Women’s experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study.
(1) To investigate the experiences of women with a previous stillbirth and their appraisal of the care they received at the hospital. (2) To assess the long-term level of post-traumatic stress symptoms (PTSS) in this group and identify risk factors for this outcome.
A retrospective study.
Two university hospitals.
The study population comprised 379 women with a verified diagnosis of stillbirth(≥23 gestational weeks or birth weight ≥500 g) in a singleton or twin pregnancy 5-18 years previously. 101 women completed a comprehensive questionnaire in two parts.
PRIMARY AND SECONDARY OUTCOME MEASURES:
The women’s experiences and appraisal of the care provided by healthcare professionals before, during and after stillbirth. PTSS at follow-up was assessed using the Impact of Event Scale (IES).
The great majority saw (98%) and held (82%) their baby. Most women felt that healthcare professionals were supportive during the delivery (85.6%) and showed respect towards their baby (94.9%). The majority (91.1%) had received some form of short-term follow-up. One-third showed clinically significant long-term PTSS (IES ≥ 20). Independent risk factors were younger age (OR 6.60, 95% CI 1.99 to 21.83), induced abortion prior to stillbirth (OR 5.78, 95% CI 1.56 to 21.38) and higher parity (OR 3.46, 95% CI 1.19 to 10.07) at the time of stillbirth. Having held the baby (OR 0.17, 95% CI 0.05 to 0.56) was associated with less PTSS.
The great majority saw and held their baby and were satisfied with the support from healthcare professionals. One in three women presented with a clinically significant level of PTSS 5-18 years after stillbirth. Having held the baby was protective, whereas prior induced abortionwas a risk factor for a high level of PTSS.
Exposure to traumatic perinatal experiences and posttraumatic stresssymptoms in midwives: Prevalence and association with burnout.
Midwives provide care in a context where life threatening or stressful events can occur. Little is known about their experiences of traumatic events or the implications for psychological health of this workforce.
To investigate midwives’ experiences of traumatic perinatal events encountered whilst providing care to women, and to consider potential implications.
A national postal survey of UK midwives was conducted.
421 midwives with experience of a perinatal event involving a perceived risk to the mother or baby which elicited feelings of fear, helplessness or horror (in the midwife) completed scales assessing posttraumatic stress symptoms, worldview beliefs and burnout.
33% of midwives within this sample were experiencing symptoms commensurate with clinical posttraumatic stress disorder. Empathy and previous trauma exposure (personal and whilst providing care to women) were associated with more severe posttraumatic stress responses. However, predictive utility was limited, indicating a need to consider additional aspects increasing vulnerability. Symptoms of posttraumatic stress were associated with negative worldview beliefs and two domains of burnout.
Midwives may experience aspects of their work as traumatic and, as a consequence, experience posttraumatic stress symptomatology at clinical levels. This holds important implications for both midwives’ personal and professional wellbeing and the wellbeing of the workforce, in addition to other maternity professionals with similar roles and responsibilities. Organisational strategies are required to prepare midwives for such exposure, support midwives following traumatic perinatal events and provide effective intervention for those with significant symptoms.
Grief Intensity, Psychological Well-Being, and the Intimate Partner Relationship in the Subsequent Pregnancy after a Perinatal Loss
Hutti, M. H., Armstrong, D. S., Myers, J. A., & Hall, L. A.
To examine the construct validity of the Perinatal Grief Intensity Scale (PGIS) and the associations of grief intensity with psychological well-being and the quality of intimate partner relationships of women in the subsequent pregnancy after perinatal loss. The consequences of intense grief due to perinatal loss may include significant couple relationship issues, depression, anxiety, and post-traumatic stress that may extend into the subsequent healthy pregnancy.
Design and Setting
A correlational, descriptive research design was used to collect survey data in this cross-sectional, web-based study.
Participants were 227 currently pregnant women who experienced perinatal loss in their immediate past pregnancies.
Instruments included the Pregnancy Outcome Questionnaire (pregnancy-specific anxiety), Impact of Event Scale (post-traumatic stress), Center for Epidemiologic Studies-Depression Scale (depression symptoms), the Autonomy and Relatedness Inventory (quality of the intimate partner relationship), and the Perinatal Grief Intensity Scale (perinatal grief intensity).
As hypothesized, greater grief intensity was associated with higher pregnancy-specific anxiety, depression symptoms, and post-traumatic stress as well as poorer quality of the intimate partner relationship.
Support for the construct validity of the PGIS was demonstrated by its significant associations in the expected directions with pregnancy-specific anxiety, depression symptoms, post-traumatic stress, and the quality of the intimate partner relationship. The scale may be useful to health care providers in identifying mothers in need of follow-up for intense grief and other clinically relevant symptoms after perinatal loss.
The roles of resilience and childhood trauma history: Main and moderating effects on postpartum maternal mental health and functioning.
Recently postpartum women participated to investigate main and moderating influences of resilience and childhood history of maltreatment on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), parental sense of mastery, and family functioning.
At 4-months postpartum, 214 mothers (145 with a history of childhood abuse or neglect) completed interviews assessing mental health symptoms, positive functioning, resilience and trauma history. Multiple and moderated linear regression with the Connor-Davidson Resilience Scale (CD-RISC) and Childhood Trauma Questionnaires (CTQ) were conducted to assess for main and moderating effects.
Resilience, childhood trauma severity, and their interaction predicted postpartum PTSD and MDD. In mothers without childhood maltreatment, PTSD was absent irrespective of CD-RISC scores. However, for those with the highest quartile of CTQ severity, 8% of those with highest resilience in contrast with 58% of those with lowest CD-RISC scores met PTSD diagnostic criteria. Similar, in those with highest resilience, no mothers met criteria for postpartum MDD, irrespective of childhood trauma, while for those with lowest quartile of resilience, 25% with lowest CTQ severity and 68% of those with highest CTQ severity were depressed. The CD-RISC, but not the CTQ, was predictive of postpartum sense of competence. The CD-RISC and the CTQ were predictive of postpartum family functioning, though no moderating influence of resilience on childhood trauma was found.
Resilience is associated with reduced psychopathology and improved wellbeing in all mothers. It further serves as a buffer against psychiatric symptoms following childhood trauma. Such findings may assist in identification of those at greatest risk of adverse functioning postpartum, utilization of resilience-enhancing intervention may benefit perinatal wellness, and reduce intergenerational transmission of risk.
Health services utilization of women following a traumatic birth.
This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.