July Research Update

Women’s experience of maternal morbidity: a qualitative analysis.

Meaney, S.; Lutomski, J. E.; O’Connor, L.; O’Donoghue, K.; Greene, R. A.

BMC Pregnancy & Childbirth, 7/25/2016; 16: 1-6. (6p)


Background: Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women’s experiences of maternal morbidity. Methods: A qualitative semi-structured interview format was utilized. Purposive sampling was used to recruit 14 women with a maternal morbidity before, during or after birth; nine women were diagnosed with one morbidity including hypertensive disorders, haemorrhage, placenta praevia and gestational diabetes whereas five women were diagnosed with two or more morbidities. Thematic analysis was employed as the analytic strategy. Results: Four superordinate themes were identified: powerlessness, morbidity management, morbidity treatment and socio-behavioural responses to morbidities. Women were accepting of the uncontrollable nature of the adverse outcome experienced. While being treated for trauma, women were satisfied to relinquish their autonomy to ensure the safety of themselves and their babies. However, these events were debilitating. Women’s inability to control their own bodies, as a result of the morbidity, contributed to high levels of frustration and anxiety. Morbidities impacted greatly on women’s quality of life and sometimes these effects persisted for a prolonged period after delivery. Women felt that they were provided very little information on the practicalities of living with their condition; many were uncertain how to manage their morbidities in the home setting. Conclusion: Healthcare providers should ensure that women who experience a maternal morbidity are fully debriefed and have sufficient information on the morbidity including ongoing care and expectations prior to discharge.


Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.

Leinweber J; Creedy DK; Rowe H; Gamble J

Women And Birth: Journal Of The Australian College Of Midwives 2016 Jul 14.


Background: Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. Aim: To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress. Methods: Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms. Findings: More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR=3.89, 95% CI [2.71, 5.59]) and guilt (OR=1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma. Discussion: Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder. Conclusion: Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced.


Prediction of posttraumatic stress disorder symptomatology after childbirth – A Croatian longitudinal study.

Srkalović Imširagić A; Begić D; Šimičević L; Bajić Ž

Women And Birth: Journal Of The Australian College Of Midwives 2016 Jul 12. Date of Electronic Publication: 2016 Jul 12.


Background: Following childbirth, a vast number of women experience some degree of mood swings, while some experience symptoms of postpartum posttraumatic stress disorder. Aim: Using a biopsychosocial model, the primary aim of this study was to identify predictors of posttraumatic stress disorder and its symptomatology following childbirth. Methods: This observational, longitudinal study included 372 postpartum women. In order to explore biopsychosocial predictors, participants completed several questionnaires 3-5 days after childbirth: the Impact of Events Scale Revised, the Big Five Inventory, The Edinburgh Postnatal Depression Scale, breastfeeding practice and social and demographic factors. Six to nine weeks after childbirth, participants re-completed the questionnaires regarding psychiatric symptomatology and breastfeeding practice. Findings: Using a multivariate level of analysis, the predictors that increased the likelihood of postpartum posttraumatic stress disorder symptomatology at the first study phase were: emergency caesarean section (odds ratio 2.48; confidence interval 1.13-5.43) and neuroticism personality trait (odds ratio 1.12; confidence interval 1.05-1.20). The predictor that increased the likelihood of posttraumatic stress disorder symptomatology at the second study phase was the baseline Impact of Events Scale Revised score (odds ratio 12.55; confidence interval 4.06-38.81). Predictors that decreased the likelihood of symptomatology at the second study phase were life in a nuclear family (odds ratio 0.27; confidence interval 0.09-0.77) and life in a city (odds ratio 0.29; confidence interval 0.09-0.94). Conclusion: Biopsychosocial theory is applicable to postpartum psychiatric disorders. In addition to screening for depression amongst postpartum women, there is a need to include other postpartum psychiatric symptomatology screenings in routine practice.


Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial

Nieminen, Katri; Berg, Ida; Frankenstein, Katri; Viita, Lina; Larsson, Kamilla; Persson, Ulrika; Spånberger, Loviisa; Wretman, Anna; Silfvernagel, Kristin; Andersson, Gerhard; Wijma, Klaas

Cognitive Behaviour Therapy; July 2016, Vol. 45 Issue: Number 4 p287-306, 20p


The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.



Muzik M; Bocknek E; Morelen D;Rosenblum KL; Liberzon I; Seng J; Abelson JL;

Depression And Anxiety 2016 Jul; Vol. 33 (7), pp. 584-91.


Background: Little is known about trajectories of PTSD symptoms across the peripartum period in women with trauma histories, specifically those who met lifetime PTSD diagnoses prior to pregnancy. The present study seeks to identify factors that influence PTSD symptom load across pregnancy and early postpartum, and study its impact on postpartum adaptation. Method: The current study is a secondary analysis on pregnant women with a Lifetime PTSD diagnosis (N = 319) derived from a larger community sample who were interviewed twice across pregnancy (28 and 35 weeks) and again at 6 weeks postpartum, assessing socioeconomic risks, mental health, past and ongoing trauma exposure, and adaptation to postpartum. Results: Using trajectory analysis, first we examined the natural course of PTSD symptoms based on patterns across peripartum, and found four distinct trajectory groups. Second, we explored factors (demographic, historical, and gestational) that shape the PTSD symptom trajectories, and examined the impact of trajectory membership on maternal postpartum adaptation. We found that child abuse history, demographic risk, and lifetime PTSD symptom count increased pregnancy-onset PTSD risk, whereas gestational PTSD symptom trajectory was best predicted by interim trauma and labor anxiety. Women with the greatest PTSD symptom rise during pregnancy were most likely to suffer postpartum depression and reported greatest bonding impairment with their infants at 6 weeks postpartum. Conclusions: Screening for modifiable risks (interpersonal trauma exposure and labor anxiety) and /or PTSD symptom load during pregnancy appears critical to promote maternal wellbeing.


Blame and guilt – a mixed methods study of obstetricians’ and midwives’ experiences and existential considerations after involvement in traumatic childbirth.

Schrøder, Katja; Jørgensen, Jan S; Lamont, Ronald F.; Hvidt, Niels C.; Schrøder, Katja; Jørgensen, Jan S

Acta Obstetricia et Gynecologica Scandinavica. Jul2016, Vol. 95 Issue 7, p735-745.


Introduction: When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns. Material and Methods: A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants. Results: The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about the meaning of life. Sixty-five percent felt that they had become a better midwife or doctor due to the traumatic incident. Conclusions: The results of this large, exploratory study suggest that obstetricians and midwives struggle with issues of blame, guilt and existential concerns in the aftermath of a traumatic childbirth.


When childbirth becomes a tragedy: What is the role of hospital organization?

Cipolletta S

Journal Of Health Psychology 2016 Jul 24.


In this autoethnographic study, I analyse my birthing event, in order to point out some relevant cultural aspects of the experience. I explore the role of expectations, childbirth place, medicalization and relationships with healthcare professionals and partner. My experience and the analysis of the context where childbirth takes place leads to the conclusion that hospital organization is central to women’s experiences of giving birth, but the hospital culture is still too centred on the security that medical interventions guarantee, relegating people to a passive position. Health services should address personal agency, in order to guarantee more respectful childbirth care.


Please Don’t Use the Restraints.

Rowe, Desireé D.

Qualitative Inquiry. Jul2016, Vol. 22 Issue 6, p484-489. 6p.


The end of the story is all you care about. So, let’s get that out of the way first. Penelope Jane was born on March 23rd. She was healthy. The trauma of that day still resonates within my body, called into being through subsequent visits to the hospital and a review of my own medical records from that day. A life-threatening fever and 9 hours of pushing led to a powerfully negative birth experience, one that I am consistently told to just forget. After she had a weeklong stay in the neonatal intensive care unit (NICU), I have a healthy daughter. In this article, I use auto/archeology as a tool to examine my own medical records and the affective traces of my experience in the hospital to call into question Halberstam’s advocacy of forgetting as queer resistance to dominant cultural logics. While Halberstam explains that “forgetting allows for a release from the weight of the past and the menace of the future” I hold tightly to my memories of that day. This article marks the disconnects between an advocacy of forgetting and my own failure of childbirth and offers a new perspective that embraces the queer potentiality of remembering trauma.



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