PTSD after childbirth: A predictive ethological model for symptom development.
Childbirth can be a traumatic experience occasionally leading to posttraumatic stress disorder (PTSD). This study aimed to assess childbirth-related PTSD risk-factors using an etiological model inspired by the transactional model of stress and coping.
348 out of 505 (70%) Dutch women completed questionnaires during pregnancy, one week postpartum, and three months postpartum. A further 284 (56%) also completed questionnaires ten months postpartum. The model was tested using path analysis.
Antenatal depressive symptoms (β=.15, p<.05), state anxiety (β=.17, p<.01), and perinatal psychoform (β=.17, p<.01) and somatoform (β=.17, p<.01) dissociation were identified as PTSD symptom risk factors three months postpartum. Antenatal depressive symptoms (β=.31, p<.001) and perinatal somatoform dissociation (β=.14, p<.05) predicted symptoms ten months postpartum.
Almost a third of our sample was lost at three months postpartum, and 44% at ten months. The sample size was relatively small. The present study did not control for prior PTSD. The PTSD A criterion was not considered an exclusion criteria for model testing, and the fit index of the ten months model was just below suggested cut-off values.
Screening for high risk pregnant women should focus on antenatal depression, anxiety and dissociative tendencies. Hospital staff and midwives are advised to be vigilant for perinatal dissociation after intense negative emotions. To help regulate perinatal negative emotional responses, hospital staff and midwifes are recommended to provide information about birth procedures and be attentive to women’s birth-related needs.
Richards, J., Graham, R., Embleton, N. D., Campbell, C., Rankin, J.
There is a growing body of literature exploring the emotional impact of perinatal loss upon parents but only limited research focussing specifically on the views and experiences of parents who have experienced a loss from a twin or higher order pregnancy. We undertook a qualitative study to provide an in-depth understanding of the experiences of mothers who have had a loss from a twin pregnancy and subsequently continued visiting hospital whilst their surviving twin was cared for.
A qualitative study involving semi-structured interviews. Mothers were recruited from a Neonatal Intensive Care Unit and Fetal Medicine department. Fourteen interviews were carried out with mothers who had experienced a loss in pregnancy or the neonatal period and had a surviving twin on the neonatal unit. Data were analysed using a generative thematic approach.
The analysis identified three key themes in the accounts mothers gave of their experiences: the status of ‘special’; the importance of trust; and control and empowerment. Where the surviving co-twin remained in hospital for many weeks, mothers described the emotional support of health professionals as crucial to their wellbeing. Few mothers sought formal bereavement support, instead they kept their grief ‘on hold’ in order to support their surviving baby. Due to the trauma of their loss, mothers reflected that they had been unable to make informed decisions, in particular in relation to the funeral of their deceased baby.
Our study highlighted that there are a specific set of issues for mothers who have lost a baby from a twin pregnancy. Relatively small changes to practice however, made a significant difference to wellbeing during their time in hospital with a surviving twin. Findings from this research will provide insight into the needs of bereaved mothers, will inform healthcare planning and the development of care packages.
Narratives of traumatic birth: Quality and changes over time*
Childbirth is a highly emotive event that can involve complications. Around 1% of births in the United Kingdom involve life-threatening complications to the mother (Waterstone, Bewley, & Wolfe, 2001) and 0.8% result in stillbirth or perinatal death (Confidential Enquiry into Maternal and Child Health [CEMACH], 2009). A review found that 3.1% of women report posttraumatic stress disorder (PTSD) after birth (Grekin & O’Hara, 2014). The aim of this study was to examine whether narrative characteristics of traumatic birth were specific to women with PTSD or observed in all women who experience a highly emotive and potentially traumatic birth. Parturient women were matched for birth events, but either had severe PTSD symptoms (n = 22) or no, or very low, PTSD symptoms (n = 22). Women were interviewed about the birth 3 and 6 months postpartum, and their birth narratives were examined for content, coherence, and cognitive and perceptual processing. Results showed birth narratives became shorter and more coherent over time. Consistent with PTSD literature, birth memories were more likely to be recalled and involuntarily triggered in women with PTSDsymptoms. However, women with PTSD symptoms had more coherent narratives, used more causal and fewer tentative words. These latter findings are inconsistent with research finding that PTSD is associated with fragmented or incoherent memories but are consistent with the view that highly emotive events result in improved memory (e.g., Berntsen, Willert, & Rubin, 2003). Possible reasons for this are discussed.