The Influence of Childbirth Experiences on Women’s Post-Partum Traumatic Stress Symptoms: A Comparison Between Israeli Jewish and Arab Women
Halperin, O., Sarid, O., & Cwikel, J.
ABSTRACT childbirth is a positive experience for most women yet some women express distress after birth. Traumatic experience can sometimes cause post-traumatic stress disorder (PTSD) in relation to childbirth. Prevalence of traumatic birth experience and PTSD after childbirth differs between cultures.
to examine the subjective recall of childbirth experiences and PTSD symptoms of Israeli Jewish and Arab women; to examine comparatively the prevalence of PTSD symptoms six to eight weeks after childbirth and to establish the factors that predict PTSD symptoms.
a prospective study was conducted in a region characterised by wide variations in ethnocultural groups. The study was comprised of two time points: Time 1 (T1) interviews were conducted at the bedside of the women in the maternity ward of each hospital 24-48 hours after childbirth. Time 2 (T2), all 171 women participating in T1 were interviewed by phone six to eight weeks after childbirth. 34 women (19.9%) reported their labour as traumatic 24-48 hours after birth (T1), and six to eight weeks later (T2) 67 women (39.2%) assessed their experience as traumatic. More Arab women (69.6%) than Jewish women (56.5%) had a positive memory of childbirth, but this difference only approached statistical significance (p=.09). Results showed rather low frequencies of PTSD symptoms, and no ethnic difference. PTSD symptoms were significantly and positively predicted by subjective recollection of childbirth experience (Time 2). PTSD symptoms were higher for women who did not have a vaginal birth, and more women with PTSD symptoms were not breast feeding. We found more similarities than differences between Arab and Jewish women’s experience of their births and no differences between them on the prevalence of PTSD symptoms after birth. The results suggest that non-vaginal birth (instrumental or caesarean section) and negative recollection of the childbirth experience are important factors related to the development of PTSD symptoms after birth, and that women with PTSD symptoms are less likely to breast feed.
Trauma and the Effects on the Midwife
Calvert. I., & Benn, C.
http://www.ingentaconnect.com/content/springer/ijc/2015/00000005/00000002/art00006
Abstract:
BACKGROUND: When practicing as a lead maternity carer, the first author (IC) found that following a traumatic practice experience, there appeared to be very little emotional support for the midwife unless provided by colleagues or family. Midwives were expected to continue as if nothing had happened and they had not been affected in any way by the event.
AIM: To explore the effects of a traumatic practice experience on the midwifery practitioner.
RESEARCH METHODOLOGY AND METHOD: A qualitative study using a narrative research method was implemented. Data were collected using an adapted biographical narrative interview method. An eclectic approach was used to analyze the data for content and form based on identity and ontology.
FINDINGS: The study demonstrated that partnership and autonomous midwifery practice are key drivers that make New Zealand midwives more likely to be blamed for unfortunate outcomes, and their competence in practice challenged. The study identified that a breach of relational trust exacerbates or prolongs the initial physiological and/or psychological symptoms experienced by the participating midwives following a traumatic practice event. The perpetrators of this betrayal of trust were organizational and clinical managers, medical and midwifery colleagues, women, and their families.
CONCLUSION: The participants’ stories have drawn attention to the effects of counterproductive behaviors that occur in dysfunctional health organizations and the need for professional emotional support.
Mixed expectations: Effects of goal ambivalence during pregnancy on maternal well‐being, stress, and coping.
http://www.ncbi.nlm.nih.gov/pubmed/26099234
Background: We hypothesised that experiencing ambivalence toward the childbearing goal would be related to indicators of well‐being, stress, and coping among women with planned pregnancies. Methods: Study 1 (N = 208) tested cross‐sectional associations between goal ambivalence and measures of well‐being, stress, and coping. It also included a postpartum measurement point (N = 71) to examine prospective effects of goal ambivalence. Study 2 (N = 109) extended the investigation to within‐person effects in a three‐week daily diary assessment. Results: In Study 1, goal ambivalence in pregnant women was positively associated with depressive symptoms, perceived stress, and pregnancy‐specific avoidance‐oriented coping, and negatively associated with coping self‐efficacy. Goal ambivalence also predicted changes in life satisfaction, depressive symptoms, perceived stress, and coping self‐efficacy postpartum. Study 2 revealed within‐person effects of daily fluctuations in goal ambivalence on day‐to‐day changes in positive emotions, negative activation, and avoidance‐oriented coping. Conclusions: Ambivalence towards the childbearing goal is a source of significant distress to pregnant women with planned pregnancies and its effects seem to extend into the postpartum period. These findings may have important clinical implications for maternal and child well‐being. Future studies should examine whether goal ambivalence during pregnancy affects the maternal–child relationship in the long term.
Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stressdisorder, symptoms of anxiety and depression.
Tinglöf,S., Högberg, U., Lundell IW., & Svanberg, A.S.
http://www.ncbi.nlm.nih.gov/pubmed/25998870
Abstract
AIM:
The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression.
DESIGN:
The design of the study was a Swedish multi-centre study targeting women requesting TOP.
METHODS:
All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied.
RESULTS:
Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence.
CONCLUSION:
Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence.
Should Perinatal Mental Health be Everyone’s Business?
Ayers, A., & Shakespeare, J.
Editorial.
I entirely agree with the authors of ‘The Influence of Childbirth Experiences on Women’s Post-Partum Traumatic Stress Symptoms: A Comparison Between Israeli Jewish and Arab Women’ regarding non -vaginal birth – if, as they do, you include instrumental delivery as a non-vaginal birth. Possibly there needs to be caution, though, in interpreting this as meaning PTSD is higher for women who do not have a vaginal birth. The causes of PTSD are diverse and can occur as a result of elective caesareans and vaginal birth. However, the highest rates of PTSD, in our experience, occur as a result of long labours resulting in instrumental or emergency caesareans particularly where the women felt uncared for. However, these are, in the main, PLANNED vaginal births not PLANNED caesareans. The distinction is important. There are some women who have combinations of very significant risk factors for complicated delivery especially those having a large, malpositioned first baby at a late age. Such is the rhetoric around caesarean sections that some of these women are told that a vaginal birth is unquestionably safest for them. We need to be more honest about the physical and psychological complications of planned vaginal births as well as those of planned caesareans.