November Research Update 2015

Sorry for the delay everyone, but here is a list of research that was published in November.

Understanding psychological traumatic birth experiences: A literature review.

Simpson, M., & Catling, C.



Traumatic birth experiences can cause postnatal mental health disturbance, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to impaired child development. Some women may develop postnatal Post Traumatic Stress Disorder, which is a particularly undesirable outcome. This paper aimed to gain a better understanding of factors contributing to birth trauma, and the efficacy of interventions that exist in the literature.


A literature search was undertaken in April 2015. Articles were limited to systematic reviews or original research of either high to moderate scientific quality. A total of 21 articles were included in this literature review.


Women with previous mental health disorders were more prone to experiencing birth as a traumatic event. Other risk factors included obstetric emergencies and neonatal complications. Poor Quality of Provider Interactions was identified as a major risk factor for experiencing birth trauma. Evidence is inconclusive on the best treatment for Post Traumatic Stress Disorder; however midwifery-led antenatal and postnatal interventions, such as early identification of risk factors for birth trauma and postnatal counselling showed benefit.


Risk factors for birth trauma need to be addressed prior to birth. Consideration needs to be taken regarding quality provider interactions and education for maternity care providers on the value of positive interactions with women. Further research is required into the benefits of early identification of risk factors for birth trauma, improving Quality of Provider Interactions and how midwifery-led interventions and continuity of midwifery carer models could help reduce the number of women experiencing birth trauma.

Self-Rated Mental Health: Screening for Depression and Posttraumatic Stress Disorder Among Women Exposed to Perinatal Intimate Partner Violence.

Kastello, J. C., Jacobsen, K. H., Gaffney, K. F., Kodadek, M. P., Bullock, L. C., Sharps, P. W.


The purpose of the current study was to evaluate the validity of a single-item, self-rated mental health (SRMH) measure in the identification of women at risk for depression and posttraumatic stress disorder (PTSD). Baseline data of 239 low-income women participating in an intimate partner violence (IPV) intervention study were analyzed. PTSD was measured with the Davidson Trauma Scale. Risk for depression was determined using the Edinburgh Postnatal Depression Scale. SRMH was assessed with a single item asking participants to rate their mental health at the time of the baseline interview. Single-item measures can be an efficient way to increase the proportion of patients screened for mental health disorders. Although SRMH is not a strong indicator of PTSD, it may be useful in identifying pregnant women who are at increased risk for depression and need further comprehensive assessment in the clinical setting. Future research examining the use of SRMH among high-risk populations is needed.

In first-time mothers, post-partum depressive symptom prospectively predict symptoms of post-traumatic stress.

Shahar, G., Herishanu-Gilutz, S., Holcberg, G., Kofman, O.



Symptoms of both depression and Post-Traumatic Stress Disorder (PTSD) are prevalent among first-time mothers following birth. However, the direction of the association between the two types of symptoms is unclear.


Ninety six first-time mothers giving birth via vaginal delivery (N=38), emergency C-Section (N=27) and planned C-Section (N=21) were assessed for depression and PTSD twice: Six weeks post-partum and six-weeks later.


Cross-lagged Structural Equation Modeling (SEM) analyses revealed a prospective effect of depressive symptoms on PTSD symptoms. No moderating factors were identified.


A relatively modest sample size and only two assessment waves.


An early detection and intervention with symptoms of post-partum depression might also prevent the development of PTSD symptoms

Pilot for Nurse-Led, Interprofessional In-Service Training on Trauma-Informed Perinatal Care.

Choi,K. R., & Seng, J. S.
Background: Perinatal health care providers receive little training on addressing posttraumatic stress in childbearing women. Provision of trauma-informed care requires agency-wide adaptations. The authors developed a brief, agency-level, in-service training on trauma-informed perinatal care and evaluated the training using a knowledge, skills, and attitudes framework.
Method: A single-group, pretest-posttest design was used for this project. Data were collected from attendees who were in mental health, health care, and administrative staff roles.
Results: Forty-seven participants were included in the analysis. Statistically significant gains in knowledge, skills, and attitudes following the in-service were noted. Qualitative data provided suggestions for future improvements.
Conclusion: Most participants found that the training program was useful and relevant to their practice settings, but more advanced programs are needed for some professionals. Educational programs and training for trauma-informed care addressing these needs should be developed and evaluated in the future.

The association between involuntary memory and emotional adjustment after childbirth.

Briddon, E., Isaac, C., & Slade, P.

Objectives: A woman’s memory of her experience of giving birth can strongly influence her mental health, and the development of her relationship with her infant, in a positive or negative direction. Highly distressing, involuntary memories of the birth may indicate symptoms of post-traumatic stress (PTS), which is increasingly recognized as a possible outcome of childbirth. Involuntary memories are not, however, exclusive to trauma and can also be experienced after positive events. This study sought to investigate involuntary memories for childbirth, as this is an event that is known to be potentially experienced both as highly positive and negative, and associated with a range of emotional outcomes, including greater well-being and symptoms of PTS. Methods: A total of 122 women completed a measure of their emotional experience of giving birth within 3 days of the event, and 65 of these women responded to a postal follow-up at 6 weeks, with measures of involuntary memory experience, PTS symptoms and well-being. Results: Experiencing pleasant involuntary memories was more common than experiencing unpleasant involuntary memories of the birth. The frequency of these memories and how they were experienced as either distressing or enjoyable was associated with post-partum emotional adjustment, demonstrated by the development of PTS symptoms or greater well-being.Conclusions: These results are important because to date, little research has examined the development of positive involuntary memories and their association with positive emotional adjustment. Statement of contribution What is already known on this subject? Positive and negative emotional experiences can coexist in childbirth. Involuntary memories after negative events can be associated with post-traumatic stress. Involuntary memories can also occur after strongly positive events. What does this study add? Women can experience both positive and negative involuntary memories after childbirth. Involuntary negative memories mediate the link between birth experience and post-traumatic stress. Positive involuntary memories are associated with greater well-being in the post-partum. Transformation of negatively experienced events into positively experienced involuntary memories may facilitate adjustment after childbirth.

4 Responses

  1. Elizabeth Skinner at |

    Here attached is the abstract and link to an article by Elizabeth Skinner, midwife Sydney Australia co authored with Professor Hans Peter Dietz urogynaecologist, Sydney Australia re a literature review on psychological and physical consequences of vaginal birth trauma.
    Additionally, I was also interviewed for this article in Sydney Morning Herald, October 16 2015.
    This literature review seeks to examine current knowledge of birth trauma associated with major pelvic floor dysfunction by interpreting and critically appraising existing published material. A search of the literature for peer reviewed journal articles was conducted between September and December 2013 of the following databases: PubMed; Wiley Online; MEDLINE; OvidSP; ScienceDirect; MD Consult Australia; Biomed Central; Sage; Cochrane Database of Systematic Reviews. Unpublished interviews from mothers who attended two tertiary teaching hospitals in Sydney, Australia and international Internet blogs/websites were also utilised. Maternal birth trauma seems to be a common cause of pelvic floor dysfunction. Women who have sustained birth trauma to the levator ani muscle or the anal sphincters are often injured more seriously than generally believed. There often is a substantial latency between trauma and the manifestation of symptoms. Urinary and faecal incontinence, prolapse and sexual dysfunction are commonly seen as too embarrassing to discuss with clinicians, and frequently, new mothers have inaccurate recollections of obstetric procedures that occurred without much explanation or explicit consent. Moreover, somatic trauma may contribute to psychological trauma and post-traumatic stress disorder. The link between somatic and psychological trauma is poorly understood.

    Key words: avulsion, birth trauma, levator ani, pelvic floor injury, post-traumatic stress disorder.
    Warm regards
    Elizabeth Skinner

    Midwife Sydney Australia
    PhD candidate Sydney Medical School
    The University of Sydney

  2. Rebecca Webb at |

    Hi Elizabeth,

    Thank you for this, I will post it in our next update 🙂

    Best wishes,


  3. Elizabeth Skinner at |

    Hi Becca
    Thank you for that – your interest in this important research is greatly appreciated.
    I probably should have also included my published qualitative study abstract re 40 injured women that was presented at Montreal International Continence Society (ICS) on 7 October 2015.
    Title: Psychological Consequences of Traumatic Vaginal Birth.
    Here is the link:
    Look forward to more communication as my thesis unfolds.
    Warm regards
    Elizabeth Skinner
    PhD Candidate
    Sydney University Medical School
    Sydney Australia

  4. Elizabeth Skinner at |

    Hi Becca
    Just including the details of the full article for ANZJOG.

    Skinner EM & Dietz HP. Psychological and somatic sequelae of traumatic vaginal delivery: A literature review. Australian and New Zealand Journal of Obstetrics and Gynaecology 2015; 55: 309–314

    If you would like this article I can send it.
    Warm regards


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