August Research Update

Nulliparous pregnant women’s narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study.

Nieminen, K., Malmquist, A., Wijma, B., Ryding, E. L, Andersson, G., & Wijma, K.



To describe the expectations concerning imminent childbirth before and after 8 weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth.


Qualitative study of nulliparous pregnant women’s narratives before and after CBT.


The first ICBT programme for treating severe fear of childbirth.


Fifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme.


Semi-structured open-ended questions over the internet before and after 8 weeks of ICBT. The data were analysed using thematic analysis.


The participants’ narratives pertaining to five different situations during labour and delivery before and after ICBT.


After therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth.


Following the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.


Post-traumatic stress disorder managed successfully with hypnosis and the rewind technique: two cases in obstetric patients.

Slater, P. M.


Two obstetric patients presenting with post-traumatic stress disorder in the antenatal period are discussed. The first patient had previously had an unexpected stillborn delivered by emergency caesarean section under general anaesthesia. She developed post-traumatic stress disorder and presented for repeat caesarean section in her subsequent pregnancy, suffering flashbacks and severe anxiety. Following antenatal preparation with hypnosis and a psychological method called the rewind technique, she had a repeat caesarean section under spinal anaesthesia, successfully managing her anxiety. The second patient suffered post-traumatic stress disorder symptoms after developing puerperal psychosis during the birth of her first child. Before the birth of her second child, she was taught self-hypnosis, which she used during labour in which she had an uneventful waterbirth. These cases illustrate the potential value of hypnosis and alternative psychological approaches in managing women with severe antenatal anxiety.

Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants.

Kim, W. J, Lee, E., Kim, K. R., Namkoong, K., Park, E. S., & Rha, D. W.



To understand how postpartum posttraumatic stress disorder (PTSD) symptoms in mothers of high-risk infants progress and identify what factors predict postpartum PTSD.


We prospectively obtained self-reported psychological data from neonatal intensive care unit discharged infants’ mothers (NICU mothers) at the infants’ corrected ages of 1 (T0), 3 (T1) and 12 months (T2) and mothers of healthy infants (controls). Maternal sociodemographic and infant-related factors were also investigated.


PTSD was present in 25 and 9% of NICU mothers and controls, respectively. We identified four PTSD patterns: none, persistent, delayed and recovered. The postpartum PTSD course was associated with trait anxiety. Whether the infant was the first child who predicted PTSD at year 1 (adjusted odds ratio=7.62, 95% confidence interval=1.07 to 54.52).


Mothers of high-risk infants can develop early or late PTSD, and its course can be influenced by factors besides medical status. We therefore recommend regular screenings of postpartum PTSD.

Psychophysiology and posttraumatic stress disorder symptom profile in pregnant African-American women with trauma exposure.

Michopoulos, V., Rothbaum, A. O., Corwin, E., Bradley, B., & Ressler, K. J.

While female sex is a robust risk factor for posttraumatic stress disorder (PTSD), pregnant women are an understudied population in regards to PTSD symptom expression profiles. Because circulating hormones during pregnancy affect emotionality, we assessed whether pregnant women would have increased expression of the intermediate phenotypes of hyperarousal and fear-potentiated startle (FPS) compared to non-pregnant women. We examined PTSD symptom profiles in pregnant (n = 207) and non-pregnant women (n = 370). In a second study, FPS responses were assessed in 15 pregnant and 24 non-pregnant women. All participants were recruited from the obstetrics and gynecology clinic at a public hospital serving a primarily African-American, low socioeconomic status, inner-city population. Our results indicate that overall PTSD symptoms were not different between the groups of women. However, pregnant women reported being more hypervigilant (p = 0.036) than non-pregnant women. In addition, pregnant women showed increased FPS to a safety signal compared to non-pregnant women (p = 0.024). FPS to a safety signal in pregnant women was significantly correlated with PTSD hyperarousal symptoms (r = 0.731, p < 0.001). Furthermore, discrimination between danger and safety signals was present in non-pregnant women (p = 0.008), but not in pregnant women (p = 0.895). Together, these data suggest that pregnant women show clinical and psychophysiological hyperarousal compared to non-pregnant women, and support screening for PTSD and assessment of PTSD risk in pregnant women.

Childbirth-Related Posttraumatic Stress Disorder and Breastfeeding: Challenges Mothers Face and How Birth Professionals Can Support Them.

Kendall-Tackett, K.

Birth is life-altering event. Under the best circumstances, it is a happy one. Labor and delivery can be empowering, with mothers feeling that they have accomplished something great. Unfortunately, birth can also be difficult, overwhelming, and for some, traumatic. Without intervention, childbirth-related trauma and PTSD can last for years, coloring how women feel about themselves as mothers, and potentially marring their relationships with partners and babies. Birth trauma and breastfeeding intersect in some key ways. Birth trauma can negatively impact breastfeeding. And breastfeeding can be a source of healing following a difficult birth. This article describes the prevalence of PTSD after childbirth, describes the role of breastfeeding, and discusses some initial steps birth professionals can take to help mothers recover.

Long-Term Maternal Stress and Post-traumatic Stress Symptoms Related to Developmental Outcome of Extremely Premature Infants.

Zerach, G, Elsayag, A., Shefer, S., & Gabis, L.


In this study, we examined the relations between the severity of developmental outcomes of extremely low birth weight (ELBW) children and their mothers’ stress and post-traumatic stress disorder (PTSD) symptoms, 4-16 years after birth. Israeli mothers (N = 78) of a cohort of extremely premature infants (24-27 weeks) born 4-16 years earlier were asked to report about the medical and developmental condition of their child and their current perceived stress and PTSD symptoms. Results show that mothers of ELBW children with normal development reported the lowest perceived stress compared with mothers of ELBW children with developmental difficulties. We also found that 25.6% of the mothers had the potential to suffer from PTSD following the birth of an ELBW child. Furthermore, the severity of prematurity developmental outcomes made a significant contribution to mothers’ perceived stress. To sum, mothers of ELBW infants’ perceived stress is related to their children’s severity of prematurity developmental outcomes, 4-16 years after birth. Clinical implications of these findings are discussed

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