression?

Article

Feb 2015
CLIN EXP OBSTET GYN

Maternal Health Related Quality of Life at Twelve Weeks following Emergency and Elective Caesarean Section in Enugu, Nigeria

Article

Full-text available

Mar 2022

Background: Very few studies have compared the impact of emergency and elective caesarean section on Health-related Quality of Life (HRQoL). This study compared the maternal HRQoL at 12 weeks following emergency and elective CS in Enugu, Nigeria. Materials and Methods: A cross-sectional analytical design was conducted on 88 mothers (45 emergency CS, 43 elective CS) attending the outpatient clinic at three selected public hospitals from December 2015 and November 2016. A consecutive sampling technique was used to enroll the study respondents until the required sample sizes for the two arms of the study were reached. HRQoL was assessed using the standardized RAND-36 Short Form (SF-36) questionnaire. Collected data was analyzed using descriptive statistics and Mann-Whitney U test at a 5% significance level. Results: The Emergency CS group (EmCS) had low HRQoL in Role limitation due to physical problems (mean 32.5(20.1), 68.9%) and Role limitation due to emotional problems (mean 36.8(31.4), 62.2%), while Vitality was moderate (mean 50.6(41.5); 48.9%). The Elective CS group (EleCS) had moderate values in Role limitation due to physical problems (mean 55.7(38.2), 44%). The EmCS had significantly lower Role limitation due to physical problem and Role limitation due to emotional problem compared to the EleCS (p < 0.001). Social function was generally good between them, but it was significantly less in the EmCS (p = 0.003). Conclusion: Impaired role function due to physical and emotional problems is more among women who had EmCS. Physical and psychological follow-up care is recommended for such women.

Impact of no publicly accessible prenatal education programming on patients and their care providers: a descriptive qualitative study in Nova Scotia, Canada

Article

Full-text available

May 2024

Objective Patients in Nova Scotia do not have access to public prenatal education programming. This study aimed to explore whether care providers find patients are uninformed or misinformed, and the impact of that on patients and their care providers with a focus on clinical outcomes, time, resources and informed decision-making. Methods Semistructured interviews were conducted with 13 care providers around Halifax and Cape Breton. An interview guide (supplemental) of open-ended questions was used for consistency. A descriptive qualitative approach was employed to describe the contents of the interviews. Each interview was audio-taped and transcribed verbatim by an interdependent transcriber. Transcripts were analysed using established techniques in qualitative descriptive research including coding, grouping, detailing and comparing the data using NVivo V.12 software. A co-coder (SS) independently coded two interviews for inter-rater reliability. Results The study revealed six themes: (1) concern for a significant population of Nova Scotians experiencing pregnancy, birth and postpartum uninformed and misinformed, (2) consequences for patients who are uninformed and misinformed, (3) more time and resources spent on care for patients who are uninformed or misinformed, (4) patients and their care providers need a publicly available education programme, particularly vulnerable populations, (5) emphasis on programme quality and disappointment with the programme previously been in place and (6) recommendations for an effective prenatal education programme for Nova Scotians. Conclusions This study shows care providers believe a public prenatal education programme could improve health literacy in Nova Scotia. Patients are seeking health education, but it is not accessible to all and being uninformed or misinformed negatively impacts patients’ experiences and outcomes. This study revealed excess time and resources are being spent on individualised prenatal education by care providers with high individual and system-wide cost and explored the complicated process of providing patient-centred care for people who are uninformed or misinformed.

The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review

Article

Full-text available

Apr 2024
Int J Environ Res Publ Health

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

Patient Reported Outcomes After Childbirth

Chapter

Mar 2024

J. Oliver Daly

Patient Reported Outcomes (PROs) and Measures (PROMs) are important tools for assessing and monitoring the physical, psychological, and social impact of childbirth on pelvic floor function and associated quality of life. A range of PROMs have been developed and are in use across many domains of pelvic floor and associated function, however, it is important to understand whether they have been validated, and in what cohorts, to ensure the PROMs are relevant, valid and provide meaningful information, whether used in a research or clinical setting. This chapter reviews the role and validation process for PROMs in childbirth-related pelvic floor trauma (CBRPFT), the domains of postpartum function included in the currently available PROMs and guidance for their use.

Incidência hospitalar de trauma durante o nascimento: Avaliação, intervenções e perspectivas para a saúde neonatal

Article

Full-text available

Feb 2024

O nascimento é um dos eventos mais significativos na vida de um ser humano, marcando o início de sua jornada neste mundo. No entanto, para alguns, esse momento crucial pode ser acompanhado por experiências traumáticas que deixam cicatrizes emocionais e físicas. O trauma durante o nascimento é uma realidade que afeta tanto os recém-nascidos quanto suas famílias, podendo ter repercussões de longo prazo no desenvolvimento infantil e na saúde mental. O objetivo deste artigo foi analisar a prevalência e o perfil epidemiológico das internações causadas por traumas durante o nascimento no Brasil de 2019 a 2023. Este é um estudo quantitativo e retrospectivo, que realizou a análise das internações causadas por trauma durante o nascimento no território brasileiro, partir de dados públicos disponíveis no Sistema de Informações Hospitalares (SIH) do Sistema Único de Saúde (SUS). Durante o período analisado, houve 2.688 internações, isso representa uma redução de 21% nas internações. O Sudeste do país apresentou os maiores números de internações, correspondendo a 40,5%, predominando entre crianças pardas, com 43%. Além disso, em todos os anos analisados, ocorreram mais internações em crianças do sexo feminino e 32% menos gastos com internações hospitalares. A redução nas internações por trauma durante o nascimento é um indicador positivo do progresso na medicina perinatal e do compromisso contínuo com a segurança e o bem-estar das mães e bebês. Investimentos em práticas obstétricas baseadas em evidências, cuidados pré-natais de qualidade, tecnologia médica avançada e educação e treinamento de profissionais de saúde são fundamentais para continuar essa tendência positiva e garantir que todas as gestações e partos ocorram com segurança e sucesso.

PTSD symptoms after the delivery in women who delivered alone or accompanied by their partners

Article

Full-text available

Jan 2006

Poród jest przez rosnącą liczbę badaczy traktowany jako doświadczenie traumatyczne. Najważniejszym elementem koncepcji porodu jako wydarzenia traumatycznego jest poczucie kontroli nad przebiegiem wydarzeń i związane z nimi reakcje emocjonalne występujące u kobiet. Towarzyszący rodzącej partner jest źródłem emocjonalnego i praktycznego wsparcia, a jego obecność może zmienić sposób, w jaki kobieta spostrzega poród i swoją nad nim kontrolę, a tym samym zmniejszyć ryzyko pojawienia się po porodzie objawów przypominających objawy zaburzenia po stresie traumatycznym (PTSD). W badaniu uczestniczyło 70 kobiet, z których połowa rodziła w towarzystwie partnera. Zastosowano Kwestionariusz objawów uwzględniających 3 grupy objawów typowych dla PTSD (unikanie sytuacji przypominających o urazie, pobudzenie, odtwarzanie stresującej sytuacji), a także Inwentarz radzenia sobie w sytuacjach stresowych (CISS) do pomiaru stylu radzenia sobie. Kobiety rodzące samotnie uzyskiwały istotnie wyższe wyniki w zakresie unikania i pobudzenia. Ich ogólny wynik w Kwestionariuszu objawów był również istotnie wyższy. Natężenie objawów PTSD było związane ze stylem radzenia sobie ze stresem – badane ujawniające styl skoncentrowany na zadaniu uzyskiwały niższe wyniki w Kwestionariuszu objawów, co świadczy o mniej intensywnych objawach. Wyniki wskazują˛ również, że ani uczestniczenie w zajęciach szkoły rodzenia, ani uprzednie doświadczenia położnicze nie modyfikowały natężenia objawów.

Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care?

Article

Feb 2024
MIDWIFERY

Incorporating co-design principles and social media strategies to enhance cross-sectional online survey participation: The Birth Experience Study

Article

Nov 2023
J NURS SCHOLARSHIP

Aim To use co‐design principles to design a nationwide maternity experiences survey and to distribute the survey through social media. Design A co‐designed, cross sectional, and national online survey. Methods Using co‐design principles from study design and throughout the research process a cross‐sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design. Results An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions. Discussion The inclusion of co‐design principles contributed to a well‐designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs. Clinical Relevance Maternity services should be designed to provide woman‐centered, individualized care. This survey was co‐designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services. Patient or Public Contribution As a co‐designed study, there was consumer engagement from the design of the study, throughout the research process.

Risk and Loss of Autonomy During Birth

Chapter

Oct 2023

This chapter first considers the importance of allowing people giving birth to have a meaningful decision-making role in their own childbirth including in interventions such as vaginal examination. Here we consider and critique the birth plan as a tool for increasing the autonomy of the person giving birth. The chapter goes on to explore the notion—or the fallacy—of informed consent, and here particularly participants’ experiences of being coerced into a performance of giving consent. Finally, the chapter addresses more overt failures of care, disrespect, and abuse of participants during childbirth including health care providers’ attempts at emotional blackmail of those giving birth through ‘shroud waving’ or ‘playing the dead baby card’.

Pregnancy-associated and Pregnancy-related Deaths in the United States Military, 2003–2014

Article

May 2023
Obstet Anesth Digest

( Am J Obstet Gynecol . 2022;227:508.e1–508.e9) The Centers for Disease Control defines pregnancy-associated deaths as those that occur while pregnant or within 1 year of the end of pregnancy from any cause. Pregnancy-related deaths are those that occur within the same time frame from any cause related to or aggravated by pregnancy itself. While the rates of death due to hemorrhage and hypertensive events have declined in the military population, pregnancy-associated overdose and suicide deaths are on the rise. Active-duty service members have distinct circumstances from the civilian population that are normally considered protective against maternal morbidity: free and full health care coverage, stable employment, and lower rates of chronic disease. Despite these factors, a sharp rise in severe maternal morbidity in the US military is evident over 2003-2015, and it is acknowledged that suicide, overdose, and homicide are rising contributors to this trend. Frequent relocation or deployment are mental health stressors that may be an exacerbating factor in these deaths.

Trauma and female reproductive health across the lifecourse: motivating a research agenda for the future of women's health

Article

May 2023
HUM REPROD

The aetiology behind many female reproductive disorders is poorly studied and incompletely understood despite the prevalence of such conditions and substantial burden they impose on women's lives. In light of evidence demonstrating a higher incidence of trauma exposure in women with many such disorders, we present a set of interlinked working hypotheses proposing relationships between traumatic events and reproductive and mental health that can define a research agenda to better understand reproductive outcomes from a trauma-informed perspective across the lifecourse. Additionally, we note the potential for racism to act as a traumatic experience, highlight the importance of considering the interaction between mental and reproductive health concerns, and propose several neuroendocrinological mechanisms by which traumatic experiences might increase the risk of adverse health outcomes in these domains. Finally, we emphasize the need for future primary research investigating the proposed pathways between traumatic experiences and adverse female reproductive outcomes.

Assessment of Maternal Posttraumatic Stress Disorder Following Childbirth: Psychometric Properties of the Swedish Version of City Birth Trauma Scale

Article

Full-text available

Apr 2023

Objective: City Birth Trauma Scale (City BiTS) is an instrument designed to evaluate and diagnose postpartum posttraumatic stress disorder (PTSD) according to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). No validated Swedish instrument exists to measure postpartum PTSD according to DSM-5. Therefore, the primary aim of this study was to assess the psychometric properties of the Swedish version of the City BiTS (City BiTS-Swe) and to examine the latent factor structure of postpartum PTSD. The secondary aim was to report the Swedish prevalence of PTSD following childbirth. Method: A total of 619 women, who had given birth at five clinics in the past 6–16 weeks, completed an online version of City BiTS-Swe and the Edinburgh Postnatal Depression Scale (EPDS). Additionally, sociodemographic and medical data were collected. A second questionnaire was answered by 110 women to examine reliability over time. Results: The confirmatory factor analysis using the two-factor model gave best fit to the data. We found a high internal consistency (α = .89–.87) and good test–retest reliability (ICC = 0.53–0.90). Divergent reliability with EPDS showed significant correlations with satisfying results for the subscale birth-related symptoms (r = .41). We also found discriminant validity concerning mode of birth, parity, gestational age, mental illness, history of traumatic childbirth, and history of traumatic event as expected. The prevalence of PTSD was 3.8%. Conclusions: The City BiTS-Swe is a valid and reliable instrument to assess and diagnose PTSD following childbirth.

Effect of Painless Labor on Postpartum Depression

Article

Sep 2018

A qualitative exploration of women’s and their partners’ experiences of birth trauma in Australia, utilising critical feminist theory

Article

Dec 2022

Background Many women in Australia emerge from childbirth describing their experience as traumatic. Birth trauma can be both physical and psychological, with long-lasting and intergenerational impacts. Aim To explore women’s and their partners’ experiences of birth trauma in Australia and consider the role of gender using a feminist theoretical lens. Methods We used a descriptive phenomenological and constructivist/interpretivist approach and two frameworks (WHO Quality of Care framework; socio-ecological model) to explore experiences of traumatic birth. Participants were recruited through social media using purposive sampling. Data were collected through online in-depth interviews. Data were analysed thematically, considering gender and power dynamics using critical feminist theory. Findings 24 women and 4 male partners were interviewed. We identified 8 themes, including: Individual: birth grief and best laid plans; breastfeeding to regain identity after trauma. Interpersonal: impact of trauma on bonding with baby; partner trauma. Institutional: inadequate consent processes; to debrief or not to debrief. Community: more than a healthy baby. Policy: an augmented reality. Discussion Findings highlighted the impact of patriarchal maternity care systems and policies in undermining women’s sense of control during birth, evident in high levels of labour augmentation and inadequate consent processes. This study draws attention to how gender shapes how birth trauma is expressed within both women’s and their partners’ identities as parents, their relationships, and society. Conclusions Recommendations include the development of women-centred policies for obtaining informed consent and training in trauma-informed care in maternity services. Further research must include the voices of women from diverse backgrounds.

Predictors of adverse perinatal and maternal outcomes of instrumental vaginal delivery at a tertiary setting in Ethiopia: A cross‐sectional study

Article

Full-text available

Dec 2022

Objective To determine the rate of instrumental vaginal delivery (IVD) and the predictors of adverse maternal and fetal outcomes associated with it in an Ethiopian setting. Methods A cross-sectional study was conducted from October 1, 2018, to January 31, 2019, at St. Paul's Hospital Millennium Medical College (SPHMMC) (Addis Ababa, Ethiopia). Data on obstetric characteristics, perinatal and maternal outcomes of women who delivered through IVD were collected prospectively, using a structured questionnaire. Data were analyzed using SPSS version 22 and descriptive analysis was applied to analyze baseline characteristics. Multivariable logistic regression model was fitted to predict the association between short-term complications of IVD and their determinants. Odds ratio, 95% CI, and p-value < 0.05 were used to present significance of study findings. Results There were 3165 deliveries during the study period, out of which 241 (7.6%) were instrumental vaginal deliveries. Sequential use of instrumental delivery (AOR = 4.82 [95% CI = 2.10–27.29] and AOR = 6.43 [95% CI = 1.19–34.73], for maternal and fetal complications, respectively) was associated with increased both maternal and fetal complications. Three number of pulls during the extraction was associated with increased fetal complications (AOR = 1.19 [95% CI = 1.05–1.67]). Conclusion The rate of instrumental delivery rate in our setting is high with sequential use of instrumental delivery found to be associated with increased adverse maternal and fetal outcomes while three number of pulls were associated with increased fetal adverse outcomes.

A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up

Article

Jul 2022
MIDWIFERY

Objectives To establish the prevalence and correlates of a subjectively traumatic birth experience in an Irish maternity sample. Design A questionnaire routinely provided to all women prior to hospital discharge post-birth was amended for data collection for this study. Two additional questions seeking information about women's perceptions of their birth were added and analysed. Women who described their birth as traumatic and agreed to follow-up, received a City Birth Trauma Scale (Ayers et al., 2018) at subsequent follow-up (6 to 12 weeks postpartum). Demographic, obstetric, neonatal variables and factors associated with birth trauma were collected from electronic maternity records retrospectively. Setting A postnatal ward in an Irish maternity hospital which provides postnatal care for public maternity patients. Participants Postpartum women (N=1154) between 1 and 5 days postpartum. Measurements & Findings Participants completed the Edinburgh Postnatal Depression Scale (Cox et al., 1987) with two additional questions about birth trauma. Eighteen percent (n=209) of women reported their birth as traumatic. Factors associated with reporting birth as traumatic included a history of depression, raised EPDS scores (>12), induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage. Of these 209 women, 134 went on to complete the City Birth Trauma Scale (Ayers et al., 2018). The average score was 3.84 and only 6 of this sample (4%) reached the threshold for PTSD. Key conclusions This study identified a prevalence of 18% of women experiencing birth as traumatic and the potentially important role of a current and past history of depression, postpartum haemorrhage, induction of labour and operative vaginal birth in defining a traumatic birth experience. The majority of women were resilient to birth trauma, few developed post-traumatic stress disorder, but a larger cohort had significant functional impairment associated with sub-clinical postpartum PTSD symptoms. Implications for practice Maternity care providers should be aware of the risk factors for traumatic birth. Introducing a trauma – informed approach amongst midwives and maternity care providers in the postnatal period may help to detect emerging or established persisting trauma-related symptoms. For women with sub-clinical postpartum PTSD symptoms a detailed enquiry may be more effective in identifying postpartum PTSD at a later postnatal stage e.g., at six weeks postpartum. Maternity services should provide ongoing supports for women who have experienced birth trauma.

Ebelik Bölümü Öğrencilerinin Doğum Algıları ve Premenstural Sendrom ile İlişkisi Birth Perceptions of Midwifery Students and Its Relationship with Premenstural Syndrome

Article

Full-text available

Jun 2022

Sümeyye Barut

In this cross-sectional study, birth perceptions of midwifery students and their relationship with premenstural syndrome were examined. The study was carried out with 214 midwifery students of Fırat University Faculty of Health Sciences in April 2021. The data were collected using the Personal Information Form prepared by the researcher, the Traumatic Birth Perception Scale (TCPS) and the Premenstrual Syndrome Scale (PMS). Analysis of the data used number, percentage, mean, chi-square test and Pearson correlation analysis in SPSS 22.0 program. It was determined that 77.1% of the students had a medium and above traumatic birth perception, 66.4% of them experienced premenstural symptoms. The total mean score of the students from the PMS scale was determined to be 127,27±42,15, and the average TCPS score to 70,64±23,56. It was determined that the relationship between students' PMS scale total score scores and TCPS total score scores was low, positive and significant ( r (214)=0,14, p

The effect of gender on mental illness and treatment

Chapter

Full-text available

Jan 2005

Pain that only she must bear: on the invisibility of women in judicial abortion rhetoric

Article

Full-text available

Mar 2022

Francesca Laguardia

The graphic and bodily facts of a legal question of rights are relevant to the courts, particularly in questions that directly implicate physical bodies and pain, such as right to die cases, or what level of search may be allowable and when. However, in the case of abortion, or more specifically the bodily ramifications of pregnancy and childbirth, this detail is conspicuously absent. This article, relying on a content analysis of over 220 legal opinions on abortion rights, documents this absence of rhetoric. Particularly in the context of other discussions of pain and physical health risks in these very same cases, the complete absence of an acknowledgement of the bodily ramifications of pregnancy and childbirth appears purposeful, if perhaps not conscious. Reviewing prior literature on abortion rights and abortion rhetoric, it is likely that this lack of language both reflects and reinforces an assumption of women's roles as mothers, a general reluctance to acknowledge the totality of the sacrifices women make in giving birth, and the refusal to acknowledge women's individual interests as whole persons.

The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations

Article

Full-text available

Jan 1986
J PERS SOC PSYCHOL

In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Increased risk of postnatal depression after emergency cesarean section

Article

Full-text available

Sep 1992

To examine whether women having an emergency caesarean section are at increased risk of developing postnatal depression at one, three and six months postpartum. Participants were part of a larger study examining the relationship between personality dysfunction and postnatal depression. All women were recruited at an antenatal clinic in the first trimester of their pregnancy. These women were followed up at one, three and six months postpartum to identify cases of postnatal depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). Data were collected from 188 women, who were divided into three groups by method of delivery: 21 women had an emergency caesarean section, 49 had a forceps delivery and 118 had a spontaneous vaginal delivery. Comparison of the groups indicated a significant difference at three months postpartum only. Women having an emergency caesarean section had significantly higher EPDS scores than women who had forceps or spontaneous vaginal delivery (9.15 +/- 6.18 v. 5.05 +/- 3.81 v. 5.79 +/- 4.47; F(2,143) = 4.2, P less than 0.02). Analysis of postnatal depression at three months indicated that women in the emergency caesarean section group had a relative risk of 6.82 (95% confidence interval, 2.85-16.15) compared with women in the other groups. When compared with women having spontaneous vaginal or forceps deliveries, women having an emergency caesarean section had more than six times the risk of developing postnatal depression three months postpartum. Special attention to this group appears warranted.

The Moderator-Mediator Variable Distinction in Social Psychological Research

Article

Full-text available

Dec 1986

Post Traumatic Stress Disorder (PTSD) after childbirth

Article

Full-text available

May 1995

There has been discussion about the possible occurrence of post-traumatic stress disorder (PTSD) in mothers after difficult childbirth. Four cases with a symptom profile suggestive of PTSD commencing within 48 hours of childbirth are presented. The PTSD was in each case associated with the delivery. In each case, there was an associated depressive illness. All four had persistent disorders, and two had difficulties with mother/infant attachment. As confirmed by other reports, the prevalence of PTSD associated with childbirth is a matter of concern.

Investigation of 33 Women Who Demanded a Cesarean Section for Personal Reasons

Article

Jan 1994

Elsa Lena Ryding

Caesarean section: women's choice

Article

Oct 1998

Jean Robinson

‘Unfortunately the law does not distinguish between the rights of a mentally competent but foolish pregnant woman and other adults. Therefore, if caesarean section is the preferred mode of delivery by the mother, her choice, however foolish or irrational, must be respected’ (Amu et al, 1998).

Post-Traumatic Stress Disorder in Women Who Have Undergone Obstetric and/or Gynaecological Procedures: A Consecutive Series of 30 Cases of PTSD

Article

Oct 1993

Janet Menage

500 women volunteers took part in a study about the psychological stress associated with obstetric and gynaecological procedures. The sample was recruited by advertisements in local and national newspapers and in women's magazines and newsletters. Women completed a preliminary questionnaire on their experiences of obstetric and gynaecological procedures, their biographical data, and their feelings associated with the procedures both at the time and now. Out of the 500 subjects, over 100 women gave an history of an obstetric and for gynaecological procedure which was ‘very distressing’ or ‘terrifying’, which was ‘out of the ordinary’ and which occurred ‘more than one month previously’. These women were sent follow-up PTSD-I questionnaires and 30 of them fulfilled the DSM-111-R criteria for a diagnosis of post-traumatic stress disorder (PTSD). Significant differences between the 30 women with PTSD, and 30 respondents who rated their experiences from ‘very good’ to ‘slightly distressing’, were found on a range of findings, including feelings of powerlessness during the procedures, lack of information given to the patient, the experience of physical pain, a perceived unsympathetic attitude on the part of the examiner, and a lack of clearly-understood consent by the patient for the procedure. The results are discussed in relation to the literature on women's emotional reactions to the childbirth process and also to sexual violence and other causes of PTSD. The present findings suggest a cause of PTSD not previously described and challenge current medical working practices in the area of obstetrics and gynaecology.

The role of obstetric factors in postpartum depression

Article

Oct 1993

A large sample of primiparous women was screened for postpartum depression and for depression occurring before childbirth. Obstetric risk data, rated on the Peripartum Events Scale (O'Hara etal., 1986, 1991), were analysed for women identified as having suffered from depression, and for a control group. Obstetric risk was unrelated to the occurrence of postpartum depression in the population as a whole; but in women with a previous history of depressive disorder obstetric risk (delivery by forceps or Caesarean section) was significantly related to the occurrence of postpartum depression. This finding did not arise as a consequence of a previous psychiatric history predisposing women to higher obstetric risk. The results suggest that it may be profitable to institute routine antenatal recording of information concerning psychiatric history. This would enable additional support to be directed to women experiencing difficult deliveries who may be particularly vulnerable to postnatal depression.

Post-traumatic stress disorder in women who have JP

Article

J Menage

Mannual for the State-Trait anxiety inventory STAI (Form)

Book

Childbirth experience and postpartum emotion disturbance

Article

Oct 1988
J REPROD INFANT PSYC

One hundred and sixty-one randomly selected Norwegian women (participants in a longitudinal family project) were studied during their stay at the birth clinic. They were interviewed the first day after delivery about the childbirth process: pain, anxiety, loss of control, confusion, joy, happiness, exaltation, cooperation with companion and with staff. Then they were interviewed the fifth day after delivery. The interviewer (clinical psychologist) made a global rating of each mother's emotional functioning the fifth day postpartum. Specific factors in mothers' childbirth experiences relate individually to postpartum emotional disturbance the fifth day after delivery, such as difficult childbirth, pain, loss of control, loss of awareness of time and space, anxiety, negative emotional reaction to the birth, dissatisfaction with own coping with the delivery process, and unmet needs in relation to midwife during delivery.

Expectations, Experiences, and Psychological Outcomes of Childbirth: A Prospective Study of 825 Women

Article

Mar 1990
BIRTH-ISS PERINAT C

A prospective study of 825 women booked for delivery in six hospitals in southeastern England was conducted to determine their expectations of childbirth. Women completed three questionnaires, two before the birth and one six weeks after. Questions covered both objective and subjective aspects of birth, and gave particular attention to control, its importance and its relevance to psychological outcomes. Four different indices of psychological outcome were considered: fulfilment, satisfaction, emotional well-being, and the words that women used to describe their babies, which were shown to be related to different patterns of independent variables and of intra-partum events. Our results did not support popular stereotypes: high expectations were not found to be bad for women, although low expectations often were. Information and feeling in control were consistently associated with positive psychological outcomes.

The Special Needs of the Cesarean Mother

Article

Jul 1978
MCN-AM J MATERN-CHIL

JOANNE SULLIVAN MARUT

The woman who has an unexpected cesarean may be disturbed by the fact that she was unable to deliver her baby vaginally. She may need help to overcome her feelings of failure and to establish a bond with her newborn infant.

The Partus Stress Reaction: A Neglected Etiological Factor in Postpartum Psychiatric Disorders

Article

May 1992

How do parents really feel after cesarean birth?

Article

Feb 1983

E C Shearer

A Guide to Effective Care in Pregnancy & Childbirth

Article

Jul 1995

Evidence about the effects of care practices is not a sufficient guide to the most appropriate care. Those who provide care, who receive care, who advocate care, or who pay for care must choose on the basis of many factors: personal experience, personal preference, personal values, availability of resources and facilities, and a myriad of other considerations, among which knowledge of the effects of care is certainly important. This knowledge is essential for choices to be properly informed. The most reliable evidence about the effects of care is provided by randomized controlled trials. Unfortunately, this evidence is not readily accessible. It is scattered through a large number of journals throughout the world, and is hidden among a mass of weak, inadequate, and sometimes frankly misleading studies. Those who wish to use all the valid evidence must rely on properly prepared, up-to-date, systematic reviews. The Cochrane Collaboration has taken on the task of preparing, maintaining, and disseminating reviews of randomized trials of health care, published electronically as the Cochrane Database of Systematic Reviews. The reviews are provided by a number of Collaborative Review Groups, and the Cochrane Pregnancy and Childbirth Database is the first specialty database to appear. It is regularly updated to incorporate data that have become available since the previous issue.

Narratives of Birth and the Postpartum: Analysis of the Focus Group Responses of New Mothers

Article

Jan 1994

Focus groups were conducted to encourage and examine women's frank discussions of the events surrounding their experiences of labor, birth, and the postpartum period. Transcripts of the tape-recorded narratives of 41 new mothers were analyzed and five themes were identified: loss of autonomy and control; unexpected physical pain of childbirth; unexpected emotional reactions; financial pressures; and the effects of support during labor and birth. Participants' perceptions shed light on and supplemented previous questionnaire and interview research on these topics. The survey results suggest ways to help improve women's birth experiences.

Investigation of 33 women who demanded a cesarean

Article

Jun 1993

Elsa Lena Ryding

The purpose of this study was to obtain a better understanding of women who demand a cesarean section when obstetricians do not think it is necessary. Thirty-three pregnant women were interviewed about their reasons for the demand. The 28 parous women referred to previous childbirth experiences and feared mainly for intractable labor pain and for the life and health of the child. The most prevalent fear of the five nulliparae was for vaginal rupture. According to their wishes and prerequisites the women received counselling or short-term psychotherapy by a psychotherapeutically trained obstetrician. At term 14 women chose vaginal delivery and 19 had elective cesareans, three on obstetric indications and 16 at their own choice.

What is the correct cesarean rate

Article

Jun 1993
Br J Obstet Gynaecol

Geoffrey Chamberlain

Posttraumatic stress disorder occurring after painful childbirth

Article

Apr 1996

C Fones

The Relationship Between Pain and Depression

Article

Jul 1996
Br J Psychiatr Suppl

Empirical results from epidemiological studies on pain-depression comorbidity in primary care and population samples have shown that: (a) pain is as strongly associated with anxiety as with depressive disorders; (b) characteristics that most strongly predict depression are diffuseness of pain and the extent to which pain interferes with activities; (c) certain psychological symptoms (low energy, disturbed sleep, worry) are prominent among pain patients, while others (guilt, loneliness) are not; (d) depression and pain dysfunction are evident early in the natural history of pain, but dysfunction and distress are often transient; and (e) among initially dysfunctional pain patients whose dysfunction is chronic, depression levels do not improve but neither do they increase over time with chronicity alone. These results seem consistent with these mechanisms of pain-depression comorbidity; (1) a trait of susceptibility to both dysphoric physical symptoms (including pain) and psychological symptoms (including depression), and a state of somatosensory amplification in which psychological distress amplifies dysphoric physical sensations (including pain); (2) psychological illness and behavioural dysfunction being interrelated features of a maladaptive response to pain evident early in the natural history of the condition, and often resolving during an early recovery phase; (3) pain constituting a significant physical and psychological stressor that may induce or exacerbate psychological distress. Thus, pain and psychological illness should be viewed as having reciprocal psychological and behavioural effects involving both processes of illness expression and adaption, as well as pain having specific effects on emotional state and behavioural function.

Post-traumatic stress disorder after childbirth: The phenomenon of traumatic birth

Article

Apr 1997

J L Reynolds

CHILDBIRTH CAN BE A VERY PAINFUL EXPERIENCE, often associated with feelings of being out of control. It should not, therefore, be surprising that childbirth may be traumatic for some women. Most women recover quickly post partum; others appear to have a more difficult time. The author asserts that post-traumatic stress disorder (PTSD) may occur after childbirth. He calls this variant of PTSD a "traumatic birth experience." There is very little literature on this topic. The evidence available is from case series, qualitative research and studies of women seeking elective cesarean section for psychologic reasons. Elective cesarean section exemplifies the avoidance behaviour typical of PTSD. There are many ways that health care professionals, including physicians, obstetric nurses, midwives, psychologists, psychiatrists and social workers, can address this phenomenon. These include taking a careful history to determine whether a woman has experienced trauma that could place her at risk for a traumatic birth experience; providing excellent pain control during childbirth and careful postpartum care that includes understanding the woman's birth experience; and ruling out postpartum depression. Much more research is needed in this area.

Adverse Psychological Impact of Operative Obstetric Interventions: A Prospective Longitudinal Study

Article

Nov 1997

This paper reports the findings of a prospective longitudinal study of 272 nulliparous pregnant women, which investigated as one of its objectives the psychological sequelae of obstetric procedures. Participants completed structured interviews and standardised, published psychometric questionnaires, including the Rosenberg Self-Esteem Scale and the Profile of Mood States late in pregnancy and again early in the postpartum period. Little evidence was found to support the notion that the total number of obstetric interventions was linked to a deterioration in postpartum mood. Significant adverse psychological effects were associated with the mode of delivery. Those women who had spontaneous vaginal deliveries were most likely to experience a marked improvement in mood and an elevation in self-esteem across the late pregnancy to early postpartum interval. In contrast, women who had Caesarean deliveries were significantly more likely to experience a deterioration in mood and a diminution in self-esteem. The group who experienced instrumental intervention in vaginal deliveries fell midway between the other two groups, reporting neither an improvement nor a deterioration in mood and self-esteem. The findings of this study suggest that operative intervention in first childbirth carries significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to posttraumatic distress and depression.

Posttraumatic Stress Disorder After Childbirth: A Cross Sectional Study

Article

Nov 1997
J ANXIETY DISORD

The prevalence of having a posttraumatic stress disorder (PTSD) profile after childbirth and women's cognitive appraisal of the childbirth were studied cross sectionally in an unselected sample of all women who had given birth over a 1-year period in Linköping, Sweden. The PTSD profile was assessed by means of Traumatic Event Scale (TES), which is based on diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The women's cognitive appraisal of the childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Twenty-eight women (1.7%) of 1640 met criteria for a PTSD profile related to the recent delivery. A PTSD profile was related to a history of having received psychiatric/psychological counseling, a negative cognitive appraisal of the past delivery, nulliparity, and rating the contact with delivery staff in negative terms.

Expectations, experi-ences, and psychological outcomes of childbirth: A

Coupland Va Green Jm
Kitzinger
Jv

Green JM, Coupland VA, Kitzinger JV. Expectations, experi-ences, and psychological outcomes of childbirth: A

Diagnosis and Statistical ered in the literature When an individual observes Manual of Mental Disorders

Jan 1994

American Psychiatric

American Psychiatric Association. Diagnosis and Statistical ered in the literature. When an individual observes Manual of Mental Disorders. 4th ed. Washington, DC: Author, 1994. another person suffering, they may experience

The role of obstetric factors in

Cartwright W Murray

Cartwright W, Murray L. The role of obstetric factors in

Childbirth experience and postpartum emotional disturbance. J Reprod Infant Psy-childbirth

Jan 1996
195-196

K Thune-Larsen
Moller
Pederson

Thune-Larsen K, Moller-Pederson K. Childbirth experience and postpartum emotional disturbance. J Reprod Infant Psy-childbirth. J Nerv Ment Dis 1996;184:195–196.

What is the correct cesarean rate? Br J Obstet and depression

Jan 1996
101-108

G Chamberlain

Chamberlain G. What is the correct cesarean rate? Br J Obstet and depression. Br J Psychiatry 1996;168(Suppl. 30):101– 108.

Post-traumatic stress person) to be disappointed or not wanting to talk about disorder after childbirth

Jan 1995
525-528

Ballard
Cg
Ak Stanley
Brockington
If

Ballard CG, Stanley AK, Brockington IF. Post-traumatic stress person) to be disappointed or not wanting to talk about disorder after childbirth. Br J Psychiatry 1995;166:525–528.

Posttraumatic stress ronments and become distracted, upset, and terrified disorder after childbirth: A cross sectional study. J Anxiety when they see their partners in pain (28)

Jan 1997
587-597

K Wijma
Ma Soderquist
Wijma

Wijma K, Soderquist MA, Wijma B. Posttraumatic stress ronments and become distracted, upset, and terrified disorder after childbirth: A cross sectional study. J Anxiety when they see their partners in pain (28). The effect Disord 1997;11:587–597.

Trauma and Its Wake: Traumatic Stress Theory

Figley
Cr

Figley CR. Trauma and Its Wake: Traumatic Stress Theory

Obstetric Intervention: Psychological Predictors and Psychological Consequences

Fisherjr

Jan 1993
459

Foa E

Trauma and Its Wake: Traumatic Stress Theory Research and Intervention

Figley

Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors

Abstract

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Childbirth and the development of acute trauma symptoms