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Barwijuk M, Pankiewicz K, Gałaś A, Nowakowski F, Gumuła P, Jakimiuk AJ, Issat T. The Impact of Platelet-Rich Plasma Application during Cesarean Section on Wound Healing and Postoperative Pain: A Single-Blind Placebo-Controlled Intervention Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:628. [PMID: 38674274 PMCID: PMC11052196 DOI: 10.3390/medicina60040628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section (CS) were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 in the placebo group. Every patient was asked to evaluate pain by using the Visual Analogue Scale (VAS) immediately after surgery, as well as 6 and 12 h after the surgery. The use of analgetics was also recorded. The postoperative scar was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: There was no case of wound dehiscence in either group. Significant differences between the groups in the scar quality assessment were detected in both patient and doctor POSAS results on days 8, 30 and 90 after surgery in the favor of the PRP group. There was no difference in the pain intensity assessment on the VAS recorded after surgery, but PRP patients required fewer paracetamol doses per day than the control group. Conclusions: PRP application during CS significantly improved wound healing in both short- and long-term assessment. Although it did not influence postoperative pain intensity, it may reduce the use of analgetics after surgery.
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Affiliation(s)
- Michał Barwijuk
- Department of Obstetrics, Women’s Diseases and Oncogynecology, National Institute of Medicine of the Ministry of Interior and Administration, Woloska 137, 02-507 Warsaw, Poland; (M.B.); (A.J.J.)
| | - Katarzyna Pankiewicz
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (P.G.); (T.I.)
| | - Aleksander Gałaś
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Jagiellonian University Medical College, 7 Kopernika St., 31034 Krakow, Poland;
| | - Filip Nowakowski
- Department of Obstetrics, Women’s Diseases and Oncogynecology, National Institute of Medicine of the Ministry of Interior and Administration, Woloska 137, 02-507 Warsaw, Poland; (M.B.); (A.J.J.)
| | - Patrycja Gumuła
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (P.G.); (T.I.)
| | - Artur J. Jakimiuk
- Department of Obstetrics, Women’s Diseases and Oncogynecology, National Institute of Medicine of the Ministry of Interior and Administration, Woloska 137, 02-507 Warsaw, Poland; (M.B.); (A.J.J.)
- Center for Reproductive Health, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland; (P.G.); (T.I.)
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Deniau B, Ricbourg A, Weiss E, Paugam-Burtz C, Bonnet MP, Goffinet F, Mignon A, Morel O, Le Guen M, Binczak M, Carbonnel M, Michelet D, Dahmani S, Pili-Floury S, Ducloy Bouthors AS, Mebazaa A, Gayat E. Association of severe postpartum hemorrhage and development of psychological disorders: Results from the prospective and multicentre HELP MOM study. Anaesth Crit Care Pain Med 2024; 43:101340. [PMID: 38128731 DOI: 10.1016/j.accpm.2023.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH. METHODS HELP-MOM study was a prospective, observational, national, and multicentre study including patients who experienced severe PPH requiring sulprostone. The primary endpoint was the occurrence of psychological disorders (anxiety and/or post-traumatic disorder and/or depression) following PPH, assessed at 1, 3, and 6 months after delivery using HADS, IES-R, and EPDS scales. RESULTS Between November 2014 and November 2016, 332 patients experienced a severe PPH and 236 (72%) answered self-questionnaires at 1, 3, and 6 months. A total of 161 (68%) patients declared a psychological disorder following severe PPH (146 (90.1%) were screened positive for anxiety, 96 (58.9%) were screened positive for post-traumatic stress disorder, and 94 (57.7%) were screened positive for post-partum depression). In multivariable analysis, the use of intra-uterine tamponnement balloon was associated with a lower risk to be screened positive for psychological disorder after severe PPH (OR = 0.33 [IC95% 0.15-0.69], p = 0.004, and after propensity score matching (OR=0.34 [IC95% 0.12-0.94], p = 0.04)). Low hemoglobin values during severe PPH management were associated with a higher risk of being screened positive for psychological disorders. Finally, we did not find differences in desire or pregnancy between patients without or with psychological disorders occurring in the year after severe PPH. DISCUSSION Severe PPH was associated with significant psychosocial morbidity including anxiety, post-traumatic disorder, and depression. This should engage a psychological follow-up. Large cohorts are urgently needed to confirm our results. REGISTRATION ClinicalTrials.gov under number NCT02118038.
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Affiliation(s)
- Benjamin Deniau
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Aude Ricbourg
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Emmanuel Weiss
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Catherine Paugam-Burtz
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Marie-Pierre Bonnet
- Université de Paris Cité, Paris, France; Département d'Anesthésie Réanimation, Hôpital Armand Trousseau, DMU DREAM, APHP, Paris, France
| | - François Goffinet
- Université de Paris Cité, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Alexandre Mignon
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Cochin-Port Royal, APHP, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Olivier Morel
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Nancy, Nancy France
| | - Morgan Le Guen
- Université de Versailles Saint-Quentin, France; Département d'Anesthésie, Hôpital Foch, Suresnes, France
| | - Marie Binczak
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Marie Carbonnel
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Daphné Michelet
- Département d'Anesthésie et Réanimation, CHU de Reims, France; Université de Reins Champagne Ardenne, Reims, France
| | - Souhayl Dahmani
- Université de Paris Cité, Paris, France; Service d'Anesthésie, Hôpital Robert Debré, APHP, Paris, France; Service d'Anesthésie et Réanimation, Hôpital Robert Ballanger, Aulnay-sous-Bois, France
| | | | | | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France.
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Sutton E, Detering K, East C, Whittaker A. Women's expectations about birth, requests for pain relief in labor and the subsequent development of birth dissonance and trauma. BMC Pregnancy Childbirth 2023; 23:777. [PMID: 37946106 PMCID: PMC10633977 DOI: 10.1186/s12884-023-06066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Birth is a significant event in women's lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. METHODS A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a 'natural birth' (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed - at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. RESULTS The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance - which we have termed 'birth dissonance' leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. CONCLUSIONS Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women's requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it.
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Affiliation(s)
- Elizabeth Sutton
- Monash Bioethics Centre - Monash University, Melbourne, Australia.
| | - Karen Detering
- Monash Bioethics Centre - Monash University, Melbourne, Australia
- Department of Health and Aged Care, Melbourne, Australia
| | - Christine East
- Nursing and Midwifery - La Trobe University, Melbourne, Australia
| | - Andrea Whittaker
- Sociology and Anthropology - Monash University, Melbourne, Australia
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Deforges C, Sandoz V, Noël Y, Avignon V, Desseauve D, Bourdin J, Vial Y, Ayers S, Holmes EA, Epiney M, Horsch A. Single-session visuospatial task procedure to prevent childbirth-related posttraumatic stress disorder: a multicentre double-blind randomised controlled trial. Mol Psychiatry 2023; 28:3842-3850. [PMID: 37759037 PMCID: PMC10730415 DOI: 10.1038/s41380-023-02275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Preventive evidence-based interventions for childbirth-related posttraumatic stress disorder (CB-PTSD) are lacking. Yet, 18.5% of women develop CB-PTSD symptoms following an unplanned caesarean section (UCS). This two-arm, multicentre, double-blind superiority trial tested the efficacy of an early single-session intervention including a visuospatial task on the prevention of maternal CB-PTSD symptoms. The intervention was delivered by trained maternity clinicians. Shortly after UCS, women were included if they gave birth to a live baby, provided consent, and perceived their childbirth as traumatic. Participants were randomly assigned to the intervention or attention-placebo group (allocation ratio 1:1). Assessments were done at birth, six weeks, and six months postpartum. Group differences in maternal CB-PTSD symptoms at six weeks (primary outcomes) and six months postpartum (secondary outcomes) were assessed with the self-report PTSD Checklist for DSM-5 (PCL-5) and by blinded research assessors with the Clinician-administered PTSD scale for DSM-5 (CAPS-5). Analysis was by intention-to-treat. The trial was prospectively registered (ClinicalTrials.gov, NCT03576586). Of the 2068 women assessed for eligibility, 166 were eligible and 146 were randomly assigned to the intervention (n = 74) or attention-placebo control group (n = 72). For the PCL-5, at six weeks, a marginally significant intervention effect was found on the total PCL-5 PTSD symptom count (β = -0.43, S.E. = 0.23, z = -1.88, p < 0.06), and on the intrusions (β = -0.73, S.E. = 0.38, z = -1.94, p < 0.0525) and arousal (β = -0.55, S.E. = 0.29, z = -1.92, p < 0.0552) clusters. At six months, a significant intervention effect on the total PCL-5 PTSD symptom count (β = -0.65, S.E. = 0.32, z = -2.04, p = 0.041, 95%CI[-1.27, -0.03]), on alterations in cognition and mood (β = -0.85, S.E. = 0.27, z = -3.15, p = 0.0016) and arousal (β = -0.56, S.E. = 0.26, z = -2.19, p < 0.0289, 95%CI[-1.07, -0.06]) clusters appeared. No group differences on the CAPS-5 emerged. Results provide evidence that this brief, single-session intervention carried out by trained clinicians can prevent the development of CB-PTSD symptoms up to six months postpartum.
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Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Vania Sandoz
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Yvonnick Noël
- Department of Psychology, Rennes 2 University, Rennes, France
| | - Valérie Avignon
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - David Desseauve
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Julie Bourdin
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Yvan Vial
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Manuella Epiney
- Department of Woman, Child and Teenager, Geneva University Hospitals, Geneva, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland.
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland.
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Vatanparast A, Kamrani A, Shakiba S, Amouchie R, Akbari E, Ayers S. The latent factor structure and assessment of childbirth-related PTSD: psychometric characteristics of the City Birth Trauma Scale-Persian version (City-BiTS-P). Front Psychiatry 2023; 14:1204392. [PMID: 37409157 PMCID: PMC10318432 DOI: 10.3389/fpsyt.2023.1204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Objective There is no validated Persian questionnaire to measure childbirth-related PTSD (CB-PTSD) symptoms. To cover this gap, the present study aimed to provide a Persian version of the City Birth Trauma Scale (CityBiTS-Pr) and to determine its psychometric properties. Method Since this is a cross-sectional study, sampling was done using a convenient sampling method. In total, 300 Persian-speaking women took part in this study and completed the City Birth Trauma Scale (CityBiTS-Pr), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Edinburgh Postnatal Depression Scale (EPDS), the Anxiety Subscale of the Depression, and the Anxiety and Stress Scale (DASS-21). In addition, sociodemographic information was completed. A confirmatory factor analysis of two- and four-factor models and a bi-factor model with a general factor and two specific factors were tested. Fit indices were calculated for all three models. Reliability, convergent, divergent, and discriminant validity also were examined. R v4.2.1 and SPSS v23 were used for data analysis. Results The four-factor model comprised intrusion, avoidance, negative cognitions and mood, and hyper-arousal showed a poor fit. The two-factor model composed of "birth-related symptoms" and "general symptoms" provided the best results based on all fit indices. The bi-factor result was relatively good, but the loadings indicated that the general symptoms factor is not well defined. Conclusion The Persian version of the City Birth Trauma Scale (CityBiTS-Pr) is a valid and reliable questionnaire for evaluating postpartum PTSD.
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Affiliation(s)
- Amin Vatanparast
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Kamrani
- Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shima Shakiba
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ramin Amouchie
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elnaz Akbari
- Paramedical Department, Islamic Azad University, Rasht Branch, Rasht, Iran
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, University of London, London, United Kingdom
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Hussein A, Torky H, Aly R, Abdel-Rasheed M, El-Baz A, Mahmoud H, Sileem S, Badawy M, Sayd Z, Dief O, Elsadek A, Marie H, Abo-Louz A. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial. J Perinat Med 2022; 50:1073-1077. [PMID: 35531757 DOI: 10.1515/jpm-2021-0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/11/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES In low-income settings, postoperative pain relief could be challenging as a high patient/nurse ratio limits pain assessment and adequate analgesics administration. The multi-center prospective double-blinded parallel randomized controlled trial was done to compare lidocaine, tramadol, and placebo (saline) intraoperative wound infiltration to relieve post-cesarean section wound pain during the first 24 h. METHODS Ninety-nine cases were equally randomized into three groups, each containing 33 pregnant women undergoing cesarean section under general anesthesia. During operation, the wound was infiltrated subcutaneously with 20 mL of 2% lidocaine solution in the first group, 2 mg/kg tramadol in the second group, and saline in the third group. The primary outcome was to assess the postoperative pain at 2, 4, 6, 12, and 24 h by the Yes-No-Don't Know (YNDK) Scale, while the secondary outcome was to assess the need for further postoperative analgesia. RESULTS Wound infiltration with lidocaine or tramadol was effective in pain relief, and both were superior to placebo. Wound infiltration with tramadol was superior to lidocaine in pain relief at 2 h and up to 24 h. CONCLUSIONS Wound infiltration with tramadol has a more prolonged pain relief effect than lidocaine in post-cesarean section pain relief in patients performing cesarean section under general anesthesia lasting up to 24 h, and both are superior to placebo in pain relief.
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Affiliation(s)
- Ahmed Hussein
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
| | - Haitham Torky
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
| | - Rania Aly
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Mazen Abdel-Rasheed
- Department of Reproductive Health Research, National Research Centre, Giza, Egypt
| | - Ashraf El-Baz
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Hossam Mahmoud
- Department of Obstetrics & Gynecology, Al-Galaa Teaching Hospital, Cairo, Egypt
| | - Sileem Sileem
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Mahmoud Badawy
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Zainab Sayd
- Department of Obstetrics & Gynecology, Al-Azhar University, Assiut, Egypt
| | - Osama Dief
- Department of Obstetrics & Gynecology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elsadek
- Department of Obstetrics & Gynecology, Al-Azhar University, Cairo, Egypt
| | - Heba Marie
- Department of Obstetrics & Gynecology, Cairo University, Cairo, Egypt
| | - Ashraf Abo-Louz
- Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt
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Nagle U, Naughton S, Ayers S, Cooley S, Duffy RM, Dikmen-Yildiz P. A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up. Midwifery 2022; 113:103419. [DOI: 10.1016/j.midw.2022.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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Roorda D, van der Steeg AFW, van Dijk M, Derikx JPM, Gorter RR, Rotteveel J, van Goudoever JB, van Heurn LWE, Oosterlaan J, Haverman L. Distress and post-traumatic stress in parents of patients with congenital gastrointestinal malformations: a cross-sectional cohort study. Orphanet J Rare Dis 2022; 17:353. [PMID: 36089585 PMCID: PMC9465926 DOI: 10.1186/s13023-022-02502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital gastrointestinal malformation (CGIM) require neonatal surgical treatment and may lead to disease-specific sequelae, which have a potential psychological impact on parents. The aim of this study is to assess distress and symptoms of post-traumatic stress disorder (PTSD) in parents of patients with CGIM. In this cross-sectional study, seventy-nine parents (47 mothers and 32 fathers) of 53 patients with CGIM completed the Distress Thermometer for Parents (DT-P) and the Self Rating Scale for Posttraumatic Stress Disorders (SRS-PTSD) as part of the multidisciplinary follow-up of their children (aged 5–35 months). Group differences were tested between parents and representative Dutch reference groups with regard to rates of (clinical) distress and PTSD, and severity of overall distress and PTSD, for mothers and fathers separately. Mixed model regression models were used to study factors associated with the risk of (clinical) distress, PTSD and with severity of symptoms of PTSD (intrusion, avoidance and hyperarousal).
Results
Prevalence of clinical distress was comparable to reference groups for mothers (46%) and fathers (34%). There was no difference in severity of overall distress between both mothers as well as fathers and reference groups. Prevalence of PTSD was significantly higher in mothers (23%) compared to the reference group (5.3%) (OR = 5.51, p < 0.001), not in fathers (6.3% vs 2.2.%). Symptoms of intrusion were commonly reported by all the parents (75%). Longer total length of child’s hospital stay was associated with more severe symptoms of intrusion, avoidance and hyperarousal. Child’s length of follow-up was negatively associated with severity of intrusion.
Conclusions
Having a child with CGIM has a huge impact on parents, demonstrated by a higher prevalence of PTSD in mothers, but not fathers, compared to parents in the general population. Monitoring of symptoms of PTSD of parents in follow-up is necessary.
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Ghanbari-Homaie S, Meedya S, Mohammad-Alizadeh-Charandabi S, Asghari Jafarabadi M, Mohammadi E, Mirghafourvand M. Correlations Between Primiparous Women’s Perceived Internal Control, External Control, Support and Their Birth Experience. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDPerceived control and support can contribute to a positive childbirth experience. However, most studies have not differentiated between perceived internal and external control.OBJECTIVEThe present study aimed to assess primiparous women’s perceived internal control, external control, and support, including family and professional support and their association with the childbirth experience.METHODSA cross-sectional study was carried out on 800 primiparous mothers recruited from health centers across Tabriz, Iran, through cluster sampling. The childbirth experience questionnaire (2.0) and the support and control in birth scale were used to measure women’s childbirth experience and their perceived internal and external control and support. Data were collected through an interview during early postpartum and analyzed by independent t-test, one-way ANOVA, Pearson correlation and general linear model.RESULTSThe results demonstrated a significant correlation between perceived internal control (r = 0.80, p < .001), external control (r = 0.79, p < .001) and professional support (r = 0.83, p < .001) with childbirth experience. By controlling confounders such as socio-demographic and reproductive variables, internal control [β (95% CI): 0.28 (0.25 to 0.31); p < .001], external control [0.10 (0.06 to 0.14); p < .001], professional support [0.27 (0.23 to 0.30); p < .001], were independent predictors of positive childbirth experience.CONCLUSIONThese findings point to the importance of perceived internal, external control and professional support and the relationship between healthcare providers, especially midwives, with the women in improving childbirth experience. It is suggested that healthcare providers give support to women and utilize methods that enhance women’s control during labor and childbirth.
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10
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Childbirth-Related Psychological Trauma. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:17-27. [PMID: 35451296 DOI: 10.2478/prilozi-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Traumatic childbirth is an international public health problem because it is supposed that currently up to 45% of new mothers have reported such an experience. International rates of PTSD due to birth trauma range between 1.5 and 9 percent of all births. Birth trauma is defined as an event occurring during the labour and delivery process that involves actual or threatened serious injury or death of the mother or her infant. A traumatic event or situation creates psychological trauma when it overwhelms the individual's ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The aim of this article is to present a review of published data for childbirth trauma over various periods of time, as well as in different regions of the world. Studies were identified through a comprehensive search of PubMed, PsycInfo, ProQuest and PILOTS (Published International Literature of Traumatic Stress) over the last 20 years. More than 8000 articles were found. In this article we present and discuss some important findings.
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Ben-Hassine S, Chabbert M, Rozenberg P, Wendland J. Prevalence, Evolution, and Predictive Factors of Symptoms of Postpartum Posttraumatic Stress Disorder in a French-Speaking Cohort. J Midwifery Womens Health 2022; 67:496-503. [PMID: 35246922 DOI: 10.1111/jmwh.13350] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Identifying factors that are predictive for postpartum posttraumatic stress disorder (PTSD) is important to inform clinical and research practice. Yet prospective longitudinal studies investigating symptoms of postpartum PTSD and their prevalence, evolution, comorbidities, and predictors remain limited. The aim of this study was to estimate the prevalence of women's symptoms of PTSD at different times in the postpartum period and to identify comorbidities and predictive factors in a French-speaking sample. METHODS A total of 168 women participated in this longitudinal study, which included 3 assessment points: immediate postpartum, 2 months postpartum, and 6 months postpartum. Participants filled out questionnaires regarding sociodemographic characteristics, pregnancy, and birth outcomes; subjective perceptions of birth; and symptoms of depression, anxiety, and PTSD. RESULTS Among the participants, 11.7% reported having symptoms of PTSD 2 months after birth and 10.5% reported having symptoms 6 months after birth. Regarding comorbidities and associated factors, depressive symptoms, poor marital adjustment, and impaired maternal-infant bonding were significantly and positively correlated with symptoms of PTSD. Peritraumatic distress, negative perceived childbirth experience, and complications and perceived difficulties during birth were predictive factors for postpartum PTSD. DISCUSSION More than 1 in 10 women experienced symptoms of postpartum PTSD. Health care professionals need to be aware of symptoms of postpartum PTSD, predictive factors, and comorbidities to be able to better identify women presenting those symptoms and refer them for appropriate psychological support.
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Affiliation(s)
- Sarra Ben-Hassine
- Laboratory of Psychopathology and Health Processes, University of Paris, Paris, France
| | - Margaux Chabbert
- Laboratory of Psychopathology and Health Processes, University of Paris, Paris, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center, Poissy, France
| | - Jaqueline Wendland
- Laboratory of Psychopathology and Health Processes, University of Paris, Paris, France
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12
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Bodin E, Peretti V, Rouillay J, Tran PL, Boukerrou M. [Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:240-260. [PMID: 35017128 DOI: 10.1016/j.gofs.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP. METHOD A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island. RESULTS Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP. CONCLUSION Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.
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Affiliation(s)
- E Bodin
- Service de PMA, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
| | - V Peretti
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - J Rouillay
- UMPP Ouest, EPSMR Saint-Paul, 11, rue de l'Hôpital, 97460 Saint-Paul, Réunion.
| | - P L Tran
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
| | - M Boukerrou
- Service de gynécologie obstétrique, CHU Sud Réunion, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion.
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Kahalon R, Yanushevsky Cnaani G, Preis H, Benyamini Y. The complex effects of maternal expectations on postpartum depressive symptoms: when does a protective factor become a risk factor? J Psychosom Obstet Gynaecol 2022; 43:74-82. [PMID: 32701018 DOI: 10.1080/0167482x.2020.1795826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The present study assessed the effects of several prenatal maternal expectations on postpartum depression (PPD), while considering two relevant factors - incongruence between planned and actual birth and the rigidity of the birth plan - that can affect whether maternal expectations act as protective factors or risk factors for PPD. METHODS Primiparous women (N = 527) were recruited to a longitudinal study about women's birth choices and experiences. At time 1, during pregnancy, women completed a questionnaire assessing prenatal depression, preferred birth plan, birth plan flexibility-rigidity and maternal expectations (i.e. Natural-Fulfillment, Infant-Reflects-Mothering, Sacrifice). At time 2, two-months post-partum, they reported their actual birth mode and answered a questionnaire assessing their PPD symptoms. RESULTS Natural-fulfillment maternal expectations were negatively related to PPD symptoms. Yet, the interaction of high natural-fulfillment expectations with an unfulfilled birth plan and the rigidity of the birth plan, served as a risk factor for PPD symptomatology. CONCLUSIONS Understanding the conditions under which specific prenatal maternal expectations serve as a risk factor for PPD, can help healthcare providers identify women who are at high risk for developing PPD symptoms and plan preemptive interventions.
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Affiliation(s)
- Rotem Kahalon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Heidi Preis
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,Department of Psychology, Stoney Brook University, Stoney Brook, NY, USA
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Kahalon R, Preis H, Benyamini Y. Mother-infant contact after birth can reduce postpartum post-traumatic stress symptoms through a reduction in birth-related fear and guilt. J Psychosom Res 2022; 154:110716. [PMID: 35063800 DOI: 10.1016/j.jpsychores.2022.110716] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, we proposed and examined a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births. METHOD In this longitudinal study, pregnant women (N = 1833) were recruited at community and hospital medical centres in the center of Israel and through internet forums. At Time 1, during pregnancy, they rated their prenatal depressive symptoms which served as an indicator for prenatal vulnerabilities. At Time 2, two-months postpartum (N = 1371, 75% of the sample), they reported their mode of birth, whether they had skin-to-skin contact with their newborn after birth, their emotions during birth, and rated their current PTSS-FC. A moderated mediation analysis was used to examine the proposed model. RESULTS Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. CONCLUSIONS Our results recognize the specific emotions that contribute to the development of PTSS-FC following operative births and show how skin-to-skin contact can possibly reduce them. As such they emphasize the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative (World Health Organization & UNICEF, 2009).
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Affiliation(s)
- Rotem Kahalon
- Bob Shapell School of Social Work Tel Aviv University, Israel; Department of Psychology, Simon Fraser University, Canada.
| | - Heidi Preis
- Bob Shapell School of Social Work Tel Aviv University, Israel; Department of Psychology, Stony Brook University, USA.
| | - Yael Benyamini
- Bob Shapell School of Social Work Tel Aviv University, Israel.
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Yalniz Dilcen H, Akin B, Türkmen H. The relationship of prenatal attachment level to traumatic childbirth perception and posttraumatic stress in pregnancy. Perspect Psychiatr Care 2022; 58:221-228. [PMID: 34047376 DOI: 10.1111/ppc.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between the extent of prenatal attachment and traumatic childbirth perception (TCP) and posttraumatic stress. METHODS A total of 308 pregnant women admitted to the Obstetrics and Gynecology Department during a period of 6 months were applied a Personal Information Form, the Prenatal Attachment Inventory, the Traumatic Childbirth Perception Scale, and the Posttraumatic Diagnostic Scale, Self-Report version. RESULTS There was a negative correlation between TCP and posttraumatic stress disorder (PTSD). Traumatic stress decreased with increasing prenatal attachment. CONCLUSION Consequently, a negative correlation was found between prenatal attachment and PTSD.
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Affiliation(s)
- Hacer Yalniz Dilcen
- Department of Midwifery, School of Health, Bartın University, Bartın, Turkey
| | - Bihter Akin
- Department of Midwifery, School of Health, Selçuk University, Konya, Turkey
| | - Hülya Türkmen
- Department of Midwifery, School of Health, Balıkesir University, Balikesir, Turkey
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Diamond RM, Colaianni A. The impact of perinatal healthcare changes on birth trauma during COVID-19. Women Birth 2021; 35:503-510. [PMID: 34924337 PMCID: PMC8678623 DOI: 10.1016/j.wombi.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022]
Abstract
Background Since the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. Aim Research has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. Methods 269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. Findings 5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. Conclusion The present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.
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Affiliation(s)
- Rachel M Diamond
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA.
| | - Allison Colaianni
- Couple and Family Therapy Department, Adler University, Chicago, IL, USA
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Chakroun M, Aribi L, Ellouz S, Aloulou J. [A longitudinal study about post-traumatic stress disorder after delivery in Tunisian primiparous]. Encephale 2021; 48:638-646. [PMID: 34801230 DOI: 10.1016/j.encep.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aims of this study were to estimate the incidence of the post-partum post-traumatic stress disorder (PP-PTSD) in primiparous women, and to determine the profile of women at risk of developing this disorder. METHODS We conducted a descriptive, prospective and longitudinal study carried out at the maternity department of the Hedi Chaker Hospital, Sfax-Tunisia over a period of 15 months. At the first stage of the study, the Saint-Antoine pain questionnaire, the peri-traumatic dissociative experiences questionnaire and the peri-traumatic distress inventory were used respectively to assess the pain of delivery, the peri-traumatic dissociation and distress. At the second stage of the study, the questionnaires, perinatal post-traumatic stress disorder (PPQ), hospital anxiety and depression scale and the Edinburgh postnatal depression scale were used respectively for the PP-PTSD screening and the assessment of the post-partum anxious and depressive symptomatology. RESULTS The study population consisted of 183 parturients at the first stage of the study and 150 parturients at the second stage of the study. The incidence of the PP-PTSD was 9.3 %. In the multivariate study, some factors studied were significantly associated with the development of PTSD-PP, including a history of therapeutic termination of pregnancy, a history of miscarriage, exposure to a stressful event during pregnancy, prenatal hospitalization of the mother, instrumental delivery, pain intensity especially in the affective component, peri-traumatic dissociation and avoidance of sexual intercourse for fear of a new pregnancy. However the skin to skin contact with the new-born immediately after delivery was a significant protective factor. CONCLUSION The psychological consequences associated with the first birth, particularly the PP-PTSD, are common. The Identification of women at risk and a systematic screening of postpartum post-traumatic stress symptoms are desirable.
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Affiliation(s)
- M Chakroun
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie; Faculté de médecine de Tunis, 1007 Tunis, Tunisie.
| | - L Aribi
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
| | - S Ellouz
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
| | - J Aloulou
- Service de psychiatrie B CHU Hèdi Chaker, 3000 Sfax, Tunisie
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Cankaya S, Erkal Aksoy Y, Dereli Yılmaz S. Midwives' experiences of witnessing traumatic hospital birth events: A qualitative study. J Eval Clin Pract 2021; 27:847-857. [PMID: 33006235 DOI: 10.1111/jep.13487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate in detail the traumatic birth experiences of midwives in the delivery rooms, and their attitudes, reactions, and coping strategies. METHODS The design of the study is descriptive and the purposive sampling method was used. This approach is ideal for a preliminary exploration of the nature of a phenomenon. Between October 2018 and January 2019, semi-structured interviews were conducted with a purposeful sample of midwives. The research was carried out with the participation of 29 midwives, who work in labour and birth room. They were asked to describe a particular stressful situation they had experienced during the birth process, their emotions about the event, and their coping strategies and support systems. All interviews were digitally recorded, stored in a database, and transferred to MAX Qualitative Data Analysis 18.1.0 for analysis. FINDINGS As a result of the content analysis, three main themes emerged: psychological impact, defensive practice, and expectations in terms of support from the hospital. It was revealed that, after the traumatic birth, midwives experienced highly emotional exhaustion in the form of sadness, flashbacks, guilt, fear, and empathy, and they performed an increasingly defensive practice. During the interviews, we observed that 19 midwives needed psychological support. Besides, midwives explicitly stated that they were not prepared enough for traumatic events and that most traumatic births were simply ignored in their workplace. Eventually, it was determined that midwives received support mostly from their colleagues in case of a traumatic birth. CONCLUSION(S) Midwives need to feel valued and be supported by their institutions in coping with emotional stress. Therefore, performing clinical inspections by experienced or specialist midwives may serve as a supporting framework for reducing defensive interventions.
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Affiliation(s)
- Seyhan Cankaya
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
| | - Yasemin Erkal Aksoy
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
| | - Sema Dereli Yılmaz
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
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Ma S, Zhang Y, Li Q. Magnesium sulfate reduces postoperative pain in women with cesarean section: A meta-analysis of randomized controlled trials. Pain Pract 2021; 22:8-18. [PMID: 33896098 DOI: 10.1111/papr.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The use of magnesium sulfate (MgSO4 ) as an adjunct in different anesthetic regimens for cesarean section (CS) delivery often reports conflicting results. This study aimed to review the effectiveness of MgSO4 on improving postoperative analgesia after CS systematically. METHODS PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to February 2020. RESULTS A total of 880 women were included (440 in each group). MgSO4 had a statistically significant effect compared to the control group on the highest VAS (weighted mean difference [WMD] = -0.74, 95% confidence interval [CI] = -1.03 to -0.46, p < 0.001, I2 = 91.7%, pheterogeneity < 0.001) and the last VAS (WMD = -0.47, 95% CI = -0.71 to -0.23, p < 0.001, I2 = 95.0%, pheterogeneity < 0.001). MgSO4 prolonged the time to the first use of analgesia compared to the control group (standardized mean difference [SMD] = -3.03 min, 95% CI = -4.32 to -1.74, p < 0.001, I2 = 96.3%, pheterogeneity < 0.001). MgSO4 decreased the consumption of analgesia compared to the control group (SMD = -3.20 mg of IV morphine equivalent, 95% CI: -5.45 to -0.95, p = 0.005, I2 = 97.6%, pheterogeneity < 0.001). DISCUSSION MgSO4 decreases the highest VAS in women who underwent general anesthesia, spinal anesthesia, or epidural for CS (all p < 0.05). Additional MgSO4 significantly reduces postoperative pain in women undergoing CS.
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Affiliation(s)
- Siguang Ma
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Yanju Zhang
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
| | - Qian Li
- Anesthesia Department, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, China.,Tianjin Key Laboratory of Human Development and Reproductive Expansion, Tianjin, China
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Dahan O. The riddle of the extreme ends of the birth experience: Birthing consciousness and its fragility. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bayrı Bingöl F, Bal MD, Dişsiz M, Sormageç MT, Yildiz PD. Validity and reliability of the Turkish version of the City Birth Trauma Scale (CityBiTS). J OBSTET GYNAECOL 2020; 41:1023-1031. [PMID: 33263267 DOI: 10.1080/01443615.2020.1821354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The City Birth Trauma Scale (CityBiTS) was developed to be consistent with the current Diagnostic and Statistical Manual of Mental Disorders-DSM-5. It has been used as a complementary instrument that measures the psychological trauma related to childbirth. The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. This research is a methodological study. This study was conducted with 315 women who had 6-month-old infants from August to October 2018. The CityBiTS is a 29-item instrument that was developed according to DSM-5 criteria to assess childbirth-related Post-Traumatic Stress Disorder. Test-retest measurements were performed at two-week intervals to evaluate the invariance of the scale over time. Cronbach's alpha coefficient of reliability was used to analyse internal consistency of scale. Cronbach's alpha coefficients were .76 for re-experiencing symptoms, .57 for avoidance symptoms, .77 for negative cognitions and mood, .83 for hyperarousal and .82 for dissociative symptoms. In conclusion, The Turkish version of the CityBiTS, as an instrument developed to be consistent with DSM-5 criteria in assessing childbirth-related trauma symptoms, is a valid and reliable tool.Impact statementWhat is already known on this subject? One of the possible barriers for this is the lack of validated questionnaires that measure the postpartum PTSD.What do the results of this study add? The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD.What are the implications of these findings for clinical practice and/or further research? The City Birth Trauma Scale provides with a measure of birth-related PTSD foruse in research and clinical practice.
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Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Meltem Demirgöz Bal
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Melike Dişsiz
- Hamidiye Faculty of Nursing, University of Health Science, Uskudar, Istanbul, Turkey
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Suetsugu Y, Haruna M, Kamibeppu K. A longitudinal study of bonding failure related to aspects of posttraumatic stress symptoms after childbirth among Japanese mothers. BMC Pregnancy Childbirth 2020; 20:434. [PMID: 32727570 PMCID: PMC7389449 DOI: 10.1186/s12884-020-03099-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background Posttraumatic stress symptoms (PTSS) after childbirth may affect mother-infant bonding. This study examined the relationship between aspects of PTSS after childbirth and bonding failure for mothers at 1 month and 4 months after delivery. Methods This longitudinal study surveyed 130 mothers at 1 month (T1) and 4 months (T2) after delivery. We performed multiple regression analysis with the Postpartum Bonding Questionnaire (PBQ) as the dependent variable and the Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), Relationship Questionnaire (RQ), Family Adaptation, Partnership, Growth, Affection, and Resolve score (F.APGAR), and demographic data as independent variables. Results The rate of mothers with an IES-R score of ≥ 25 was 6.2% at T1 and 3.8% at T2. The IES-R and the EPDS were relevant factors for the PBQ at T1. The IES-R was not a relevant factor, but the EPDS was a relevant factor for the PBQ at T2. The IES-R at T1 was not a predictor for the PBQ at T2. The PBQ at T1 was the largest predictor for the PBQ at T2, when compared with the EPDS, F.APGAR, and dismissive attachment pattern (RQ) at T1. Conclusions PTSS after childbirth had a strong influence on bonding failure at T1. However, the important factor affecting bonding failure was not PTSS after childbirth, but depression at T2. If PTSS after childbirth are accompanied by depression at T2, bonding failure may be affected. Bonding failure affected by PTSS after childbirth at T1 could affect bonding failure at T2. Health professionals should assess the degree of PTSS after childbirth and start to care for mothers at T1.
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Affiliation(s)
- Yoshiko Suetsugu
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan.
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Kountanis JA, Muzik M, Chang T, Langen E, Cassidy R, Mashour GA, Bauer ME. Relationship between postpartum mood disorder and birth experience: a prospective observational study. Int J Obstet Anesth 2020; 44:90-99. [PMID: 32861082 DOI: 10.1016/j.ijoa.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. METHODS In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum. RESULTS We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02). CONCLUSION Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.
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Affiliation(s)
- J A Kountanis
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA.
| | - M Muzik
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Psychiatry, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; U-M for Healthcare Policy and Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, MI, USA
| | - T Chang
- Department of Family Medicine, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; U-M for Healthcare Policy and Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, MI, USA
| | - E Langen
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - R Cassidy
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - G A Mashour
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
| | - M E Bauer
- Department of Anesthesiology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA; Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E Medical Center Dr, MI, USA
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Townsend ML, Brassel AK, aafi M, Grenyer BFS. Childbirth satisfaction and perceptions of control: postnatal psychological implications. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.4.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BackgroundSatisfaction with childbirth is associated with a number of factors prior to and during birth, including perceived control during labour, and has implications for postnatal psychological health.MethodsA total of 38 pregnant women recruited prior to 20-weeks gestation completed questionnaires regarding perceptions of control during, and satisfaction with, childbirth, mental health and maternal attachment at two-months postpartum. Birth details and breastfeeding difficulties were obtained from hospital records.ResultsSatisfaction with childbirth was associated with perceived control and a physiological birth, and perceived control was associated with a physiological birth and midwife-led continuity of care. At two-months postpartum, satisfaction with childbirth was associated with fewer depressive symptoms, while perceived control was associated with fewer anxiety symptoms.DiscussionIt is important for healthcare providers to implement practices that support birthing satisfaction, such as provision of midwife-led continuity of care. Healthcare provision should also provide psychological support to mothers whose birthing experience was unsatisfactory and tailor additional support during early breastfeeding for these women.
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Affiliation(s)
- Michelle L Townsend
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
| | - Alexandra K Brassel
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
| | - Mercy aafi
- School of nursing, University of Wollongong
| | - Brin FS Grenyer
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
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Alipanahpour S, Zarshenas M, Ghodrati F, Akbarzadeh M. The Severity of Post-abortion Stress in Spontaneous, Induced and Forensic Medical Center Permitted Abortion in Shiraz, Iran, in 2018. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 25:84-90. [PMID: 31956603 PMCID: PMC6952917 DOI: 10.4103/ijnmr.ijnmr_36_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
Background: Abortion and loss of pregnancy in the first trimester may affect maternal mortality and morbidity. This study aimed to determine the severity of post-abortion stress in spontaneous abortion, induced abortion, and Forensic Medical Center (FMC) referral abortions immediately after abortion and after 1 month of follow-up in Shiraz, Iran, in 2018. Materials and Methods: This cross-sectional study was conducted on 104 mothers selected through convenience sampling method in 2018. The data collection tools included a demographic characteristics questionnaire and the Mississippi Post-Traumatic Stress Disorder (M-PTSD) Scale that were filled out by mothers immediately and 1 month after the abortion. Data were analyzed using one-way ANOVA and post-hoc LSD test in SPSS software. Moreover, p < 0.05 was considered as statistically significant. Results: The mean (SD) of post-traumatic stress scores was 83.87 (18.35) and 77.40 (9.88) in spontaneous abortion, 82.28 (13.27) and 75.71 (14.73) in FMC permitted abortions, and 86.66 (10.10) and 74.98 (12.99) in induced abortions immediately and 1 month after abortion, respectively. Stress was reduced in the three groups of mothers, after one month of severe value. The score for frequency of stress was 3.10% in FMC-permitted abortions and 5.10% in induced abortions; moreover, no stress was observed in the spontaneous abortion cases. Conclusions: Stress was gradually reduced over time. The level of PTSD was lower after 1 month in women who had experienced spontaneous abortion. Given that 1 month after abortion, women are still often moderately stressed, follow-up care, and appropriate counseling for these women are necessary.
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Affiliation(s)
- Sedighe Alipanahpour
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Zarshenas
- Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Ghodrati
- Department of Theology, Faculty of Humanities Science College, Yasouj University, Yasouj, Iran
| | - Marzieh Akbarzadeh
- Department of Midwifery, Maternal -Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, Semakula D, Olufolabi AJ. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res 2019; 19:68. [PMID: 30683083 PMCID: PMC6347795 DOI: 10.1186/s12913-019-3911-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. Methods We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered. Results Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control. Conclusion Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.
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Affiliation(s)
- Andrew Kintu
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda.
| | - Sadiq Abdulla
- Department of Anesthesia, University of British Columbia and BC Women's Hospital, Vancouver, Canada
| | - Aggrey Lubikire
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Mary T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Elizabeth Igaga
- Department of Anesthesia, Makerere University College of Health Sciences, Mulago, Uganda
| | - Fred Bulamba
- Department of Anesthesia, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Daniel Semakula
- Innovations and Knowledge Translation Office, Makerere University College of Health Sciences, Mulago, Uganda
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Anderson CA. Adolescent Substance Use and Effects on the Birth Experience. Issues Ment Health Nurs 2018; 39:988-997. [PMID: 30111219 DOI: 10.1080/01612840.2018.1479904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Depression, violence, and infant complications are recognized risk factors for negative birth experiences. Substance use, which often co-occurs with these risk factors, is unexplored for its role upon the birth experience. The frequency of these risk factors among childbearing adolescents suggests a need for research in this area. This study revealed direct and indirect effects by all risk factors on the adolescent's birth experience. Implications for nursing practice suggest collaboration between maternal child health and mental health nurses in prenatal, hospital, and follow-up healthcare settings to provide essential assessment of risk factors and resources and referrals across the perinatal period.
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Affiliation(s)
- Cheryl Ann Anderson
- a College of Nursing and Health Innovation , University of Texas at Arlington , Arlington , Texas , USA
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Crawley R, Wilkie S, Gamble J, Creedy DK, Fenwick J, Cockburn N, Ayers S. Characteristics of memories for traumatic and nontraumatic birth. APPLIED COGNITIVE PSYCHOLOGY 2018. [DOI: 10.1002/acp.3438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jenny Gamble
- Menzies Health Institute Queensland; Griffith University; Meadowbrook Queensland Australia
| | - Debra K. Creedy
- Menzies Health Institute Queensland; Griffith University; Meadowbrook Queensland Australia
| | - Jenny Fenwick
- Menzies Health Institute Queensland; Griffith University; Meadowbrook Queensland Australia
| | - Nicola Cockburn
- School of Psychology; University of Sunderland; Sunderland UK
| | - Susan Ayers
- Centre for Maternal and Child Health; City University London; London UK
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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.
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Affiliation(s)
- Cheryl Ann Anderson
- a College of Nursing and Health Innovation , University of Texas at Arlington , Arlington , Texas , USA
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30
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Murphy H, Strong J. Just another ordinary bad birth? A narrative analysis of first time mothers' traumatic birth experiences. Health Care Women Int 2018; 39:619-643. [PMID: 29474791 DOI: 10.1080/07399332.2018.1442838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Helen Murphy
- a School of Psychology, University of East London , London , England
| | - Joanna Strong
- a School of Psychology, University of East London , London , England
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31
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Affiliation(s)
- Barbara Jackson
- School of Nursing, Bellarmine University, Louisville, KY, USA
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32
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Hogan S, Sheffield D, Woodward A. The value of art therapy in antenatal and postnatal care: A brief literature review with recommendations for future research. INTERNATIONAL JOURNAL OF ART THERAPY 2017. [DOI: 10.1080/17454832.2017.1299774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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King L, McKenzie-McHarg K, Horsch A. Testing a cognitive model to predict posttraumatic stress disorder following childbirth. BMC Pregnancy Childbirth 2017; 17:32. [PMID: 28088194 PMCID: PMC5237569 DOI: 10.1186/s12884-016-1194-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/10/2016] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Lydia King
- The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | | | - Antje Horsch
- Department of Maternal and Child Health, University Hospital Lausanne, Avenue Pierre-Decker 2, CH-1011, Lausanne, Switzerland.
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Posttraumatic Stress Disorder after Vaginal Delivery at Primiparous Women. Sci Rep 2016; 6:27554. [PMID: 27271544 PMCID: PMC4897652 DOI: 10.1038/srep27554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/18/2016] [Indexed: 11/08/2022] Open
Abstract
Although severe gynaecological pathology during delivery and negative outcome have been shown to be related with posttraumatic stress disorder (PTSD) little is known about traumatic experiences following regular delivery, at the expected time and with a healthy child. The objective of our study was to determine the prevalence of PTSD during postpartum period after vaginal delivery and its risk factors. The sample included 126 primiparous women. Monthly, for the next three months, the women were assessed for PTSD using the gold standard interview for PTSD, Clinician-Administered PTSD Scale (CAPS). Risk factors were assessed including sociodemographic variables, personal medical history and clinical variables. After the first month, 2.4% women had acute full PTSD and another 9.5% had clinically significant level of PTSD symptoms. Following the second and the third month, partial PTSD was found in 5.9% and 1.3% of the women, respectively, and none of participants had full PTSD. Obstetrical interventions were the only significant risk factor for the development of PTSD. Symptoms of postpartum PTSD are not rare after a traumatic delivery, and associated with specific obstetrical risk factors. Awareness of these risk factors may stimulate interventions to prevent this important and neglected postpartum disorder.
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Shlomi Polachek I, Dulitzky M, Margolis-Dorfman L, Simchen MJ. A simple model for prediction postpartum PTSD in high-risk pregnancies. Arch Womens Ment Health 2016; 19:483-90. [PMID: 26399873 DOI: 10.1007/s00737-015-0582-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.
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Affiliation(s)
- Inbal Shlomi Polachek
- Beer Yaakov Mental Health Center, Beer Yaakov, Israel. .,Reproductive Life Stages Program, Women's Mental Health Program, Women's College Hospital, Toronto, Canada.
| | | | | | - Michal J Simchen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Williams C, Patricia Taylor E, Schwannauer M. A WEB-BASED SURVEY OF MOTHER-INFANT BOND, ATTACHMENT EXPERIENCES, AND METACOGNITION IN POSTTRAUMATIC STRESS FOLLOWING CHILDBIRTH. Infant Ment Health J 2016; 37:259-73. [PMID: 27090507 DOI: 10.1002/imhj.21564] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Postnatal depression is linked to adverse outcomes for parent and child, with metacognition and parenting experiences key variables in the development and maintenance of depression. The attachment between mother and infant is especially vulnerable to the effects of untreated postnatal depression. Despite high levels of reported postnatal stress symptoms, less attention has been given the relationship between attachment, metacognition, and postnatal traumatic symptoms in the context of birth trauma. This study tested several hypotheses regarding the relationships between recalled parenting experiences, metacognition, postnatal symptoms of posttraumatic stress disorder and depression and perceptions of the mother-infant bond, confirming and extending upon metacognitive and mentalization theories. METHOD A Web-based, cross-sectional, self-report questionnaire design was employed in an analog sample of new mothers. Participants were 502 women recruited via open-access Web sites associated with birth organizations. Structural equation modeling was employed for the principal analysis. RESULTS Metacognition fully mediated the relationship between recalled parenting experiences and postnatal psychological outcomes. Posttraumatic stress was indirectly associated with maternal perceptions of the bond, with this relationship mediated by depression. CONCLUSION Metacognition may have a key role in postnatal psychological distress. Where postnatal depression or traumatic birth experiences are identified, screening for posttraumatic stress is strongly indicated.
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Affiliation(s)
- Charlotte Williams
- Child & Adolescent Mental Health Services, NHS Lanarkshire, United Kingdom
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Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med 2016; 46:1121-1134. [PMID: 26878223 DOI: 10.1017/s0033291715002706] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.
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Affiliation(s)
- S Ayers
- Centre for Maternal and Child Health Research,City University London,London,UK
| | - R Bond
- School of Psychology, University of Sussex,Brighton,UK
| | - S Bertullies
- Centre for Maternal and Child Health Research,City University London,London,UK
| | - K Wijma
- Unit of Medical Psychology,Department of Clinical and Experimental Medicine,Faculty of Medicine and Health Sciences,Linköping University,Linköping,Sweden
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Factors Associated with Post-Traumatic Symptoms in Mothers of Preterm Infants. Arch Psychiatr Nurs 2016; 30:96-101. [PMID: 26804509 DOI: 10.1016/j.apnu.2015.08.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Symptoms of post-traumatic distress in mothers of preterm infants have been a subject of mental health research. The aim of this study was to assess the prevalence of and risk factors associated with such symptoms in mothers of preterm infants in Taiwan. METHODS This was a cross-sectional study performed between January 1, 2010 and June 30, 2011. One hundred and two mothers of preterm infants born at less than 37 weeks gestation and with a subsequent neonatal intensive care unit (NICU) stay between 2005 and 2009 were recruited. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression Scale (CES-D) and the neuroticism subscale of the Maudsley Personality Inventory (MPI). The preterm infants' data were taken from medical records. RESULTS The prevalence of symptoms of distress was 25.5% (26/102) in the participants. These symptoms were associated with previous miscarriages, preterm premature rupture of membranes, neurotic personality and depression. CONCLUSIONS The experience of preterm birth and NICU hospitalization can be traumatic to mothers. Early support for mothers during the preterm infants' NICU stay and transition to home care are recommended.
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Spyridou A, Schauer M, Ruf-Leuschner M. Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview. BMC Pregnancy Childbirth 2016; 16:13. [PMID: 26801404 PMCID: PMC4722714 DOI: 10.1186/s12884-016-0799-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/06/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother's health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences. METHODS The study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy. RESULTS We found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk. CONCLUSIONS The relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.
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Affiliation(s)
- Andria Spyridou
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Maggie Schauer
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Martina Ruf-Leuschner
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
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Psychiatric outcomes after childbirth: can posttraumatic growth protect me from disordered eating symptoms? Arch Gynecol Obstet 2015; 293:1271-8. [PMID: 26650423 DOI: 10.1007/s00404-015-3969-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE While many studies on mood disorder and posttraumatic stress disorder (PTSD) following childbirth have been conducted, little is known regarding posttraumatic growth (PTG) and disordered eating in the postpartum period. This study aims to (a) identify the typology of women following childbirth based on anxiety, depressive, PTSD symptoms and level of PTG and (b) evaluate whether these profiles differ on disordered eating symptoms. METHODS Up to 2 years after childbirth, 306 French-speaking mothers [mean age (SD) = 29.4 (4.6) years] completed questionnaires assessing PTSD, depressive, anxiety and disordered-eating symptoms and level of posttraumatic growth. RESULTS Four profiles were highlighted: a first one labeled growing cluster (22.2 % of the sample, n = 68), a second one labeled low level of symptoms cluster (37.6 % of the sample, n = 115), a third one labeled vulnerable cluster (21.6 % of the sample, n = 66) and a last one labeled anxious-depressed-traumatized cluster (18.6 % of the sample, n = 57). Our findings also highlight an impact of these profiles on disordered eating symptoms, suggesting that disordered eating in postpartum would not be the result of pregnancy. CONCLUSION Consistent with our expectation, our findings suggest a potential protective role of posttraumatic growth on the development of disordered eating symptoms. Further researches focusing on traumatic experience, disordered eating and posttraumatic growth in postpartum are warranted.
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Turkstra E, Creedy DK, Fenwick J, Buist A, Scuffham PA, Gamble J. Health services utilization of women following a traumatic birth. Arch Womens Ment Health 2015; 18:829-32. [PMID: 25577338 DOI: 10.1007/s00737-014-0495-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.
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Affiliation(s)
- E Turkstra
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - D K Creedy
- Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Fenwick
- Griffith Health Institute, Griffith University and Gold Coast Hospital, Queensland, Australia.
| | - A Buist
- University of Melbourne, Melbourne, Australia.
| | - P A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Gamble
- Griffith Health Institute, Griffith University, Queensland, Australia.
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Haagen JFG, Moerbeek M, Olde E, van der Hart O, Kleber RJ. PTSD after childbirth: A predictive ethological model for symptom development. J Affect Disord 2015; 185:135-43. [PMID: 26172985 DOI: 10.1016/j.jad.2015.06.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childbirth can be a traumatic experience occasionally leading to posttraumatic stress disorder (PTSD). This study aimed to assess childbirth-related PTSD risk-factors using an etiological model inspired by the transactional model of stress and coping. METHODS 348 out of 505 (70%) Dutch women completed questionnaires during pregnancy, one week postpartum, and three months postpartum. A further 284 (56%) also completed questionnaires ten months postpartum. The model was tested using path analysis. RESULTS Antenatal depressive symptoms (β=.15, p<.05), state anxiety (β=.17, p<.01), and perinatal psychoform (β=.17, p<.01) and somatoform (β=.17, p<.01) dissociation were identified as PTSD symptom risk factors three months postpartum. Antenatal depressive symptoms (β=.31, p<.001) and perinatal somatoform dissociation (β=.14, p<.05) predicted symptoms ten months postpartum. LIMITATIONS Almost a third of our sample was lost at three months postpartum, and 44% at ten months. The sample size was relatively small. The present study did not control for prior PTSD. The PTSD A criterion was not considered an exclusion criteria for model testing, and the fit index of the ten months model was just below suggested cut-off values. CONCLUSIONS Screening for high risk pregnant women should focus on antenatal depression, anxiety and dissociative tendencies. Hospital staff and midwives are advised to be vigilant for perinatal dissociation after intense negative emotions. To help regulate perinatal negative emotional responses, hospital staff and midwifes are recommended to provide information about birth procedures and be attentive to women's birth-related needs.
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Affiliation(s)
- Joris F G Haagen
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | | | - Onno van der Hart
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Rolf J Kleber
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Groep, Diemen, The Netherlands
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Peñacoba-Puente C, Marín-Morales D, Carmona-Monge FJ, Velasco Furlong L. Post-Partum Depression, Personality, and Cognitive-Emotional Factors: A Longitudinal Study on Spanish Pregnant Women. Health Care Women Int 2015; 37:97-117. [DOI: 10.1080/07399332.2015.1066788] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ayers S, Wright DB, Ford E. Hyperarousal symptoms after traumatic and nontraumatic births. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1004164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shepherd J. Minimizing harm via psychological intervention: response to Glannon. JOURNAL OF MEDICAL ETHICS 2014; 40:662-663. [PMID: 24763221 DOI: 10.1136/medethics-2014-102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In a recent discussion, Walter Glannon discusses a number of ways we might try to minimise harm to patients who experience intraoperative awareness. In this response, I direct attention to a possibility that deserves further attention. It might be that a kind of psychological intervention--namely, informing patients of the possibility of intraoperative awareness and of what to expect in such a case--would constitute a unique way to respect patient autonomy, as well as minimise the harm that typically follows intraoperative awareness events.
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Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clin Psychol Rev 2014; 34:389-401. [DOI: 10.1016/j.cpr.2014.05.003] [Citation(s) in RCA: 381] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/01/2014] [Accepted: 05/18/2014] [Indexed: 01/12/2023]
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Goutaudier N, Séjourné N, Bui É, Cazenave N, Chabrol H. [Premature delivery: a traumatic birth? Posttraumatic stress symptoms and associated features]. ACTA ACUST UNITED AC 2014; 42:749-54. [PMID: 24931321 DOI: 10.1016/j.gyobfe.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES While researches focusing on posttraumatic stress disorder (PTSD) symptoms following childbirth tend to develop, few studies have been conducted on French samples. The aim of the current study was to explore the prevalence rate of women developing postpartum PTSD following preterm birth and highlighting associated features. PATIENTS AND METHOD In the 4weeks following the preterm infant's hospital discharge, a sample of 110 French women (mean age [SD]=29.5 [4.3]years) who delivered prematurely completed questionnaires assessing PTSD symptoms (Impact of Event Scale-Revised) postpartum depressive symptomatology (Edinburgh Postnatal Depression Scale), quality of marital relationship (Dyadic Adjustment Scale) and partner support (Multidimensional Scale of Perceived Social Support). Sociodemographic and gynecologic data were also gathered. RESULTS Thirty percent of our sample reported a score on the IES-R highlighting a probable posttraumatic stress disorder. Increased postpartum depressive symptoms (β=0.47, P<0.05), having undergone a caesarian section (β=0.24, P<0.05), and prior traumatic event (β=0.20, P<0.05), were independently associated with the intensity of PTSD symptoms. DISCUSSION AND CONCLUSION Given the traumatic impact of preterm birth on mothers, further studies focusing on the trauma of premature delivery are warranted.
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Affiliation(s)
- N Goutaudier
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France.
| | - N Séjourné
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - É Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, États-Unis; Harvard Medical School, Boston, Massachusetts, États-Unis
| | - N Cazenave
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - H Chabrol
- Centre d'études et de recherches en psychopathologie, URI Octogone, université Toulouse II-Le Mirail, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
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O'Donovan A, Alcorn KL, Patrick JC, Creedy DK, Dawe S, Devilly GJ. Predicting posttraumatic stress disorder after childbirth. Midwifery 2014; 30:935-41. [PMID: 24793491 DOI: 10.1016/j.midw.2014.03.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/13/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE around 50% of women report symptoms that indicate some aspect of their childbirth experience was 'traumatic', and at least 3.1% meet diagnosis for PTSD six months post partum. Here we aimed to conduct a prospective longitudinal study and examine predictors of birth-related trauma - predictors that included a range of pre-event factors - as a first step in the creation of a screening questionnaire. METHOD of the 933 women who completed an assessment in their third trimester, 866 were followed-up at four to six week post partum. Two canonical discriminant function analyses were conducted to ascertain factors associated with experiencing birth as traumatic and, of the women who found the birth traumatic, which factors were associated with those who developed PTSD. FINDINGS a mix of 16 pre-birth predictor variables and event-specific predictor variables distinguished women who reported symptoms consistent with trauma from those who did not. Fourteen predictor variables distinguished women who went on to develop PTSD from those who did not. CONCLUSIONS anxiety sensitivity to possible birthing problems, breached birthing expectations, and severity of any actual birth problem, predicted those who found the birth traumatic. Prior trauma was the single most important predictive factor of PTSD. Evaluating the utility of brief, cost-effective, and accurate screening for women at risk of developing birth-related PTSD is suggested.
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Affiliation(s)
- Analise O'Donovan
- School of Applied Psychology and Griffith Health Institute, Griffith University, Mt Gravatt, Queensland 4122, Australia.
| | | | - Jeff C Patrick
- Australian Institute of Health Service Management, University of Tasmania, Australia
| | - Debra K Creedy
- Queensland Centre for Mothers & Babies, University of Queensland, Australia
| | - Sharon Dawe
- School of Applied Psychology and Griffith Health Institute, Griffith University, Mt Gravatt, Queensland 4122, Australia
| | - Grant J Devilly
- School of Applied Psychology and Griffith Health Institute, Griffith University, Mt Gravatt, Queensland 4122, Australia.
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Fenech G, Thomson G. Tormented by ghosts from their past’: A meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being. Midwifery 2014; 30:185-93. [DOI: 10.1016/j.midw.2013.12.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
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Onoye JM, Shafer LA, Goebert DA, Morland LA, Matsu CR, Hamagami F. Changes in PTSD symptomatology and mental health during pregnancy and postpartum. Arch Womens Ment Health 2013; 16:453-63. [PMID: 23797809 PMCID: PMC3888817 DOI: 10.1007/s00737-013-0365-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 06/10/2013] [Indexed: 01/12/2023]
Abstract
Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman's experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians' office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.
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