February to June Research Update

Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia.

Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, Phibbs CS.

Paediatr Perinat Epidemiol. 2017 May;31(3):185-194. doi: 10.1111/ppe.12349. Epub 2017 Mar 22.

Abstract

BACKGROUND:

Prior work shows that Post-traumatic Stress Disorder (PTSD) predicts an increased risk of preterm birth, but the causal pathway(s) are uncertain. We evaluate the associations between PTSD and antepartum complications to explore how PTSD’s pathophysiology impacts pregnancy.

METHODS:

This retrospective cohort analysis of all Veterans Health Administration (VA)-covered deliveries from 2000-12 used the data of VA clinical and administration. Mothers with current PTSD were identified using the ICD-9 diagnostic codes (i.e. code present during the antepartum year), as were those with historical PTSD. Medical and administrative data were used to identify the relevant obstetric diagnoses, demographics and health, and military deployment history. We used Poisson regression with robust error variance to derive the adjusted relative risk estimates (RR) for the association of PTSD with five clinically relevant antepartum complications [gestational diabetes (GDM), preeclampsia, gestational hypertension, growth restriction, and abruption]. Secondary outcomes included proxies for obstetric complexity (repeat hospitalisation, prolonged delivery hospitalisation, and caesarean delivery).

RESULTS:

Of the 15 986 singleton deliveries, 2977 (19%) were in mothers with PTSD diagnoses (1880 (12%) current PTSD). Mothers with the complication GDM were 4.9% and those with preeclampsia were 4.6% of all births. After adjustment, a current PTSD diagnosis (reference = no PTSD) was associated with an increased risk of GDM (RR 1.4, 95% confidence interval (CI) 1.2, 1.7) and preeclampsia (RR 1.3, 95% CI 1.1, 1.6). PTSD also predicted prolonged (>4 day) delivery hospitalisation (RR 1.2, 95% CI 1.01, 1.4), and repeat hospitalisations (RR 1.4, 95% CI 1.2, 1.6), but not caesarean delivery.

CONCLUSIONS:

The observed association of PTSD with GDM and preeclampsia is consistent with our nascent understanding of PTSD as a disruptor of neuroendocrine and cardiovascular health.

https://www.ncbi.nlm.nih.gov/pubmed/28328031

Post-traumatic stress disorder in the perinatal period: A concept analysis.

Vignato J, Georges JM, Bush RA, Connelly CD.

J Clin Nurs. 2017 Mar 15. doi: 10.1111/jocn.13800.

Abstract

AIMS AND OBJECTIVES:

To report an analysis of the concept of perinatal post-traumatic stress disorder.

BACKGROUND:

Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs.

DESIGN:

Concept analysis via Walker and Avant’s approach.

METHODS:

The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumaticstress disorder.

RESULTS:

Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumaticstress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma(perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes.

CONCLUSIONS:

Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder.

RELEVANCE TO CLINICAL PRACTICE:

Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/28295746

Maternal mind-mindedness as a linking mechanism between childbirth-related posttraumatic stress symptoms and parenting stress.

Camisasca E, Procaccia R, Miragoli S, Valtolina GG, Di Blasio P.

Health Care Women Int. 2017 Jun;38(6):593-612. doi: 10.1080/07399332.2017.1296840. Epub 2017 Feb 19.

Abstract

The researchers of this study have two aims. The first aim is to verify whether posttraumatic stress (PTS) symptoms, evaluated at 87 hours and at 3 months postpartum, are associated with maternal mind-mindedness (MM) and parenting stress, measured at 17 months postpartum. The second aim is to investigate, at 17 months, the predictive effects of PTS symptoms on the dimensions of parenting stress and to explore whether MM mediates these associations. Forty-one mother-infant dyads participated in the study. The results show that at 17 months, hyper-arousal symptoms predicted both MM and parenting stress. MM was a linking mechanism between maternal PTS symptoms and parenting stress.

https://www.ncbi.nlm.nih.gov/pubmed/28278020

“Nothing’s actually happened to me.”: the experiences of fathers who found childbirth traumatic.

Etheridge J, Slade P.

BMC Pregnancy Childbirth. 2017 Mar 7;17(1):80. doi: 10.1186/s12884-017-1259-y.

Abstract

BACKGROUND:

Given the limited research into men’s experiences of being present at childbirth this study explored the experiences of fathers who found childbirth traumatic. The aim of the research was to investigate how men coped with these experiences; the impact on their lives; and their views on what may have helped to reduce distress.

METHODS:

Participants were recruited via websites relating to birth trauma and parenthood. A consent and screening questionnaire was used to ensure that participants met the inclusion criteria of: being resident in the UK; being 16 years or older; having been present at the birth and answering yes to the question “At some point during the childbirth I experienced feelings of intense fear, helplessness or horror”. Semi-structured telephone interviews were completed with 11 fathers who reported finding childbirth traumatic. Participants also completed the Impact of Event Scale as a measure of trauma symptoms. Template Analysis was used to analyse the interview data.

RESULTS:

Childbirth was experienced as “a rollercoaster of emotion” because of the speed and unexpectedness of events. Men described fears of death, mirroring their partner’s distress; trying ‘to keep it together’ and helplessly watching a catastrophe unfold. Fathers felt themselves abandoned by staff with a lack of information. Men were subsequently distressed and preoccupied with the birth events but tended to feel that their responses were unjustified and tried to cope through avoidance. Men described the need for support but reluctance to receive it.

CONCLUSIONS:

Fathers may experience extreme distress as a result of childbirth which is exacerbated by aspects of current maternity care. Maternity services need to be aware of the potential impacts of fathers’ attendance at childbirth and attend to fathers’, as well as mothers’, emotional responses.

https://www.ncbi.nlm.nih.gov/pubmed/28270116

Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trauma-Exposed Mothers.

Wilson CK, Padrón E, Samuelson KW.

Violence Vict. 2017 Feb 1;32(1):141-158. doi: 10.1891/0886-6708.VV-D-13-00077

Abstract

Trauma exposure is associated with various parenting difficulties, but few studies have examined relationships between trauma, posttraumatic stress disorder (PTSD), and parenting stress. Parenting stress is an important facet of parenting and mediates the relationship between parental trauma exposure and negative child outcomes (Owen, Thompson, & Kaslow, 2006). We examined trauma type (child maltreatment, intimate partner violence, community violence, and non-interpersonal traumas) and PTSD symptoms as predictors of parenting stress in a sample of 52 trauma-exposed mothers. Community violence exposure and PTSD symptom severity accounted for significant variance in parenting stress. Further analyses revealed that emotional numbing was the only PTSD symptom cluster accounting for variance in parenting stress scores. Results highlight the importance of addressing community violence exposure and emotion regulation difficulties with trauma-exposed mothers.

https://www.ncbi.nlm.nih.gov/pubmed/28234203

Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

Aftyka A, Rybojad B, Rosa W, Wróbel A, Karakuła-Juchnowicz H.

J Clin Nurs. 2017 Feb 23. doi: 10.1111/jocn.13773. [Epub ahead of print]

Abstract

AIMS AND OBJECTIVES:

The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

BACKGROUND:

The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder.

DESIGN:

An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12 months who were hospitalised in the neonatal intensive care unit during the neonatal period.

SETTING:

Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire.

RESULTS:

The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p = .020) and presented a higher severity of post-traumatic stress disorder (p < .001). Previous miscarriages (p = .023) and the presence of chronic diseases (p = .032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1 min after birth (p = .030) and a partner’s post-traumatic stress disorder (p = .038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1 min after birth, a lack of congenital anomalies in the child and mental disengagement.

CONCLUSION:

Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men.

RELEVANCE TO CLINICAL PRACTICE:

Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.

https://www.ncbi.nlm.nih.gov/pubmed/28231614

Maternal Interpersonal Trauma and Child Social-Emotional Development: An Intergenerational Effect.

Folger AT, Putnam KT, Putnam FW, Peugh JL, Eismann EA, Sa T, Shapiro RA, Van Ginkel JB, Ammerman RT.

Paediatr Perinat Epidemiol. 2017 Mar;31(2):99-107. doi: 10.1111/ppe.12341. Epub 2017 Jan 31.

 Abstract

BACKGROUND:

Evidence suggests that maternal interpersonal trauma can adversely affect offspring health, but little is known about potential transmission pathways. We investigated whether interpersonal trauma exposure had direct and indirect associations with offspring social-emotional development at 12-months of age in an at-risk, home visited population.

METHODS:

A retrospective cohort study was conducted of 1172 mother-child dyads who participated in a multi-site, early childhood home visiting program. Children were born January 2007 to June 2010 and data were collected at enrolment (prenatal/birth) through 12-months of age. Multivariable path analyses were used to examine the relationship between maternal interpersonal trauma, subsequent psychosocial mediators (maternal depressive symptoms, social support, and home environment), and the outcome of child social-emotional development measured with the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE). Maternal interpersonal trauma was characterized as any previous exposure, the level of exposure, and type (e.g. abuse) of exposure.

RESULTS:

The prevalence of maternal interpersonal trauma exposure was 69.1%, and exposures ranged from 1 type (19.3%) to 7 types (2.3%). Interpersonal trauma was associated with a 3.6 point (95% confidence interval 1.8, 5.4) higher ASQ:SE score among offspring and indicated greater developmental risk. An estimated 23.4% of the total effect was mediated by increased maternal depressive symptoms and lower social support. Differential effects were observed by the level and type of interpersonal trauma exposure.

CONCLUSION:

Maternal interpersonal trauma exposures can negatively impact child social-emotional development, acting in part through maternal psychosocial factors. Future research is needed to further elucidate the mechanisms of intergenerational risk.

https://www.ncbi.nlm.nih.gov/pubmed/28140478

Testing a cognitive model to predict posttraumatic stress disorder following childbirth.

King L, McKenzie-McHarg K, Horsch A.

BMC Pregnancy Childbirth. 2017 Jan 14;17(1):32. doi: 10.1186/s12884-016-1194-3.

Abstract

BACKGROUND:

One third of women describes their childbirth as traumatic and between 0.8 and 6.9% goes on to develop posttraumatic stress disorder (PTSD). The cognitive model of PTSD has been shown to be applicable to a range of trauma samples. However, childbirth is qualitatively different to other trauma types and special consideration needs to be taken when applying it to this population. Previous studies have investigated some cognitive variables in isolation but no study has so far looked at all the key processes described in the cognitive model. This study therefore aimed to investigate whether theoretically-derived variables of the cognitive model explain unique variance in postnatal PTSD symptoms when key demographic, obstetric and clinical risk factors are controlled for.

METHOD:

One-hundred and fifty-seven women who were between 1 and 12 months post-partum (M = 6.5 months) completed validated questionnaires assessing PTSD and depressive symptoms, childbirth experience, postnatal social support, trauma memory, peritraumatic processing, negative appraisals, dysfunctional cognitive and behavioural strategies and obstetric as well as demographic risk factors in an online survey.

RESULTS:

A PTSD screening questionnaire suggested that 5.7% of the sample might fulfil diagnostic criteria for PTSD. Overall, risk factors alone predicted 43% of variance in PTSD symptoms and cognitive behavioural factors alone predicted 72.7%. A final model including both risk factors and cognitive behavioural factors explained 73.7% of the variance in PTSD symptoms, 37.1% of which was unique variance predicted by cognitive factors.

CONCLUSIONS:

All variables derived from Ehlers and Clark’s cognitive model significantly explained variance in PTSD symptoms following childbirth, even when clinical, demographic and obstetric were controlled for. Our findings suggest that the CBT model is applicable and useful as a way of understanding and informing the treatment of PTSD following childbirth.

https://www.ncbi.nlm.nih.gov/pubmed/28088194

Childhood sexual abuse, intimate partner violence during pregnancy, and post traumatic stress symptoms following childbirth: a path analysis.

Oliveira AG, Reichenheim ME, Moraes CL, Howard LM, Lobato G.

Arch Womens Ment Health. 2017 Apr;20(2):297-309. doi: 10.1007/s00737-016-0705-6. Epub 2016 Dec 28.

Abstract

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSDsymptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

https://www.ncbi.nlm.nih.gov/pubmed/28032212

Posttraumatic stress and depression may undermine abuse survivors’ self-efficacy in the obstetric care setting.

Stevens NR, Tirone V, Lillis TA, Holmgreen L, Chen-McCracken A, Hobfoll SE.

J Psychosom Obstet Gynaecol. 2017 Jun;38(2):103-110. doi: 10.1080/0167482X.2016.1266480. Epub 2016 Dec 14.

Abstract

INTRODUCTION:

Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women’s actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors’ sense of self-efficacy when communicating their obstetric care needs.

METHODS:

Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit.

RESULTS:

The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences.

DISCUSSION:

Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.

https://www.ncbi.nlm.nih.gov/pubmed/27960615

A socioecological model of posttraumatic stress among Australian midwives.

Leinweber J, Creedy DK, Rowe H, Gamble J.

Midwifery. 2017 Feb;45:7-13. doi: 10.1016/j.midw.2016.12.001. Epub 2016 Dec 6.

Abstract

OBJECTIVE:

to develop a comprehensive model of personal, trauma event-related and workplace-related risk factors for posttraumatic stresssubsequent to witnessing birth trauma among Australian midwives.

DESIGN:

a descriptive, cross-sectional design was used.

PARTICIPANTS:

members of the Australian College of Midwives were invited to complete an online survey.

MEASUREMENTS:

the survey included items about witnessing a traumatic birth event and previous experiences of life trauma. Traumasymptoms were assessed with the Posttraumatic Stress Disorder Symptom Scale Self-Report measure. Empathy was assessed with the Interpersonal Reactivity Index. Decision authority and psychological demand in the workplace were measured with the Job Content Questionnaire. Variables that showed a significant univariate association with probable posttraumatic stress disorder were entered into a multivariate logistic regression model.

FINDINGS:

601 completed survey responses were analysed. The multivariable model was statistically significant and explained 27.7% (Nagelkerke R square) of the variance in posttraumatic stress symptoms and correctly classified 84.1% of cases. Odds ratios indicated that intention to leave the profession, a peritraumatic reaction of horror, peritraumatic feelings of guilt, and a personal traumatic birth experience were strongly associated with probable Posttraumatic Stress Disorder.

CONCLUSIONS:

risk factors for posttraumatic stress following professional exposure to traumatic birth events among midwives are complex and multi-factorial. Posttraumatic stress may contribute to attrition in midwifery. Trauma-informed care and practice may reduce the incidence of traumatic births and subsequent posttraumatic stress reactions in women and midwives providing care

https://www.ncbi.nlm.nih.gov/pubmed/27960122

“Am I too emotional for this job?” An exploration of student midwives’ experiences of coping with traumatic events in the labour ward.

Coldridge L, Davies S.

Midwifery. 2017 Feb;45:1-6. doi: 10.1016/j.midw.2016.11.008. Epub 2016 Nov 28.

Abstract

BACKGROUND:

midwifery is emotionally challenging work, and learning to be a midwife brings its own particular challenges. For the student midwife, clinical placement in a hospital labour ward is especially demanding. In the context of organisational tensions and pressures the experience of supporting women through the unpredictable intensity of the labour process can be a significant source of stress for student midwives. Although increasing attention is now being paid to midwives’ traumatic experiences and wellbeing few researchers have examined the traumatic experiences of student midwives. Such research is necessary to support the women in their care as well as to protect and retain future midwives.

AIM:

this paper develops themes from a research study by Davies and Coldridge (2015) which explored student midwives’ sense of what was traumatic for them during their undergraduate midwifery education and how they were supported with such events. It examines the psychological tensions and anxieties that students face from a psychotherapeutic perspective.

DESIGN:

a qualitative descriptive study using semi-structured interviews.

SETTING:

a midwifery undergraduate programme in one university in the North West of England.

PARTICIPANTS:

11second and third year students.

ANALYSIS:

interviews were analysed using interpretative phenomenological analysis.

FINDINGS:

the study found five themes related to what the students found traumatic. The first theme Wearing the Blues referred to their enculturation within the profession and experiences within practice environments. A second theme No Man’s Land explored students’ role in the existential space between the woman and the qualified midwives. Three further themes described the experiences of engaging with emergency or unforeseen events in practice and how they coped with them (“Get the Red Box!”, The Aftermath and Learning to Cope).This paper re-examines aspects of the themes from a psychotherapeutic perspective.

KEY CONCLUSIONS:

researchers have suggested that midwives’ empathic relationships with women may leave them particularly vulnerable to secondary traumatic stress. For student midwives in the study the close relationships they formed with women, coupled with their diminished control as learners may have amplified their personal vulnerability. The profession as a whole is seen by them as struggling to help them to safely and creatively articulate the emotional freight of the role.

IMPLICATIONS FOR PRACTICE:

for midwifery educators, a focus on the psychological complexities in the midwifery role could assist in giving voice to and normalising the inevitable anxieties and difficulties inherent in the role. Further research could explore whether assisting students to have a psychological language with which to reflect upon this emotionally challenging work may promote safety, resilience and self-care.

https://www.ncbi.nlm.nih.gov/pubmed/27936414

Effect of Previous Posttraumatic Stress in the Perinatal Period.

Geller PA, Stasko EC.

J Obstet Gynecol Neonatal Nurs. 2017 Jun 28. pii: S0884-2175(17)30282-4. doi: 10.1016/j.jogn.2017.04.136. [Epub ahead of print]

Abstract

OBJECTIVE:

To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry.

DATA SOURCES:

Electronic databases CINAHL, PsychINFO, and PubMed were searched. Manual searches of bibliographies supplemented the electronic search.

STUDY SELECTION:

Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included.

DATA EXTRACTION:

Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes.

DATA SYNTHESIS:

Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD.

CONCLUSION:

Women’s health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.

https://www.ncbi.nlm.nih.gov/pubmed/28667832

The Perfect Storm of Trauma: The experiences of women who have experienced birth trauma and subsequently accessed residential parenting services in Australia.

Priddis HS, Keedle H, Dahlen H.

Women Birth. 2017 Jun 27. pii: S1871-5192(17)30061-6. doi: 10.1016/j.wombi.2017.06.007. [Epub ahead of print]

Abstract

BACKGROUND:

There appears to be a chasm between idealised motherhood and reality, and for women who experience birth trauma this can be more extreme and impact on mental health. Australia is unique in providing residential parenting services to support women with parenting needs such as sleep or feeding difficulties. Women who attend residential parenting services have experienced higher rates of intervention in birth and poor perinatal mental health but it is unknown how birth trauma may impact on early parenting.

AIMS AND OBJECTIVES:

This study aims to explore the early parenting experiences of women who have accessed residential parenting services in Australia and consider their birth was traumatic.

METHODS:

In-depth interviews were conducted with eight women across Australia who had experienced birth trauma and accessed residential parenting services in the early parenting period. These interviews were conducted both face to face and over the telephone. The data was analysed using thematic analysis.

FINDINGS:

One overarching theme was identified: “The Perfect Storm of Trauma” which identified that the participants in this study who accessed residential parenting services were more likely to have entered pregnancy with pre-existing vulnerabilities, and experienced a culmination of traumatic events during labour, birth, and in the early parenting period. Four subthemes were identified: “Bringing Baggage to Birth”, “Trauma through a Thousand Cuts”, “Thrown into the Pressure Cooker”, and “Trying to work it all out”.

CONCLUSION:

How women are cared for during their labour, birth and postnatal period impacts on how they manage early parenthood. Support is crucial for women, including practical parenting support, and emotional support by health professionals and peers.

https://www.ncbi.nlm.nih.gov/pubmed/28666701

Factors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study.

Dikmen-Yildiz P, Ayers S, Phillips L.

J Affect Disord. 2017 Jun 21;221:238-245. doi: 10.1016/j.jad.2017.06.049. [Epub ahead of print]

Abstract

BACKGROUND:

Identifying factors that precipitate and maintain post-traumatic stress symptoms (PTSS) after birth is important to inform clinical and research practice; yet, prospective longitudinal studies on the predictors of PTSS are limited. This study aimed to determine the pregnancy and postpartum factors associated with PTSS at 4-6 weeks and 6-months postpartum.

METHOD:

A systematic sample of 950 pregnant women were recruited from three maternity hospitals in Turkey. Participants completed assessments of depression, anxiety, PTSS and social support in pregnancy, 4-6 weeks and 6-months postpartum. Fear of childbirth was assessed in pregnancy and 4-6 weeks after birth.

RESULTS:

Regression models showed that PTSS six months after birth were associated with anxiety and PTSS in pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth 4-6 weeks after birth, PTSS and depression 4-6 weeks after birth, social support 4-6 weeks after birth, traumatic events after birth, need for psychological help, and social support 6-months after birth. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4-6 weeks postpartum. Intra-partum complications were not associated with PTSS 4-6 weeks after birth. No socio-demographic variables were correlated with PTSS postpartum.

LIMITATIONS:

Self-report questionnaires were used to measure outcomes. This study is based on sampling from public hospitals so may not represent women treated in private hospitals.

CONCLUSIONS:

Associated risk factors may help to identify women at risk of PTSS after birth and to inform targeted early intervention.

https://www.ncbi.nlm.nih.gov/pubmed/28654849

The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants.

Diab SY, Isosävi S, Qouta SR, Kuittinen S, Punamäki RL.

Infant Behav Dev. 2017 Jun 12. pii: S0163-6383(16)30179-5. doi: 10.1016/j.infbeh.2017.05.008. [Epub ahead of print]

Abstract

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts.” This study examined whether mothers’ high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants’ stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants’ stressregulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants’ stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.

https://www.ncbi.nlm.nih.gov/pubmed/28619421

Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study.

Lopez U, Meyer M, Loures V, Iselin-Chaves I, Epiney M, Kern C, Haller G.

Health Qual Life Outcomes. 2017 Jun 2;15(1):118. doi: 10.1186/s12955-017-0692-y.

Abstract

BACKGROUND:

Post-traumatic stress disorder (PTSD) occurs in 1-7% of women following childbirth. While having a caesarean section (C-section) is known to be a significant risk factor for postpartum PTSD, it is currently unknown whether coexisting anaesthesia-related factors are also associated to the disorder. The aim of this study was to assess anaesthesia-linked factors in the development of acute postpartumPTSD.

METHODS:

We performed a prospective cohort study on women having a C-section in a tertiary hospital in Switzerland. Patients were followed up six weeks postpartum. Patient and procedure characteristics, past morbidity or traumatic events, psychosocial status and stressful perinatal events were measured. Outcome was divided into two categories: full PTSD disease and PTSD profile. This was based on the number of DSM-IV criteria of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) present. The PTSD Checklist Scale and the Clinician Administered PTSD Scale were used for measurement.

RESULTS:

Of the 280 patients included, 217 (77.5%) answered the questionnaires and 175 (62.5%) answered to an additional phone interview. Twenty (9.2%) had a PTSD profile and six (2.7%) a PTSD. When a full predictive model of risk factors for PTSD profile was built using logistic regression, maternal prepartum and intrapartum complications, anaesthetic complications and dissociative experiences during C-section were found to be the significant predictors for PTSD profile.

CONCLUSION:

This is the first study to show in parturients having a C-section that an anaesthesia complication is an independent risk factor for postpartum PTSD and PTSD profile development, in addition to known perinatal and maternal risk factors.

https://www.ncbi.nlm.nih.gov/pubmed/28577570

Preventing traumatic childbirth experiences: 2192 women’s perceptions and views.

Hollander MH, van Hastenberg E, van Dillen J, van Pampus MG, de Miranda E, Stramrood CAI.

Arch Womens Ment Health. 2017 May 29. doi: 10.1007/s00737-017-0729-6. [Epub ahead of print]

Abstract

The purpose of this study is to explore and quantify perceptions and experiences of women with a traumatic childbirth experience in order to identify areas for prevention and to help midwives and obstetricians improve woman-centered care. A retrospective survey was conducted online among 2192 women with a self-reported traumatic childbirth experience. Women were recruited in March 2016 through social media, including specific parent support groups. They filled out a 35-item questionnaire of which the most important items were (1) self-reported attributions of the trauma and how they believe the traumatic experience could have been prevented (2) by the caregivers or (3) by themselves. The responses most frequently given were (1) Lack and/or loss of control (54.6%), Fear for baby’s health/life (49.9%), and High intensity of pain/physical discomfort (47.4%); (2) Communicate/explain (39.1%), Listen to me (more) (36.9%), and Support me (more/better) emotionally/practically (29.8%); and (3) Nothing (37.0%), Ask for (26.9%), or Refuse (16.5%) certain interventions. Primiparous participants chose High intensity of pain/physical discomfort, Long duration of delivery, and Discrepancy between expectations and reality more often and Fear for own health/life, A bad outcome, and Delivery went too fast less often than multiparous participants. Women attribute their traumaticchildbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.

https://www.ncbi.nlm.nih.gov/pubmed/28553692

Correlation between Kind of Delivery and Posttraumatic Stress Disorder.

Mahmoodi Z, Dolatian M, Shaban Z, Shams J, Alavi-Majd H, Mirabzadeh A.

Ann Med Health Sci Res. 2016 Nov-Dec;6(6):356-361. doi: 10.4103/amhsr.amhsr_397_15.

Abstract

BACKGROUND:

Posttraumatic stress disorder (PTSD) is a very common mental condition and a unique anxiety disorder.

AIM:

The present study tried to examine the correlation between kind of delivery and PTSD.

SUBJECTS AND METHODS:

This prospective study evaluated 240 Iranian female residents of Tehran, Iran, during the third trimester of their pregnancy and 6-8 weeks after labor. Data were collected using the customized screening form, the Symptom Checklist-90, PTSD Symptom Scale (PSS), and Social Support Questionnaire. The collected data were then analyzed with SPSS software.

RESULTS:

According to the participants’ responses to the subscales of the PSS, reexperiencing, avoidance, and hyperarousal symptoms were present in 100, 25, and 77 participants, respectively. Moreover, 15 individuals manifested all three groups of symptoms. Therefore, the prevalence of PTSD in the studied population was 6.2%. The logistic regression analysis revealed PTSD to be 0.06 times more prevalent in women with poor social support after delivery than in those enjoying a desirable level of support (P < 0.01; odds ratio = 0.06). Based onChisquare test results, there was no significant correlation between the kind of delivery and the incidence of PTSD after delivery (P = 0.48).

CONCLUSION:

Since PTSD was more common after cesarean sections (than after vaginal deliveries), health policymakers need to develop efficient strategies to promote vaginal delivery.

https://www.ncbi.nlm.nih.gov/pubmed/28540103

Intergenerational transmission of traumatization: Theoretical framework and implications for prevention.

Lang AJ, Gartstein MA.

J Trauma Dissociation. 2017 May 16:1-14. doi: 10.1080/15299732.2017.1329773. [Epub ahead of print]

Abstract

Intergenerational transmission of traumatization (ITT) occurs when traumatized parents have offspring with increased risk for emotional and behavioral problems. Although fetal exposure to the maternal biological milieu is known to be one factor in ITT, PTSD-driven parent-child interactions represent an additional important and potentially modifiable contributor. The Perinatal Interactional Model of ITT presented herein proposes that PTSD leads to social learning and suboptimal parent-child interactions, which undermine child regulatory capacity and increase distress, largely explaining poor social-emotional outcomes for offspring of parents with PTSD. Psychosocial intervention, particularly when delivered early in pregnancy, holds the possibility of disrupting ITT.

https://www.ncbi.nlm.nih.gov/pubmed/28509617

Validity of the posttraumatic stress disorders (PTSD) checklist in pregnant women.

Gelaye B, Zheng Y, Medina-Mora ME, Rondon M, Sánchez SE, Williams MA.

BMC Psychiatry. 2017 May 12;17(1):179. doi: 10.1186/s12888-017-1304-4.

Abstract

BACKGROUND:

The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women.

METHODS:

A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach’s alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches.

RESULTS:

The reliability of the PCL-C was excellent (Cronbach’s alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09.

CONCLUSION:

The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.

https://www.ncbi.nlm.nih.gov/pubmed/28494804

What about me? The loss of self through the experience of traumatic childbirth.

Byrne V, Egan J, Mac Neela P, Sarma K

Midwifery. 2017 Aug;51:1-11. doi: 10.1016/j.midw.2017.04.017. Epub 2017 May 1.

Abstract

BACKGROUND AND OBJECTIVE:

birth trauma has become an increasingly recognised maternal mental health issue and has important implications for both mother and infant. The importance of subjective birth experience in the development of birth trauma has been identified and may mediate the lack of theoretical consistency in this area. The current study aims to explore the subjective experience of birth traumaamong first time mothers in Ireland. It aims to separate the potential effects of peripartum depression (PPD) from this in limiting this qualitative investigation to women who reported birth trauma, without PPD.

DESIGN:

mixed methods: Quantitative methods facilitated the recruitment of participants, the selection of a homogenous sample and addressed previous methodological flaws in birth trauma research. Interpretative Phenomenological Analysis (IPA) was used to explore the subjective experience of traumatic childbirth.

PARTICIPANTS:

seven, first- time mothers who reported a traumatic childbirth, without significant symptoms of PPD participated.

MEASUREMENT AND FINDINGS:

screening measures of birth trauma and PPD were completed by participants. A semi-structured interview was then conducted with each participant about their childbirth experience. Interviews were transcribed and analysed using IPA. The primary superordinate theme recounted how the identity and individuality of women is ignored and discounted, throughout the process of childbirth. Identity is challenged and altered as a result of women’s incompatibility with the maternity system.

CONCLUSIONS:

this study supports the existence of birth trauma in an Irish context and highlights the subjective experience of women as central to the development of birth trauma.

IMPLICATIONS FOR PRACTICE:

acknowledgement and inclusion of the mother as an individual throughout the process of childbirth may be protective in limiting the experience of birth trauma.

https://www.ncbi.nlm.nih.gov/pubmed/28494225

Maternal posttraumatic stress disorder and infant developmental outcomes in a South African birth cohort study.

Koen N, Brittain K, Donald KA, Barnett W, Koopowitz S, Maré K, Zar HJ, Stein DJ.

Psychol Trauma. 2017 May;9(3):292-300. doi: 10.1037/tra0000234.

Abstract

OBJECTIVE:

To investigate the association between maternal posttraumatic stress disorder (PTSD) and infant development in a South African birth cohort.

METHOD:

Data from the Drakenstein Child Health Study were analyzed. Maternal psychopathology was assessed using self-report and clinician-administered interviews; and 6-month infant development using the Bayley III Scales of Infant Development. Linear regression analyses explored associations between predictor and outcome variables.

RESULTS:

Data from 111 mothers and 112 infants (1 set of twins) were included. Most mothers (72%) reported lifetime trauma exposure; the lifetime prevalence of PTSD was 20%. Maternal PTSD was significantly associated with poorer fine motor and adaptive behavior – motor development; the latter remaining significant when adjusted for site, alcohol dependence, and infant head-circumference-for-age z score at birth.

CONCLUSION:

Maternal PTSD may be associated with impaired infant neurodevelopment. Further work in low- and middle-income populations may improve early childhood development in this context. (PsycINFO Database Record

https://www.ncbi.nlm.nih.gov/pubmed/28459271

Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study.

Horsch A, Vial Y, Favrod C, Harari MM, Blackwell SE, Watson P, Iyadurai L, Bonsall MB, Holmes EA.

Behav Res Ther. 2017 Jul;94:36-47. doi: 10.1016/j.brat.2017.03.018. Epub 2017 Apr 6.

Abstract

Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game ‘Tetris’ via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention “rather” to “extremely” acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513.

https://www.ncbi.nlm.nih.gov/pubmed/28453969

Screening for birth-related PTSD: psychometric properties of the Turkish version of the Posttraumatic Diagnostic Scale in postpartum women in Turkey.

Dikmen-Yildiz P, Ayers S, Phillips L.

Eur J Psychotraumatol. 2017 Apr 3;8(1):1306414. doi: 10.1080/20008198.2017.1306414. eCollection 2017.

Abstract

Background: Evidence suggests that 4% of women develop posttraumatic stress disorder (PTSD) after childbirth, with a potentially negative impact on women and families. Detection of postpartum PTSD is essential but few measures have been validated in this population. Objective: This study aimed to examine psychometric properties of the Turkish version of the Posttraumatic Diagnostic Scale (PDS) to screen for birth-related PTSD among postpartum women and identify factorial structure of PTSD after birth. Method: PDS was administered to 829 postpartum women recruited from three maternity hospitals in Turkey. Participants with PTSD (= 68) and a randomly selected group of women without PTSD (= 66), underwent a structured clinical interview (SCID). Results: PDS demonstrated high internal consistency (α = .89) and test-retest reliability between 4-6 weeks and 6-months postpartum (rs = .51). PDS showed high concurrent validity with other measures of postpartum psychopathology, rs (829) = .60 for depression and rs (829) = .61 for anxiety. Satisfactory diagnostic agreement was observed between diagnoses obtained by PDS and SCID, with good sensitivity (92%) and specificity (76%). Exploratory and confirmatory factor analyses revealed that the latent structure of birth-related PTSD was best identified by a three-factor model: re-experiencing and avoidance (RA), numbing and dysphoric-arousal (NDA) and dysphoric-arousal and anxious-arousal symptoms (DAA). Conclusions: The findings supported use of PDS as an effective screening measure for birth-related PTSD among postpartum women.

https://www.ncbi.nlm.nih.gov/pubmed/28451072

Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors.

Dekel S, Stuebe C, Dishy G.

Front Psychol. 2017 Apr 11;8:560. doi: 10.3389/fpsyg.2017.00560. eCollection 2017.

Abstract

Background: Posttraumatic stress related with the childbirth experience of full-term delivery with health outcomes has been recently documented in a growing body of studies. The magnitude of this condition and the factors that might put a woman at risk for developing childbirth-related postpartum posttraumatic stress disorder (PP-PTSD) symptoms are not fully understood. Methods: In this systematic review of 36 articles representing quantitative studies of primarily community samples, we set to examine PP-PTSD prevalence rates and associated predictors with a focus on the role of prior PTSD and time since childbirth. Results: A significant minority of women endorsed PP-PTSD following successful birth. Acute PP-PTSD rates were between 4.6 and 6.3%, and endorsement of clinically significant PP-PTSDsymptoms was identified in up to 16.8% of women in community samples of high quality studies. Negative subjective experience of childbirth emerged as the most important predictor. Endorsement of PTSD before childbirth contributed to PP-PTSD; nevertheless, women without PTSD also exhibited PP-PTSD, with acute rates at 4.6%, signifying a new PTSD onset in the postpartum period. Conclusion: Although the majority of women cope well, childbirth for some can be perceived as a highly stressful experience and even result in the development of PP-PTSD symptoms. More research is needed to understand postpartum adaption and childbirth-related posttraumatic stress outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/28443054

Post-traumatic stress disorder symptoms in pregnant Australian Indigenous women residing in rural and remote New South Wales: A cross-sectional descriptive study.

Mah B, Weatherall L, Burrows J, Blackwell CC, Gwynn J, Wadhwa P, Lumbers ER, Smith R, Rae KM.

Aust N Z J Obstet Gynaecol. 2017 Apr 7. doi: 10.1111/ajo.12618. [Epub ahead of print]

Abstract

BACKGROUND:

Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non-Indigenous Australians. However, little evidence exists that examines stressful events and post-traumatic stress disorder (PTSD) symptoms in pregnant women who are members of this community.

AIMS:

To quantify the rates of stressful events and PTSD symptoms in pregnant Indigenous women.

METHODS:

One hundred and fifty rural and remote Indigenous women were invited to complete a survey during each trimester of their pregnancy. The survey measures were the stressful life events and the Impact of Events Scale.

RESULTS:

Extremely high rates of PTSD symptoms were reported by participants. Approximately 40% of this group exhibited PTSDsymptoms during their pregnancy with mean score 33.38 (SD = 14.37) significantly higher than a study of European victims of crisis, including terrorism attacks (20.6, SD = 18.5).

CONCLUSIONS:

The extreme levels of PTSD symptoms found in the women participating in this study are likely to result in negative implications for both mother and infant. An urgent response must be mounted at government, health, community development and research levels to address these findings. Immediate attention needs to focus on the development of interventions to address the high levels of PTSDsymptoms that pregnant Australian Indigenous women experience.

https://www.ncbi.nlm.nih.gov/pubmed/28386930

Different coping strategies influence the development of PTSD among first-time mothers.

Tomsis Y1,2Gelkopf M1Yerushalmi H1Zipori Y3.

J Matern Fetal Neonatal Med. 2017 Apr 24:1-7. doi: 10.1080/14767058.2017.1315658. [Epub ahead of print]

Abstract

OBJECTIVE:

To evaluate the different coping strategies for post-traumatic stress disorder (PTSD), described in the non-obstetric traumaliterature, with respect to first time postpartum women.

STUDY DESIGN:

This was a prospective cohort study conducted between 2011 and 2013. Eligible women had a singleton pregnancy and delivered a healthy newborn at term. Five sets of relevant questionnaires were sent to the participants six weeks postpartum. Posttraumatic stress disorder was defined as per DSM-V criteria.

RESULTS:

One hundred and eighty eight completed questionnaires were considered for the final analysis. Two women (1.1%) had PTSD and nine women (4.8%) had partial PTSD. Coping by self-blame and/or rumination together with perception of resource loss emerged as independent variables that were significantly associated with post-traumatic symptomatology (PTS) severity. Objective birth factors such as participation in birth classes or the different modes of delivery seem to have no significant impact on postpartum PTS in our study.

CONCLUSIONS:

Cognitive coping styles such as self-blame and rumination, as well as perception of resource loss, were all related to postpartum PTS. Redirecting resources to address postpartum negative coping mechanisms may reduce the overall incidence of full and partial postpartum PTSD.

https://www.ncbi.nlm.nih.gov/pubmed/28372468

Posttraumatic Stress in Mothers Related to Giving Birth Prematurely: A Mixed Research Synthesis.

Beck CT, Harrison L.

J Am Psychiatr Nurses Assoc. 2017 Mar 1:1078390317700979. doi: 10.1177/1078390317700979. [Epub ahead of print]

Abstract

BACKGROUND:

Globally the preterm birth rate for 184 countries in 2010 was 11.1%. Preterm births can be a traumatic experience for mothers.

OBJECTIVE:

This article provides a mixed research synthesis of the quantitative and qualitative studies on posttraumatic stress in mothers who have given birth prematurely.

DESIGN:

Narrative synthesis was the mixed research synthesis approach used.

RESULTS:

Included in this narrative synthesis were quantitative prevalence studies ( n = 19), quantitative intervention studies ( n = 6), and qualitative studies ( n = 5). Prevalence rates ranged from 14% to 79%. Four of the intervention studies had significant results and two did not. Qualitative data synthesis revealed five themes: (a) shocked and horrified, (b) consuming guilt, (c) pervasive anxiety and hypervigilance, (d) intrusive thoughts, and (e) numbing and avoiding reminders.

CONCLUSIONS:

Women’s traumatic experiences of preterm birth are clearly important issues for psychiatric nurses to address.

https://www.ncbi.nlm.nih.gov/pubmed/28362564

The Trauma of Birth or Parenting a Child: Effect on Parents’ Negative Emotion in China.

Xiang Y, Chi X, Wu H, Zeng T, Chao X, Zhang P, Mo L.

Arch Psychiatr Nurs. 2017 Apr;31(2):211-216. doi: 10.1016/j.apnu.2016.10.001. Epub 2016 Oct 18.

Abstract

The present study assessed negative emotions associated with the traumas of infertility and child rearing (child’s disability or death) and the correlates of duration of trauma. The widely used Chinese Mental Health Scale was used to assess negative emotions in 294 individuals who experienced the aforementioned traumas and 124 who did not (control group). Results showed that individuals with infertility exhibited greater anxiety, depression, and solitude than the control group; bereaved parents and had greater solitude and fear than control group; and parents of children with disabilities had greater solitude than the control group. Parents who experienced the death of a child had more fear and physiological maladjustment than parents of a child with disabilities. In addition, individuals without parenting experience had higher scores on solitude, fear, and physiological disease than those with parenting experience. After controlling for demographic variables, the duration of trauma significantly negatively predicted depression in the infertile group and for bereaved parents. The results suggest that in order to prevent psychological and physiological health problems among infertile couples, parents of a disabled child, and parents who experience the death of child, family and community-based strategies should be developed and implemented.

https://www.ncbi.nlm.nih.gov/pubmed/28359435

The OptiMUM-study: EMDR therapy in pregnant women with posttraumatic stress disorder after previous childbirth and pregnant women with fear of childbirth: design of a multicentre randomized controlled trial.

Baas MA, Stramrood CA, Dijksman LM, de Jongh A, van Pampus MG.

Eur J Psychotraumatol. 2017 Feb 24;8(1):1293315. doi: 10.1080/20008198.2017.1293315. eCollection 2017.

Abstract

Background: Approximately 3% of women develop posttraumatic stress disorder (PTSD) after giving birth, and 7.5% of pregnant women show a pathological fear of childbirth (FoC). FoC or childbirth-related PTSD during (a subsequent) pregnancy can lead to a request for an elective caesarean section as well as adverse obstetrical and neonatal outcomes. For PTSD in general, and several subtypes of specific phobia, eye movement desensitization and reprocessing (EMDR) therapy has been proven effective, but little is known about the effects of applying EMDR during pregnancy. Objective: To describe the protocol of the OptiMUM-study. The main aim of the study is to determine whether EMDR therapy is an effective and safe treatment for pregnant women with childbirth-related PTSD or FoC. In addition, the cost-effectiveness of this approach will be analysed. Method: The single-blind OptiMUM-study consists of two two-armed randomized controlled trials (RCTs) with overlapping design. In several hospitals and community midwifery practices in Amsterdam, the Netherlands, all eligible pregnant women with a gestational age between eight and 20 weeks will be administered the Wijma delivery expectations questionnaire (WDEQ) to asses FoC. Multiparous women will also receive the PTSD checklist for DSM-5 (PCL-5) to screen for possible PTSD. The clinician administered PTSD scale (CAPS-5) will be used for assessing PTSD according to DSM-5 in women scoring above the PCL-5 cut-off value. Fifty women with childbirth-related PTSD and 120 women with FoC will be randomly allocated to either EMDR therapy carried out by a psychologist or care-as-usual. Women currently undergoing psychological treatment or women younger than 18 years will not be included. Primary outcome measures are severity of childbirth-related PTSD or FoC symptoms. Secondary outcomes are percentage of PTSDdiagnoses, percentage caesarean sections, subjective childbirth experience, obstetrical and neonatal complications, and health care costs. Results: The results are meant to provide more insight about the safety and possible effectiveness of EMDR therapy during pregnancy for women with PTSD or FoC. Conclusion: This study is the first RCT studying efficacy and safety of EMDR in pregnant women with PTSD after childbirth or Fear of Childbirth.

https://www.ncbi.nlm.nih.gov/pubmed/28348720

October-January Research Update

Delivery as Trauma: A Prospective Time-Cohort Study of Maternal and Perinatal Mortality in Rural Cambodia.

Houy C, Ha SO, Steinholt M, Skjerve E, Husum H.

Prehosp Disaster Med. 2017 Jan 26:1-7. doi: 10.1017/S1049023X1600145X.

Abstract

OBJECTIVE:

The majority of maternal and perinatal deaths are preventable, but still women and newborns die due to insufficient Basic Life Support in low-resource communities. Drawing on experiences from successful wartime trauma systems, a three-tier chain-of-survival model was introduced as a means to reduce rural maternal and perinatal mortality.

METHODS:

A study area of 266 villages in landmine-infested Northwestern Cambodia were selected based on remoteness and poverty. The five-year intervention from 2005 through 2009 was carried out as a prospective study. The years of formation in 2005 and 2006 were used as a baseline cohort for comparisons with later annual cohorts. Non-professional and professional birth attendants at village level, rural health centers (HCs), and three hospitals were merged with an operational prehospital trauma system. Staff at all levels were trained in life support and emergency obstetrics. Findings The maternal mortality rate was reduced from a baseline level of 0.73% to 0.12% in the year 2009 (95% CI Diff, 0.27-0.98; P<.01). The main reduction was observed in deliveries at village level assisted by traditional birth attendants (TBAs). There was a significant reduction in perinatal mortality rate by year from a baseline level at 3.5% to 1.0% in the year 2009 (95% CI Diff, 0.02-0.03; P<.01). Adjusting maternal and perinatal mortality rates for risk factors, the changes by time cohort remained a significant explanatory variable in the regression model.

CONCLUSION:

The results correspond to experiences from modern prehospital trauma systems: Basic Life Support reduces maternal and perinatal death if provided early. Trained TBAs are effective if well-integrated in maternal health programs.

https://www.ncbi.nlm.nih.gov/pubmed/28122653

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis.

Yildiz PD, Ayers S, Phillips L.

J Affect Disord. 2017 Jan 15;208:634-645. doi: 10.1016/j.jad.2016.10.009.

Abstract

BACKGROUND:

Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time.

METHODS:

PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.

RESULTS:

59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum.

LIMITATIONS:

Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters.

CONCLUSIONS:

PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.

https://www.ncbi.nlm.nih.gov/pubmed/27865585

 

Testing a cognitive model to predict posttraumatic stress disorder following childbirth.

King L, McKenzie-McHarg K, Horsch A.

BMC Pregnancy Childbirth. 2017 Jan 14;17(1):32. doi: 10.1186/s12884-016-1194-3.

Abstract

BACKGROUND:

One third of women describes their childbirth as traumatic and between 0.8 and 6.9% goes on to develop posttraumatic stress disorder (PTSD). The cognitive model of PTSD has been shown to be applicable to a range of trauma samples. However, childbirth is qualitatively different to other trauma types and special consideration needs to be taken when applying it to this population. Previous studies have investigated some cognitive variables in isolation but no study has so far looked at all the key processes described in the cognitive model. This study therefore aimed to investigate whether theoretically-derived variables of the cognitive model explain unique variance in postnatal PTSD symptoms when key demographic, obstetric and clinical risk factors are controlled for.

METHOD:

One-hundred and fifty-seven women who were between 1 and 12 months post-partum (M = 6.5 months) completed validated questionnaires assessing PTSD and depressive symptoms, childbirth experience, postnatal social support, trauma memory, peritraumatic processing, negative appraisals, dysfunctional cognitive and behavioural strategies and obstetric as well as demographic risk factors in an online survey.

RESULTS:

A PTSD screening questionnaire suggested that 5.7% of the sample might fulfil diagnostic criteria for PTSD. Overall, risk factors alone predicted 43% of variance in PTSD symptoms and cognitive behavioural factors alone predicted 72.7%. A final model including both risk factors and cognitive behavioural factors explained 73.7% of the variance in PTSD symptoms, 37.1% of which was unique variance predicted by cognitive factors.

CONCLUSIONS:

All variables derived from Ehlers and Clark’s cognitive model significantly explained variance in PTSD symptoms following childbirth, even when clinical, demographic and obstetric were controlled for. Our findings suggest that the CBT model is applicable and useful as a way of understanding and informing the treatment of PTSD following childbirth

https://www.ncbi.nlm.nih.gov/pubmed/28088194

 

Women’s descriptions of childbirth trauma relating to care provider actions and interactions.

Reed R, Sharman R, Inglis C.

BMC Pregnancy Childbirth. 2017 Jan 10;17(1):21. doi: 10.1186/s12884-016-1197-0.

Abstract

BACKGROUND:

Many women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.

METHODS:

As part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.

RESULTS:

Four themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.

CONCLUSION:

Care provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

https://www.ncbi.nlm.nih.gov/pubmed/28068932

 

Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism.

Choi KW, Sikkema KJ, Vythilingum B, Geerts L, Faure SC, Watt MH, Roos A, Stein DJ.

J Affect Disord. 2017 Jan 8;211:107-115. doi: 10.1016/j.jad.2017.01.004.

Abstract

BACKGROUND:

Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation.

METHODS:

A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children’s outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes.

RESULTS:

Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism.

LIMITATIONS:

Limitations included modest sample size, self-report measures, and unmeasured potential confounders.

https://www.ncbi.nlm.nih.gov/pubmed/28110156

 

Aetiological relationships between factors associated with postnataltraumatic symptoms among Japanese primiparas and multiparas: A longitudinal study.

Takegata M, Haruna M, Matsuzaki, M, Shiraishi M, Okano T, Severinsson E.

Midwifery. 2017 Jan;44:14-23. doi: 10.1016/j.midw.2016.10.008.

Abstract

OBJECTIVE:

this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas.

DESIGN:

a longitudinal, observational survey.

SETTING:

participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum.

MEASUREMENTS:

The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth.

FINDINGS:

of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001).

KEY CONCLUSIONS:

antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women.

IMPLICATION FOR PRACTICE:

the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.

https://www.ncbi.nlm.nih.gov/pubmed/27865160

 

The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study.

Garthus-Niegel S, Ayers S, Martini J, von Soest T, Eberhard-Gran M.

Psychol Med. 2017 Jan;47(1):161-170. doi: 10.1017/S003329171600235X.

Abstract

BACKGROUND:

Against the background of very limited evidence, the present study aimed to prospectively examine the impact of maternal postpartum post-traumatic stress disorder (PTSD) symptoms on four important areas of child development, i.e. gross motor, fine motor, communication and social-emotional development.

METHOD:

This study is part of the large, population-based Akershus Birth Cohort. Data from the hospital’s birth record as well as questionnaire data from 8 weeks and 2 years postpartum were used (n = 1472). The domains of child development that were significantly correlated with PTSD symptoms were entered into regression analyses. Interaction analyses were run to test whether the influence of postpartum PTSD symptoms on child development was moderated by child sex or infant temperament.

RESULTS:

Postpartum PTSD symptoms had a prospective relationship with poor child social-emotional development 2 years later. This relationship remained significant even when adjusting for confounders such as maternal depression and anxiety or infant temperament. Both child sex and infant temperament moderated the association between maternal PTSD symptoms and child social-emotional development, i.e. with increasing maternal PTSD symptom load, boys and children with a difficult temperament were shown to have comparatively higher levels of social-emotional problems.

CONCLUSIONS:

Examining four different domains of child development, we found a prospective impact of postpartum PTSD symptoms on children’s social-emotional development at 2 years of age. Our findings suggest that both boys and children with an early difficult temperament may be particularly susceptible to the adverse impact of postpartumPTSD symptoms. Additional studies are needed to further investigate the mechanisms at work.

https://www.ncbi.nlm.nih.gov/pubmed/27682188

 

Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis.

Oliveira AG1, Reichenheim ME2, Moraes CL2,3, Howard LM4, Lobato G5.

Arch Womens Ment Health. 2016 Dec 28. doi: 10.1007/s00737-016-0705-6.

Abstract

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

https://www.ncbi.nlm.nih.gov/pubmed/28032212

 

Predictors of birth-related post-traumatic stress symptoms: secondary analysis of a cohort study.

Furuta M1, Sandall J2, Cooper D3, Bick D3.

Arch Womens Ment Health. 2016 Dec;19(6):987-999. Epub 2016 May 13.

Abstract

This study aimed to identify factors associated with birth-related post-traumatic stress symptoms during the early postnatal period. Secondary analysis was conducted using data from a prospective cohort study of 1824 women who gave birth in one large hospital in England. Post-traumatic stress symptoms were measured by the Impact of Event Scale at 6 to 8 weeks postpartum. Zero-inflated negative binomial regression models were developed for analyses. Results showed that post-traumatic stress symptoms were more frequently observed in black women and in women who had a higher pre-pregnancy BMI compared to those with a lower BMI. Women who have a history of mental illness as well as those who gave birth before arriving at the hospital, underwent an emergency caesarean section or experienced severe maternal morbidity or neonatal complications also showed symptoms. Women’s perceived control during labour and birth significantly reduced the effects of some risk factors. A higher level of perceived social support during the postnatal period also reduced the risk of post-traumatic stress symptoms. From the perspective of clinical practice, improving women’s sense of control during labour and birth appears to be important, as does providing social support following the birth.

https://www.ncbi.nlm.nih.gov/pubmed/27178126

 

Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study.

Diorgu FC1Steen MP2Keeling JJ3Mason-Whitehead E4.

Women Birth. 2016 Dec;29(6):518-523. doi: 10.1016/j.wombi.2016.05.002. Epub 2016 May 26.

Abstract

BACKGROUND:

Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries.

AIMS:

To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma.

METHODS:

A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson’s chi-square test was used to measure association between birthing positions and perineal trauma.

FINDINGS:

Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, n=106 (96%) and midwives, n=97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n=80 (73%) and n=76 (69%) reported they did not give their consent. N=59 (53%) reported they were not given local anaesthesia for an episiotomy. n=30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia.

CONCLUSION:

Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.

https://www.ncbi.nlm.nih.gov/pubmed/27237831

 

Effectiveness of trauma-focused psychological therapies compared to usual postnatal care for treating post-traumatic stress symptoms in women following traumatic birth: a systematic review protocol.

Furuta M1Spain D2Bick D3Ng ES4Sin J2,5.

BMJ Open. 2016 Nov 24;6(11):e013697. doi: 10.1136/bmjopen-2016-013697.

Abstract

INTRODUCTION:

Maternal mental health has been largely neglected in the literature. Women, however, may be vulnerable to developing post-traumatic stress symptoms or post-traumaticstress disorder (PTSD), following traumatic birth. In turn, this may affect their capacity for child rearing and ability to form a secure bond with their baby and impact on the wider family. Trauma-focused psychological therapies (TFPT) are widely regarded as effective and acceptable interventions for PTSD in general and clinical populations. Relatively little is known about the effectiveness of TFPT for women postpartum who have post-traumatic stress symptoms.

METHODS AND ANALYSIS:

We will conduct a review to assess the effectiveness of TFPT, compared with usual postpartum care, as a treatment for post-traumatic stress symptoms or PTSD for women following traumatic birth. Using a priori search criteria, we will search for randomised controlled trials (RCT) in four databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO and OpenGrey. We will use search terms that relate to the population, TFPT and comparators. Screening of search results and data extraction will be undertaken by two reviewers, independently. Risk of bias will be assessed in RCTs which meet the review criteria. Data will be analysed using the following methods, as appropriate: narrative synthesis; meta-analysis; subgroup analysis and meta-regression.

DISSEMINATION AND ETHICS:

As this work comprises a synthesis of existing studies, ethical approvals are not required. Results will be disseminated at conferences and in publications.

https://www.ncbi.nlm.nih.gov/pubmed/27884855

 

Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence.

Silove DM1Tay AK1Tol WA2Tam N1Dos Reis N3da Costa Z3Soares C3Rees S4.

J Affect Disord. 2016 Nov 15;205:292-300. doi: 10.1016/j.jad.2016.07.052. Epub 2016 Jul 29.

Abstract

BACKGROUND:

Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors.

METHODS:

In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors.

RESULTS:

LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors.

LIMITATIONS:

The study is cross-sectional, cautioning against inferring causal inferences.

CONCLUSIONS:

The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/27552593

 

Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study.

Farren J1Jalmbrant M2Ameye L3Joash K1Mitchell-Jones N4Tapp S1Timmerman D3,5Bourne T1,3,5.

BMJ Open. 2016 Nov 2;6(11):e011864. doi: 10.1136/bmjopen-2016-011864.

Abstract

OBJECTIVES:

This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.

DESIGN:

This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey 1, 3 and 9 months after a diagnosis of EPL, and 1 month after the diagnosis of a viable ongoing pregnancy.

SETTING:

The Early Pregnancy Assessment Unit (EPAU) of a central London teaching hospital.

PARTICIPANTS:

We recruited 186 women. 128 had a diagnosis of EPL, and 58 of ongoing pregnancies. 11 withdrew consent, and 11 provided an illegible or invalid email address.

MAIN OUTCOME MEASURES:

Post-traumatic stress disorder (PTSD) was measured using the Post-traumatic Diagnostic Scale (PDS), and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

RESULTS:

Response rates were 69/114 at 1 month and 44/68 at 3 months in the EPL group, and 20/50 in controls. Psychological morbidity was higher in the EPL group with 28% meeting the criteria for probable PTSD, 32% for anxiety and 16% for depression at 1 month and 38%, 20% and 5%, respectively, at 3 months. In the control group, no women met criteria for PTSD and 10% met criteria for anxiety and depression. There was little difference in type or severity of distress following ectopic pregnancy or miscarriage.

CONCLUSIONS:

We have shown a large number of women having experienced a miscarriage or ectopic pregnancy fulfil the diagnostic criteria for probable PTSD. Many suffer from moderate-to-severe anxiety, and a lesser number depression. Psychological morbidity, and in particular PTSD symptoms, persists at least 3 months following pregnancy loss.

https://www.ncbi.nlm.nih.gov/pubmed/27807081

 

The effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder (PTSD) symptoms following childbirth: an experimental study.

Gökçe İsbir G1İnci F2Önal H3Yıldız PD4.

Appl Nurs Res. 2016 Nov;32:227-232. doi: 10.1016/j.apnr.2016.07.013.

Abstract

BACKGROUND:

Fear of birth and low childbirth self-efficacy is predictive of post-traumaticstress disorder symptoms following childbirth. The efficacy of antenatal education classes on fear of birth and childbirth self-efficacy has been supported; however, the effectiveness of antenatal classes on post-traumatic stress disorder symptoms after childbirth has received relatively little research attention.

PURPOSE:

This study examined the effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder symptoms following childbirth.

DESIGN:

Quasi-experimental study.

METHODS:

The study was conducted in a city located in the Middle Anatolia region of Turkey and data were collected between December 2013 and May 2015. Two groups of women were compared-an antenatal education intervention group (n=44), and a routine prenatal care control group (n=46). The Wijma Delivery Expectancy/Experience Questionnaire, Version A and B, Childbirth Self-efficacy Inventory and Impact of Event Scale-Revised was used to assess fear of childbirth, maternal self-efficacy and PTSD symptoms following childbirth.

RESULTS:

Compared to the control group, women who attended antenatal education had greater childbirth self-efficacy, greater perceived support and control in birth, and less fear of birth and post-traumatic stress disorder symptoms following childbirth (all comparisons, p<0.05).

CONCLUSIONS:

Antenatal education appears to alleviate post-traumatic stress disorder symptoms after childbirth.

https://www.ncbi.nlm.nih.gov/pubmed/27969033

 

Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth.

König J1Schmid S2Löser E3Neumann O4Buchholz S5Kästner R6.

Eur J Psychotraumatol. 2016 Oct 24;7:32377. doi: 10.3402/ejpt.v7.32377.

Abstract

BACKGROUND:

There has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously.

OBJECTIVE:

In this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally.

METHOD:

We assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277).

RESULTS:

Our final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect.

CONCLUSIONS:

Given that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.

HIGHLIGHTS OF THE ARTICLE:

Our results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables). The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care. Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.

https://www.ncbi.nlm.nih.gov/pubmed/27782876

 

Post-traumatic stress disorder following emergency peripartum hysterectomy.

de la Cruz CZ1Coulter M2O’Rourke K3Mbah AK3Salihu HM3,4.

Arch Gynecol Obstet. 2016 Oct;294(4):681-8. doi: 10.1007/s00404-016-4008-y.

Abstract

PURPOSE:

Our objective was to explore if women who experience emergency peripartum hysterectomy (EPH), a type of severe maternal morbidity, are more likely to screen positive for post-traumatic stress disorder (PTSD) compared to women who did not experience EPH.

METHODS:

Using a retrospective cohort design, women were sampled through online communities. Participants completed online screens for PTSD. Additionally, women provided sociodemographic, obstetric, psychiatric, and psychosocial information. We conducted bivariate and logistic regression analyses, then Monte Carlo simulation and propensity score matching to calculate the risk of screening positive for PTSD after EPH.

RESULTS:

74 exposed women (experienced EPH) and 335 non-exposed women (did not experience EPH) completed the survey. EPH survivors were nearly two times more likely to screen positive for PTSD (aOR: 1.90; 95 % CI: 1.57, 2.30), and nearly 2.5 times more likely to screen positive for PTSD at 6 months postpartum compared to women who were not EPH survivors (aOR: 2.46; 95 % CI: 1.92, 3.16).

CONCLUSION:

The association of EPH and PTSD was statistically significant, indicating a need for further research, and the potential need for support services for these women following childbirth.

https://www.ncbi.nlm.nih.gov/pubmed/26781263

 

Maternal birth trauma: why should it matter to urogynaecologists?

Dietz HP1Wilson PDMilsom I.

Curr Opin Obstet Gynecol. 2016 Oct;28(5):441-8. doi:10.1097/GCO.0000000000000304.

Abstract

PURPOSE OF REVIEW:

There is increasing awareness of the importance of intrapartum events for future pelvic floor morbidity in women. In this review, we summarize recent evidence and potential consequences for clinical practice.

RECENT FINDINGS:

Both epidemiological evidence and data from perinatal imaging studies have greatly improved our understanding of the link between childbirth and later morbidity. The main consequences of traumatic childbirth are pelvic organ prolapse (POP) and anal incontinence. In both instances the primary etiological pathways have been identified: levator trauma in the case of POP and anal sphincter tears in the case of anal incontinence. As most such trauma is occult, imaging is required for diagnosis.

SUMMARY:

Childbirth-related major maternal trauma is much more common than generally assumed, and it is the primary etiological factor in POP and anal incontinence. Both sphincter and levator trauma can now be identified on imaging. This is crucial not only for clinical care and audit, but also for research. Postnatally diagnosed trauma can serve as intermediate outcome measure in intervention trials, opening up multiple opportunities for clinical research aimed at primary and secondary prevention.

https://www.ncbi.nlm.nih.gov/pubmed/27454848

 

Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population.

Wenz-Gross M1,2Weinreb L3Upshur C3,4,5.

Matern Child Health J. 2016 Oct;20(10):1995-2002. doi: 10.1007/s10995-016-2073-2.

Abstract

Objectives Investigate the feasibility of using a brief, 4-item PTSD screening tool (PTSD-PC) as part of routine prenatal care in two community health care settings serving ethnically and linguistically diverse low-income populations. Report prevalence and differences by sub-threshold and clinical levels, in demographic, health, mental health, risk behaviors, and service use. Methods Women were screened as part of their prenatal intake visit over a 2-year period. Those screening positive at clinical or sub-threshold levels were recruited if they spoke English, Spanish, Portuguese, Vietnamese or Arabic. Enrolled women were interviewed about psychosocial risk factors, prior traumas, PTSD symptoms, depression, anxiety, substance use, health and services, using validated survey instruments. Results Of 1362 women seen for prenatal intakes, 1259 (92 %) were screened, 208 (17 %) screened positive for PTSD at clinical (11 %) or sub-threshold levels (6 %), and 149 (72 % of all eligible women) enrolled in the study. Those screening positive were significantly younger, had more prior pregnancies, were less likely to be Asian or black, and were more likely to be non-English speakers. Enrolled women at clinical as compared to sub-threshold levels showed few differences in psychosocial risk, but had significantly more types of trauma, more trauma before age 18, more interpersonal trauma, and had greater depression, anxiety, and PTSD symptoms. Only about 25 % had received mental health treatment. Conclusions The PTSD-PC was a feasible screening tool for use in prenatal care. While those screening in at clinical levels were more symptomatic, those at subthreshold levels still showed substantial symptomology and psychosocial risk.

https://www.ncbi.nlm.nih.gov/pubmed/27400916

 

Paternal mental health following perceived traumatic childbirth.

Inglis C1Sharman R2Reed R3.

Midwifery. 2016 Oct;41:125-131. doi: 10.1016/j.midw.2016.08.008. Epub 2016 Aug 22.

Abstract

OBJECTIVE:

the objective behind the current study was to explore the experiences and perceptions of fathers after childbirth trauma, an area of minimal research. This is part two of a two-part series conducted in 2014 researching the mental health of fathers after experiencing a perceived traumatic childbirth.

DESIGN:

qualitative methodology using semi-structured interviews and reporting of qualitative questions administered in part one’s online survey (Inglis, 2014).

SETTING:

interviews conducted face-to-face at an Australian University or on Skype.

PARTICIPANTS:

sixty-nine responded to the online qualitative questions and of these seven were interviewed.

MEASUREMENTS:

thematic analysis of verbal and written qualitative responses.

FINDINGS:

thematic analysis of qualitative survey data and interviews found a global theme ‘standing on the sideline’ which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes.

KEY CONCLUSIONS:

according to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support.

https://www.ncbi.nlm.nih.gov/pubmed/27621058

 

Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey.

Gökçe İsbİr G1İncİ F1Bektaş M2Dikmen Yıldız P3Ayers S4.

Midwifery. 2016 Oct;41:96-103. doi: 10.1016/j.midw.2016.07.016.

Abstract

OBJECTIVE:

this study examined factors associated with symptoms of post-traumatic stress (PTS) following childbirth in women with normal, low-risk pregnancies in Nigde, Turkey.

DESIGN:

a prospective longitudinal design where women completed questionnaire measures at 20+ weeks’ gestation and 6-8 weeks after birth.

SETTING:

eligible pregnant women were recruited from nine family healthcare centres in Nigde between September 2013 and July 2014.

PARTICIPANTS:

a total of 242 women completed questionnaires at both time points.

MEASURES:

PTS symptoms were measured using the Impact of Event Scale-Revised (IES-R) 6-8 weeks after birth. Potential protective or risk factors of childbirth self-efficacy, fear of childbirth, adaptation to pregnancy/motherhood, and perceived social support were measured in pregnancy and after birth. Perceived support and control during birth was measured after birth. Demographic and obstetric information was collected in pregnancy using standard self-report questions.

FINDINGS:

PTS symptoms were associated with being multiparous, having a planned pregnancy, poor psychological adaptation to pregnancy, higher outcome expectancy but lower efficacy expectancy during pregnancy, urinary catheterization during labour, less support and perceived control in birth, less satisfaction with hospital care, poor psychological adaptation to motherhood and increased fear of birth post partum. Regression analyses showed the strongest correlates of PTS symptoms were high outcome and low efficacy expectancies in pregnancy, urinary catheterization in labour, poor psychological adaptation to motherhood and increased fear of birth post partum. This model accounted for 29% of the variance in PTS symptoms.

CONCLUSIONS:

this study suggests women in this province in Turkey report PTS symptoms after birth and this is associated with childbirth self-efficacy in pregnancy, birth factors, and poor adaptation to motherhood and increased fear of birth post partum.

IMPLICATIONS FOR PRACTICE:

maternity care services in Turkey need to recognise the potential impact of birth experiences on women’s mental health and adaptation after birth. The importance of self-efficacy in pregnancy suggests antenatal education or support may protect women against developing post partum PTS, but this needs to be examined further.

https://www.ncbi.nlm.nih.gov/pubmed/27571774

 

Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth.

Schrøder K1Larsen PV2Jørgensen JS3Hjelmborg JV4Lamont RF5Hvidt NC6.

Midwifery. 2016 Oct;41:45-53. doi: 10.1016/j.midw.2016.07.013.

Abstract

OBJECTIVE:

this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth.

MATERIAL AND METHODS:

a 2012 national survey of all Danish obstetricians and midwives (n=2098). The response rate was 59% of which 85% (n=1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen Psychosocial Questionnaire (COPSOQII). Responses were assessed on six scales: burnout, sleep disorders, general stress, depressive symptoms, somatic stress and cognitive stress. Associations between COPSOQII scales and participant characteristics were analysed using linear regression.

RESULTS:

midwives reported significantly higher scores than obstetricians, to a minor extent during the most recent four weeks and to a greater extent immediately following a traumatic childbirth scale, indicating higher levels of self-reported psychosocial health problems. Sub-group analyses showed that this difference might be gender related. Respondents who had left the labour ward partly or primarily because they felt that the responsibility was too great a burden to carry reported significantly higher scores on all scales in the aftermath of the traumatic birth than did the group who still worked on the labour ward. None of the scales were associated with age or seniority in the time after the traumatic birth indicating that both junior and senior staff may experience similar levels of psychosocial health and well-being in the aftermath. KEY CONCLUSIONS AND IMPLICATIONS: this study shows an association between profession (midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by gender. This knowledge may lead to better awareness of the possibility of differences related to profession and gender when conducting debriefings and offering support to HCPs in the aftermath of traumatic childbirth. As many as 85% of the respondents in this national study stated that they had been involved in at least one traumatic childbirth, suggesting that the handling of the aftermath of these events is important when caring for the psychosocial health and well-being of obstetric and midwifery staff.

https://www.ncbi.nlm.nih.gov/pubmed/27540830

 

Emotional, physical, and sexual abuse and the association with symptoms of depression and posttraumatic stress in a multi-ethnic pregnant population in southern Sweden.

Wangel AM1Ryding EL2Schei B3Östman M1Lukasse M4Bidens study group.

Sex Reprod Healthc. 2016 Oct;9:7-13. doi: 10.1016/j.srhc.2016.04.003.

Abstract

OBJECTIVES:

This study aims to describe the prevalence of emotional, physical, and sexual abuse and analyze associations with symptoms of depression and posttraumatic stress (PTS) in pregnancy, by ethnic background.

STUDY DESIGN:

This is a cross-sectional study of the Swedish data from the Bidens cohort study. Ethnicity was categorized as native and non-native Swedish-speakers. Women completed a questionnaire while attending routine antenatal care. The NorVold Abuse Questionnaire (NorAQ) assessed a history of emotional, physical or sexual abuse. The Edinburgh Depression Scale-5 measured symptoms of depression. Symptoms of Posttraumatic Stress (PTS) included intrusion, avoidance and numbness.

RESULTS:

Of 1003 women, 78.6% were native and 21.4% were non-native Swedish-speakers. Native and non-native Swedish-speakers experienced a similar proportion of lifetime abuse. Moderate emotional and physical abuse in childhood was significantly more common among non-native Swedish-speakers. Sexual abuse in adulthood was significantly more prevalent among native Swedish-speakers. Emotional and sexual abuse were significantly associated with symptoms of depression for both natives and non-natives. Physical abuse was significantly associated with symptoms of depression for non-natives only. All types of abuse were significantly associated with symptoms of PTS for both native and non-native Swedish-speakers. Adding ethnicity to the multiple binary regression analyses did not really alter the association between the different types of abuse and symptoms of depression and PTS.

CONCLUSION:

The prevalence of lifetime abuse did not differ significantly for native and non-native Swedish-speakers but there were significant differences on a more detailed level. Abuse was associated with symptoms of depression and PTS. Being a non-native Swedish-speaker did not influence the association much.

https://www.ncbi.nlm.nih.gov/pubmed/27634658

A socioecological model of posttraumatic stress among Australian midwives

Julia Leinweber, Debra K. Creedy, Heather Rowe, Jenny Gamble

Highlights

  • Recalled reactions of horror and feelings of guilt during or shortly after witnessing birth trauma predicted probable posttraumatic stress disorder among midwives.
  • Witnessing birth trauma can reactivate personal traumatic birth experiences among midwives.
  • Posttraumatic stress symptoms were associated with intention to leave the profession and may contribute to attrition in midwifery.

Abstract

Objective

to develop a comprehensive model of personal, trauma event-related and workplace-related risk factors for posttraumatic stress subsequent to witnessing birth trauma among Australian midwives.

Design

a descriptive, cross-sectional design was used.

Participants

members of the Australian College of Midwives were invited to complete an online survey.

Measurements

the survey included items about witnessing a traumatic birth event and previous experiences of life trauma. Trauma symptoms were assessed with the Posttraumatic Stress Disorder Symptom Scale Self-Report measure. Empathy was assessed with the Interpersonal Reactivity Index. Decision authority and psychological demand in the workplace were measured with the Job Content Questionnaire. Variables that showed a significant univariate association with probable posttraumatic stress disorder were entered into a multivariate logistic regression model.

Findings

601 completed survey responses were analysed. The multivariable model was statistically significant and explained 27.7% (Nagelkerke R square) of the variance in posttraumatic stress symptoms and correctly classified 84.1% of cases. Odds ratios indicated that intention to leave the profession, a peritraumatic reaction of horror, peritraumatic feelings of guilt, and a personal traumatic birth experience were strongly associated with probable Posttraumatic Stress Disorder.

Conclusions

risk factors for posttraumatic stress following professional exposure to traumatic birth events among midwives are complex and multi-factorial. Posttraumatic stress may contribute to attrition in midwifery. Trauma-informed care and practice may reduce the incidence of traumatic births and subsequent posttraumatic stress reactions in women and midwives providing care.

http://www.midwiferyjournal.com/article/S0266-6138(16)30305-9/abstract

September Research Update

What are the characteristics of perinatal events perceived to be traumatic by midwives?

Midwifery. 2016 Sep;40:55-61.

Sheen K, Spiby H, Slade P.

Abstract

OBJECTIVE:there is potential for midwives to indirectly experience events whilst providing clinical care that fulfil criteria for trauma. This research aimed to investigate the characteristics of events perceived as traumatic by UK midwives. METHODS: as part of a postal questionnaire survey conducted between December 2011 and April 2012, midwives (n=421) who had witnessed and/or listened to an account of an event and perceived this as traumatic for themselves provided a written description of their experience. A traumatic perinatal event was defined as occurring during labour or shortly after birth where the midwife perceived the mother or her infant to be at risk, and they (the midwife) had experienced fear, helplessness or horror in response. Descriptions of events were analysed using thematic analysis. Witnessed (W; n=299) and listened to (H; n=383) events were analysed separately and collated to identify common and distinct themes across both types of exposure. FINDINGS: six themes were identified, each with subthemes. Five themes were identified in both witnessed and listened to accounts and one was salient to witnessed accounts only. Themes indicated that events were characterised as severe, unexpected and complex. They involved aspects relating to the organisational context; typically limited or delayed access to resources or personnel. There were aspects relating to parents, such as having an existing relationship with the parents, and negative perceptions of the conduct of colleagues.Traumatic events had a common theme of generating feelings of responsibility and blame Finally for witnessed events those that were perceived as traumatic sometimes held personal salience, so resonated in some way with the midwife’s own life experience. KEY CONCLUSIONS: midwives are exposed to events as part of their work that they may find traumatic. Understanding the characteristics of the events that may trigger this perception may facilitate prevention of any associated distress and inform the development of supportive interventions.

https://www.ncbi.nlm.nih.gov/pubmed/27428099

Grief, Traumatic Stress, and Posttraumatic Growth in Women Who Have Experienced Pregnancy Loss.

Psychol Trauma. 2016 Sep 8.

Krosch DJ, Shakespeare-Finch J.

Abstract

Objective: Pregnancy loss is common and can be devastating for those who experience it. However, a historical focus on negative outcomes, and grief in particular, has rendered an incomplete portrait of both the gravity of the loss, and the potential for growth in its wake. Consistent with contemporary models of growth following bereavement, this study explored the occurrence of posttraumatic growth following pregnancy loss and further assessed the role of core belief disruptions and common loss context factors across perinatal grief, posttraumatic stress symptoms, and posttraumatic growth. Method: Women who had experienced a miscarriage or stillbirth (N = 328) were recruited through perinatal loss support groups and completed an online survey that assessed core belief disruption, perinatal grief, posttraumatic stress symptoms, posttraumatic growth, loss context factors, and demographics. Hypotheses were tested via hierarchical multiple regression. Results: All hypotheses were supported. Specifically, (a) moderate levels of posttraumatic growth were reported; (b) core belief disruptions predicted perinatal grief, posttraumatic stress symptoms, and posttraumatic growth; and (c) perinatal grief predicted posttraumatic stress symptoms and growth. Conclusion: Findings suggest that pregnancy loss can be a traumatic event, that core belief disruptions play a significant role in post-trauma outcomes, and that other factors may contribute to grief, posttraumatic stress symptoms, and posttraumatic growth following pregnancy loss that warrant further research (e.g., rumination). Despite potential methodological and sampling limitations, the use of validated measures to assess posttraumatic growth in a large sample represents a robust attempt to quantify the occurrence of post-trauma change following pregnancy loss.

https://www.ncbi.nlm.nih.gov/pubmed/27607765

Understanding Bidirectional Mother-Infant Affective Displays across Contexts: Effects of Maternal Maltreatment History and Postpartum Depression and PTSD Symptoms.

Psychopathology. 2016 Sep 1.

Morelen D, Menke R, Rosenblum KL, Beeghly M, Muzik M.

Abstract

BACKGROUND: This study examined the bidirectional nature of mother-infant positive and negative emotional displays during social interactions across multiple tasks among postpartum women accounting for childhood maltreatment severity. Additionally, effects of maternal postpartum psychopathology on maternal affect and effects of task and emotional valence on dyadic emotional displays were evaluated. SAMPLING AND METHODS: A total of 192 mother-infant dyads (51% male infants) were videotaped during free play and the Still-Face paradigm at 6 months postpartum. Mothers reported on trauma history and postpartum depression and posttraumatic stress disorder (PTSD) symptoms. Reliable, masked coders scored maternal and infant positive and negative affect from the videotaped interactions. RESULTS: Three path models evaluated whether dyadic affective displays were primarily mother driven, infant driven, or bidirectional in nature, adjusting for mothers’ maltreatment severity and postpartum psychopathology. The bidirectional model had the best fit. Child maltreatment severity predicted depression and PTSD symptoms, and maternal symptoms predicted affective displays (both positive and negative), but the pattern differed for depressive symptoms compared to PTSD symptoms. Emotional valence and task altered the nature of bidirectional affective displays. CONCLUSIONS: The results add to our understanding of dyadic affective exchanges in the context of maternal risk (childhood maltreatment history, postpartum symptoms of depression and PTSD). Findings highlight postpartum depression symptoms as one mechanism of risk transmission from maternal maltreatment history to impacted parent-child interactions. Limitations include reliance on self-reported psychological symptoms and that the sample size prohibited testing of moderation analyses. Developmental and clinical implications are discussed.

https://www.ncbi.nlm.nih.gov/pubmed/27576477

The impact of postpartum post-traumatic stress disorder symptoms on child development: A population-based, 2-year follow-up study.

Psychological Medicine, Sep 29, 2016

Garthus-Niegel, S., Ayers, S., Martini, J., von Soest, T., Eberhard-Gran, M.

Abstract

Background: Against the background of very limited evidence, the present study aimed to prospectively examine the impact of maternal postpartum post-traumatic stress disorder (PTSD) symptoms on four important areas of child development, i.e. gross motor, fine motor, communication and social–emotional development. Method: This study is part of the large, population-based Akershus Birth Cohort. Data from the hospital’s birth record as well as questionnaire data from 8 weeks and 2 years postpartum were used (n = 1472). The domains of child development that were significantly correlated with PTSD symptoms were entered into regression analyses. Interaction analyses were run to test whether the influence of postpartum PTSD symptoms on child development was moderated by child sex or infant temperament. Results: Postpartum PTSD symptoms had a prospective relationship with poor child social–emotional development 2 years later. This relationship remained significant even when adjusting for confounders such as maternal depression and anxiety or infant temperament. Both child sex and infant temperament moderated the association between maternal PTSD symptoms and child social–emotional development, i.e. with increasing maternal PTSD symptom load, boys and children with a difficult temperament were shown to have comparatively higher levels of social–emotional problems. Conclusions: Examining four different domains of child development, we found a prospective impact of postpartum PTSD symptoms on children’s social–emotional development at 2 years of age. Our findings suggest that both boys and children with an early difficult temperament may be particularly susceptible to the adverse impact of postpartum PTSD symptoms. Additional studies are needed to further investigate the mechanisms at work

https://www.ncbi.nlm.nih.gov/pubmed/27682188

Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study.

Neuroscience Letters 2016 Sep 6; Vol. 630, pp. 120-6.

Sanjuan PM; Poremba C; Flynn LR; Savich R; Annett RD; Stephen J

Abstract

Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences.

https://www.ncbi.nlm.nih.gov/pubmed/27473944

The prevalence of women’s emotional and physical health problems following a postpartum haemorrhage: a systematic review.

BMC Pregnancy And Childbirth [BMC Pregnancy Childbirth] 2016 Sep 05; Vol. 16, pp. 261.

Carroll M; Daly D; Begley CM

Abstract

Background: Postpartum Haemorrhage (PPH) is a leading cause of maternal mortality with approximately 225 women dying as a result of it each day especially in low income countries. However, much less is known about morbidity after a PPH. This systematic review aimed to determine the overall prevalence of emotional and physical health problems experienced by women following a postpartum haemorrhage. Methods: Eight databases were searched for published non-randomised, observational, including cohort, primary research studies that reported on the prevalence of emotional and/or physical health problems following a PPH. Intervention studies were included and data, if available, were abstracted on the control group. All authors independently screened the papers for inclusion. Of the 2210 papers retrieved, six met the inclusion criteria. Data were extracted independently by two authors. The methodological quality of the included studies was assessed using a modified Newcastle Ottawa Scale (NOS). The primary outcome measure reported was emotional and physical health problems up to 12 months postpartum following a postpartum haemorrhage. Results: Two thousand two hundred ten citations were identified and screened with 2089 excluded by title and abstract. Following full-text review of 121 papers, 115 were excluded. The remaining 6 studies were included. All included studies were judged as having strong or moderate methodological quality. Five studies had the sequelae of PPH as their primary focus, and one study focused on morbidity postnatally, from which we could extract data on PPH. Persistent morbidities following PPH (at ≥ 3 and < 6 months postpartum) included postnatal depression (13 %), post-traumatic stress disorder (3 %), and health status ‘much worse than one year ago’ (6 %). Due to the different types of health outcomes reported in the individual studies, it was possible to pool results from only four studies, and only then by accepting the slightly differing definitions of PPH. Those that could be pooled reported rates of acute renal failure (0.33 %), coagulopathy (1.74 %) and re-admission to hospital following a PPH between 1 and 3 months postpartum (3.6 %), an appreciable indication of underlying physical problems. Conclusion: This systematic review demonstrates that the existence and type of physical and emotional health problems post PPH, regardless of the volume of blood lost, are largely unknown. Further large cohort or case control studies are necessary to obtain better knowledge of the sequelae of this debilitating morbidity.

https://www.ncbi.nlm.nih.gov/pubmed/27596720

Seeing Their Children in Pain: Symptoms of Posttraumatic Stress Disorder in Mothers of Children with an Anomaly Requiring Surgery at Birth.

American Journal of Perinatology. 2016, Vol. 33 Issue 8, p770-775. 6p.

Aite, Lucia1, Bevilacqua, Francesca, Zaccara, Antonio, La Sala, Edoardo, Gentile, Simonetta, Bagolan, Pietro

Abstract:

Objective: Assess the presence of posttraumatic stress disorder (PTSD) symptoms in mothers of newborns requiring early surgery. Study Design: Mothers of newborns operated on for a congenital anomaly underwent a semi-structured interview on their experience 6 months postpartum. Interviews were audiotaped, transcribed verbatim, and analyzed for symptoms of the three major criteria of PTSD: re-experiencing, avoidance, and heightened arousal. Results: A total of 120 mothers took part in the study; their children were affected by one of the following congenital anomaly: esophageal atresia (n = 29); congenital diaphragmatic hernia (n = 38); midgut malformations (n = 38); and abdominal wall defects (n = 15). Two mothers did not show any symptoms; 12 mothers (10%) had one posttraumatic symptom, 77 (64.2%) had two, and 29 (24.2%) had three. Overall, 106 mothers (88.4%) presented at least two symptoms. Conclusion: PTSD can be considered a useful model to describe and comprehend mothers’ reactions in this specific population. Preventive interventions and dedicated follow-up program should be offered to these families.

https://www.ncbi.nlm.nih.gov/pubmed/26890434

 

August Research Update

Using Prenatal Advocates to Implement a Psychosocial Education Intervention for Posttraumatic Stress Disorder during Pregnancy: Feasibility, Care Engagement, and Predelivery Behavioral Outcomes.

Upshur CC1, Wenz-Gross M2, Weinreb L2, Moffitt JJ3.

Womens Health Issues. 2016 Jul 29. pii: S1049-3867(16)30059-7. doi: 10.1016/j.whi.2016.06.003.

Abstract

BACKGROUND:

Pregnant women with posttraumatic stress disorder (PTSD) engage in more high-risk behavior and use less prenatal care. Although treating depression in pregnancy is becoming widespread, options for addressing PTSD are few. This study was designed to test the feasibility of implementing a manualized psychosocial PTSD intervention, Seeking Safety, delivered by prenatal advocates.

METHODS:

All women entering prenatal care at two federally qualified health centers were screened for current symptoms of PTSD. One site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women that indicated clinical or subclinical PTSD symptoms. Baseline and predelivery interviews were conducted and collected background characteristics and assessed PTSD severity and coping skills. Medical records were collected to document care visits. Documentation of participation rates, fidelity to the treatment, and qualitative feedback from advocates and participants was collected.

RESULTS:

More than one-half (57.3%) of the intervention women received all Seeking Safety sessions and fidelity ratings of the session showed acceptable quality. Using an intent-to-treat analysis, intervention women participated in significantly more prenatal care visits (M = 11.7 versus 8.9; p < .001), and had a significantly higher rate of achieving adequate prenatal care (72.4% vs. 42.9%; p < .001). Although not significant when accounting for baseline differences, intervention women also reduced negative coping skills but not PTSD symptoms.

CONCLUSIONS:

Using prenatal care advocates to deliver Seeking Safety sessions to women screening positive for PTSD symptoms at entry to prenatal care is a promising intervention that seems to increase prenatal care participation and may reduce negative coping strategies.

http://www.ncbi.nlm.nih.gov/pubmed/27480668

Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey.

Gökçe İsbİr G1, İncİ F1, Bektaş M2, Dikmen Yıldız P3, Ayers S4.

Midwifery. 2016 Aug 1;41:96-103. doi: 10.1016/j.midw.2016.07.016.

Abstract

OBJECTIVE:

this study examined factors associated with symptoms of post-traumatic stress (PTS) following childbirth in women with normal, low-risk pregnancies in Nigde, Turkey.

DESIGN:

a prospective longitudinal design where women completed questionnaire measures at 20+ weeks’ gestation and 6-8 weeks after birth.

SETTING:

eligible pregnant women were recruited from nine family healthcare centres in Nigde between September 2013 and July 2014.

PARTICIPANTS:

a total of 242 women completed questionnaires at both time points.

MEASURES:

PTS symptoms were measured using the Impact of Event Scale-Revised (IES-R) 6-8 weeks after birth. Potential protective or risk factors of childbirth self-efficacy, fear of childbirth, adaptation to pregnancy/motherhood, and perceived social support were measured in pregnancy and after birth. Perceived support and control during birth was measured after birth. Demographic and obstetric information was collected in pregnancy using standard self-report questions.

FINDINGS:

PTS symptoms were associated with being multiparous, having a planned pregnancy, poor psychological adaptation to pregnancy, higher outcome expectancy but lower efficacy expectancy during pregnancy, urinary catheterization during labour, less support and perceived control in birth, less satisfaction with hospital care, poor psychological adaptation to motherhood and increased fear of birth post partum. Regression analyses showed the strongest correlates of PTS symptoms were high outcome and low efficacy expectancies in pregnancy, urinary catheterization in labour, poor psychological adaptation to motherhood and increased fear of birth post partum. This model accounted for 29% of the variance in PTS symptoms.

CONCLUSIONS:

this study suggests women in this province in Turkey report PTS symptoms after birth and this is associated with childbirth self-efficacy in pregnancy, birth factors, and poor adaptation to motherhood and increased fear of birth post partum.

IMPLICATIONS FOR PRACTICE:

maternity care services in Turkey need to recognise the potential impact of birth experiences on women’s mental health and adaptation after birth. The importance of self-efficacy in pregnancy suggests antenatal education or support may protect women against developing post partum PTS, but this needs to be examined further.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Risk+factors+associated+with+post-traumatic+stress+symptoms+following+childbirth+in+Turkey.

Impact of holding the baby following stillbirth on maternal mental health and well-being: findings from a national survey.

Redshaw M1, Hennegan JM1, Henderson J1.

BMJ Open. 2016 Aug 18;6(8):e010996. doi: 10.1136/bmjopen-2015-010996.

Abstract

OBJECTIVES:

To compare mental health and well-being outcomes at 3 and 9 months after the stillbirth among women who held or did not hold their baby, adjusting for demographic and clinical differences.

DESIGN:

Secondary analyses of data from a postal population survey.

POPULATION:

Women with a registered stillbirth in England in 2012.

METHODS:

468 eligible responses were compared. Differences in demographic, clinical and care characteristics between those who held or did not hold their infant were described and adjusted for in subsequent analysis. Mental health and well-being outcomes were compared, and subgroup comparisons tested hypothesised moderating factors.

OUTCOME MEASURES:

Self-reported depression, anxiety, post-traumatic stress disorder (PTSD) symptoms and relationship difficulties.

RESULTS:

There was a 30.2% response rate to the survey. Most women saw (97%, n=434) and held (84%, n=394) their baby after stillbirth. There were some demographic differences with migrant women, women who had a multiple birth and those whose pregnancy resulted from fertility treatment being less likely to hold their baby. Women who held their stillborn baby consistently reported higher rates of mental health and relationship difficulties. After adjustment, women who held their baby had 2.12 times higher odds (95% CI 1.11 to 4.04) of reporting anxiety at 9 months and 5.33 times higher odds (95% CI 1.26 to 22.53) of reporting relationship difficulties with family. Some evidence for proposed moderators was observed with poorer mental health reported by women who had held a stillborn baby of <33 weeks’ gestation, and those pregnant at outcome assessment.

CONCLUSIONS:

This study supports concern about the negative impact of holding the infant after stillbirth. Results are limited by the observational nature of the study, survey response rate and inability to adjust for women’s baseline anxiety. Findings add important evidence to a mixed body of literature.

http://bmjopen.bmj.com/content/6/8/e010996.full

Posttraumatic Growth in Parents After Infants’ NICU Hospitalization.

Aftyka A1, Rozalska-Walaszek I1, Rosa W2, Rybojad B1, Karakuła-Juchnowicz H1.

J Clin Nurs. 2016 Aug 18. doi: 10.1111/jocn.13518.

Abstract

AIMS AND OBJECTIVES:

We aimed to determine the incidence and severity of Post-traumatic Growth (PTG) in a group of parents of children hospitalized in the intensive care unit in the past.

BACKGROUND:

A premature birth or a birth with life-threating conditions is a traumatic event for the parents and may lead to a number of changes, some of which are positive, known as PTG.

METHOD:

The survey covered 106 parents of 67 infants aged 3 to 12 months. An original questionnaire and standardized research tools were used in the study: Impact Event Scale – Revised, Perceived Stress Scale, COPE Inventory: Positive Reinterpretation and Growth, Coping Inventory for Stressful Situations, Post-traumatic Growth Inventory and Parent and Infant Characteristic Questionnaire.

RESULTS:

Due to a stepwise backward variables selection, we found three main factors that explain PTG: post-traumatic stress symptoms, positive reinterpretation and growth and dichotomic variable infants’ survival. This model explained 29% of the PTG variation. Similar models that were considered separately for mothers and fathers showed no significantly better properties.

CONCLUSION:

PTG was related to a lesser extent to sociodemographic variables or the stressor itself, and related to a far greater extent to psychological factors.

http://www.ncbi.nlm.nih.gov/pubmed/27539892

Who is distressed? A comparison of psychosocial stress in pregnancy across seven ethnicities.

Robinson AM1, Benzies KM2, Cairns SL1, Fung T3, Tough SC4.

BMC Pregnancy Childbirth. 2016 Aug 11;16(1):215. doi: 10.1186/s12884-016-1015-8.

Abstract

BACKGROUND:

Calgary, Alberta has the fourth highest immigrant population in Canada and ethnic minorities comprise 28 % of its total population. Previous studies have found correlations between minority status and poor pregnancy outcomes. One explanation for this phenomenon is that minority status increases the levels of stress experienced during pregnancy. The aim of the present study was to identify specific types of maternal psychosocial stress experienced by women of an ethnic minority (Asian, Arab, Other Asian, African, First Nations and Latin American).

METHODS:

A secondary analysis of variables that may contribute to maternal psychosocial stress was conducted using data from the All Our Babies prospective pregnancy cohort (N = 3,552) where questionnaires were completed at < 24 weeks of gestation and between 34 and 36 weeks of gestation. Questionnaires included standardized measures of perceived stress, anxiety, depression, physical and emotional health, and social support. Socio-demographic data included immigration status, language proficiency in English, ethnicity, age, and socio-economic status.

RESULTS:

Findings from this study indicate that women who identify with an ethnic minority were more likely to report symptoms of depression, anxiety, inadequate social support, and problems with emotional and physical health during pregnancy than women who identified with the White reference group.

CONCLUSIONS:

This study has identified that women of an ethic minority experience greater psychosocial stress in pregnancy compared to the White reference group.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982239/

Understanding the Experience of Miscarriage in the Emergency Department.

MacWilliams K1, Hughes J2, Aston M2, Field S2, Moffatt FW2.

J Emerg Nurs. 2016 Aug 6. pii: S0099-1767(16)30079-4. doi: 10.1016/j.jen.2016.05.011.

Abstract

INTRODUCTION:

Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women.

METHODS:

Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis.

RESULTS:

Five themes emerged: “Pregnant/Life: Miscarriage/Death”; “Deciding to go to the emergency department: Something’s wrong”; “Not an illness: A different kind of trauma”; “Need for acknowledgement”; and “Leaving the emergency department: What now?”. Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization.

DISCUSSION:

This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization.

http://www.ncbi.nlm.nih.gov/pubmed/27507550

Effect of Parent Presence During Multidisciplinary Rounds on Neonatal Intensive Care Unit-Related Parental Stress.

Gustafson KW, LaBrecque MA, Graham DA, Tella NM, Curley MA.

J Obstet Gynecol Neonatal Nurs. 2016 Aug 3. pii: S0884-2175(16)30227-1. doi: 10.1016/j.jogn.2016.04.012.

Abstract

OBJECTIVE:

To evaluate the effect of parent presence during multidisciplinary rounds on NICU-related parental stress.

DESIGN:

Quasi-experimental study.

SETTING:

University-affiliated, 24-bed NICU located within a children’s hospital that admits infants from birth to 6 months of age.

PARTICIPANTS:

One hundred thirty-two parents of infants admitted to the NICU for the first time.

METHODS:

All parents completed the Parent Stressor Scale: NICU (PSS:NICU) on Study Days 0 and 3. In addition to usual family communication practices, parents in the experimental group were offered the opportunity to participate in multidisciplinary rounds on their infants.

RESULTS:

A total of 132 parents completed the study; the first 46 parents were enrolled in the control group, and the subsequent 86 parents in the experimental group. Overall PSS:NICU scores decreased significantly in the experimental group between Study Days 0 and 3 (mean ± standard error (SE) = -0.24 ± 0.07, p < .001), but the change was not significantly different between the control and experimental groups (mean ± SE = -0.12 ± 0.10, p = .25). The PSS:NICU Parental Role Alteration subscale decreased by the largest margin in the experimental group (mean ± SE = -0.42 ± 0.09, p < .0001), but the change was not significantly different between groups (mean ± SE = -0.26 ± 0.14, p = .06). Overall PSS:NICU stress scores were higher in mothers than fathers (mothers, mean ± SE = 3.4 ± 0.81; fathers, mean ± SE = 2.7 ± 0.67; p < .001).

CONCLUSION:

Providing parents with the opportunity to participate in multidisciplinary rounds did not affect NICU-related parental stress. Mothers reported higher levels of stress than fathers.

http://www.ncbi.nlm.nih.gov/pubmed/27497030

Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth.

Schrøder K; Larsen PV; Jørgensen JS; Hjelmborg JV; Lamont RF; Hvidt NC;

Midwifery [Midwifery] 2016 Aug 2; Vol. 41, pp. 45-53. Date of Electronic Publication: 2016 Aug 2.

Abstract:

Objective: this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth. Material and Methods: a 2012 national survey of all Danish obstetricians and midwives (n=2098). The response rate was 59% of which 85% (n=1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen Psychosocial Questionnaire (COPSOQII). Responses were assessed on six scales: burnout, sleep disorders, general stress, depressive symptoms, somatic stress and cognitive stress. Associations between COPSOQII scales and participant characteristics were analysed using linear regression. Results: midwives reported significantly higher scores than obstetricians, to a minor extent during the most recent four weeks and to a greater extent immediately following a traumatic childbirth scale, indicating higher levels of self-reported psychosocial health problems. Sub-group analyses showed that this difference might be gender related. Respondents who had left the labour ward partly or primarily because they felt that the responsibility was too great a burden to carry reported significantly higher scores on all scales in the aftermath of the traumatic birth than did the group who still worked on the labour ward. None of the scales were associated with age or seniority in the time after the traumatic birth indicating that both junior and senior staff may experience similar levels of psychosocial health and well-being in the aftermath. Key Conclusions and Implications: this study shows an association between profession (midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by gender. This knowledge may lead to better awareness of the possibility of differences related to profession and gender when conducting debriefings and offering support to HCPs in the aftermath of traumatic childbirth. As many as 85% of the respondents in this national study stated that they had been involved in at least one traumatic childbirth, suggesting that the handling of the aftermath of these events is important when caring for the psychosocial health and well-being of obstetric and midwifery staff.

http://www.midwiferyjournal.com/article/S0266-6138(16)30122-X/fulltext?rss=yes

Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment.

Oh W; Muzik M; McGinnis EW; Hamilton L; Menke RA; Rosenblum KL

Journal Of Affective Disorders [J Affect Disord] 2016 Aug; Vol. 200, pp. 133-41.

Abstract:

Background: Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history. Methods: 177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors. Results: Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors. Limitations: Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk. Conclusions: The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.

http://www.ncbi.nlm.nih.gov/pubmed/27131504

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)

Abstract:

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.

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0974-0

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.

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/27425165

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.

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/27421663

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

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/27152849

PTSD SYMPTOMS ACROSS PREGNANCY AND EARLY POSTPARTUM AMONG WOMEN WITH LIFETIME PTSD DIAGNOSIS.

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.

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/26740305

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.

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/27072600

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

Cipolletta S

Journal Of Health Psychology 2016 Jul 24.

Abstract:

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.

http://www.ncbi.nlm.nih.gov/pubmed/27458107

Please Don’t Use the Restraints.

Rowe, Desireé D.

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

Abstract:

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.

http://qix.sagepub.com/content/22/6/484

 

May and June Research Update

The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review.

Agius A, Xuereb RB, Carrick-Sen D, Sultana R, Rankin J.
Midwifery. 2016 May;36:70-9. doi: 10.1016/j.midw.2016.02.013.

Abstract

OBJECTIVE:

to identify and appraise the current international evidence regarding the presence and prevalence of the co-existence of depression, anxiety and post-traumatic stress symptoms in the antenatal and post partum period.

METHODS:

using a list of keywords, Medline, CINHAL, Cochrane Library, EMBASE, PsychINFO, Web of Science and the Index of Theses and Conference Proceedings (Jan 1960 – Jan 2015) were systematically searched. Experts in the field were contacted to locate papers that were in progress or in press. Reference lists from relevant review articles were searched. Inclusion criteria included full papers published in English reporting concurrent depression, anxiety and post-traumatic stress symptoms in pregnant and post partum women. A validated data extraction review tool was used.

FINDINGS:

3424 citations were identified. Three studies met the full inclusion criteria. All reported findings in the postnatal period. No antenatal studies were identified. The prevalence of triple co-morbidity was relatively low ranging from 2% to 3%.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:

triple co-morbidity does occur, although the prevalence appears to be low. Due to the presentation of complex symptoms, women with triple co-morbidity are likely to be difficult to identify, diagnose and treat. Clinical staff should be aware of the potential of complex symptomatology.

http://www.ncbi.nlm.nih.gov/pubmed/27106946

Predictors of birth-related post-traumatic stress symptoms: secondary analysis of a cohort study.

Furuta M, Sandall J, Cooper D, Bick D.
Arch Womens Ment Health. 2016 May 13.

Abstract

This study aimed to identify factors associated with birth-related post-traumatic stress symptoms during the early postnatal period. Secondary analysis was conducted using data from a prospective cohort study of 1824 women who gave birth in one large hospital in England. Post-traumatic stress symptoms were measured by the Impact of Event Scale at 6 to 8 weeks postpartum. Zero-inflated negative binomial regression models were developed for analyses. Results showed that post-traumatic stress symptoms were more frequently observed in black women and in women who had a higher pre-pregnancy BMI compared to those with a lower BMI. Women who have a history of mental illness as well as those who gave birth before arriving at the hospital, underwent an emergency caesarean section or experienced severe maternal morbidity or neonatal complications also showed symptoms. Women’s perceived control during labour and birth significantly reduced the effects of some risk factors. A higher level of perceived social support during the postnatal period also reduced the risk of post-traumatic stress symptoms. From the perspective of clinical practice, improving women’s sense of control during labour and birth appears to be important, as does providing social support following the birth.

http://www.ncbi.nlm.nih.gov/pubmed/27178126

Emotional Distress Following Childbirth: An Intervention to Buffer Depressive and PTSD Symptoms.

Di Blasio P, Miragoli S, Camisasca E, Di Vita AM, Pizzo R, Pipitone L.
Eur J Psychol. 2015 May 29;11(2):214-32. doi: 10.5964/ejop.v11i2.779.

Abstract

Childbirth for some women is a negative experience associated with depressive and post-traumatic symptoms. The preventive actions focusing on helping mothers to cope with negative emotions experienced after childbirth are strongly recommended. It is also recommended both to intervene early and on all women to avoid the risk that these symptoms can worsen in the months after childbirth. The intervention described in the current study is focalized on the elaboration of post-partum negative thoughts and emotion through a writing task, with the purpose to help new mothers to reflect, understand, evaluate and, thus, reformulate the stressful situation with new beliefs and emotions. 176 women aged from 19 to 43 years (M = 31.55, SD = 4.58) were assessed for depression and PTSD in the prenatal phase (T1). In about 96 hours after childbirth they were randomly assigned to either “Making Sense condition” (MS: in which they wrote about the thoughts and emotions connected with delivery and childbirth) or “Control-Neutral condition” (NC: in which they wrote about the daily events in behavioural terms) and then reassessed for depression and PTSD (T2). A follow up was conducted 3 months later (T3) to verify depression and posttraumatic symptoms. The results showed that depressive symptoms decreased both at 96 hours and at 3 months as a result of making-sense task. Regarding the posttraumatic symptoms the positive effect emerged at three months and not at 96 hours after birth.

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

Nieminen K1,2, Berg I3, Frankenstein K3, Viita L3, Larsson K3, Persson U3, Spånberger L3, Wretman A3, Silfvernagel K3, Andersson G3,4, Wijma K1.
Cogn Behav Ther. 2016 Jun;45(4):287-306. doi: 10.1080/16506073.2016.1169626.

Abstract

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.

http://www.ncbi.nlm.nih.gov/pubmed/27152849

Posttraumatic Stress Disorder Following Stillbirth: Trauma Characteristics, Locus of Control, Posttraumatic Cognitions.

Chung MC, Reed J.
Psychiatr Q. 2016 Jun 23.

Abstract

This study examined the incidence of PTSD and psychiatric co-morbidity among women who experienced stillbirth and investigated the relationship between locus of control, trauma characteristics of stillbirth, posttraumatic cognitions, PTSD and co-morbid psychiatric symptoms following stillbirth. Fifty women recorded information on stillbirth experiences, and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Edinburgh Post-natal Depression Scale, Rotter’s Locus of Control Scale and the Posttraumatic Cognitions Inventory. 60, 28 and 12 % met the diagnostic criteria for probable full-PTSD, partial and no-PTSD respectively. Sixty-two percent and 54 % scored at or above the cutoff of the General Health Questionnaire-28 and postnatal depression respectively. Women who experienced stillbirth reported significantly more psychiatric co-morbid and post-natal depressive symptoms than the comparison group. Both groups were similar in locus of control. Women who experienced stillbirth reported negative cognitions about the self the most. After adjusting for postnatal depression, trauma characteristics were significantly correlated with Posttraumatic cognitions which, in turn, were significantly correlated with PTSD and psychiatric co-morbidity. Locus of control was not significantly correlated with psychological outcomes. Mediational analyses showed that negative cognitions about self mediated the relationship between trauma characteristics and psychiatric co-morbidity only. Women reported a high incidence of probable PTSD and co-morbid psychiatric symptoms following stillbirth. Stillbirth trauma characteristics influenced how they negatively perceived themselves. This then specifically influenced general psychological problems rather than PTSD symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/27338722

The Effects of Trauma History and Prenatal Affective Symptoms on Obstetric Outcomes.

Blackmore ER, Putnam FW, Pressman EK, Rubinow DR, Putnam KT, Matthieu MM, Gilchrist MA, Jones I, O’Connor TG.
J Trauma Stress. 2016 Jun;29(3):245-52. doi: 10.1002/jts.22095.

Abstract

Prenatal maternal mood may inform the adverse obstetric outcomes seen in disadvantaged populations. The contribution of having a trauma history is not well studied. We examined the impact of trauma exposure and mood symptoms on obstetric outcomes in 358 women. Women with antecedent trauma were more likely to have a history of depression, odds ratio = 2.83, 95% confidence interval [1.81, 4.42], were younger at their first pregnancy, 18.86 years versus 20.10 years, and had a higher number of previous pregnancies, 2.01 versus 1.54, compared to those with no trauma exposure. Women with prenatal anxiety had significantly smaller babies than nonanxious women, 3,313.17 g, (SD = 441.58) versus 3,429.27 g, (SD = 437.82) Trauma history magnified the effects of maternal prenatal mood on birthweight; the moderating effect was limited to those who first experienced a trauma under 18 years of age. Childhood trauma exposure increased vulnerability for low birthweight delivery associated with prenatal mood disturbance. Screening pregnant women for trauma history and current mood symptoms is indicated.

http://www.ncbi.nlm.nih.gov/pubmed/27276162

Posttraumatic Growth after Birth Trauma: “I Was Broken, Now I Am Unbreakable”.

Beck CT, Watson S.
MCN Am J Matern Child Nurs. 2016 Jun 7.

Abstract

PURPOSE:

The aim of this study was to investigate women’s experiences of posttraumatic growth following traumatic childbirth.

STUDY DESIGN AND METHODS:

A descriptive phenomenological study was conducted using Colaizzi’s data analysis method. The Internet sample of 15 mothers was recruited from the Trauma and Birth Stress Web site. Women were asked to describe in as much detail as they could remember, their experiences of any positive changes in their beliefs or life as a result of their traumatic childbirth.

RESULTS:

Using Calhoun and Tedeschi’s metaphor of an earthquake to help explain posttraumatic growth, the seismic waves of birth trauma had enough power to lead to four themes of posttraumatic growth revealed in this phenomenological study: (1) Opening oneself up to a new present, (2) Achieving a new level of relationship nakedness, (3) Fortifying spiritual-mindedness, and (4) Forging new paths.

CLINICAL IMPLICATIONS:

Mothers’ experiences of their personal growth after birth trauma can help inform future research that can promote posttraumatic growth in mothers. Clinicians can share results of this study with their patients to provide some hope to mothers struggling with the aftermath of a traumatic birth that some women have reported positive growth. Healthcare providers need to respect trauma survivors’ struggles while at the same time permitting mothers to explore possibilities for growth. Clinicians must not, however, create the false expectation that posttraumatic growth will happen in most trauma survivors.

http://www.ncbi.nlm.nih.gov/pubmed/27276105

Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women.

Milosavljevic M, Lecic Tosevski D, Soldatovic I, Vukovic O, Miljevic C, Peljto A, Kostic M, Olff M.
Sci Rep. 2016 Jun 8;6:27554. doi: 10.1038/srep27554.

Abstract

Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women were assessed for PTSD using the gold standard interview for PTSD, Clinician-Administered PTSD Scale (CAPS). Risk factors were assessed including sociodemographic variables, personal medical history and clinical variables. After the first month, 2.4% women had acute full PTSD and another 9.5% had clinically significant level of PTSD symptoms. Following the second and the third month, partial PTSD was found in 5.9% and 1.3% of the women, respectively, and none of participants had full PTSD. Obstetrical interventions were the only significant risk factor for the development of PTSD. Symptoms of postpartum PTSD are not rare after a traumatic delivery, and associated with specific obstetrical risk factors. Awareness of these risk factors may stimulate interventions to prevent this important and neglected postpartum disorder.

http://www.ncbi.nlm.nih.gov/pubmed/27271544

Cumulative Trauma and Partner Conflict Predict Posttraumatic Stress Disorder in Postpartum African-American Women.

Hauff NJ1, Fry-McComish J1, Chiodo LM2.
Clin Nurs. 2016 Jun 6. doi: 10.1111/jocn.13421.

Abstract

AIM:

To describe relationships between cumulative trauma, partner conflict, and posttraumatic stress in African-American postpartum women.

BACKGROUND:

Cumulative trauma exposure estimates for women in the United States range from 51%-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Posttraumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality.

DESIGN:

This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women ages 18-45 who had given birth.

METHODS:

Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Posttraumatic Stress Scale, Edinburgh Postnatal Depression Scale, and a Demographic Data form. Descriptive statistics, correlations, and multiple regressions were used for data analysis.

RESULTS:

All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life threatening event for a loved one reported by 60% of the sample. Nearly one fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict, and lower level of education were related to higher rates of PTSD symptoms.

CONCLUSION:

Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. This article is protected by copyright. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/27271531

 

 

April Research Update

Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment.

Oh W, Muzik M, McGinnis EW, Hamilton L, Menke RA, Rosenblum KL.

J Affect Disord. 2016 Apr 20;200:133-141. doi: 10.1016/j.jad.2016.04.037.

Abstract

BACKGROUND:

Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history.

METHODS:

177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors.

RESULTS:

Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors.

LIMITATIONS:

Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk.

CONCLUSIONS:

The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.

http://www.ncbi.nlm.nih.gov/pubmed/27131504

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

Schrøder K, Jørgensen JS, Lamont RF, Hvidt NC.

Acta Obstet Gynecol Scand. 2016 Apr 13. doi: 10.1111/aogs.12897.

Abstract

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.

http://www.ncbi.nlm.nih.gov/pubmed/27072600

[Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms].

[Article in French]
Gosselin P, Chabot K, Béland M, Goulet-Gervais L, Morin AJ

Encephale. 2016 Apr;42(2):191-6. doi: 10.1016/j.encep.2016.01.007. Epub 2016 Feb 26.

Abstract

OBJECTIVE:

Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested.

METHOD:

Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum).

RESULTS:

Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD.

CONCLUSIONS:

These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.

http://www.ncbi.nlm.nih.gov/pubmed/26924001

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.

Ayers S, Bond R, Bertullies S, Wijma K.
Psychol Med. 2016 Apr;46(6):1121-34. doi: 10.1017/S0033291715002706.

Abstract

There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

http://www.ncbi.nlm.nih.gov/pubmed/26878223

Posttraumatic Stress Disorder After Birth: A Metaphor Analysis.

Beck CT.
MCN Am J Matern Child Nurs. 2016 Mar-Apr;41(2):76-83. doi: 10.1097/NMC.0000000000000211.

Abstract

PURPOSE:

Nine percent of mothers screened positive for meeting the diagnostic criteria for posttraumatic stress disorder (PTSD) due to childbirth in a recent study of childbearing women in the United States. The purpose of this study was to analyze the language used by mothers experiencing PTSD after traumatic birth for metaphors as a rich source of insight into this mental illness for maternal-child nurses.

STUDY DESIGN AND METHODS:

A secondary analysis was conducted of the corpus of 124 typed pages from the primary qualitative study of women’s experiences of PTSD following traumatic childbirth. The Pragglejaz Group’s metaphor identification procedure was the method used for identifying metaphorically used words in the mothers’ discourse.

RESULTS:

Nine metaphors emerged. These metaphors portray PTSD due to childbirth as a mechanical robot, a ticking time bomb, an invisible wall, a video on constant reply, enveloping darkness, a dangerous ocean, a thief in the night, a bottomless abyss, and suffocating layers of trauma.

CLINICAL IMPLICATIONS:

Metaphors that mothers used to describe their experiences of PTSD following a traumatic birth provide rich insight for maternal-child nurses. These metaphors give a new voice to women’s experiences of PTSD and are a perfect match for a valuable source for nurses’ evidence-based practice.

http://www.ncbi.nlm.nih.gov/pubmed/26909720

February and March Research Update

Apologies for missing February’s update. To ensure no studies are missed I have decided to compile February’s and Marchs into one post:

[Reliability and Validity of the Korean Version of the Perinatal Post-Traumatic Stress Disorder Questionnaire].

[Article in Korean]

 

Park YK, Ju HO, Na H3.

 

Abstract

PURPOSE:

The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was designed to measure post-traumatic symptoms related to childbirth and symptoms during postnatal period. The purpose of this study was to develop a translated Korean version of the PPQ and to evaluate reliability and validity of the Korean PPQ.

METHODS:

Participants were 196 mothers at one to 18 months after giving childbirth and data were collected through e-mails. The PPQ was translated into Korean using translation guideline from World Health Organization. For this study Cronbach’s alpha and split-half reliability were used to evaluate the reliability of the PPQ. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and known-group validity were conducted to examine construct validity. Correlations of the PPQ with Impact of Event Scale (IES), Beck Depression Inventory II (BDI-II), and Beck Anxiety Inventory (BAI) were used to test a criterion validity of the PPQ.

RESULTS:

Cronbach’s alpha and Spearman-Brown split-half correlation coefficient were 0.91 and 0.77, respectively. EFA identified a 3-factor solution including arousal, avoidance, and intrusion factors and CFA revealed the strongest support for the 3-factor model. The correlations of the PPQ with IES, BDI-II, and BAI were .99, .60, and .72, respectively, pointing to criterion validity of a high level.

CONCLUSION:

The Korean version PPQ is a useful tool for screening and assessing mothers’ experiencing emotional distress related to child birth and during the postnatal period. The PPQ also reflects Post Traumatic Stress Disorder’s diagnostic standards well.

 

http://www.ncbi.nlm.nih.gov/pubmed/26963412

 

[Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms].

[Article in French]

 

Gosselin P, Chabot K, Béland M, Goulet-Gervais L, Morin AJ.

 

Abstract

OBJECTIVE:

Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested.

METHOD:

Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum).

RESULTS:

Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD.

CONCLUSIONS:

These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.

 

http://www.ncbi.nlm.nih.gov/pubmed/26924001

 

Posttraumatic Stress Disorder After Birth: A Metaphor Analysis.

 

Beck CT1.

 

Abstract

PURPOSE:

Nine percent of mothers screened positive for meeting the diagnostic criteria for posttraumatic stress disorder (PTSD) due to childbirth in a recent study of childbearing women in the United States. The purpose of this study was to analyze the language used by mothers experiencing PTSD after traumatic birth for metaphors as a rich source of insight into this mental illness for maternal-child nurses.

STUDY DESIGN AND METHODS:

A secondary analysis was conducted of the corpus of 124 typed pages from the primary qualitative study of women’s experiences of PTSD following traumatic childbirth. The Pragglejaz Group’s metaphor identification procedure was the method used for identifying metaphorically used words in the mothers’ discourse.

RESULTS:

Nine metaphors emerged. These metaphors portray PTSD due to childbirth as a mechanical robot, a ticking time bomb, an invisible wall, a video on constant reply, enveloping darkness, a dangerous ocean, a thief in the night, a bottomless abyss, and suffocating layers of trauma.

CLINICAL IMPLICATIONS:

Metaphors that mothers used to describe their experiences of PTSD following a traumatic birth provide rich insight for maternal-child nurses. These metaphors give a new voice to women’s experiences of PTSD and are a perfect match for a valuable source for nurses’ evidence-based practice.

 

http://www.ncbi.nlm.nih.gov/pubmed/26909720

 

Anxiety Sensitivity Among First-Time Fathers Moderates the Relationship Between Exposure to Stress During Birth and Posttraumatic Stress Symptoms.

 

Zerach G, Magal O.

 

Abstract

This longitudinal study examined posttraumatic stress disorder (PTSD) and anxiety symptoms among men attending the birth of their first offspring. Furthermore, we examined the moderating role of anxiety sensitivity (AS) and intolerance of uncertainty in the association between exposure to stress during birth and PTSD and anxiety symptoms. Participants were Israeli men (n = 171) who were assessed with self-report questionnaires during the third trimester of pregnancy (T1) and approximately a month following birth (T2). Results show that the rates of postnatal PTSD and anxiety symptoms were relatively low. Subjective exposure to stress during birth and AS predicted PTSD in T2, above and beyond other negative life events and PTSD in T1. In addition, AS moderated the relations between subjective exposure to stress during birth and PTSD symptoms. Pregnancy and childbirth professionals may benefit from the insight that men with high levels of AS might experience childbirth as a highly stressful situation with possible posttraumatic stress symptoms.

 

http://www.ncbi.nlm.nih.gov/pubmed/26894317

 

Seeing Their Children in Pain: Symptoms of Posttraumatic Stress Disorder in Mothers of Children with an Anomaly Requiring Surgery at Birth.

 

Aite L, Bevilacqua F, Zaccara A, La Sala E, Gentile S, Bagolan P.

 

Abstract

Objective Assess the presence of posttraumatic stress disorder (PTSD) symptoms in mothers of newborns requiring early surgery. Study Design Mothers of newborns operated on for a congenital anomaly underwent a semi-structured interview on their experience 6 months postpartum. Interviews were audiotaped, transcribed verbatim, and analyzed for symptoms of the three major criteria of PTSD: re-experiencing, avoidance, and heightened arousal. Results A total of 120 mothers took part in the study; their children were affected by one of the following congenital anomaly: esophageal atresia (n = 29); congenital diaphragmatic hernia (n = 38); midgut malformations (n = 38); and abdominal wall defects (n = 15). Two mothers did not show any symptoms; 12 mothers (10%) had one posttraumatic symptom, 77 (64.2%) had two, and 29 (24.2%) had three. Overall, 106 mothers (88.4%) presented at least two symptoms. Conclusion PTSD can be considered a useful model to describe and comprehend mothers’ reactions in this specific population. Preventive interventions and dedicated follow-up program should be offered to these families.

 

http://www.ncbi.nlm.nih.gov/pubmed/26890434

 

Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study.

 

Koen N, Brittain K, Donald KA, Barnett W, Koopowitz S, Maré K, Zar HJ, Stein DJ.

 

Abstract

BACKGROUND:

Prenatal and peripartum trauma may be associated with poor maternal-fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition.

OBJECTIVE:

We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study.

METHODS:

Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES), and depression.

RESULTS:

A total of 544 mother-infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV). The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction (95% CI: 0.1; 0.5) in infant head-circumference-for-age z-scores (HCAZ scores) at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model.

CONCLUSIONS:

In this exploratory study, maternal trauma and PTSD were found to be highly prevalent, and preliminary evidence suggested that trauma may adversely affect fetal growth, as measured by birth head circumference. However, these findings are limited by a number of methodological weaknesses, and further studies are required to extend findings and delineate causal links and mechanisms of association.

 

http://www.ncbi.nlm.nih.gov/pubmed/26886489

 

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.

 

Ayers S, Bond R, Bertullies S, Wijma K.

 

Abstract

There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

 

http://www.ncbi.nlm.nih.gov/pubmed/26878223

 

Does abortion increase women’s risk for post-traumatic stress? Findings from a prospective longitudinal cohort study.

 

Biggs MA, Rowland B, McCulloch CE, Foster DG.

 

Abstract

OBJECTIVE:

To prospectively assess women’s risk for post-traumatic stress disorder (PTSD) and of experiencing post-traumatic stress symptoms (PTSS) over 4 years after seeking an abortion, and to assess whether symptoms are attributed to the pregnancy, abortion or birth, or other events in women’s lives.

DESIGN:

Prospective longitudinal cohort study which followed women from approximately 1 week after receiving or being denied an abortion (baseline), then every 6 months for 4 years (9 interview waves).

SETTING:

30 abortion facilities located throughout the USA.

PARTICIPANTS:

Among 956 women presenting for abortion care, some of whom received an abortion and some of whom were denied due to advanced gestational age; 863 women are included in the longitudinal analyses.

MAIN OUTCOME MEASURES:

PTSS and PTSD risk were measured using the Primary Care PTSD Screen (PC-PTSD). Index pregnancy-related PTSS was measured by coding the event(s) described by women as the cause of their symptoms.

ANALYSES:

We used unadjusted and adjusted logistic mixed-effects regression analyses to assess whether PTSS, PTSD risk and pregnancy-related PTSS trajectories of women obtaining abortions differed from those who were denied one.

RESULTS:

At baseline, 39% of participants reported any PTSS and 16% reported three or more symptoms. Among women with symptoms 1-week post-abortion seeking (n=338), 30% said their symptoms were due to experiences of sexual, physical or emotional abuse or violence; 20% attributed their symptoms to non-violent relationship issues; and 19% said they were due to the index pregnancy. Baseline levels of PTSS, PTSD risk and pregnancy-related PTSS outcomes did not differ significantly between women who received and women who were denied an abortion. PTSS, PTSD risk and pregnancy-related PTSS declined over time for all study groups.

CONCLUSIONS:

Women who received an abortion were at no higher risk of PTSD than women denied an abortion.

 

http://www.ncbi.nlm.nih.gov/pubmed/26832431

 

Factors Associated with Post-Traumatic Symptoms in Mothers of Preterm Infants.

 

Chang HP, Chen JY, Huang YH, Yeh CJ, Huang JY, Su PH, Chen VC.

 

Abstract

OBJECTIVES:

Symptoms of post-traumatic distress in mothers of preterm infants have been a subject of mental health research. The aim of this study was to assess the prevalence of and risk factors associated with such symptoms in mothers of preterm infants in Taiwan.

METHODS:

This was a cross-sectional study performed between January 1, 2010 and June 30, 2011. One hundred and two mothers of preterm infants born at less than 37weeks gestation and with a subsequent neonatal intensive care unit (NICU) stay between 2005 and 2009 were recruited. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression Scale (CES-D) and the neuroticism subscale of the Maudsley Personality Inventory (MPI). The preterm infants’ data were taken from medical records.

RESULTS:

The prevalence of symptoms of distress was 25.5% (26/102) in the participants. These symptoms were associated with previous miscarriages, preterm premature rupture of membranes, neurotic personality and depression.

CONCLUSIONS:

The experience of preterm birth and NICU hospitalization can be traumatic to mothers. Early support for mothers during the preterm infants’ NICU stay and transition to home care are recommended.

 

http://www.ncbi.nlm.nih.gov/pubmed/26804509

 

Mother’s Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth.

 

Petit AC, Eutrope J, Thierry A, Bednarek N, Aupetit L, Saad S, Vulliez L, Sibertin-Blanc D, Nezelof S, Rolland AC.

 

Abstract

Objectives: Very preterm infants are known to be at risk of developmental disabilities and behavioural disorders. This condition is supposed to alter mother-infant interactions. Here we hypothesize that the parental coping with the very preterm birth may greatly influence mother-infant interactions. Methods: 100 dyads were included in 3 university hospitals in France. Preterm babies at higher risk of neurodevelopmental sequelae (PRI>10) were excluded to target the maternal determinants of mother-infant interaction. We report the follow-up of this cohort during 1 year after very preterm birth, with regular assessment of infant somatic state, mother psychological state and the assessment of mother-infant interaction at 12 months by validated scales (mPPQ, HADS, EPDS, PRI, DDST and PIPE). Results: We show that the intensity of post-traumatic reaction of the mother 6 months after birth is negatively correlated with the quality of mother-infant interaction at 12 months. Moreover, the anxious and depressive symptoms of the mother 6 and 12 months after birth are also correlated with the quality of mother-infant interaction at 12 months. By contrast, this interaction is not influenced by the initial affective state of the mother in the 2 weeks following birth. In this particular population of infants at low risk of sequelae, we also show that the quality of mother-infant interaction is not correlated with the assessment of the infant in the neonatal period but is correlated with the fine motor skills of the baby 12 months after birth. Conclusions: This study suggests that mothers’ psychological condition has to be monitored during the first year of very preterm infants’ follow-up. It also suggests that parental interventions have to be proposed when a post-traumatic, anxious or depressive reaction is suspected.

http://www.ncbi.nlm.nih.gov/pubmed/27022953

 

Computer- or web-based interventions for perinatal mental health: A systematic review.

 

Ashford MT, Olander EK, Ayers S

 

Abstract

Background: Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women’s perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy. Methods: Twelve electronic databases were searched for published and unpublished literature using keywords, supplemented by hand searches. Data were extracted for characteristics of the intervention and the study, study findings and the methodological quality was assessed. Results: The majority of the eleven eligible studies were randomized controlled trials. Interventions were targeted at depression, stress, and complicated grief during the antenatal or postpartum period or the time after pregnancy loss. Findings suggest that computer- or web-based interventions targeted at improving mental health, especially depression and complicated grief, may be effective. Limitations: Findings and their generalizability is limited by the heterogeneity of reviewed interventions and study designs, as well as methodological limitations. Conclusions: This systematic review constitutes the first synthesis of research on computer- or web-based interventions for perinatal mental health issues and provides preliminary support that this could be a promising form of treatment during this period. However, there are significant gaps in the current evidence-base so further research is needed.
http://www.ncbi.nlm.nih.gov/pubmed/26991368

Mindfulness and perinatal mental health: A systematic review.

 

Hall HG, Beattie J, East C, Anne Biro M

 

Abstract

Background: Perinatal stress is associated with adverse maternal and infant outcomes. Mindfulness training may offer a safe and acceptable strategy to support perinatal mental health. Aim: To critically appraise and synthesise the best available evidence regarding the effectiveness of mindfulness training during pregnancy to support perinatal mental health. Methods: The search for relevant studies was conducted in six electronic databases and in the grey literature. Eligible studies were assessed for methodological quality according to standardised critical appraisal instruments. Data were extracted and recorded on a pre-designed form and then entered into Review Manager. Findings: Nine studies were included in the data synthesis. It was not appropriate to combine the study results because of the variation in methodologies and the interventions tested. Statistically significant improvements were found in small studies of women undertaking mindfulness awareness training in one study for stress (mean difference (MD) -5.28, 95% confidence intervals (CI) -10.4 to -0.42, n=22), two for depression (for example MD -5.48, 95% CI -8.96 to -2.0, n=46) and four for anxiety (for example, MD -6.50, 95% CI -10.95 to -2.05, n=32). However the findings of this review are limited by significant methodological issues within the current research studies. Conclusion: There is insufficient evidence from high quality research on which to base recommendations about the effectiveness of mindfulness to promote perinatal mental health. The limited positive findings support the design and conduct of adequately powered, longitudinal randomised controlled trials, with active controls.
http://www.ncbi.nlm.nih.gov/pubmed/26346905

 

 

January 2016 Research Update

Middle range theory of traumatic childbirth: The ever –widening ripple effect.

Beck, C. T.

ABSTRACT

A middle range theory of traumatic childbirth was developed using Morse’s method of theoretical coalescence. The scope of this qualitative theory was increased by formalizing the connections between 14 individual studies all conducted by the same researcher on the same topic, with different groups, using different research designs and different types of analyses. Axioms were derived from this research program along with attributes of traumatic childbirth, posttraumatic stress, and secondary traumatic stress. This middle range theory addresses the long-term chronic consequences of a traumatic birth for mothers including its impact on breastfeeding, subsequent childbirth, and the anniversary of birth trauma. The impact on fathers and clinicians present at the traumatic birth is highlighted as secondary traumatic stress comes into play. Troubling glimpses of difficulties in mother–infant bonding are revealed.

 

http://gqn.sagepub.com/content/2/2333393615575313.abstract

 

Shaken belief in the birth process: A mixed methods study of secondary traumatic stress in certified nurse-midwives.

Beck, C. T., LoGiudice, J., & Gable, R. K.

ABSTRACT

INTRODUCTION:

Secondary traumatic stress (STS) is an occupational hazard for clinicians who can experience symptoms of posttraumatic stress disorder (PTSD) from exposure to their traumatized patients. The purpose of this mixed-methods study was to determine the prevalence and severity of STS in certified nurse-midwives (CNMs) and to explore their experiences attending traumatic births.

METHODS:

A convergent, parallel mixed-methods design was used. The American Midwifery Certification Board sent out e-mails to all their CNM members with a link to the SurveyMonkey study. The STS Scale was used to collect data for the quantitative strand. For the qualitative strand, participants were asked to describe their experiences of attending one or more traumatic births. IBM SPSS 21.0 (Version 21.0, Armonk, NY) was used to analyze the quantitative data, and Krippendorff content analysis was the method used to analyze the qualitative data.

RESULTS:

The sample consisted of 473 CNMs who completed the quantitative portion and 246 (52%) who completed the qualitative portion. In this sample, 29% of the CNMs reported high to severe STS, and 36% screened positive for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for PTSD due to attending traumatic births. The top 3 types of traumatic births described by the CNMs were fetal demise/neonatal death, shoulder dystocia, and infant resuscitation. Content analysis revealed 6 themes: 1) protecting my patients: agonizing sense of powerlessness and helplessness; 2) wreaking havoc: trio of posttraumatic stress symptoms; 3) circling the wagons: it takes a team to provide support … or not; 4) litigation: nowhere to go to unburden our souls; (5) shaken belief in the birth process: impacting midwifery practice; and 6 moving on: where do I go from here?

 

http://www.ncbi.nlm.nih.gov/pubmed/25644069

 

Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial.

Horsch A, Tolsa JF, Gilbert L, du Chêne LJ, Müller-Nix C, Graz MB

Abstract

Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care.

 

http://www.ncbi.nlm.nih.gov/pubmed/26659113

 

An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder

Jane Vesel, Bonnie Nickasch.

ABSTRACT

Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centered maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD? This review includes a description of key variables associated with P-PTSD. Socioeconomic, environmental and genetic determinants are discussed, as are evidence-based prevention and treatment approaches.

 

http://nwhjournal.org/article/S1751-4851(15)30842-4/abstract

 

Post-traumatic stress disorder following emergency peripartum hysterectomy.

de la Cruz CZ, Coulter M, O’Rourke K, Mbah AK, Salihu HM.

Abstract

PURPOSE:

Our objective was to explore if women who experience emergency peripartum hysterectomy (EPH), a type of severe maternal morbidity, are more likely to screen positive for post-traumatic stress disorder (PTSD) compared to women who did not experience EPH.

METHODS:

Using a retrospective cohort design, women were sampled through online communities. Participants completed online screens for PTSD. Additionally, women provided sociodemographic, obstetric, psychiatric, and psychosocial information. We conducted bivariate and logistic regression analyses, then Monte Carlo simulation and propensity score matching to calculate the risk of screening positive for PTSD after EPH.

RESULTS:

74 exposed women (experienced EPH) and 335 non-exposed women (did not experience EPH) completed the survey. EPH survivors were nearly two times more likely to screen positive for PTSD (aOR: 1.90; 95 % CI: 1.57, 2.30), and nearly 2.5 times more likely to screen positive for PTSD at 6 months postpartum compared to women who were not EPH survivors (aOR: 2.46; 95 % CI: 1.92, 3.16).

CONCLUSION:

The association of EPH and PTSD was statistically significant, indicating a need for further research, and the potential need for support services for these women following childbirth.

 

http://www.ncbi.nlm.nih.gov/pubmed/26781263

 

Predisposing and Precipitating Factors for Dissociation During Labor in a Cohort Study of Posttraumatic Stress Disorder and Childbearing Outcomes.

Choi KR, Seng JS.

Abstract

INTRODUCTION:

Peritraumatic dissociation is an important predictor of posttraumatic stress disorder (PTSD), depression, and impaired bonding following childbirth. The purpose of this study was to follow up on an earlier finding that peritraumatic dissociation in labor was associated with adverse postpartum outcomes by identifying predictors of dissociation in labor.

METHODS:

This analysis used data from a prospective cohort study of primiparous women from southeast Michigan. There were 564 women included in the analysis; the primary outcome measure was the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) score measuring dissociation during labor.

RESULTS:

The prevalence of dissociation in labor for this sample was 7.4%. Important predictors of dissociation in labor included both predisposing (eg, childhood maltreatment trauma, preexisting psychopathology) and precipitating (eg, perception of care, negative appraisal of labor) factors. Overall, these predictors explained 14.7% of variance in PDEQ score. In 3 separate, simple linear regression models, the PDEQ score explained 20% of variance in postpartum PTSD, 13% of variance in postpartum depression, and 9% of variance in impaired bonding.

DISCUSSION:

Women with maltreatment history and PTSD are at risk to be retraumatized or overwhelmed by birth and to dissociate. Although it would be optimal to assess for dissociative coping prenatally, assessing with the PDEQ following birth could contribute to evaluation of risk for postpartum psychopathology.

 

http://www.ncbi.nlm.nih.gov/pubmed/26774007

 

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms.

Beauquier-Maccotta B, Chalouhi GE, Picquet AL, Carrier A, Bussières L, Golse B, Ville Y.

Abstract

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn’t for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.

 

http://www.ncbi.nlm.nih.gov/pubmed/26751570

 

PTSD SYMPTOMS ACROSS PREGNANCY AND EARLY POSTPARTUM AMONG WOMEN WITH LIFETIME PTSD DIAGNOSIS.

Muzik M, McGinnis EW, Bocknek E, Morelen D, Rosenblum KL, Liberzon I, Seng J, Abelson JL.

Abstract

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.

 

http://www.ncbi.nlm.nih.gov/pubmed/26740305

 

Depressive and post-traumatic stress symptoms following termination of pregnancy in South African women: A longitudinal study measuring the effects of chronic burden, crisis support and resilience.

Subramaney U, Wyatt GE, Williams JK, Zhang M, Liu HH, Chin D.

Abstract

BACKGROUND:

Termination of pregnancy (TOP) remains a controversial issue, regardless of legislation. Access to services as well as psychological effects may vary across the world.

OBJECTIVES AND METHODS:

To better understand the psychological effects of TOP, this study describes the circumstances of 102 women who underwent a TOP from two socioeconomic sites in Johannesburg, South Africa, one serving women with few economic resources and the other serving women with adequate resources. The relationship between demographic characteristics, resilience and symptoms of post-traumatic stress disorder (PTSD) and depression before, 1 month after and 3 months after the procedure was also examined.

RESULTS:

Time since TOP, age, chronic burden, resilience and the interaction of site with religion and site with chronic burden were significant. In addition, site differences were found for religion and chronic burden in predicting depression scores. Women from both sites had significant decreases in depression scores over time. The interaction of time with site was not significant. Higher chronic burden scores correlated with higher depression scores. No variables were significant in the bivariate analysis for PTSD.

CONCLUSION:

Resilience, religion and chronic burden emerge as significant variables in women undergoing a first-trimester TOP, and warrant further assessment in studies of this nature.

 

http://www.ncbi.nlm.nih.gov/pubmed/26632322

 

The Association of Family Support After Childbirth With Posttraumatic Stress Disorder in Women With Preeclampsia.

Soltani N, Abedian Z, Mokhber N, Esmaily H.

Abstract

BACKGROUND:

Stressful situations and life-threatening issues such as preeclampsia can lead to Post-traumatic stress disorders [PTSD]. It seems that within social supports, family support has more effect on mental health.

OBJECTIVES:

The aim of this study was to determine the association between family supports in the postpartum period with occurrence of post-traumatic stress disorder following preeclampsia.

PATIENTS AND METHODS:

In this descriptive longitudinal study, 100 women with preeclampsia admitted in government hospitals of Mashhad were selected using convenience sampling. Post-traumatic stress disorder was diagnosed by psychiatrist interview and perinatal posttraumatic stress questionnaire (PPQ) in sixth week postpartum and family support was measured by family support scale (FSS) in second and sixth weeks postpartum. Data analyzed by SPSS 16 using Spearman correlation coefficient, paired sample T-test and Kruskal-Wallis test.

RESULTS:

A reverse significant association was found between family support in weeks 2 and 6 (92.6 ± 22.6, 83.7 ± 21.6, respectively) and PTSD (mean score of 4.8 ± 2.5) (respectively, P = 0.010 and P =0.011). The most important variables affecting PTSD with presence of family support in weeks 2 and 6 were postpartum depression in week 6 as well as trait anxiety at the time of admission.

CONCLUSIONS:

The more support in weeks 2 and 6 postpartum, the less PTSD occurs. Therefore, it is suggested to health care providers who face mothers after delivery to evaluate the support received by mothers and help those with inadequate or inappropriate support.

 

http://www.ncbi.nlm.nih.gov/pubmed/26568844

 

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.

Abstract

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 PTSD symptoms.

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