September Research Update

Improvements in the Child-Rearing Attitudes of Latina Mothers Exposed to Interpersonal Trauma Predict Greater Maternal Sensitivity Toward Their 6-Month-Old Infants.

Waters SF, Hagan MJ, Rivera L, Lieberman AF.

The current study investigated maternal sensitivity in a treatment-seeking sample of predominately Latina, low-income pregnant women with histories of interpersonal trauma exposure. Pregnant women (N = 52; M = 27.08 years, SD = 5.66) who enrolled in a study of a perinatal adaptation of child-parent psychotherapy reported on their posttraumatic stress symptoms and child-rearing attitudes at baseline and again at 6-months postpartum. Maternal sensitivity was measured via observational coding of a free-play episode at 6-months postpartum. Two thirds of mothers exhibited healthy levels of maternal sensitivity, M > 4.0 (range = 2.5-7.0). The results of multiple linear regression predicting maternal sensitivity, R2 = .26, indicated that greater improvements in child-rearing attitudes over the course of treatment predicted higher levels of maternal sensitivity, β = .33, whereas improvements in posttraumatic stress symptoms over the course of treatment did not, β = -.10. Mothers’ attitudes regarding parenting during the perinatal period may be a mechanism by which intervention fosters healthy mother-infant relationship dynamics. Thus, parenting attitudes are a worthy target of intervention in vulnerable families.

http://www.ncbi.nlm.nih.gov/pubmed/26418308

Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study.

De Schepper S, Vercauteren T, Tersago J, Jacquemyn Y, Raes F, Franck E.

OBJECTIVE:

we examined the prevalence of Post-Traumatic Stress Disorder (PTSD) and the role of personal and obstetric risk factors, as well as the role of midwifery team care factors in a cohort of Flemish women.

DESIGN:

prospective cohort study. Data collection was performed at two times post partum: During the first week, socio-demographic and obstetric data as well as information related to midwifery team care factors were assessed using self-report measures. To asses PTSD symptomatology, the Impact of Event Scale-Revised (IES-R) and the Traumatic Event Scale (TES) were used. At six weeks post partum, PTSD symptoms were reassessed either by telephone interviews or e-mail. Results were calculated in frequencies, means and standard deviations. Differences between week one and six were analysed using parametrical and non-parametrical statistics. Multiple and logistic regression was performed to determine risk factors for PTSD symptomatology. P-value was set at 0.05.

SETTING:

maternity wards in Flanders, Belgium.

PARTICIPANTS:

the first (week 1) and follow-up (week 6) sample of the data collection consisted of 340 and 229 women respectively.

RESULTS:

the prevalence of PTSD symptoms after childbirth ranged from 22% to 24% in the first week and from 13% to 20% at six weeks follow-up. Multiple regression analysis showed that Islamic belief, a traumatic childbirth experience, family income <€2500, a history of psychological or psychiatric consults and labour/birth with complications significantly predicted PTSD symptomatology at six weeks post-birth. Midwifery team care and the opportunity to ask questions, as well as experiencing a normal physiological birth were significantly associated with less postnatal PTSDsymptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: the results of this study suggest that contextual factors such as religion, socio-economic status, and childbirth experience might be important factors to address by the midwifery team. Midwifery team care factors such as ‘providing the opportunity to the mother to ask questions’ and the ‘perception of the midwife being in control’ proved to be potential protective factors for postnatal PTSD symptoms. Despite its prevalence, PTSD symptoms after birth are not yet well understood by health care workers. Further research concerning the influence of midwifery team care factors on developing childbirth related PTSD is required.

http://www.ncbi.nlm.nih.gov/pubmed/26410818

A simple model for prediction postpartum PTSD in high-risk pregnancies.

Shlomi Polachek I, Dulitzky M, Margolis-Dorfman L, Simchen MJ.

This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-riskpregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partialPTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.

http://www.ncbi.nlm.nih.gov/pubmed/26399873

Where there was love … Compassionate midwifery as protection against trauma.

Knapp R.

Midwifery is more than a job; it is a privilege and honour where a woman chooses to allow us into one of the defining moments of her life. The role of the midwife in ensuring the clinical safety and wellbeing of both the mother and baby is well defined, but the reality is that the midwife’s role extends far beyond the clinical and impacts both the initial and long-term bonding within the mother-baby dyad. Written from the perspective of a service-user turned midwife, this piece explores the impact and potential areas for practice improvement in order to identify ways to enhance care for women. It also looks at how the personal birth experience of this author has informed the way in which she provides care to women, as a qualified midwife. Its aim is to reiterate to midwives that this vocation requires consistent passionate and compassionate care.

http://www.ncbi.nlm.nih.gov/pubmed/26349326

Women’s experiences of symptoms of posttraumatic stress disorder (ptsd) after traumatic childbirth: A review and critical appraisal

This paper critically analyses nine studies on postnatal posttraumatic stress disorder (PTSD) following traumatic childbirth, in order to find common themes of PTSD symptoms, using the cognitive model of PTSD as a guide; it critically appraised one of the studies in depth and it attempted to explain the lived experience of women suffering from postnatal PTSD following traumatic childbirth and the suitability of cognitive behavioural therapy (CBT) for postnatal PTSD. This paper found that women following traumatic childbirth do experience postnatal PTSD; postnatal PTSD symptoms are similar to PTSD symptoms of other events and that CBT for PTSD of other events is just as effective for postnatal PTSD. Future recommendations include more qualitative studies with interpretative phenomenological approach in order to establish evidence-based CBT treatment for this client group, and more referrals need to be sent to the psychological services for CBT intervention.

http://www.ncbi.nlm.nih.gov/pubmed/26264506