August 2018 – September 2018 Research Update

The association between the degree of nausea in pregnancy and subsequent posttraumatic stress.

Arch Womens Ment Health. 2018 Sep 17. doi: 10.1007/s00737-018-0909-z. [Epub ahead of print]

Kjeldgaard HKVikanes ÅBenth JŠJunge CGarthus-Niegel SEberhard-Gran M.

Abstract

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.

https://www.ncbi.nlm.nih.gov/pubmed/30225528

 

Maternal experiences of trauma and hair cortisol in early childhood in a prospective cohort.

Psychoneuroendocrinology. 2018 Aug 22;98:168-176. doi: 10.1016/j.psyneuen.2018.08.027. [Epub ahead of print]

Slopen NRoberts ALLeWinn KZBush NRRovnaghi CRTylavsky FAnand KJS.

Abstract

BACKGROUND AND OBJECTIVE: Maternal trauma can have intergenerational consequences but little is known about whether maternal traumas affect key biological domains associated with mental health in their offspring. The objective of this study was to examine maternal lifetime history of traumatic events through mid-gestation in relation to offspring cortisol production in early childhood.

METHODS: The sample was comprised of 660 children (49.9% Black, 44.4% White) from a longitudinal study of mother-offspring dyads in Shelby County, Tennessee, followed from mid-gestation to child age 4 years (enrolled 2006-2011). Maternal lifetime history of traumatic life events were assessed mid-gestation using the Traumatic Life Events Questionnaire. Total cortisol output among offspring was measured using hair cortisol concentrations at ages 1 to 4 years.

RESULTS: Associations of maternal trauma history with child hair cortisol varied by child’s age. No association was observed at age 1 or 2. In adjusted regression models, at ages 3 and 4, offspring of mothers in the third (β = 0.99, P < .01), fourth (β=0.72, P < .05), and fifth (β=0.83, P < .01) quintiles of trauma exposure history had elevated (natural log) hair cortisol concentrations, relative to mothers in the lowest quintile (P-trend = 0.003). The associations were not attenuated after adjustment for theorized pathways, including premature birth, maternal postpartum depression, and maternal parenting stress.

CONCLUSIONS: Maternal lifetime trauma exposures are associated with offspring hair cortisol concentrations. Future research is needed to determine intermediary mechanisms and functional significance of elevated hair cortisol concentration in young children.

https://www.ncbi.nlm.nih.gov/pubmed/30170311

 

“The loss was traumatic… some healthcare providers added to that”: Women’s experiences of miscarriage.

Women Birth. 2018 Aug 25. pii: S1871-5192(17)30479-1. doi: 10.1016/j.wombi.2018.06.006. [Epub ahead of print]

Bellhouse CTemple-Smith MWatson SBilardi J.

Abstract

BACKGROUND: Miscarriage is a common event in Australia and is estimated to occur in up to one in four confirmed pregnancies. Prior research has demonstrated that miscarriage is associated with significant distress, grief and loss, and in some cases clinically significant levels of depression, anxiety, and Post Traumatic Stress Disorder. Despite these consequences for women’s emotional and mental health, studies have commonly found that women feel that healthcare providers often lack empathy, support, and acknowledgement of their loss.

AIM: The aim of this study is to explore the psychological distress experienced by women as a result of miscarriage, as well as the perceived support provided by healthcare professionals.

METHODS: Fifteen women were recruited in Australia and participated in semi-structured interviews either in person or over the telephone.

FINDINGS: It was found that for most women, the levels of distress, grief, and loss associated with their miscarriages were significant. While women experienced both positive and negative interactions with healthcare providers throughout their miscarriage journeys, all women interviewed expressed their increased distress following negative experiences.

CONCLUSION: A number of recommendations have been provided by women to improve the service of healthcare providers in the event of a miscarriage, including referral to a psychologist, and ongoing follow-up after their miscarriage, which women felt would assist them with managing their distress.

https://www.ncbi.nlm.nih.gov/pubmed/30153984

 

Childbirth as a forthcoming traumatic event: pretraumatic stress disorder during pregnancy and its psychological correlates.

J Reprod Infant Psychol. 2018 Aug 10:1-12. doi: 10.1080/02646838.2018.1504284. [Epub ahead of print]

Goutaudier NBertoli CSéjourné NChabrol H.

Abstract

BACKGROUND: Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, ‘but largely ignored’, aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms.

METHODS: At 34 weeks’ gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms.

RESULTS: 8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity.

CONCLUSION: Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis.

https://www.ncbi.nlm.nih.gov/pubmed/30095279

 

[Study of the relations between the pain of childbirth and postpartum, and depressive and traumatic symptoms].

[Article in French]

Gynecol Obstet Fertil Senol. 2018 Sep;46(9):658-663. doi: 10.1016/j.gofs.2018.06.002. Epub 2018 Jun 19.

Séjourné NDe la Hammaide MMoncassin AO’Reilly AChabrol H.

Abstract

OBJECTIVES: This study aims to determine the incidence of pain in childbirth and postpartum on depressive and post-traumatic symptomatology 6weeks after delivery.

METHODS: One hundred and nine women who gave birth in maternity hospitals of type 2$participated in the study. Two to four days after delivery they have completed five self-administered questionnaires to assess pain of childbirth (QDSA), dramatization of pain (PCS-CF), satisfaction of childbirth (CEQ), peri-traumatic distress (IDP) and depressive symptoms (EPDS) and visual analogue scales to measure immediate postnatal pain. Six weeks after birth they have again completed questionnaires to measure pain (QDSA and visual analogue scales) and depressive symptoms (EPDS) and a scale measuring posttraumatic symptomatology (IES-R).

RESULTS: The pain of childbirth and immediate postpartum was associated with depressive (r=0.27 and r=0.31 respectively) and traumatic symptomatology (r=0.30 and r=0.34 respectively) in postpartum. Regression analysis, however, revealed that only the depressive symptomatology and the affective dimension of postpartum pain at six weeks post-partum was related to post-traumatic stress.

CONCLUSION: The results of this study highlight the importance to support the pain of childbirth but also the pain occurring in the postpartum period.

https://www.ncbi.nlm.nih.gov/pubmed/29933918

 

Depression, posttraumatic stress and relationship distress in parents of very preterm infants.

Arch Womens Ment Health. 2018 Aug;21(4):445-451. doi: 10.1007/s00737-018-0821-6. Epub 2018 Mar 3.

Winter LColditz PBSanders MRBoyd RNPritchard MGray PHWhittingham KForrest KLeeks RWebb LMarquart LTaylor KMacey J.

Abstract

To determine the prevalence, associated factors, and relationships between symptoms of depression, symptoms of posttraumatic stress (PTS), and relationship distress in mothers and fathers of very preterm (VPT) infants (< 32 weeks). Mothers (n = 323) and fathers (n = 237) completed self-report measures on demographic and outcome variables at 38 days (SD = 23.1, range 9-116) postpartum while their infants were still hospitalised. Of mothers, 46.7% had a moderate to high likelihood of depression, 38.1% had moderate to severe symptoms of PTS, and 25.1% were in higher than average relationship distress. The corresponding percentages in fathers were 16.9, 23.7, and 27%. Depression was positively associated with having previous children (p = 0.01), speaking little or no English at home (p = 0.01), financial stress (p = 0.03), and recently accessing mental health services (p = 0.003) for mothers, and financial stress (p = 0.005) and not being the primary income earner (p = 0.04) for fathers. Similar associations were found for symptoms of PTS and relationship distress. Being in higher relationship distress increased the risk of depression in both mothers (p < .001) and fathers (p = 0.03), and PTS symptoms in mothers (p = 0.001). For both mothers and fathers, depression was associated with more severe PTS symptoms (p < .001). Fathers of VPT infants should be screened for mental health problems alongside mothers, and postpartum parent support programs for VPT infants should include strategies to improve the couple relationship.

https://www.ncbi.nlm.nih.gov/pubmed/29502280

 

Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression.

Arch Womens Ment Health. 2018 Aug;21(4):391-399. doi: 10.1007/s00737-017-0807-9. Epub 2017 Dec 29.

Hanschmidt FTreml JKlingner JStepan HKersting A.

Erratum in

Correction to: Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression. [Arch Womens Ment Health. 2018]

Abstract

Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women’s psychological reactions. This study examined the influence of perceived and internalized stigma on women’s long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

https://www.ncbi.nlm.nih.gov/pubmed/29288285

March 2018 – July 2018 Research Update

Psychosocial predictors of postpartum posttraumatic stress disorder in women with a traumatic childbirth experience

Front. Psychiatry. 31 July 2018. doi: 10.3389/fpsyt.2018.00348

Mark A. van Heumen1Martine H. Hollander1, Maria G. van Pampus2, Jeroen van Dillen1and Claire A. I. Stramrood3*

Abstract

Objective: To analyze the predictive value of antepartum vulnerability factors, such as social support, coping, history of psychiatric disease, and fear of childbirth, and intrapartum events on the development of symptoms of postpartum posttraumatic stress disorder (PP-PTSD) in women with a traumatic childbirth experience.

Materials and methods: Women with at least one self-reported traumatic childbirth experience in or after 2005 were invited to participate through various social media platforms in March 2016. They completed a 35-item questionnaire including validated screening instruments for PTSD (PTSD Symptom Checklist, PCL-5), social support (Oslo social support scale, OSS-3), and coping (Antonovsky’s sense of coherence scale, SoC).

Results: Of the 1,599 women who completed the questionnaire, 17.4% met the diagnostic criteria for current PTSD according to the DSM-5, and another 26.0% recognized the symptoms from a previous period, related to giving birth. Twenty-six percent of the participating women had received one or more psychiatric diagnoses at some point in their life, and five percent of all women had been diagnosed with PTSD prior to their traumatic childbirth experience. Women with poor (OR = 15.320, CI = 8.001–29.336), or moderate (OR = 3.208, CI = 1.625–6.333) coping skills were more likely to report PP-PTSD symptoms than women with good coping skills. Low social support was significantly predictive for current PP-PTSD symptoms compared to high social support (OR = 5.557, CI = 2.967–7.785). A predictive model which could differentiate between women fulfilling vs. not fulfilling the symptom criteria for PTSD had a sensitivity of 80.8% and specificity of 62.6% with an accuracy of 66.5%.

Conclusions: Low social support, poor coping, experiencing “threatened death” and experiencing “actual or threatened injury to the baby” were the four significant factors in the predictive model for women with a traumatic childbirth experience to be at risk of developing PP-PTSD. Further research should investigate the effects of interventions aimed at the prevention of PP-PTSD by strengthening coping skills and increasing social support, especially in women at increased risk of unfavorable obstetrical outcomes.

https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00348/full?platform=hootsuite

 

Anxiety and depressive symptoms during pregnancy, perceived control and posttraumatic stress symptoms after childbirth: a longitudinal mediation analysis.

J Health Psychol. 2018 Jul 1. doi: 10.1177/1359105318787018.

Brandão T1,2Brites R1Nunes O1Pires M1Hipólito J1.

Abstract

This longitudinal study evaluated the mediating role of sense of control during labour in the association between anxiety and depression levels during pregnancy and postpartum posttraumatic stress disorder symptoms. Participants were 57 women. Anxiety and depression were assessed during pregnancy; sense of control and childbirth-related posttraumatic stress disorder symptoms were collected 6-8 weeks after childbirth. Higher levels of anxiety and depression were associated with more postpartum posttraumatic stress disorder symptoms through lack of perceived control. For depression, this happened only for primiparous. Interventions targeting mechanisms enhancing perceptions/feelings of control should be offered to these women to prevent/minimize childbirth-related posttraumatic stress disorder.

https://www.ncbi.nlm.nih.gov/pubmed/29987940

 

Traumatic birth: recognition and prevention.

[Article in German; Abstract available in German from the publisher]

Z Geburtshilfe Neonatol. 2018 Jul 9. doi: 10.1055/a-0641-6584.

Weidner K1Garthus-Niegel S1Junge-Hoffmeister J1.

Abstract

A history of sexual as well as physical or emotional abuse may represent a high-risk factor for difficult pregnancies and birth processes, potentially yielding the development of postpartum posttraumatic stress disorder as well as impaired mother-child attachment. However, birth itself may also be experienced as primarily traumatic, i. e., without having had prior trauma experiences. Difficult and traumatic births may affect midwives and obstetricians, too. This article provides an overview of the prevalence and risk factors of traumatic childbirth as well as the course, consequences, and intervention possibilities.

https://www.ncbi.nlm.nih.gov/pubmed/29986355

 

Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: a systematic review.

Clin Psychol Rev. 2018 Jun 9. doi: 10.1016/j.cpr.2018.06.004.

Nillni YI1Mehralizade A2Mayer L3Milanovic S3.

Abstract

Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.

https://www.ncbi.nlm.nih.gov/pubmed/29935979

 

To lose an unborn child: post-traumatic stress disorder and major depressive disorder following pregnancy loss among Israeli women.

Gen Hosp Psychiatry. 2018 May 16. doi: 10.1016/j.genhosppsych.2018.02.003.

Horesh D1Nukrian M2Bialik Y3.

Abstract

Objectives: Pregnancy loss (PL) can be a very difficult experience. However, the evidence regarding the prevalence and correlates of psychopathology following PL is inconsistent at best. The present study aimed to assess the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) following PL, and their differential predictors.

Methods: Participants were 97 women, ages 23-47, who have experienced PL starting from the 2nd trimester. They were recruited at the Hadassah Ein-Kerem Medical Center in Jerusalem, Israel. The mean pregnancy week of loss was 27.92. Participants completed self-report questionnaires assessing PTSD (PCL-5), MDD (BDI-II), sociodemographic variables and factors related to the loss.

Results: We have found high rates of probable PTSD (33.3%) and MDD (29.4%) among our sample, as well as high PTSD-MDD comorbidity. A more advanced gestational week of loss and shorter time since PL were positively associated with both PTSD and MDD. Younger age and lower religiosity were associated with more severe PTSD, but not MDD.

Conclusions: PL is a potentially-traumatic experience, entailing a heavy burden of PTSD and MDD. Mental health professionals are encouraged to closely monitor women following PL, particularly young mothers, who have experienced PL more recently, and at the advanced stages of pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/29934032

 

Study of the relations between the pain of childbirth and postpartum, and depressive and traumatic symptoms.

[Article in French]

Gynecol Obstet Fertil Senol. 2018 Jun 19. doi: 10.1016/j.gofs.2018.06.002.

Séjourné N1De la Hammaide M2Moncassin A2O’Reilly A2Chabrol H2.

Abstract

Objectives: This study aims to determine the incidence of pain in childbirth and postpartum on depressive and post-traumatic symptomatology 6weeks after delivery.

Methods: One hundred and nine women who gave birth in maternity hospitals of type 2$participated in the study. Two to four days after delivery they have completed five self-administered questionnaires to assess pain of childbirth (QDSA), dramatization of pain (PCS-CF), satisfaction of childbirth (CEQ), peri-traumatic distress (IDP) and depressive symptoms (EPDS) and visual analogue scales to measure immediate postnatal pain. Six weeks after birth they have again completed questionnaires to measure pain (QDSA and visual analogue scales) and depressive symptoms (EPDS) and a scale measuring posttraumatic symptomatology (IES-R).

Results: The pain of childbirth and immediate postpartum was associated with depressive (r=0.27 and r=0.31 respectively) and traumatic symptomatology (r=0.30 and r=0.34 respectively) in postpartum. Regression analysis, however, revealed that only the depressive symptomatology and the affective dimension of postpartum pain at six weeks post-partum was related to post-traumatic stress.

Conclusion: The results of this study highlight the importance to support the pain of childbirth but also the pain occurring in the postpartum period.

https://www.ncbi.nlm.nih.gov/pubmed/29933918

 

Depressive and trauma symptoms in expectant, risk-exposed, mothers and fathers: Is mindfulness a buffer?

J Affect Disord. 2018 Oct 1. doi: 10.1016/j.jad.2018.05.044.

Hicks LM1Dayton CJ2Victor BG3.

Abstract

Background: Perinatal depression is reported in 15-20% of women (Marcus, 2009), 8-16% of men (Paulson and Bazemore, 2010) and low-SES, diverse populations are particularly at risk (Sareen, 2011). Trauma symptoms are commonly comorbid with depression, especially when individuals are exposed to risk factors such as community violence and poverty (Kastello et al., 2015; WenzGross et al., 2016). Parental mental illness places infants at risk for negative outcomes (Junge et al., 2016). Evidence supports that dispositional mindfulness is linked to mental health in many populations, however, a gap lies in the understanding of the relationship between mindfulness, trauma and depression in risk-exposed, pregnant populations, especially with fathers. We hypothesize that dispositional mindfulness is negatively associated with lower depression and trauma symptoms in pregnancy, in mothers and fathers.

Methods: Dispositional mindfulness, depressive and trauma symptoms were examined in women and men, exposed to adversity who were expecting a baby (N = 102). Independent t-tests, and bivariate correlations examined the relationships between these variables. Hierarchical regression was utilized to understand how mindfulness and trauma symptoms may contribute to antenatal depression symptoms.

Results: Significant differences were observed with mindfulness and depressive symptoms, with no differences reported across gender. Mindfulness, depressive and trauma symptoms were associated in the expected directions. Total mindfulness, specifically being non-reactive to one’s own thoughts and trauma symptoms predicted depressive symptoms.

Limitations: Limitations include small sample size, cross-sectional data and self-report measures.

Conclusion: Mindfulness and trauma symptoms were found to be significant predictors of depressive symptoms in parents-to-be. Those with lower mindfulness exhibited higher levels of depression. These findings may be helpful in disseminated mindfulness-based interventions aimed at treating antenatal depression in both expectant mothers and fathers who are exposed to adversity. Further research is necessary to understand the mechanisms of mindfulness in risk-exposed, expectant parents.

https://www.ncbi.nlm.nih.gov/pubmed/29885607

 

Examining the impact of trauma-informed cognitive behavioral therapy on perinatal mental health outcomes among survivors of intimate partner violence (the path study): protocol for a feasibility study.

JMIR Res Protoc. 2018 May 25. doi: 10.2196/resprot.9820.

Jackson KT#1Parkinson S2Jackson B1Mantler T#3.

Abstract

Background: Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV.

Objective: We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial.

Methods: The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program’s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum(intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women’s perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables.

Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018.

Conclusions: Findings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this intervention could be readily adopted by health care and social support services, thereby contributing to an improved standard of care for this unique population.

https://www.ncbi.nlm.nih.gov/pubmed/29802091

 

Is childbirth-induced PTSD associated with low maternal attachment?

Arch Womens Ment Health. 2018 May 21. doi: 10.1007/s00737-018-0853-y. Dekel S1,2Thiel F3Dishy G3Ashenfarb AL3.

Abstract

Few studies examined maternal attachment in childbirth-related postpartum posttraumatic stress disorder (PP-PTSD). We studied 685 postpartum women, assessing for PP-PTSD, non-childbirth PTSD, maternal attachment, pre-birth, birth, and post-birth factors. Attachment was lower in PP-PTSD than in non-childbirth PTSD and no PP-PTSD. Hierarchical regression showed that PP-PTSD predicted less maternal attachment above and beyond pre-birth psychiatric conditions, acute distress in birth, and lack of breastfeeding. Childbirth-induced posttraumatic stress may interfere with the formation of maternal attachment, warranting screening of at-risk women.

https://www.ncbi.nlm.nih.gov/pubmed/29786116

 

Trauma and fear in Australian midwives.

Women Birth. 2018 May 11. doi: 10.1016/j.wombi.2018.04.003.

Toohill J1Fenwick J2Sidebotham M3Gamble J4Creedy DK5.

Abstract

Background: Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice.

Aim: (1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives’ confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives’ experiences of birth related trauma and/or fear.

Method: A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma.

Results: The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having ‘high fear’ reported more practice concerns (Med 23.5, n=20) than midwives with ‘low fear’ (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma.

Conclusion: High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.

https://www.ncbi.nlm.nih.gov/pubmed/29759933

 

Posttraumatic stress disorder related to postpartum haemorrhage: A systematic review.

Eur J Obstet Gynecol Reprod Biol. 2018 Jun 225. doi: 10.1016/j.ejogrb.2018.04.012.

Zaat TR1van Steijn ME2de Haan-Jebbink JM1Olff M3Stramrood CAI4van Pampus MG5.

Abstract

In some cases childbirth leads to negative psychological responses such as posttraumatic stress disorder (PTSD). Postpartum hemorrhage (PPH) is a common and major complication of childbirth, which occasionally requires emergency hysterectomy in severe cases. Patients often describe these complications as a traumatic experience. It is unknown whether PPH is a risk factor for developing PTSD. In this systematic review we summarize the current knowledge about the association between PPH with or without emergency hysterectomy and posttraumatic stress symptoms or PTSD. If PPH is a risk factor for PTSD, this will allow adequate preventive measures with the aim to reduce the long-term effects and socioeconomic problems associated with PTSD. To conduct this review MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Library and PsycINFO databases were searched for publications between January 1986 and October 2017. Manuscripts evaluating the association between PPH and peripartum emergency hysterectomy and PTSD or posttraumatic stress symptoms were included. Fifty-two articles met the criteria for full-text review. Seven articles were included in this review. Five studies focused on the association between PPH and PTSD and two studies evaluated the association between emergency hysterectomy and PTSD. Three studies found no association between PPH and PTSD. Two studies reported a higher risk of developing PTSD or posttraumatic stress symptoms after PPH. Two studies reported a higher risk of developing PTSD after emergency hysterectomy. Meta-analysis was not possible due to the heterogeneity of these studies. Based on the results of these studies there may be an association between PPH and PTSD. Secondly, it seems likely that an association exists between emergency postpartum hysterectomy and PTSD, but the strength of this conclusion is limited by the small amount of studies included.

https://www.ncbi.nlm.nih.gov/pubmed/29747143

 

Neurobehavioural outcome in 6-18 year old children after trauma in pregnancy: case-control study.

Eur J Paediatr Neurol. 2018 Apr 12. doi: 10.1016/j.ejpn.2018.04.004.

van der Knoop BJ1Oostrom KJ2Zonnenberg IA3van Weissenbruch MM4Vermeulen RJ5de Vries JIP6.

Abstract

Background: Maternal trauma complicates pregnancy in approximately 7%. Long-term development of children exposed to maternal trauma is unknown.

Aim: To determine neurobehavioural outcome of children (6-18 years) born after maternal trauma in pregnancy compared to a matched control group.

Study design: Case-control study performed at a tertiary medical centre.

Subjects: All consecutive children born after maternal hospitalization for trauma during pregnancy between 1995 and 2005. Controls were children born at the same hospital and period after an uneventful pregnancy.

Outcome measures: Trauma type and severity (Injury Severity Score, ≥9: severe); information from medical files at admission (cases). All mothers filled out two questionnaires about the infant; 1. concerning health, motor development and educational level, 2. concerning behavioural development through the validated Dutch version of the Child Behavior Checklist (CBCL).

Results: Questionnaires were returned by 34 cases and 28 controls. The traumas concerned mainly motor vehicle accidents and falls, and 3/34 had severe injuries. No differences in health, motor development, educational level and CBCL was found between the cases and controls, except for more hospitalization in the cases (p = 0.009).

Conclusion: Long-term follow-up of a limited population of children 6-18 years after exposure of mainly non-severe trauma before birth is similar to a control population except for unexplained more hospitalization in the cases.

https://www.ncbi.nlm.nih.gov/pubmed/29735386

 

Post-traumatic stress disorder and severe maternal morbidity: is there an association?

Clinics (Sao Paulo). 2018;73:e309. doi: 10.6061/clinics/2018/e309.

Angelini CR1Pacagnella RC1Parpinelli MA1Silveira C1Andreucci CB1Ferreira EC1Santos JP1Zanardi DM1Souza RT1Cecatti JG1.

Abstract

Objective: To evaluate the occurrence of Post-Traumatic Stress Disorder among women experiencing a severe maternal morbidity event and associated factors in comparison with those without maternal morbidity.

Methods: In a retrospective cohort study, 803 women with or without severe maternal morbidity were evaluated at 6 months to 5 years postpartum for the presence of Post-Traumatic Stress Disorder. Interviews were conducted by telephone and electronic data was stored. Data analysis was carried out by using χ2, Fisher’s Exact test, and logistic regression analysis.

Results: There was no significant change in the prevalence of Post-Traumatic Stress Disorder related to a previous severe maternal morbidity experience. There were also no differences in diagnostic criteria for severe maternal morbidity (hypertensive syndromes, hemorrhage, surgical intervention or intensive care unit admission required, among other management criteria). Low parity (2.5-fold risk) and increasing age were factors associated with Post-Traumatic Stress Disorder.

Conclusions: A severe maternal morbidity episode is not associated with Post-Traumatic Stress Disorder symptoms within five years of the severe maternal morbidity event and birth. However, a more advanced maternal age and primiparity increased the risk of Post-Traumatic Stress Disorder. This does not imply that women who had experienced a severe maternal morbidity event did not suffer or need differentiated care.

https://www.ncbi.nlm.nih.gov/pubmed/29723346

 

Allostatic load: a theoretical model for understanding the relationship between maternal posttraumatic stress disorder and adverse birth outcomes.

Midwifery. 2018 Jul 62. doi: 10.1016/j.midw.2018.04.002.

Li Y1Rosemberg MS2Seng JS3.

Abstract

Background: Adverse birth outcomes such as preterm birth and low birth weight are significant public health concerns and contribute to neonatal morbidity and mortality. Studies have increasingly been exploring the predictive effects of maternal posttraumatic stress disorder (PTSD) on adverse birth outcomes. However, the biological mechanisms by which maternal PTSD affects birth outcomes are not well understood. Allostatic load refers to the cumulative dysregulations of the multiple physiological systems as a response to multiple social-ecological levels of chronic stress. Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. However, the mediating role of allostatic load is less understood when it comes to maternal PTSD and adverse birth outcomes.

Objective: To propose a theoretical model that depicts how allostatic load could mediate the impact of maternal PTSD on birth outcomes.

Method: We followed the procedures for theory synthesis approach described by Walker and Avant (2011), including specifying focal concepts, identifying related factors and relationships, and constructing an integrated representation. We first present a theoretical overview of the allostatic load theory and the other 4 relevant theoretical models. Then we provide a brief narrative review of literature that empirically supports the propositions of the integrated model. Finally, we describe our theoretical model.

Findings/conclusions: The theoretical model synthesized has the potential to advance perinatal research by delineating multiple biomarkers to be used in future. After it is well validated, it could be utilized as the theoretical basis for health care professionals to identify high-risk women by evaluating their experiences of psychosocial and traumatic stress and to develop and evaluate service delivery and clinical interventions that might modify maternal perceptions or experiences of stress and eliminate their impacts on adverse birth outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/29709774

 

Memories of infant pain in the neonatal intensive care unit influence posttraumatic stress symptoms in mothers of infants born preterm.

Clin J Pain. 2018 Apr 25. doi: 10.1097/AJP.0000000000000620.

Vinall J1Noel M2,3Disher T4Caddell K4Campbell-Yeo M4,5,6.

Abstract

Objectives: The birth of a preterm infant and witnessing ones’ infant in pain is remembered by parents as being one of the most stressful aspects of the neonatal care intensive unit (NICU). Elevated symptoms of posttraumatic stress symptoms (PTSS) are highly prevalent among mothers of preterm infants, however, little is known about mothers’ memories of invasive procedures in the NICU and how these memories may contribute to the development of PTSS. We examined the relationships between number of invasive procedures, mothers’ memories of these procedures, and their PTSS at discharge from the NICU.

Methods: Participants included thirty-six mothers of infants born <37 weeks gestational age recruited from a tertiary-level NICU. Medical chart review was performed between birth and discharge from the NICU. At discharge, a research nurse conducted a structured memory interview with the mothers that assessed their memories of their infants’ invasive procedures. Mothers also completed a self-report measure of PTSS (PTSD Checklist for the DSM-5).

Results: Mothers of infants exposed to greater numbers of invasive procedures had more elevated PTSS at discharge (R=0.37). Moreover, mothers who recalled having greater anxiety about their infant’s invasive procedures had greater symptoms of re-experiencing (R=0.34) and avoidance (R=0.28) at discharge from the NICU.

Discussion: Greater neonatal exposure to invasive procedures and mothers’ recall of these procedures were related to mothers’ posttraumatic stress symptomatology at discharge. Invasive procedures in the NICU represent an important target area for neonatal intervention to reduce maternal distress and improve outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/29698249

 

Couples facing the birth of a newborn with a congenital anomaly: PTSD symptoms in the first year.

Am J Perinatol. 2018 Apr 18. doi: 10.1055/s-0038-1641591.

Bevilacqua F1Morini F2Zaccara A3De Marchis C2Braguglia A2Gentile S1Bagolan P2Aite L1.

Abstract

Objective: The objective of this study was to assess the presence of posttraumatic stress disorder (PTSD) symptoms in parental couples of newborn requiring early surgery at 6 and 12 months after birth.

Study design: A longitudinal study was set up from January 2014 to June 2015. As a measure of PTSD, we used the Italian version of the Impact of Event Scale-Revised (IES-R).

Results: Thirty-four couples form the object of the study. At 6 months, half of mothers (52.9%) and fathers (44.1%) reported traumatic stress symptoms above the clinical cutoff. Percentages remained stable at 12 months. When parental gender and length of follow-up were compared with two-factor analysis of variance, none had an impact on IES-R score, nor an interaction between these factors was found. A significant correlation of IES-R total score was present within the couple both at 6 and 12 months (6 months-r: 0.6842, p < 0.0001 and 12 months-r: 0.4045, p = 0.0177).

Conclusion: Having a child with a repaired malformation represents a complex prolonged stressful situation with persistent burden for both parents who are at high risk of developing PTSD symptoms.

https://www.ncbi.nlm.nih.gov/pubmed/29669363

 

Prenatal exposure to disaster-related traumatic stress and developmental trajectories of temperament in early childhood: Superstorm Sandy pregnancy study.

J Affect Disord. 2018 Jul 234. doi: 10.1016/j.jad.2018.02.067.

Zhang W1Rajendran K2Ham J3Finik J4Buthmann J5Davey K6Pehme PM5Dana K5Pritchett A5Laws H7Nomura Y8.

Abstract

Background: Little is known about the impact of prenatal maternal stress (PNMS) on the developmental trajectory of temperament and few studies have been able to incorporate a natural disaster as a quasi-experimental stressor. The current study investigated PNMS related to Superstorm Sandy (‘Sandy’), a hurricane that struck the New York metropolitan area in October 2012, in terms of objective exposure during pregnancy, subjective stress reaction as assessed by maternal symptoms of post-traumatic stress, and their impact on the developmental changes in temperament during early childhood.

Method: A subsample of 318 mother-child dyads was drawn from the Stress in Pregnancy Study. Temperament was measured at 6, 12, 18, and 24 months of age.

Results: Objective exposure was associated with greater High-Intensity Pleasure, Approach, Perceptual Sensitivity and Fearfulness, but lower Cuddliness and Duration of Orientation at 6 months. Objective exposure and its interaction with subjective stress reaction predicted developmental changes in temperament. In particular, objective exposure was linked to greater increases in Activity Level but decreases in High-Intensity Pleasure, Approach, and Fearfulness. The combination of objective exposure and subjective stress reaction was also associated with greater increases in Activity Level.

Limitations: Temperament was measured solely via maternal report. Trimester-specific effects of Sandy on temperament were not examined.

Conclusion: This is the first study to examine the effects of prenatal maternal exposure to a natural disaster on trajectories of early childhood temperament. Findings suggest that both objective stress exposure and subjective stress reaction in-utero predict developmental trajectories of temperament in early childhood.

https://www.ncbi.nlm.nih.gov/pubmed/29614461

 

Childbirth narratives of women with posttraumatic stress symptoms in the postpartum period.

J Obstet Gynecol Neonatal Nurs. 2018 May 47. doi: 10.1016/j.jogn.2018.02.009.

Santoro EStagni-Brenca EOlivari MGConfalonieri EDi Blasio P.

Abstract

Objective: To examine cognitive, emotional, and perceptual differences in the childbirth narratives of women with high levels of posttraumatic stress symptoms (PTSS) compared with women with low levels of PTSS in the postpartum period.

Design: A cross-sectional design. Participants were retrospectively assigned to the high or low PTSS group on the basis of their scores on the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) administered at 1 week and 3 months after childbirth.

Setting: Participants’ homes and Internet survey.

Participants: Twenty-five women were included in the high PTSS group (PPQ score ≥ 12), and 25 were included in the low PTSS group (PPQ score ≤ 1).

Methods: Participants completed the PPQ and a writing task about the birth experience 1 week after birth and completed an online version of the PPQ 3 months after birth. Characteristics of the narratives were analyzed and compared between the two groups using the Linguistic Inquiry Word Count.

Results: Compared with participants with low levels of PTSS, participants with high levels of PTSS reported more negative emotions, including horrific images connected to labor and birth and fewer positive emotions. Participants with high levels of PTSS used more sensory and perceptual terms (tactile, visual, and auditory). In contrast, women with low levels of PTSS described more active participation during birth and used more future tense verbs.

Conclusion: Our findings suggest the aspects that are involved in the development and maintenance of PTSS after birth and may be considered for use in clinical practice to improve quality of care and women’s health during the postpartum period.

https://www.ncbi.nlm.nih.gov/pubmed/29580803

 

Recognizing postpartum posttraumatic stress disorder.

Nursing. 2018 Apr 48. doi: 10.1097/01.NURSE.0000531015.55589.2f.

Ferguson R1.

Abstract

During the initial assessment of an infant in our pediatric clinic, the mother mentioned that
she was having flashbacks and nightmares about the birth. Are these signs of posttraumatic
stress disorder (PTSD)?

https://www.ncbi.nlm.nih.gov/pubmed/29561363

 

Depression, posttraumatic stress and relationship distress in parents of very preterm infants.

Arch Womens Ment Health. 2018 Aug 21. doi: 10.1007/s00737-018-0821-6.

Winter L1,2Colditz PB3,4Sanders MR5Boyd RN6Pritchard M3,7,8Gray PH7,9Whittingham K6Forrest K3,7Leeks R4,10Webb L10Marquart L10Taylor K3,4Macey J7.

Abstract

To determine the prevalence, associated factors, and relationships between symptoms of depression, symptoms of posttraumatic stress (PTS), and relationship distress in mothers and fathers of very preterm (VPT) infants (< 32 weeks). Mothers (n = 323) and fathers (n = 237) completed self-report measures on demographic and outcome variables at 38 days (SD = 23.1, range 9-116) postpartum while their infants were still hospitalised. Of mothers, 46.7% had a moderate to high likelihood of depression, 38.1% had moderate to severe symptoms of PTS, and 25.1% were in higher than average relationship distress. The corresponding percentages in fathers were 16.9, 23.7, and 27%. Depression was positively associated with having previous children (p = 0.01), speaking little or no English at home (p = 0.01), financial stress (p = 0.03), and recently accessing mental health services (p = 0.003) for mothers, and financial stress (p = 0.005) and not being the primary income earner (p = 0.04) for fathers. Similar associations were found for symptoms of PTS and relationship distress. Being in higher relationship distress increased the risk of depression in both mothers (p < .001) and fathers (p = 0.03), and PTS symptoms in mothers (p = 0.001). For both mothers and fathers, depression was associated with more severe PTS symptoms (p < .001). Fathers of VPT infants should be screened for mental health problems alongside mothers, and postpartum parent support programs for VPT infants should include strategies to improve the couple relationship.

https://www.ncbi.nlm.nih.gov/pubmed/29502280

 

Ambiguous loss and post-traumatic growth: experiences of mothers whose school-aged children were born extremely prematurely.

J Clin Nurs. 2018 Apr 27. doi: 10.1111/jocn.14319.

Wilson C1Cook C2.

Abstract

Aims and objectives: To develop insight into the experiences of mothers whose school-aged children were born extremely prematurely.

Background: Extreme prematurity, where infants are born at 28 weeks or earlier, has significant initial maternal impact in terms of distress, uncertainty and disruption to maternal identity. However, little is known about the experiences of these mothers beyond their child’s infancy.

Design: A qualitative study was undertaken using thematic analysis, drawing on a cluster of social constructionist theories that have been applied to studies investigating mothers’ early preterm or childhood disability experiences.

Methods: The study involved face-to-face interviews with nine mothers whose children were born prior to 28 weeks and were now aged between 4-to-7 years old.

Results: Participants described a prolonged period of anxiety, and relative isolation due to infection fears and complex care regimes. Although they grieved their different mothering trajectory, they celebrated their children’s successes and noted their own resilience. The following themes were identified: traumatic beginnings; dialectics and the horror-miracle contradiction; labour-intensive parenting and managing the multidisciplinary team; stigma and storying the meaning of premature birth; and impact on relationships.

Conclusions: Women’s vulnerability and resilience are evident long after the birth of an extremely prematurely born infant. Women value connection with similar mothers, and yet finding community is often daunting due to their children’s early complex needs. Generalist healthcare providers may be unaware of the experiences these mothers have endured, and need to enquire about their well-being.

Relevance to clinical practice: The lives of mothers of extremely preterm infants may take years to merge with the world of those mothers who parent healthy, term infants. Neonatal nurses and those in primary health care are well placed to notice signs of isolation, depression and anxiety, and to support and refer women appropriately.

https://www.ncbi.nlm.nih.gov/pubmed/29495088

 

Postpartum bonding difficulties and adult attachment styles: the mediating role of postpartum depression and childbirth-related PTSD.

Infant Ment Health J. 2018 Mar 39. doi: 10.1002/imhj.21695.

S Hairston I1E Handelzalts J2Assis C2Kovo M3.

Abstract

Despite decades of research demonstrating the role of adult attachment styles and early mother-infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth-related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant-focused anxiety, mediated by postpartum depression but not childbirth-related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth-related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth-related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.

https://www.ncbi.nlm.nih.gov/pubmed/29485675

 

Just another ordinary bad birth? A narrative analysis of first time mothers’ traumatic birth experiences.

Health Care Women Int. 2018 Jun 39. doi: 10.1080/07399332.2018.1442838.

Murphy H1Strong J1.

Abstract

A difficult birth experience can have long lasting psychological effects on both mother and baby and this study details four in-depth accounts of first time mothers who described their birth experience as traumatizing. Narrative analysis was used to record discrepancies between the ideal and the real and produced narrative accounts that highlighted how these mothers felt invisible and dismissed in a medical culture of engineering obstetrics. Participants also detailed how their birth experience could be improved and this is set in context alongside current recommendations in maternal health care and the complexities of delivering such care in UK health settings.

https://www.ncbi.nlm.nih.gov/pubmed/29474791

 

Preventing post-traumatic stress disorder following childbirth and traumatic birth experiences: a systematic review.

Acta Obstet Gynecol Scand. 2018 Jun 97. doi: 10.1111/aogs.13291.

de Graaff LF1Honig A1,2van Pampus MG1Stramrood CAI3.

Abstract

Introduction: Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a post-traumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumaticbirth experiences and childbirth-related post-traumatic stress disorder.

Material and methods: Major databases [Cochrane; Embase; PsycINFO; PubMed (Medline)] were searched using combinations of the key words and their synonyms.

Results: After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns immediately postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer post-traumatic stress disorder symptoms in women who delivered via emergency cesarean section.

Conclusions: No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and post-traumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous.

https://www.ncbi.nlm.nih.gov/pubmed/29336486

 

Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors.

J Affect Disord. 2018 Mar 15. doi: 10.1016/j.jad.2017.12.074.

Dikmen-Yildiz P1Ayers S2Phillips L3.

Abstract

Background: Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD.

Method: 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4-6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained.

Results: Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD(13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4-6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4-6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4-6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help.

Limitations: Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study.

Conclusion: Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.

https://www.ncbi.nlm.nih.gov/pubmed/29331697

 

The influence of postpartum PTSD on breastfeeding: a longitudinal population-based study.

Birth. 2018 Jun 45. doi: 10.1111/birt.12328.

Garthus-Niegel S1,2Horsch A3,4Ayers S5Junge-Hoffmeister J1Weidner K1Eberhard-Gran M2,6,7.

Abstract

Background: In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years.

Methods: The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital’s birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses.

Results: Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization’s breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables.

Conclusion: Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.

https://www.ncbi.nlm.nih.gov/pubmed/29265443

 

Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units.

Arch Womens Ment Health. 2018 Jun 21. doi: 10.1007/s00737-017-0802-1.

Skinner EM1Barnett B2,3Dietz HP4.

Abstract

Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) “putting up” with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.

https://www.ncbi.nlm.nih.gov/pubmed/29256069

 

Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy.

Arch Womens Ment Health. 2018 Jun 21. doi: 10.1007/s00737-017-0794-x.

Weinreb L1Wenz-Gross M2Upshur C2.

Abstract

This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.

https://www.ncbi.nlm.nih.gov/pubmed/29116416

 

Reappraising the dimensional structure of the PTSD checklist: lessons from the DSM-IV-based PCL-C.

Rev Bras Psiquiatr. 2018 Apr./June 40. doi: 10.1590/1516-4446-2017-2239.

Reichenheim ME1Oliveira AG1Moraes CL1,2Coutinho ES1,3Figueira I4Lobato G5.

Abstract

Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures.

Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C.

Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal).

Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

https://www.ncbi.nlm.nih.gov/pubmed/29069251

 

Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women.

Arch Womens Ment Health. 2018 Apr 21. doi: 10.1007/s00737-017-0776-z.

Levey EJ1,2,3Gelaye B4Koenen K5,6,4Zhong QY4Basu A5,6,4Rondon MB7Sanchez S8Henderson DC9,10Williams MA4.

Abstract

Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/28905129

 

Fear of childbirth and depressive symptoms among postnatal women: A cross-sectional survey from Chhattisgarh, India.

Women Birth. 2018 Apr 31. doi: 10.1016/j.wombi.2017.07.003.

Jha P1Larsson M2Christensson K3Svanberg AS4.

Abstract

Background: Prevalence rates of Fear of Birth and postnatal depressive symptoms have not been explored in Chhattisgarh, India.

Objective: To validate Hindi Wijma Delivery Experience Questionnaire and to study the prevalence of Fear of Birth and depressive symptoms among postnatal women.

Methods: A cross-sectional survey at seventeen public health facilities in two districts of Chhattisgarh, India among postnatal women who gave birth vaginally or through C-section to a live neonate. Participants were recruited through consecutive sampling based on health facility records of daily births. Data were collected through one-to-one interviews using the Wijma Delivery Experience Questionnaire Version B and the Edinburgh Postnatal Depression Scale. Non-parametric associations and linear regression data analyses were performed.

Results: The Hindi Wijma Delivery Experience Questionnaire Version B had reliable psychometric properties. The prevalence of Fear of Birth and depressive symptoms among postnatal women were 13.1% and 17.1%, respectively, and their presence had a strong association (p<0.001). Regression analyses revealed that, among women having vaginal births: coming for institutional births due to health professionals’ advice, giving birth in a district hospital and having postnatal depressive symptoms were associated with presence of FoB; while depressive symptoms were associated with having FoB, perineal suturing without pain relief, and giving birth to a low birth-weight neonate in a district hospital.

Conclusion: The prevalence of Fear of Birth and depressive symptoms is influenced by pain management during childbirth and care processes between women and providers. These care practices should be improved for better mental health outcomes among postnatal women.

https://www.ncbi.nlm.nih.gov/pubmed/28756932

 

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

J Trauma Dissociation. 2018 Mar-Apr 19. doi: 10.1080/15299732.2017.1329773.

Lang AJ1Gartstein MA2.

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

 

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

J Matern Fetal Neonatal Med. 2018 May 31. doi: 10.1080/14767058.2017.1315658.

Tomsis Y1,2Gelkopf M1Yerushalmi H1Zipori Y3.

Abstract

Objective: To evaluate the different coping strategies for post-traumatic stress disorder (PTSD), described in the non-obstetric trauma literature, 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

 

Maternal Mental Health Alliance Conference – 6th September 2018, London

Booking is now open for the Maternal Mental Health Alliance’s  Maternal Mental Health Conference: the annual conference dedicated to providing stimulating debate and discussion on perinatal mental health.
 
The theme of this year’s conference is “Diversity – understanding and reaching the missing families” . Topics covered include culture and migration, women with learning disabilities, women in the criminal justice system, military families, Gypsy, Roma and Traveller families and more…
 
From key note speakers and a series of break-out sessions, the conference will provide an overview of the latest research on families experiencing barriers in accessing perinatal mental health support. It is an opportunity to highlight women’s experience and bring together practitioners from health and social care services to discuss diversity and mental health problems.
 
The conference takes place on 6th September 2018 at Imperial College London.
 
Book your ticket now at www.mmharegistration.co.uk  
 
Poster submission is now open at https://www.mmharegistration.co.uk/poster/

January 2018-February 2018 Research Update

Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units.

Arch Womens Ment Health. 2017 Dec 19. doi: 10.1007/s00737-017-0802-1

Skinner EMBarnett BDietz HP.

Abstract

Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) “putting up” with injuries (36/40); (9) symptoms of post-traumatic stressdisorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum.

https://www.ncbi.nlm.nih.gov/pubmed/28867420

 

Women’s experiences of living with postnatal PTSD.

Midwifery. 2018 Jan;56:70-78. doi: 10.1016/j.midw.2017.09.019.

Peeler SStedmon JChung MCSkirton H.

Abstract

the mental health of new mothers is a public health concern as it is likely to have an impact on the mother herself, her close relationships and the behavioural and emotional health of her children. Post-traumatic stress disorder affects some women after childbirth.

OBJECTIVE:

the aim of this study was to explore how women were affected by the memories of a birth that they perceived as traumatic.

DESIGN:

in this paper the authors report the qualitative analysis of interview data from seven postnatal women reporting symptoms of PTSD. Participants were recruited from a large NHS Trust in the South West of England. Thematic analysis was used to analyse interview data collected from the seven women reporting symptoms of postnatal PTSD.

FINDINGS:

complicating factors such as relationship difficulties and pre-existing health problems appeared to contribute to postnatal post-traumatic stress disorder and some women reported difficulty expressing emotions. The study findings confirm that women value good relationships with midwives during labour.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:

antenatal screening for personality traits such as alexithymia (difficulty expressing emotions) may be useful and midwives should be alert to current life events that may increase women’s vulnerability to post-traumatic stress disorder.

https://www.ncbi.nlm.nih.gov/pubmed/29096282

 

Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review.

J Affect Disord. 2018 Jan 1;225:18-31. doi: 10.1016/j.jad.2017.07.045.

Cook NAyers SHorsch A.

Abstract

BACKGROUND:

Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.

METHOD:

A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.

RESULTS:

26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.

LIMITATIONS:

Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity.

CONCLUSION:

Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.

 

Postnatal post-traumatic stress: An integrative review.

Women Birth. 2018 Jan 11. pii: S1871-5192(17)30475-4. doi: 10.1016/j.wombi.2017.12.003.

Simpson MSchmied VDickson CDahlen HG.

Abstract

PROBLEM:

Post-traumatic stress disorder and post-traumatic stress symptoms following birth occur amongst a small proportion of women but can lead to poor maternal mental health, impairment in mother-infant bonding and relationship stress. This integrative review aims to examine the associated risk factors and women’s own experiences of postnatal post-traumatic stress in order to better understand this phenomenon.

METHOD:

Fifty three articles were included and critically reviewed using the relevant Critical Appraisal Skills Program checklists or Strengthening the Reporting of Observational studies in Epidemiology assessment tool.

FINDINGS:

Risk factors for postnatal post-traumatic stress symptoms and disorder include factors arising before pregnancy, during the antenatal period, in labour and birth and in the postnatal period. Potential protective factors against postnatal post-traumatic stress have been identified in a few studies. The development of postnatal post-traumatic stress can lead to negative outcomes for women, infants and families.

DISCUSSION:

Risk factors for post-traumatic stress symptoms and disorder are potentially identifiable pre-pregnancy and during the antenatal, intrapartum and postnatal periods. Potential protective factors have been identified however they are presently under researched. Predictive models for postnatal post-traumatic stress disorder development have been proposed, however further investigation is required to test such models in a variety of settings.

CONCLUSIONS:

Postnatal post-traumatic stress symptoms and disorder have been shown to negatively impact the lives of childbearing women. Further investigation into methods and models for identifying women at risk of developing postnatal post-traumatic stress following childbirth is required in order to improve outcomes for this population of women.

https://www.ncbi.nlm.nih.gov/pubmed/29337007

 

Preventing Posttraumatic Stress Disorder following childbirth and traumatic birth experiences: A systematic review.

Acta Obstet Gynecol Scand. 2018 Jan 16. doi: 10.1111/aogs.13291.

de Graaff LFHonig Avan Pampus MGStramrood CAI.

Abstract

INTRODUCTION:

Between 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a posttraumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth-related posttraumatic stress disorder.

MATERIAL AND METHODS:

Major databases (Cochrane; Embase; PsycINFO; PubMed (Medline)) were searched using combinations of the key words and their synonyms.

RESULTS:

After screening titles and abstracts and reading 135 full-text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin-to-skin contact with healthy newborns directly postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho-education seemed to lead to fewer posttraumatic stress disorder symptoms in women who delivered via emergency cesarean section.

CONCLUSIONS:

No research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumaticchildbirth and posttraumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous.

https://www.ncbi.nlm.nih.gov/pubmed/29336486

 

Birth experiences, trauma responses and self-concept in postpartum psychotic-like experiences.

Schizophr Res. 2018 Feb 2. pii: S0920-9964(17)30767-3. doi: 10.1016/j.schres.2017.12.015.

Holt LSellwood WSlade P.

Abstract

The frequency of psychotic-like experiences (PLEs) amongst new mothers is beginning to be explored but the mechanisms underlying such experiences are yet to be understood. First time mothers (N=10,000) receiving maternity care via the UK National Health Service were contacted postnatally via Emma’s Diary, an online resource for mothers. Measures assessed birth experience, trauma appraisals, post-traumatic stress symptoms, adjustment to motherhood, self-concept clarity and PLEs (in the form of hallucinations and delusions). There was a 13.9% response rate (N=1393) and 1303 participants reported experiencing at least one PLE (93.5%). Three competing nested path models were analysed. A more negative birth experience directly predicted delusions, but not hallucinations. Trauma appraisals and poorer adjustment to motherhood indirectly predicted PLEs, via disturbed self-concept clarity. Post-traumatic stress symptoms directly predicted the occurrence of all PLEs. PLEs in first time mothers may be more common than previously thought. A key new understanding is that where new mothers have experienced birth as traumatic and are struggling with adjustment to their new role, this can link to disturbances in a coherent sense of self (self-concept clarity) and be an important predictor of PLEs. Understanding the development of PLEs in new mothers may be helpful in postnatal care, as would public health interventions aimed at reducing the sense of abnormality or stigma surrounding such experiences.

https://www.ncbi.nlm.nih.gov/pubmed/29402582

 

POSTPARTUM BONDING DIFFICULTIES AND ADULT ATTACHMENT STYLES: THE MEDIATING ROLE OF POSTPARTUM DEPRESSION AND CHILDBIRTH-RELATED PTSD.

Infant Ment Health J. 2018 Feb 27. doi: 10.1002/imhj.21695

S Hairston IE Handelzalts JAssis CKovo M.

Abstract

Despite decades of research demonstrating the role of adult attachment styles and early mother-infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth-related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh PostnatalDepression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant-focused anxiety, mediated by postpartum depression but not childbirth-related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth-related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth-related PTSDand postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.

https://www.ncbi.nlm.nih.gov/pubmed/29485675

 

Just another ordinary bad birth? A narrative analysis of first time mothers’ traumatic birth experiences.

Health Care Women Int. 2018 Feb 23:1-43. doi: 10.1080/07399332.2018.1442838.

Murphy HStrong J.

Abstract

A difficult birth experience can have long lasting psychological effects on both mother and baby and this study details 4 in-depth accounts of first time mothers who described their birth experience as traumatizing. Narrative analysis was used to record discrepancies between the ideal and the real and produced narrative accounts that highlighted how these mothers felt invisible and dismissed in a medical culture of engineering obstetrics. Participants also detailed how their birth experience could be improved and this is set in context alongside current recommendations in maternal health care and the complexities of delivering such care in UK health settings.

https://www.ncbi.nlm.nih.gov/pubmed/29474791

 

The impact of childbirth-related post-traumatic stress on a couple’s relationship: a systematic review and meta-synthesis

https://doi.org/10.1080/02646838.2017.1397270

  1. Delicate,S. Ayers ,A. Easter&S. McMullen

Abstract

Objective: This review aimed to identify the impact of childbirth-related post-traumatic stress disorder (PTSD) or symptoms (PTSS) on a couple’s relationship.

Background: Childbirth can be psychologically traumatic and can lead to PTSD. There is emerging evidence that experiencing a traumatic birth can affect the quality of the couple’s relationship. This is an important issue because poor-quality relationships can impact on the well-being of partners, their parenting and the welfare of the infant.

Methods: A systematic search was conducted of Amed, CENTRAL, Cinahl, Embase, Maternity and Infant Care, Medline, MITCognet, POPLINE, PsycARTICLES, PsycBITE, PsycINFO, Pubmed and Science Direct. Additionally, grey literature, citation and reference searches were conducted. Papers were eligible for inclusion if they reported qualitative data about parents who had experienced childbirth and measures of PTSD or PTSS and the relationship were taken. Analysis was conducted using meta-ethnography.

Results: Seven studies were included in the meta-synthesis. Results showed that childbirth-related PTSD or PTSS can have a perceived impact on the couple’s relationship and five themes were identified: negative emotions; lack of understanding and support; loss of intimacy; strain on the relationship; and strengthened relationships. A model of proposed interaction between these themes is presented.

Conclusions: The impact of childbirth-related PTSD or PTSS on the couple’s relationships is complex. As the quality of the couple relationship is important to family well-being, it is important that healthcare professionals are aware of the impact of experiencing psychologically traumatic childbirth as impetus for prevention and support.

https://www.tandfonline.com/doi/abs/10.1080/02646838.2017.1397270?journalCode=cjri20

 

Gestational and Postnatal Cortisol Profiles of Women With Posttraumatic Stress Disorder and the Dissociative Subtype.

J Obstet Gynecol Neonatal Nurs. 2018 Jan;47(1):12-22. doi: 10.1016/j.jogn.2017.10.008

Seng JSLi YYang JJKing APLow LMKSperlich MRowe HLee HMuzik MFord JDLiberzon I.

Abstract

OBJECTIVE:

To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD.

DESIGN:

Prospective, longitudinal, biobehavioral cohort study.

SETTING:

Prenatal clinics at academic health centers in the Midwest region of the United States.

PARTICIPANTS:

Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD.

METHODS:

In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic measures. Generalized estimating equations were used to determine group differences.

RESULTS:

Generalized estimating equations showed that women with the dissociative subtype of PTSD had the highest and flattest gestational cortisol level curves. The difference was greatest in early pregnancy, when participants in the dissociative subtype group had cortisol levels 8 times greater in the afternoon and 10 times greater at bedtime than those in the nonexposed control group.

CONCLUSION:

Women with the dissociative subtype of PTSD, a complex form associated with a history of childhood maltreatment, may have toxic levels of cortisol that contribute to intergenerational patterns of adverse health outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/29175262

 

Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy.

Br J Psychiatry. 2018 Jan;212(1):50-56. doi: 10.1192/bjp.2017.9.

Howard LMRyan EGTrevillion KAnderson FBick DBye AByford SO’Connor SSands PDemilew JMilgrom JPickles A.

Abstract

BACKGROUND:

There is limited evidence on the prevalence and identification of antenatal mental disorders. Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR.

METHOD:

Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate.

RESULTS:

Population prevalence was 27% (95% CI 22-32): 11% (95% CI 8-14) depression; 15% (95% CI 11-19) anxiety disorders; 2% (95% CI 1-4) obsessive-compulsive disorder; 0.8% (95% CI 0-1) post-traumatic stress disorder; 2% (95% CI 0.4-3) eating disorders; 0.3% (95% CI 0.1-1) bipolar disorder I, 0.3% (95% CI 0.1-1%) bipolar disorder II; 0.7% (95% CI 0-1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6).

CONCLUSIONS:

Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available.

https://www.ncbi.nlm.nih.gov/pubmed/29433610

 

There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care.

J Clin Nurs. 2018 Feb;27(3-4):e476-e487. doi: 10.1111/jocn.13986.

Higgins ADownes CCarroll MGill AMonahan M.

Abstract

AIMS AND OBJECTIVES:

To explore public health nurses’ engagement, competence and education needs in relation to perinatal mental health care in Ireland.

BACKGROUND:

It is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support women’s mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses’ knowledge, skills and current practices in perinatal mental health and establish their education needs.

DESIGN:

The research used a descriptive design.

METHOD:

A total of 186 public health nurses completed an anonymous, online survey, designed by the research team.

RESULTS:

While public health nurses are positive about their role in supporting women’s mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without.

CONCLUSION:

Public health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period.

RELEVANCE TO CLINICAL PRACTICE:

Without knowledge and skill among nurses in all aspects of perinatal mental health, women with significant mental health needs may be left to cope alone and lack the necessary prompt evidence-based interventions and supports.

https://www.ncbi.nlm.nih.gov/pubmed/28771981

 

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

Women Birth. 2018 Feb;31(1):17-24. doi: 10.1016/j.wombi.2017.06.007.

Priddis HSKeedle HDahlen H.

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

 

A Model to Predict Birth Stress in Adolescents Within 72 Hours of Childbirth.

ANS. Advances in Nursing Science [22 Feb 2018]

Anderson CA  Connolly JP 

Abstract

An organizing framework for understanding adolescent birth stress in immediate postpartum does not exist. Researchers evaluated adolescent birth stress within 72 hours postpartum via a modification of Slade’s conceptual model of risk factors for posttraumatic stress (PTS). Birth stress was defined by negative birth appraisal and subjective distress. Precipitating factors pain management, partner presence, and delivery type, plus maintaining factor infant complications, predicted negative birth appraisal. Predisposing factors depression and prior trauma predicted subjective distress. Findings support utility of Slade’s modified model of PTS risk factors for identification of adolescent early birth stress and generate nursing practice and research implications.

http://europepmc.org/abstract/med/29474225

 

July – December 2017 Research Update

I would like to apologise for the delay in posting this, I have spent the last six months trying to finish my thesis so have not had time to keep up to date with the blog. I will try and make posts more regular from now. I have gathered the research published in July – December last year and posted it here for you.

Grief, traumatic stress, and posttraumatic growth in women who have experienced pregnancy loss.

Krosch, Daniel Jay; Shakespeare-Finch, Jane.

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 posttrauma 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 posttrauma change following pregnancy loss.

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

Posttraumatic stress in mothers related to giving birth prematurely: A mixed research synthesis.

Beck, Cheryl Tatano; Harrison, Lisa

Journal of the American Psychiatric Nurses Association, Vol 23(4), Jul, 2017. pp. 241-257.

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.

http://journals.sagepub.com/doi/abs/10.1177/1078390317700979

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

Horsch, Antje; Vial, Yvan; Favrod, Céline; Harari, Mathilde Morisod; Blackwell, Simon E., Watson, Peter.; Iyadurai, Lalitha.; Bonsall, Michael B.; Holmes, Emily A

Behaviour Research and Therapy, Vol 94, Jul, 2017. pp. 36-47.

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.

https://www.sciencedirect.com/science/article/pii/S0005796717300670

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

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

Health Care Women Int. 2017 Jul;38(6):593-612. doi: 10.1080/07399332.2017.1296840.

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.

http://www.tandfonline.com/doi/abs/10.1080/07399332.2017.1296840

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 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/pmc/articles/PMC5457569/

The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis.

Hunter A; Tussis L; MacBeth A

Journal Of Affective Disorders [J Affect Disord] 2017 Jul 11; Vol. 223, pp. 153-164.

Abstract:

Background: Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss METHODS: Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted.
Results: We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = – 0.002, 95% CI = – 0.0639 to 0.0605).
Limitations: This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners.
Conclusions: Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.

https://www.ncbi.nlm.nih.gov/pubmed/28755623

Narrative Exposure Therapy to Address Intimate Partner Violence-Related PTSD in Parenting and Pregnant Adolescents.

Volpe EM, Quinn CR, Resch K, Sommers MS, Wieling E, Cerulli C.

Fam Community Health. 2017 Jul/Sep;40(3):258-277. doi: 10.1097/FCH.0000000000000072.

Abstract

Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET’s theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.

https://www.ncbi.nlm.nih.gov/pubmed/26422231

Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey.

Wahlberg Å, Andreen Sachs M, Johannesson K, Hallberg G, Jonsson M, Skoog Svanberg A, Högberg U.

BJOG. 2017 Jul;124(8):1264-1271. doi: 10.1111/1471-0528.14259.

Abstract

OBJECTIVE:

To examine post-traumatic stress reactions among obstetricians and midwives, experiences of support and professional consequences after severe events in the labour ward.

DESIGN:

Cross-sectional online survey from January 7 to March 10, 2014.

POPULATION:

Members of the Swedish Society of Obstetrics and Gynaecology and the Swedish Association of Midwives.

METHODS:

Potentially traumatic events were defined as: the child died or was severely injured during delivery; maternal near-miss; maternal mortality; and other events such as violence or threat. The validated Screen Questionnaire Posttraumatic Stress Disorder (SQ-PTSD), based on DSM-IV (1994) 4th edition, was used to assess partial post-traumatic stress disorder (PTSD) and probable PTSD.

MAIN OUTCOME MEASURES:

Partial or probable PTSD.

RESULTS:

The response rate was 47% for obstetricians (n = 706) and 40% (n = 1459) for midwives. Eighty-four percent of the obstetricians and 71% of the midwives reported experiencing at least one severe event on the delivery ward. Fifteen percent of both professions reported symptoms indicative of partial PTSD, whereas 7% of the obstetricians and 5% of the midwives indicated symptoms fulfilling PTSD criteria. Having experienced emotions of guilt or perceived insufficient support from friends predicted a higher risk of suffering from partial or probable PTSD. Obstetricians and midwives with partial PTSD symptoms chose to change their work to outpatient care significantly more often than colleagues without these symptoms.

CONCLUSIONS:

A substantial proportion of obstetricians and midwives reported symptoms of partial or probable PTSD after severe traumatic events experienced on the labour ward. Support and resilience training could avoid suffering and consequences for professional carers.

https://www.ncbi.nlm.nih.gov/pubmed/27562912

Understanding and Promoting Birth Satisfaction in New Mothers.

Hinic K;

MCN. The American Journal Of Maternal Child Nursing [MCN Am J Matern Child Nurs] 2017 Jul/Aug; Vol. 42 (4), pp. 210-215.

Abstract:

Purpose: The purpose of this study was to examine the impact of select maternal psychosocial and experiential factors on birth satisfaction of new mothers during early postpartum.
Study Design and Methods: This is a descriptive correlational study exploring the relationships among birth satisfaction, breastfeeding self-efficacy, and perceived stress in 107 new mothers in the first 4 days postpartum. Instruments used included the Birth Satisfaction Scale-Revised, the Perceived Stress Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and a researcher-generated demographic form. Quantitative analysis included descriptive statistics, correlation, one-way Analysis of Variance, and multiple linear regression.
Results: Birth satisfaction was negatively correlated with perceived stress (r = -.299, p < .05) and positively correlated with feeling prepared for birth (rho = .243, p < .05) and breastfeeding self-efficacy (r = .226, p < .05). The predictive model for birth satisfaction was significant (R = .204, F [6, 99] = 4.225, p = .001), explaining approximately 20.4% of variance in birth satisfaction in the sample.
Clinical Implications: Stress reduction and management, establishment of realistic expectations for labor and birth, and promotion of togetherness with newborn immediately after birth are nursing priorities to promote birth satisfaction.

https://www.ncbi.nlm.nih.gov/pubmed/28654447

Traumatic Experience, Polytraumatization, and Perinatal Depression in a Diverse Sample of Adolescent Mothers.

Killian-Farrell C, Rizo CF, Lombardi BM, Meltzer-Brody S, Bledsoe SE.

J Interpers Violence. 2017 Aug 1

Abstract

This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample ( N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.

https://www.ncbi.nlm.nih.gov/pubmed/29294877

Facilitators and barriers to disclosure of postpartum mood disorder symptoms to a healthcare provider.

Prevatt, Betty-Shannon; Desmarais, Sarah L.

Maternal and Child Health Journal, Aug 1, 2017.

Abstract:

Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n = 211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient’s perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking ‘extremely difficult’ or ‘impossible.’ Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers’ social support networks.

https://www.ncbi.nlm.nih.gov/pubmed/28766092

Cumulative trauma and partner conflict predict post‐traumatic stress disorder in postpartum African‐American women.

Hauff, Nancy J; Fry‐McComish, Judith; Chiodo, Lisa M

Journal of Clinical Nursing, Vol 26(15-16), Aug, 2017. pp. 2372-2383.

Abstract:

Aim and objective: To describe relationships between cumulative trauma, partner conflict and post‐traumatic stress in African‐American postpartum women. Background: Cumulative trauma exposure estimates for women in the USA range from 51–69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post‐traumatic 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 aged between 18–45 who had given birth. Methods: Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post‐traumatic 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. Relevance to Clinical Practice: The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African‐American women. Healthcare providers need to be sensitive to patient life‐threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post‐traumatic stress symptoms during pregnancy.

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

Impact of psychological grief counseling on the severity of post-traumatic stress symptoms in mothers after stillbirths.

Navidian, Ali; Saravani, Zahra; Shakiba, Mansour

Issues in Mental Health Nursing, Vol 38(8), Aug, 2017. pp. 650-654.

Abstract:

Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ, which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.

https://www.ncbi.nlm.nih.gov/pubmed/28745912

The feeling of discomfort during vaginal examination, history of abuse and sexual abuse and post-traumatic stress disorder in women.

Güneş, GizemKaraçam, Zekiye

Journal of Clinical Nursing. Aug2017, Vol. 26 Issue 15/16, p2362-2371.

Abstract:

Aims and objectives To examine the feeling of discomfort during vaginal examinations, history of abuse and sexual abuse and post-traumatic stress disorder in women to determine the correlation between these variables. Background Women who have experienced abuse or sexual abuse may feel more discomfort during vaginal examinations and may perceive a sensation similar to what they experienced during sexual abuse. Design Cross-sectional. Methods This study included 320 women receiving a vaginal examination. The data were collected using a questionnaire composed of items related to descriptive characteristics, vaginal examinations and violence, a visual analogue scale of discomfort, and the Post-Traumatic Stress Disorder Scale-civilian version. Results The mean score for the feeling of discomfort during vaginal examinations was 3·92 ± 3·34; 26·3% of the women described discomfort. Thirty-eight (12%) of the 320 women had experienced emotional violence, 25 (8%) had experienced physical violence, and 25 (8%) had been forced into sexual intercourse by their spouses. Of the women, 64·7% suffered from post-traumatic stress disorder, and physical, emotional and sexual violence were found to increase the possibility of this disorder. Exposure to emotional violence increased the possibility of discomfort during vaginal examinations by 4·5 ( OR = 4·482; 95% CI = 1·421-14·134). Post-traumatic stress disorder ( OR = 1·038; 95% CI = 1·009-1·066) was found to increase the possibility of discomfort during vaginal examinations; however, as the number of live births increases, women reported a reduction in their discomfort with vaginal examinations. Conclusion This study revealed a positive correlation between discomfort during vaginal examinations and emotional violence and post-traumatic stress disorder but a negative correlation between discomfort during vaginal examinations and the number of live births. In addition, having a history of abuse and sexual abuse was found to increase post-traumatic stress disorder. Relevance to clinical practice Considering these findings during vaginal examinations may help change women’s experiences for the positive and reduce the trauma, this procedure may cause.

https://www.ncbi.nlm.nih.gov/pubmed/27603931

Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis.

Baumeler, LuziaGürber, SusanneGrob, AlexanderSurbek, DanielStadlmayr, Werner

European Journal of Obstetrics & Gynecology & Reproductive Biology. Aug2017, Vol. 215, p68-74. 7p.

Abstract:

Objectives: Postpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. Study Design: One hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon’s Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale – revised (IES-r). The data were evaluated in a longitudinal path analysis.Results: Compared with fathers, mothers reported more depressive symptoms (pregnancy: p<0.001; postpartum: p<0.001), higher ASR (p<0.001), and lower ‘positive birth experience’ (p<0.001). The association between depressive symptoms in mothers and fathers was not significant during pregnancy (r=0.107, p>0.10), but moderately correlated four weeks after birth (r=0.387, p<0.001). Depressive symptoms during pregnancy and a negative subjective birth experience were independently predictive of PDS and ASR after childbirth in mothers and fathers controlling for age, mode of delivery, parity, epidural anaesthesia, infant gender and birth weight. Antenatal depressive symptoms were related to subjective childbirth experience only in fathers.Conclusion: Parental prenatal depressive symptoms and subjective birth experience are important predictors of postnatal psychological adjustment in mothers and fathers.

https://www.ncbi.nlm.nih.gov/pubmed/28601730

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.

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 trauma among 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

Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths.

Navidian A1, Saravani Z2, Shakiba M3.

Issues Ment Health Nurs. 2017 Aug;38(8):650-654.

Abstract

Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ,1 which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.

https://www.ncbi.nlm.nih.gov/pubmed/28745912

Post traumatic stress disorder post childbirth versus postnatal depression: a guide for midwives.

Bromley, PhilippaHollins Martin, Caroline J; Patterson, Jenny

British Journal of Midwifery. Aug2017, Vol. 25 Issue 8, p484-490. 7p.

Abstract:

Post traumatic stress disorder-post childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between 1–6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women’s social interactions, ability to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond 1 month, a diagnosis of PTSD-PC should be considered. In awareness that there are additional mental health problems that a childbearing woman could encounter, the authors have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and postnatal depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and PND, because diagnoses and treatments differ. Generally, PND is treated with antidepressants and cognitive behavioural therapy (CBT), while PTSD is treated with eye movement desensitisation and reprocessing (EMDR) therapy or emotional freedom technique (EFT). There is potential for a women to develop a dual diagnosis, with partner and family also affected. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment.

https://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2017.25.8.484

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

Hollander MH1, van Hastenberg E2, van Dillen J2, van Pampus MG3, de Miranda E4, Stramrood CAI5.

Arch Womens Ment Health. 2017 Aug;20(4):515-523.

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 traumatic childbirth 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

The effects of trauma on perinatal depression: Examining trajectories of depression from pregnancy through 24 months postpartum in an at-risk population.

Grekin R, Brock RL, O’Hara MW.

J Affect Disord. 2017 Aug 15;218:269-276. doi: 10.1016/j.jad.2017.04.051

Abstract

BACKGROUND:

Research suggests that trauma exposure is associated with perinatal depression; however, little is known about the nature of the relation between trauma history and trajectory of depression, as well as the predictive power of trauma history beyond other risk factors. Additionally, more research is needed in at-risk samples that are likely to experience severe traumatic exposure.

METHODS:

Secondary data analysis was conducted using demographic and depression data from the Healthy Start and Empowerment Family Support programs in Des Moines, Iowa. Hierarchical linear modeling was used to examine trajectories of perinatal depressive symptoms, from pregnancy to 24 months postpartum, and clarify whether trauma exposure, relationship status, and substance use uniquely contribute to trajectories of symptoms over time.

RESULTS:

On average, depressive symptoms decreased from pregnancy to 24 months postpartum; however, trajectories varied across women. Single relationship status, substance use, and trauma history were each predictors of higher depression levels at several points in time across the observed perinatal period. Single relationship status was also associated with decline in depressive symptoms followed by a rebound of symptoms at 22 months postpartum.

LIMITATIONS:

These data were not collected for research purposes and thus did not undergo the rigorous data collection strategies typically implemented in an established research study.

CONCLUSIONS:

History of trauma, substance use and single relationship status represent unique risk factors for perinatal depression. For single women, depressive symptoms rebound late in the postpartum period. Single women are at greater risk for substance use and traumatic exposure and represent a sample with cumulative risk. Eliciting social support may be an important intervention for women presenting with these risk factors.

https://www.ncbi.nlm.nih.gov/pubmed/28477506

There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care.

Higgins A; Downes C; Carroll M; Gill A; Monahan M

Journal Of Clinical Nursing [J Clin Nurs] 2017 Aug 03.

Abstract:

Aims and Objectives: To explore public health nurses’ engagement, competence and education needs in relation to perinatal mental health care in Ireland.
Background: It is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support women’s mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses’ knowledge, skills and current practices in perinatal mental health and establish their education needs.
Design: The research used a descriptive design.
Method: A total of 186 public health nurses completed an anonymous, online survey, designed by the research team.
Results: While public health nurses are positive about their role in supporting women’s mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without.
Conclusion: Public health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period.

https://www.ncbi.nlm.nih.gov/pubmed/28771981

Risk factors for chronic post-traumatic stress disorder development one year after vaginal delivery: a prospective, observational study.

Sentilhes L, Maillard F, Brun S, Madar H, Merlot B, Goffinet F, Deneux-Tharaux C.

Sci Rep. 2017 Aug 18;7(1):8724. doi: 10.1038/s41598-017-09314-x.

Abstract

Our study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) after childbirth one year after vaginal delivery and to identify characteristics of women and deliveries associated with it. Questionnaires were mailed a year after delivery to 1103 women with prospectively collected delivery and postpartum data, including a question on day 2 assessing their experience of childbirth. PTSD was assessed a year later by the Impact of Event and Traumatic Event Scales; 22 women (4.2%, 95%CI 2.7-6.3%) met the PTSD diagnostic criteria and 30 (5.7%; 95%CI 3.9-8.0%) PTSD profile criteria. Factors associated with higher risk of PTSD profile were previous abortion(aOR 3.6, 95%CI 1.4-9.3), previous postpartum hemorrhage (Aor 5.3, 95%CI 1.3-21.4), and postpartum hemoglobin <9 g/dl (aOR 2.7, 95%CI 1.0-7.5). Among 56 women (10.3%) reporting bad childbirth memories at day 2 postpartum, 11 (21.1%) met PTSD diagnosis and 11 (21.1%) PTSD profile criteria a year later, compared with 11 (2.4%) (P < 0.001) and 18 (3.8%) (P < 0.001), respectively, of the 489 (87.7%) women with good memories. PTSD is not rare at one year after vaginal delivery in a low-risk population. A simple question at day 2 post partum may identify women most at risk of PTSD and help determine if early intervention is needed.

https://www.nature.com/articles/s41598-017-09314-x

Grief, Bereavement, and Traumatic Stress as Natural Results of Reproductive Losses.

Abi-Hashem, Naji; Div, M.

Issues in Law & Medicine. Fall2017, Vol. 32 Issue 2, p245-254. 10p.

Abstract:

The article focuses on the influence reproductive losses has on traumatic stress, grief, and bereavement. It presents definitions of terminology such as grief, loss, and reproductive losses, and assigns meanings to reproduction and pregnancy. It considers the cultural roots on opposing views concerning how to deal with reproductive losses. It talks about signs and symptoms of grief and trauma, and the phases and steps used in successful grief counseling processes.

https://www.ncbi.nlm.nih.gov/m/pubmed/29108148/

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS.

Isosävi S, Diab SY, Kangaslampi S, Qouta S, Kankaanpää S, Puura K, Punamäki RL.

Infant Ment Health J. 2017 Sep;38(5):617-633. doi: 10.1002/imhj.21658.

Abstract

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide-ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war-exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.

https://www.ncbi.nlm.nih.gov/pubmed/28833322

Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women.

Levey EJ, Gelaye B, Koenen K, Zhong QY, Basu A, Rondon MB, Sanchez S, Henderson DC, Williams MA.

Arch Womens Ment Health. 2017 Sep 13. doi: 10.1007/s00737-017-0776-z

Abstract

Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSDduring pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic StressDisorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/28905129

The influence of acculturation on traumatic stress following childbirth among Hispanic adolescents.

Anderson, Cheryl;  Strickland, Sarah.

Hispanic Health Care International, Vol 15(3), Sep, 2017. pp. 99-106.

Abstract:

Introduction: Many studies have explored the role of acculturation on health outcomes; however, no studies to date have examined relationships between acculturation and the traumatic stress of childbirth among Hispanic adolescents. Method: A convenience sample of 66 Hispanic adolescents 13 to 19 years of age completed the Acculturation Rating Scale for Mexican Americans–II (ARSMA-II), a demographic sheet, birth appraisal scale, and the Impact of Event Scale within 72 hours of birth. Results: Significant associations were found between the ARSMA-II subscales and acculturation proxy variables, excluding language; however, only the Mexican Orientation Subscale and generation proxy variable influenced the birth experience. The study findings showed that Hispanic adolescents reporting a more traumatic childbirth identified closer with the Mexican culture and reported fewer family generations residing in the United States. Conclusion: As an overlooked area of research, our findings support the need for additional research related to the traumatic stress of birth among Hispanic adolescents. Using multiple acculturation measurements, including the ARSMA-II, with larger, more diverse samples of adolescents, equally balanced between all categories of acculturation and placement within the five-tier generation matrix, can provide some insightful information and directed health care.

https://www.ncbi.nlm.nih.gov/pubmed/29164933

Partners of nulliparous women with severe fear of childbirth: A longitudinal study of psychological well-being.

Ryding EL; Read S; Rouhe H; Halmesmäki E; Salmela-Aro K; Toivanen R; Tokola M; Saisto T

Birth (Berkeley, Calif.) [Birth] 2017 Sep 11.

Abstract:

Background: Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth.
Methods: During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid-pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale.
Results: Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well-being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners.
Conclusion: Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well-being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women.

https://www.ncbi.nlm.nih.gov/pubmed/28892237

Validating the psychometric characteristics of the perinatal posttraumatic stress disorder questionnaire (ppq) in a Chinese context.

Zhang, Jun; Zhang, Di; Gan, Quan; Wang, Qiaoling; Fan, Nian; Zhang, Rong; Song, Yayun

Archives of Psychiatric Nursing, Sep 28, 2017.

Abstract:

BACKGROUND: Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet. OBJECTIVES: The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context. METHODS: After translation, back-translation, and expert discussion, 280 mothers at 1 to 18months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested. RESULTS: The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach’s ± coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing ‘arousal’, ‘avoidance’ and ‘intrusion’) accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (Ç2=76.40, p<0.05). IMPLICATIONS FOR PRACTICE: The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening. IMPLICATIONS FOR RESEARCH: Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture.

https://www.sciencedirect.com/science/article/pii/S0883941717302650

Does maternal parenting stress mediate the association between postpartum PTS symptoms and children’s internalizing and externalizing problems? A longitudinal perspective.

Di Blasio, Paola; Miragoli, Sarah; Ionio, Chiara; Milani, Luca

Child & Youth Care Forum, Vol 46(5), Oct, 2017. pp. 685-701.

Abstract:

Background: The research carried out in the last years outlined that childbirth could be considered as a sufficient stressor for the insurgence of posttraumatic stress (PTS) symptoms with important consequences for the child care. Objectives: In a longitudinal perspective, this study focused on PTS symptoms after childbirth to understand their impact on maternal parenting stress and children’s adjustment. First, we investigated whether childbirth-related PTS symptoms, at 87 h and 3 months postpartum, were associated with parenting stress and children’s adjustment at 18 months. Second, we explored, at 18 months, the predictive effects of postpartum PTS symptoms on children’s adjustment and verified the mediational effect of parenting stress this association. Methods: Eighty-eight women participated and completed the following questionnaires: PPQ (for assessing maternal PTS symptoms at 87 h, 3 and 18 months postpartum), PSI-SF (for maternal parenting stress at 18 months) and CBCL (for children’s adjustment at 18 months). Results: Findings outlined that more PTS symptoms at 3 months are associated with greater levels of parental distress and they predicted children’s adjustment at 18 months. Moreover, maternal parenting stress explained the predictive effects of childbirth-related PTS symptoms on children’s adjustment. More precisely parental distress partially mediated the association between PTS symptoms and children’s internalizing behaviors, while the perception of the difficult child fully mediated the effects of PTS symptoms on externalizing behaviors. Conclusion: This study was consistent with the idea that women may experience childbirth-related chronic distress and child adjustment was connected to different sources of parenting stress.

https://link.springer.com/article/10.1007/s10566-017-9400-7

A comparative prospective cohort study of women following childbirth: Mothers of low birthweight infants at risk for elevated PTSD symptoms.

Feeley, Nancy; Hayton, Barbara; Gold, Ian; Zelkowitz, Phyllis.

Journal of Psychosomatic Research, Vol 101, Oct, 2017. pp. 24-30.

Abstract:

A comparative, prospective cohort study compared PTSD symptoms in four groups of women at three times after childbirth: 5, 8 and 26 weeks. Two groups considered at-risk for PTSD were included (i.e., women giving birth to a LBW infant requiring NICU admission, and those who experienced an EmCB) and two low-risk groups (i.e., women who had a vaginal birth (VB) and those who had a planned caesarean birth (PCB)). This study examined four main hypotheses. We expected that: 1) at each time women in the two at-risk groups would experience greater PTSD symptoms compared to women in the low-risk groups, 2) the decrease in mean PTSD symptom levels for at-risk groups would be less than in the low-risk groups from 5 to 8, and 8 to 26 weeks postpartum, 3) the at-risk groups would have poorer maternal interactive behavior compared low-risk groups; and 4) regardless of group, women with clinically important PTSD symptom levels (e.g., scores in the clinical range) would exhibit poorer interactive behavior compared to women without; and women with co-morbidity of PTSD and depressive symptoms, would also have poorer interactive behavior. Additional exploratory analyses were conducted. Associations between PTSD symptoms and interactive behaviors were examined. The proportion of women in the clinical range in the different groups was explored. Lastly, we also investigated the proportion of women who had symptom levels in the clinical range on the self-report measure of PTSD compared to the more rigorous structured interview; and the concordance between these two measures with respect to classification of women in the clinical range.

https://www.ncbi.nlm.nih.gov/pubmed/28867420

PTSD Symptom Trajectories among Mothers Reporting Interpersonal Trauma: Protective Factors and Parenting Outcomes.

Guyon-Harris, KatherineAhlfs-Dunn, SarahHuth-Bocks, Alissa

Journal of Family Violence. Oct2017, Vol. 32 Issue 7, p657-667. 11p. 3

Abstract:

The childbearing years are further complicated when experiences of interpersonal trauma from childhood and/or adulthood lead to symptoms of posttraumatic stress disorder (PTSD). Maternal symptoms of PTSD over time were examined in relation to supportive adult relationships and parenting experiences. Ninety-five primarily economically disadvantaged mothers reporting exposure to childhood maltreatment and/or intimate partner violence were assessed from pregnancy through 2-years postpartum. Latent class growth analysis of PTSD symptoms indicated a 2-group model: stable low (82%) and moderate dysfunction (18%). The stable low group reported higher levels of support from romantic partners and family members, but not friends, and lower levels of parenting distress compared to the moderate dysfunction group. Results highlight individual variability in adaptation after violence exposure; current support from romantic partners and family members may have helped maintain lower PTSD symptoms for some trauma-exposed mothers. Psychological interventions aimed at reducing the impact of trauma exposure on parenting should consider promoting ongoing social support.

https://link.springer.com/article/10.1007/s10896-017-9934-3

The trauma of birth.

Anderson CA

Health Care For Women International [Health Care Women Int] 2017 Oct; Vol. 38 (10), pp. 999-1010.

Abstract:

The trauma of birth is an international concern for all childbearing women globally. Since changes in 1994 to the Diagnostic Statistical Manual that included childbirth as a potentially traumatic event, several clusters of researchers, particularly representing the Scandinavian countries, the United Kingdom, and Australia, have emerged. Their research findings appear in numerous publications; yet, what is known from these studies is based on a variety of methodological designs and differing measurement tools making it difficult to draw many firm conclusions (Ayers, 2004 ; Ayers, Joseph, Mc-Kenzie-McHarg, Slade, & Wijma, 2008 ). This review offers information obtained from frequently cited, current and seminal research studies describing the trauma of birth among women of the world.

https://www.ncbi.nlm.nih.gov/labs/journals/health-care-women-int/

Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study.

Wallin Lundell I; Sundström Poromaa I; Ekselius L;Georgsson S; Frans Ö; Helström L; Högberg U; Skoog Svanberg A

BMC Women’s Health [BMC Womens Health] 2017 Oct 02; Vol. 17 (1), pp. 96

Abstract:

Background: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.
Methods: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.
Results: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively.
Conclusion: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625823/

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

Dikmen-Yildiz, Pelin; Ayers, Susan; Phillips, Louise.

Journal of Affective Disorders, Vol 221, Oct 15, 2017. pp. 238-245.

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

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 Oct;57(5):520-525. doi: 10.1111/ajo.12618.

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

 

Mother–infant bonding in the postpartum period: Assessment of the impact of pre-delivery factors in a clinical sample.

Farré-Sender, Borja; Torres, Anna; Gelabert, Estel; Andrés, Susana; Roca, Alba; Lasheras, Gracia; Valdés, Manuel; Garcia-Esteve, Lluïsa.

Archives of Women’s Mental Health, Oct 18, 2017.

Abstract:

This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother–infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6–7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women’s risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.

https://www.ncbi.nlm.nih.gov/pubmed/29046965

Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy.

Weinreb, Linda; Wenz-Gross, Melodie; Upshur, Carole.

Archives of Women’s Mental Health, Nov 7, 2017.

Abstract:

This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.

https://www.ncbi.nlm.nih.gov/pubmed/29116416

Trauma and traumatic stress in a sample of pregnant women.

Gelaye, Bizu; Zhong, Qiu-Yue.; Basu, Archana; Levey, Elizabeth J.; Rondon, Marta B.; Sanchez, Sixto; Koenen, Karestan C.; Henderson, David C.;Williams, Michelle A

Psychiatry Research, Vol 257, Nov, 2017. pp. 506-513.

Abstract:

Objective: To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru. Methods: Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders. Results: The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, Pvalue < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001). Conclusion: Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients.

https://www.ncbi.nlm.nih.gov/pubmed/28843870

Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women.

Sanchez SE; Pineda O; Chaves DZ; Zhong QY; Gelaye B; Simon GE; Rondon MB; Williams MA;

Annals Of Epidemiology [Ann Epidemiol] 2017 Nov; Vol. 27 (11), pp. 716-723.e1.

Abstract:

Purpose: We sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV).
Methods: In-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Compared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18-8.49), 5.33-fold for sexual abuse only (95% CI, 2.38-11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10-15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18-49.85).
Conclusions: Childhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women’s mental health.

https://www.ncbi.nlm.nih.gov/pubmed/29079333

Posttraumatic Stress Disorder and Its Effects on Pregnancy and Mothering.

J Midwifery Womens Health. 2017 Nov;62(6):775-776. doi: 10.1111/jmwh.12705

http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12705/full

Birth trauma and post-traumatic stress disorder: the importance of risk and resilience.

Ayers, Susan

Journal of Reproductive & Infant Psychology. Nov2017, Vol. 35 Issue 5, p427-430. 4p.

Abstract:

The author discusses the significance of risk and resilience in birth trauma and post-traumatic stress disorder (PTSD). Topics mentioned include the number of women in the European Union and the U.S. who are likely to be affected by birth trauma and PTSD every year, association of PTSD with poor coping and stress after birth, and conceptualization of resilience on two main dimensions.

http://www.tandfonline.com/doi/full/10.1080/02646838.2017.1386874

Maternal psychological distress after preterm birth: Disruptive or adaptive?

Hall, Ruby A. S.; Hoffenkamp, Hannah N.; Braeken, Johan; Tooten, Anneke; Vingerhoets, Ad J. J. M.; van Bakel, Hedwig J. A.

Infant Behavior & Development, Vol 49, Nov, 2017. pp. 272-280.

Abstract:

Background: Maternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother’s quality of parenting. Method: Latent Class Analysis was used to group mothers (N = 197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews. Results: A 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting. Conclusions: While heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers’ emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.

https://www.ncbi.nlm.nih.gov/pubmed/29073522

Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants.

Greene MM; Rossman B; Meier P; Patra K;

Early Human Development [Early Hum Dev] 2017 Nov 08; Vol. 116, pp. 33-39.

Abstract:

Aim: The literature is sparse with respect to the impact of elevated maternal psychological distress in the neonatal intensive care unit (NICU) on later neurodevelopmental outcome in VLBW infants. The objective of this study is to examine the impact of elevated maternal distress, defined as elevated depression, anxiety and perinatal-specific post-traumatic stress, during the NICU hospitalization on VLBW infant ND outcome at 20months corrected age (CA).
Methods: This was a prospective study of 69 mothers and their VLBW infants recruited in 2011-2012. Elevated maternal distress was collected by maternal questionnaire in the NICU. Elevated depression was quantified with the Center for Epidemiological Studies-Depression Scale, anxiety with the Spielberger State-Trait Anxiety Inventory and perinatal-specific post-traumatic stress with the Modified Perinatal Posttraumatic Stress Disorder Questionnaire. VLBW infant ND outcome was assessed using the Bayley Scales of Infant & Toddler Development-III at 20months CA. Regression analyses determined the impact of elevated distress on ND outcome after adjusting for infant medical and maternal sociodemographic variables.
Results: After controlling for infant and maternal covariates, elevated maternal anxiety in the NICU predicted lower fine motor scores at 20months CA.
Conclusion: Elevated maternal anxiety in the NICU is associated with adverse ND outcome in VLBW infants in the 2nd year of life. NICU-based support services may help mothers’ quality of life and VLBW infant outcome.

https://www.ncbi.nlm.nih.gov/pubmed/29127891

Effect of Previous Posttraumatic Stress in the Perinatal Period.

Authors:

Geller PA; Stasko EC

Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN [J Obstet Gynecol Neonatal Nurs] 2017 Nov – Dec; Vol. 46 (6), pp. 912-922.

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 Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists 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

 

Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression.

Hanschmidt F, Treml J, Klingner J, Stepan H, Kersting A

Arch Womens Ment Health. 2017 Dec 29. doi: 10.1007/s00737-017-0807-9.

Abstract

Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women’s psychological reactions. This study examined the influence of perceived and internalized stigma on women’s long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

https://www.ncbi.nlm.nih.gov/pubmed/29288285

The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study.

Garthus-Niegel S; Horsch A; Ayers S; Junge-Hoffmeister J; Weidner K; Eberhard-Gran M

Birth (Berkeley, Calif.) [Birth] 2017 Dec 18.

Abstract:

Background: In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years.
Methods: The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital’s birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses.
Results: Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization’s breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables.
Conclusion: Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.

https://www.ncbi.nlm.nih.gov/pubmed/29265443

Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective.

Jaffe J

Psychotherapy (Chic). 2017 Dec;54(4):380-385. doi: 10.1037/pst0000125.

Abstract

The reproductive story offers a unique way to conceptualize pregnancy loss and infertility. This article describes the development of the reproductive story from early childhood on, and focuses on the devastating losses when the story does not unfold as originally hoped. Regardless of the type of reproductive trauma that clients experience, the underlying psychological constructs of grief are the same. The goal is to help clients work through their grief and loss, accept that their story can be edited and rewritten, and come away with a positive new ending. This paper illustrates how to utilize the reproductive story with infertility and pregnancy loss clients in psychotherapy. Using clinical illustrations, interventions for the treatment of perinatal grief, particularly in the context of infertility, are discussed. Specific suggestions are offered to help clients rethink past ideals, cope with their current trauma, and make constructive decisions in their effort to build their future family.

https://www.ncbi.nlm.nih.gov/pubmed/29251957

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 Dec;26(23-24):4436-4445. doi: 10.1111/jocn.13773.

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

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

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

J Clin Nurs. 2017 Dec;26(23-24):3859-3868. 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

Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women.

Friedman, Lauren E; Aponte, Christina; Perez Hernandez, Rigoberto; Velez, Juan Carlos; Gelaye, Bizu; Sánchez, Sixto E; Williams, Michelle A; Peterlin, B. Lee

The Journal of Headache and Pain, Vol 18, Dec, 2017. ArtID: 67

Abstract:

Background: Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods: We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results: Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion: In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.

https://www.ncbi.nlm.nih.gov/pubmed/28685258

The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions.

Gondwe KW; White-Traut R; Brandon D; Pan W; Holditch-Davis D

Research In Nursing & Health [Res Nurs Health] 2017 Dec; Vol. 40 (6), pp. 528-540.

Abstract:

Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child’s health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.

https://www.ncbi.nlm.nih.gov/pubmed/28877554

Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study.

Dikmen-Yildiz P; Ayers S; Phillips L

Midwifery [Midwifery] 2017 Dec; Vol. 55, pp. 29-37.

Abstract:

Objective: (a) to assess prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) and their comorbidity among women during the perinatal period (b) to examine course of those disorders from pregnancy to 6 months postpartum (c) to determine the rates of new-onset cases at 4-6 weeks and 6 months postpartum.
Design: A longitudinal population-based study in which participants completed psychosocial measures of depression, anxiety and PTSD in pregnancy (n = 950), 4-6 weeks (n = 858) and 6 months (n = 829) after birth.
Setting: A consecutive sample of pregnant women were recruited from three maternity hospitals in three cities of Turkey: Istanbul, Ankara and Izmir.
Measures: Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Diagnostic Scale (PDS) were used to assess depression, anxiety and PTSD, respectively.
Findings: Depression and PTSD peaked at 4-6 weeks postpartum and then fell at 6 months postpartum, whereas anxiety followed a gradually declining linear-pattern from pregnancy to 6 months postpartum. The prevalence of depression was 14.6% in pregnancy, 32.6% at 4-6 weeks and 18.5% at 6 months postpartum, respectively. The prevalence of PTSD was 5.8% in pregnancy, 11.9% at 4-6 weeks postpartum and 9.2% at 6 months postpartum. Anxiety was highest in pregnancy (29.6%) and then decreased to 24.6% 4-6 weeks after birth and to 16.2% 6 months after birth. New-onset cases were most apparent at 4-6 weeks postpartum: 24.6% for depression; 13.7% for anxiety and 8.9% for PTSD.
Key Conclusions: A relatively high prevalence of psychological disorders was identified during the perinatal period. Anxiety was most prevalent in pregnancy, and depression and PTSD were highest at 4-6 weeks postpartum. Depression was more common than anxiety 4-6 weeks and 6 months after birth and highly comorbid with anxiety throughout this period. New-onset cases were observed at both 4-6 weeks and 6 months postpartum.
Implications: High rates of affective disorders in pregnancy and after birth highlight three main points: first, it is important to have effective perinatal screening to identify women with psychological needs; second, providing early treatment to women experiencing severe psychological problems is essential to ensure psychological well-being of those women and to prevent chronicity; and finally, psychosocial screening and interventions should be offered until at least 6 months after birth to catch new-onset cases.

https://www.ncbi.nlm.nih.gov/pubmed/28917088

Stress in fathers in the perinatal period: A systematic review.

Philpott LF; Leahy-Warren P; FitzGerald S; Savage E

Midwifery [Midwifery] 2017 Dec; Vol. 55, pp. 113-127.

Abstract:

Background: despite the evidence that fatherhood has a long-term positive and protective effect on men’s health, there is also evidence that fatherhood in the perinatal period can be complex and demanding. Due to the potential increase in stressors in the perinatal period, there is reason to hypothesise that it is a time of increased stress for fathers. However, it is not clear how significant a problem stress is for fathers during this stage of life. This is in part, due to the fact that the available research has not been systematically reviewed.
Purpose: the purpose of this systematic review was to critically appraise the empirical evidence that examined stress in fathers in the perinatal period.
Design: systematic review.
Methods: a systematic review protocol was developed and registered with PROSPERO (Reference number: CRD42016035821). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology and Behavioural Sciences Collections were searched to identify studies that met the inclusion criteria. Studies that researched fathers in the perinatal period were included if stress was the principal focus of the research, if stress was in the title and/or aim of the study or if stress was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures.
Findings: eighteen studies met the inclusion criteria. The findings indicate that fathers experience stress in the perinatal period, particularly at the time of birth. Stress levels were found to increase from the antenatal period to the time of birth, with a decrease in stress levels from the time of birth to the later postnatal period. There are a number of factors that contribute to stress in fathers in the perinatal period and these included negative feelings about the pregnancy, role restrictions related to becoming a father, fear of childbirth and feelings of incompetence related to infant care. The review found that stress has a negative impact on fathers, with higher stress levels contributing to mental health issues such as anxiety, depression, psychological distress and fatigue.
Key Conclusion: during the perinatal period fathers experience stress and face unique stressors that can impact negatively on their health and social relationships.

https://www.ncbi.nlm.nih.gov/pubmed/28992554

Vicarious birth trauma and posttraumatic stress disorder: Preparing and protecting student midwives.

Power, AlisonMullan, Jenny

British Journal of Midwifery. Dec 2017, Vol. 25 Issue 12, p799-802. 4p.

Abstract:

Post-traumatic stress disorder was first recognised in war veterans who had experienced extreme violence during military combat; however, it is now understood to be caused by a wide range of traumatic experiences, including serious accidents, abuse, natural disasters or terrorist attacks–any event in which a person fears for their life. Traumatic childbirth is also a potential cause, not only for the mother, but also for those who may witness the birth, such as midwives, student midwives, obstetricians and birth partners. This condition is termed vicarious birth trauma. This article will examine the definition of both vicarious birth trauma and post-traumatic stress disorder, and consider the evidence in relation to how these conditions affect midwives and student midwives. It will offer suggestions for personal and organisational management and support strategies, based on research findings and expert advice.

https://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2017.25.12.799?af=R

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