October Research Update

Emotional impact of severe post-partum haemorrhage on women and their partners: an observational, case-matched, prospective, single-centre pilot study.

Ricbourg, A., Gosme, C., Gayat, E., Ventre, C., Barranger, E., & Mebazaa, A.

Objective

This observational, matched-control, prospective, single-centre study sought to estimate the emotional impact of post-partum haemorrhage (PPH) on women and their partners, including its influences on post-traumatic stress disorder (PTSD), postpartum depression and the mother/child relationship.

Study design

All consecutive women who were admitted for PPH from December 2010 through December 2011 and their partners were screened for eligibility.

Emotional impact was assessed using three self-reported questionnaires (Impact of Event Scale-Revised to assess PTSD, Edinburgh Post Natal Depression Scale to assess post-natal depression and Mother-Infant Bonding Scale to assess the relationship between mother and child). Each PPH patient was matched with a control woman for whom the delivery was not complicated by PPH.

Results

The results showed (a) that women with PPH and their partners were more likely to report symptoms related to PTSD compared with controls, (b) that women with PPH were less likely to suffer from postnatal depression and (c) that there was no difference in the mother/child relationship between women with PPH and controls.

Conclusion

PPH is associated with a high incidence of PTSD-related symptoms in both women and their partners. PTSD in the context of PPH is likely an under-recognised phenomenon by health care professionals.

 

A meta-ethnographic synthesis of fathers׳ experiences of complicated births that are potentially traumatic.

Elmir,R., Schmied,V.

Abstract

INTRODUCTION:

birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father.

AIM:

the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father’s experiences of complicated births that are potentially traumatic.

METHODS:

databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013.

INCLUSION CRITERIA:

studies were included if they focused on fathers/men׳s experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.

FINDINGS:

eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.

SYNTHESIS:

Four major themes were identified: ‘the unfolding crisis’, ‘stripped of my role: powerless and helpless’, ‘craving information’ and ‘scarring the relationship’. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men׳s interactions and relationships with their partners.

CONCLUSIONS:

witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms ofbirth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact ofbirth complications. Effective support may help address men׳s confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?

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

Waters, S. F., Hagan, M. J., Rivera, L., Lieberman, A. F.

Abstract

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, R(2) = .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.

PTSD after childbirth: A predictive ethological model for symptom development.

Haagen, Joris F G;Moerbeek, Mirjam; Olde, Eelco; van der Hart, Onno; Kleber, Rolf J

http://www.ncbi.nlm.nih.gov/pubmed/26172985

 

 

Background: 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.Methods: 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.Results: 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.Limitations: 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.Conclusions: 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.

Posttraumatic stress & oxytocin in women with a premature infant in the Neonatal Intensive Care Unit.

Garfield, L.Holditch-Davis, D.Giurgescu, C.Carter, C.McFarlin, B. L.Schwertz, D.Seng, J.S. &  White-Traut, R.

http://www.sciencedirect.com/science/article/pii/S0889159115002494

Abstract: In the USA, 11.38% of infants are born prematurely with over 300,000 infants born low-birth weight. Mothers of premature infants are at greater risk for postpartum posttraumatic stress and depressive symptoms. Variation in the neuropeptide oxytocin has been implicated in perinatal depression, maternal behavior, and regulation of stress responses. The purposes of this pilot was to determine feasibility of obtaining serial oxytocin blood-samples on mothers while infants were in the Neonatal Intensive Care Unit (NICU) and examine the association among posttraumatic stress, prenatal depressive symptoms, and plasma oxytocin levels in urban low-income minority women. This pilot consisted of 8 postpartum minority women who completed surveys and had 4 serial blood draws over 1-h while visiting their infant in the NICU. Analysis included descriptive statistics, correlations, and t -tests. One-fourth of participants reported elevated posttraumatic stress and 50% reported elevated prenatal depressive symptoms. Women with elevated posttraumatic stress had higher depressive symptoms ( t (8) = 6.1, p = 0.001), higher anxiety ( t (8) = 2.6, p = 0.041), more worry ( r (8) = 0.71, p = 0.047). A trend was identified between women with elevated posttraumatic stress and low plasma oxytocin levels ( t (8) = −1.5, p = 0.057). Women with greater depressive symptoms tended to have greater anxiety ( r (8) = 0.65, p = 0.081). Further research is needed to understand the mechanisms between posttraumatic stress, premature birth, and oxytocin in order to better understand this psychological condition. All women with a premature infant should be screened for posttraumatic stress and postpartum depression