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

The significance of paramedic communication during women's birth experiences: A scoping review

BACKGROUND

Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked.

METHODS

A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint.

RESULTS

Three themes were generated: 1. First Impressions Count: paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. Choice as a Pathway to Control: when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. Exposed, Violated and Disempowered: some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby.

CONCLUSIONS

This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.

Is pregnancy a disease? A normative approach

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host's body. Like a disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the 'normality' of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease.

Measuring post-traumatic stress after childbirth: a review and critical appraisal of instruments

BACKGROUND

Addressing psychological trauma after childbirth requires accurate measurement of its prevalence, risk factors, and outcomes using validated instruments that distinguish perceptions of traumatic birth, subclinical post-traumatic stress (PTS) symptoms, and symptoms meeting a diagnostic threshold.

OBJECTIVE

The purpose of this study was to review literature on psychological trauma following childbirth and appraise instruments that measure postpartum PTS.

METHODS

In January 2020, the authors searched for and evaluated peer-reviewed studies that quantitatively measured PTS following hospital-based live births in the United States, United Kingdom, Canada, Australia, Norway, Sweden, and Switzerland; 37 articles were selected and evaluated.

RESULTS

Levels of post-traumatic stress disorder were most commonly measured, followed by PTS symptoms. Diagnostic instruments suggested lower PTS prevalence estimates than those screening for or assessing PTS symptoms. Community samples yielded lower prevalence estimates than samples recruited from the internet or settings specifically addressing mental health. Measurement sooner after birth yielded higher estimates.

CONCLUSION

Study design, sample characteristics, instruments, and timing of measurements likely impact postpartum PTS prevalence estimates. Variation in these characteristics make it difficult to draw conclusions on the prevalence of postpartum PTS. Researchers should consider the appraisal of measurement tools presented here and use rigorous study methodology when studying traumatic birth experiences and evaluating interventions.

Korean women's perceptions of traumatic childbirth: a qualitative descriptive study

BACKGROUND

Previous studies have established that negative or traumatic childbirth can create childbirth-related post-traumatic stress disorder (CB-PTSD). Because of the negative implications of CB-PTSD for mothers, children, and families, global qualitative research on traumatic or negative childbirth has risen in recent years. However, few studies have been conducted in South Korea. This study aims to explore women's various perceptions of traumatic childbirth in South Korea.

METHODS

This qualitative descriptive study examined nine women who were at high risk of PTSD (IES-R-K > 24) at the time of the interview, between 1 and 11 years after childbirth. Semi-structured interviews were conducted. Interview transcripts were subjected to thematic analysis.

RESULTS

The analysis identified two themes with six subthemes, as follows: (1) person-centred factors (pain, guilt, maternal identity conflict, and damaged femininity); (2) society-centred factors (threatened dignity and disrupted relationships). These findings may be attributed to Korean culture (excessive motherhood and lookism), as well as unbearable pain, disrespectful childbirth environments, lack of spouse's support, loss of their lifestyle, and unrealistic expectations.

CONCLUSIONS

This study demonstrates various negative consequences, ranging from psychological damage to conflict in women's relationships with their spouses, and others. This highlights the various perceptions stemming from traumatic childbirth and emphasizes the significance of clinical intervention. Therefore, healthcare professionals' greater understanding of women's perceptions and increased concern about childbirth and respectful childbirth environments are required. In addition, based on our findings, there is a need to develop interventions that can alleviate CB-PTSD and further improve women's mental health, particularly through women-centred interventions.

Mental Health and Placenta Accreta Spectrum

Nearly half of women describe childbirth as traumatic in some way, making them more vulnerable to perinatal psychiatric illness. Patients with high risk pregnancies, such as abnormal placentation, are even more susceptible to childbirth related mental health sequelae. There are no formal recommendations for mental health intervention in women with placenta accreta spectrum (PAS). In many institutions, the Edinburgh Postpartum Depression Scale is used to assess for depressive and anxiety symptoms during pregnancy and postpartum. Women with PAS should be screened at time of diagnosis, monthly until delivery, and at multiple time points through the first year postpartum. It is also recommended to screen women for PTSD prior to and after delivery. Interventions shown helpful in the PAS population include establishing a multidisciplinary team, patient access to a support person or care coordinator, development of a postpartum care team and plan, and extending mental health follow up through the first year postpartum. Women with PAS are at increased risk for negative mental health outcomes. To support the mental health of women with PAS and their families, we recommend a multi-disciplinary treatment team, screening for mental health sequelae early and often, referring women with positive screens to mental health professionals, involving the partner/family in care, and considering referral to a PAS support group for peer support.

Development and psychometric testing of a scale for assessing the psychological birth trauma

Background

Psychological birth trauma is widespread in postpartum women, and its harms are serious to mothers' health. Existing tools rely on posttraumatic stress disorder to evaluate, which cannot effectively evaluate its connotation. The aim of this study was to develop a new instrument for use to comprehensively assess the psychological birth trauma level of women after birth and test the scale's psychometric properties.

Methods

The scale was developed and evaluated through item generation, expert consultation, pre-survey, and psychometric evaluation. A literature review, focus group, and individual deep semi-structured interviews were utilized to identify the scale items. The expert consultation evaluated the content validity. Psychometric testing was conducted in a convenience sample of 712 mothers within the first 72 h postpartum who were recruited from three hospitals in China.

Results

The total Cronbach alpha coefficient of the scale was 0.874. Exploratory factor analysis supported that the final scale consisted of four dimensions and fifteen items. The explanatory variance of the four factors was 66.724%. The four dimensions are named "being neglected," "out of control," "physiological emotional response," and "cognitive behavioral response." The results of the confirmatory factor analysis showed that the fit indices were all at acceptable and good levels.

Conclusion

The 15-item Birth Trauma Scale is a valid and reliable tool to evaluate the psychological trauma of mothers who experienced spontaneous childbirth. The scale is a maternal self-assessment scale that can help women understand their mental health. Healthcare providers can identify key populations and intervene with them.

Psychological birth trauma: A concept analysis

Aim

To define and analyze the concept of psychological birth trauma.

Design

The concept analysis method of Walker and Avant was used.

Method

Eight databases (PubMed, CINAHL Complete, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP Information Chinese Journal Service Platform, and Chinese BioMedicine Literature Database) were searched from inception to July 2022 for studies focused on psychological birth trauma.

Results

Of the 5,372 studies identified, 44 ultimately met the inclusion criteria. The attributes identified were (1) women's subjective feelings, (2) intertwined painful emotional experiences, (3) originating in the birth process, and (4) lasting until postpartum. Antecedents were divided into two groups: pre-existing antecedents and birth-related antecedents. Consequences were identified as negative and positive.

Conclusion

Psychological birth trauma is a more complex and comprehensive concept than previously thought, and should be regarded as a separate postpartum mental health problem. This study deepens the understanding of psychological birth trauma through a comprehensive concept analysis and also puts forward some suggestions for the prevention, identification, and intervention of psychological birth trauma, which provides a basis for assisting in the identification of psychological birth trauma and provides a reference for the development of rigorous assessment tools and the design of appropriate interventions in the future. Further research is needed to update and refine this concept.

Textbook typologies: Challenging the myth of the perfect obstetric pelvis

Medical education's treatment of obstetric-related anatomy exemplifies historical sex bias in medical curricula. Foundational obstetric and midwifery textbooks teach that clinical pelvimetry and the Caldwell-Moloy classification system are used to assess the pelvic capacity of a pregnant patient. We describe the history of these techniques-ostensibly developed to manage arrested labors-and offer the following criticisms. The sample on which these techniques were developed betrays the bias of the authors and does not represent the sample needed to address their interest in obstetric outcomes. Caldwell and Moloy wrote as though the size and shape of the bony pelvis are the primary causes of "difficult birth"; today we know differently, yet books still present their work as relevant. The human obstetric pelvis varies in complex ways that are healthy and normal such that neither individual clinical pelvimetric dimensions nor the artificial typologies developed from these measurements can be clearly correlated with obstetric outcomes. We critique the continued inclusion of clinical pelvimetry and the Caldwell-Moloy classification system in biomedical curricula for the racism that was inherent in the development of these techniques and that has clinical consequences today. We call for textbooks, curricula, and clinical practices to abandon these outdated, racist techniques. In their place, we call for a truly evidence-based practice of obstetrics and midwifery, one based on an understanding of the complexity and variability of the physiology of pregnancy and birth. Instead of using false typologies that lack evidence, this change would empower both pregnant people and practitioners.

Women's experiences of birth trauma: A scoping review

BACKGROUND

A high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women's future fertility choices can be inhibited by birth trauma.

AIM

To summarize the existing literature to provide insight into women's experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor.

METHODS

The review follows 5 stages of Arksey and O'Malley's framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria.

FINDINGS

Three key themes emerged; (1) health care providers and the maternity care system. (2) Women's sense of knowing and control. (3) Support.

DISCUSSION

Continuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth.

CONCLUSION

Existing literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women's trauma. Insufficient support further compounds women's experiences.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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