Research Update – October & November 2019

 2019 Nov 27. doi: 10.1007/s00737-019-01011-0. [Epub ahead of print]

Posttraumatic stress symptoms following childbirth: associations with prenatal attachment in subsequent pregnancies.

Garthus-Niegel S1,2Horsch A3,4von Soest T5Haga SM6Drozd F6Ayers S7Eberhard-Gran M6,8,9.


This longitudinal population-based study aimed to investigate the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy. Data were derived from the Norwegian Akershus Birth Cohort (ABC), a large population-based prospective cohort study. Data from 1473 women who had given birth at least once before and who had completed questionnaires at 17 and 32 weeks of gestation were included. Confirmatory factor analysis of the short version of the Prenatal Attachment Inventory was conducted to validate the scale. Further, structural equation modeling techniques were used to estimate prospective associations of PTSD symptoms following childbirth with prenatal attachment. Finally, to explore potential mechanisms of the association, mediation and moderation analyses were conducted. PTSD symptoms following previous childbirth were found to be prospectively related to higher levels of prenatal attachment in the subsequent pregnancy, while controlling for important confounding factors, such as symptoms of maternal depression and anxiety, previous pregnancy loss, and sociodemographic factors (maternal age, educational level, marital status, and number of children). When fear of childbirth was included as a potential mediating variable, the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy increased, thereby indicating a suppressor effect. Fear of childbirth did not act as a significant moderator. Our findings suggest that a subsequent pregnancy following a traumatic childbirth may for some women represent an opportunity for a higher level of prenatal attachment, whereas high levels of fear of childbirth may be detrimental for prenatal attachment.

KEYWORDS: Akershus Birth Cohort; Fear of childbirth; PTSD following childbirth; Posttraumatic stress disorder; Prenatal attachment


 2019 Nov 4. pii: S0165-0327(19)31277-7. doi: 10.1016/j.jad.2019.11.006. [Epub ahead of print]

Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery.


BACKGROUND: Low- and middle-income countries bear a disproportionate burden of preterm birth (PTB) and low infant birth weight (LBW) complications where affective and anxiety disorders are more common in the antepartum period than in industrialized countries.

OBJECTIVE: To evaluate the extent to which early pregnancy antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) are associated with infant birth weight and gestational age at delivery among a cohort of pregnant women in Peru.

METHODS: Our prospective cohort study consisted of 4408 pregnant women. Antepartum depression, generalized anxiety, and PTSD were assessed in early pregnancy using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist – Civilian Version, respectively. Pregnancy outcome data were obtained from medical records. Multivariable linear and logistic regression procedures were used to estimate adjusted measures of association (β coefficients and odds ratios) and 95% confidence intervals (CI).

RESULTS: After adjusting for confounders, women with antepartum generalized anxiety (32.6% prevalence) had higher odds of LBW (adjusted odds ratio (OR)=1.47; 95%CI: 1.10-1.95) and were more likely to deliver small for gestational age (OR = 1.39; 95%CI: 1.01-1.92) infants compared to those without anxiety. Compared to those without PTSD, women with PTSD (34.5%) had higher odds of delivering preterm (OR = 1.28; 95%CI: 1.00-1.65) yet PTSD was not associated with LBW nor gestational age at delivery. Women with antepartum depression (26.2%) were at no increased risk of delivering a preterm, low-birth-weight or small-for-gestational-age infant.

LIMITATIONS: Our ability to make casual inferences from this observational study is limited; however, these findings are consistent with prior studies.

CONCLUSION: Generalized anxiety disorder during pregnancy appeared to increase odds of delivering a low-birth-weight or small-for-gestational-age infant, while PTSD was associated with increased odds of delivering preterm. Our findings, and those of others, suggest antenatal care should be tailored to screen for and provide additional mental health services to patients.

KEYWORDS: Anxiety; Birth weight; Depression; Posttraumatic stress disorder; Pregnancy; Preterm delivery


 2019 Oct 27. doi: 10.1111/scs.12786. [Epub ahead of print]

Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman’s perspective.


OBJECTIVE: To explore women’s traumatic childbirth experiences in order to make maternity care professionals more aware of women’s intrapartum care needs.

METHOD: A qualitative exploratory study with a constant comparison/grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting.

FINDINGS: Three themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: (i) lack of information and consent – maternity care professionals’ unilateral decision making during intrapartum care, lacking informed-consent. (ii) feeling excluded – women’s mal-adaptive response to the healthcare professionals’s one-sided decision making, leaving women feeling distant and estranged from the childbirth event and the experience. (iii) discrepancies – inconsistency between women’s expectations and the reality of labour and birth – on an intrapersonal level.

CONCLUSION: Women’s intrapartum care needs cohere with the concept of woman-centred care, including personalised care and reflecting humanising values. Care should include informed consent and shared decision-making. Maternity care professionals need to continuously evaluate whether the woman is consistently part of her own childbearing process. Maternity care professionals should maintain an ongoing dialogue with the woman, including women’s internalised ideas of birth.

KEYWORDS: intrapartum care; maternity care; midwives; qualitative research; traumatic birth experience


 2019 Oct 25. doi: 10.1007/s00737-019-01006-x. [Epub ahead of print]

Beyond postpartum depression: posttraumatic stress-depressive response following childbirth.

Dekel S1,2Ein-Dor T3Dishy GA4Mayopoulos PA4.


Although depression following childbirth is well recognized, much less is known about comorbid postpartum psychiatric conditions. Some women can endorse posttraumatic stress related to the childbirth experience accompanied by symptoms of depression. The objective of our study was to examine the nature of the comorbidity of symptoms of childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression. We studied a sample of 685 women who were on average 3 months following childbirth and collected data about their mental health pertaining to PTSD, depression, general distress, and childbirth experience. The vast majority of women with elevated childbirth-related PTSD symptoms also endorsed elevated postpartum depression symptoms. Factor analysis revealed that symptoms of childbirth-related PTSD and postpartum depression loaded onto one single factor rather than two factors. Stepwise multi-nominal regression analysis revealed that childbirth stressors, including obstetric complications and peritraumatic distress in birth, predicted the likelihood of developing comorbid childbirth-related PTSD and postpartum depression, but not depression alone. The findings suggest that beyond postpartum depression, postpartum women suffer from a posttraumatic stress-depressive response in the wake of a traumatic childbirth experience. Increasing awareness in routine postpartum care about traumatic childbirth and its associated emotional sequela is warranted.

KEYWORDS: Factor analysis; PTSD; Postpartum depression; Posttraumatic stress; Traumatic childbirth


 2019 Oct 9;6:147. doi: 10.3389/fcvm.2019.00147. eCollection 2019.

Depression, Anxiety, and Post-traumatic Stress Disorder Following a Hypertensive Disorder of Pregnancy: A Narrative Literature Review.

Roberts L1,2,3Davis GK1,2,3Homer CSE2,4.


Introduction: Pregnancy and childbirth can be a source of anxiety and worry for women. This is probably more so for women with a complicated pregnancy. Anxiety and worry may contribute to, or exacerbate, mental health disorders including depression and post-traumatic stress disorder (PTSD). Mental health is an integral part of health and well-being and poor mental health can be detrimental to the woman’s welfare and her infant’s behavior and cognitive development. It may be undetected, potentially leading to a burden on the woman, her family, the health system, and society. Women with complicated pregnancies, such as those with hypertensive disorders of pregnancy (HDP), may be at greater risk of poor mental health. The aim of this review was to examine whether there is an association between depression, anxiety, and PTSD in postpartum women with a history of HDP. Methods: A narrative literature review was undertaken. Using the key search terms: preeclampsia, gestational hypertension, hypertensive disorders, pregnancy complications, depression, anxiety, and post-traumatic stress disorder; electronic databases were searched to determine what is known about depression, anxiety, and PTSD after HDP. Results: In total, 17 publications were included. The relationship between HDP and depression, anxiety, and PTSD was variable between studies and inconsistent. Although some studies reported no significant association, there is a trend for increased prevalence and symptom severity of depression, anxiety, and PTSD following HDP. This trend was particularly evident following the more severe presentations of HDP. It was uncertain whether this association was due to the hypertensive disorder itself, the sequelae of the HDP, such as giving birth to a preterm baby, or it predated the pregnancy. Conclusions: Women who experience HDP may be at increased risk of developing postpartum depression, anxiety, and PTSD. Awareness of, and screening for, these mental health disorders in the postpartum period will alert clinicians to the need for additional follow-up and referral for women following HDP. More research on the benefits and risks of such an approach is needed.


 2019 Oct;13(4):270-276. doi: 10.1016/j.anr.2019.10.002. Epub 2019 Oct 9.

Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study.


PURPOSE: As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives.

METHODS: A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi’s method was used to analyze the contents of the interviews.

RESULTS: We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother’s expectations).

CONCLUSION: Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.


 2019 Nov/Dec;44(6):338-344. doi: 10.1097/NMC.0000000000000565.

Mothers’ Experiences Interacting with Infants after Traumatic Childbirth.


PURPOSE: The purpose of this study is to describe experiences of mothers interacting with their infants after traumatic childbirth.

STUDY DESIGN AND METHODS: A descriptive phenomenological method guided by Dahlberg, Dahlberg, and Nystrom’s reflective lifeworld research was used. Women were recruited through Trauma and Birth Stress (TABS), a charitable trust in New Zealand, whose mission is to provide support for women who have experienced traumatic childbirth. Data were collected via an electronic survey. Women were asked to describe how their traumatic births affected their caring for and interactions with their infants and any other children they may have.

RESULTS: Eighteen women representing six countries across the globe participated. Four constituents of mothers’ experiences interacting with their infants after traumatic births were identified: feelings of numbness and detachment, crying and anger, distressing cognitive changes, and limited outside social interactions.

CLINICAL IMPLICATIONS: To help women struggling with the aftermath of their traumatic birth, nurses first need to identify them. Clinicians need to be attentive to symptoms such as a withdrawn, dazed look, and appearing distanced from their infants. Prior to hospital discharge after childbirth, women should be given opportunities to share their perceptions of their birth to determine if they view it as traumatic. Interventions should be started as soon as possible in this fragile mother-infant dyad to prevent long-term consequences.


 2019 Oct;55(7):1173-1178. doi: 10.1007/s10597-019-00424-6. Epub 2019 Jun 8.

Effect of Brief Cognitive Behavioral Counseling and Debriefing on the Prevention of Post-traumatic Stress Disorder in Traumatic Birth: A Randomized Clinical Trial.


OBJECTIVE: Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth.

METHODS: In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4-6 weeks and 3 months after delivery.

RESULTS: Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms.

CONCLUSION: Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended.


KEYWORDS: Brief cognitive behavioral counseling; Debriefing; PTSD; Traumatic birth

Leave a Reply

Skip to toolbar