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Vega-Sanz M, Rey-Sáez R, Berástegui A, Sánchez-López Á. Difficulties in Pregnancy Adjustment as Predictors of Perinatal Depression: Indirect Effects through the Role of Brooding Rumination and Maternal-Fetal Bonding. Am J Perinatol 2024; 41:e2870-e2877. [PMID: 37848044 PMCID: PMC11150065 DOI: 10.1055/s-0043-1776062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The aim of this research was to study the ways in which problems of adaptation to pregnancy influence the development of symptoms of perinatal depression via the presence of brooding and low maternal-fetal bonding, in addition to other risk factors previously established in the literature. STUDY DESIGN Representative sample of pregnant women in the third trimester of gestation (N = 594) completed an online survey that included sociodemographic data and measures of perinatal depression, adjustment to pregnancy, bonding, and brooding. Other risk factors were also assessed as covariates, such as previous history of depression, generalized anxiety, perceived social support, and experience of stressful life events. Descriptive and correlational analyses were performed on the scores obtained by the subjects with the different instruments. A path model was formulated to establish the pathways through which adjustment influences perinatal depression symptomatology. On the one hand, the presence of brooding (worst adjustment to pregnancy → high brooding → perinatal depression symptomatology), and on the other hand, the quality of maternal-fetal bonding (worst adjustment to pregnancy → poor quality fetal-maternal bonding → perinatal depression symptomatology) would act as a mediator. RESULTS The factors proposed by the literature were predictive of perinatal depressive symptomatology and the quality of adjustment to pregnancy. Problems adjusting to changes during pregnancy and experiencing it unsatisfactorily may predict individual differences in perinatal depressive symptoms. Significantly, this relationship was mediated by two key factors, the presence of brooding and low quality of the maternal-fetal bond. CONCLUSION Our results provide evidence in favor of the existence of multiple paths through which difficulties in adapting to pregnancy can favor the occurrence of higher levels of perinatal depressive symptoms and identify new avenues for developing research in this area and preventive interventions empirically informed.
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Affiliation(s)
- Maria Vega-Sanz
- University Institute of Family Studies, Comillas Pontifical University, Madrid, Spain
| | - Ricardo Rey-Sáez
- Department of Personality, Evaluation and Psychological Treatments, Complutense University of Madrid, Madrid, Spain
| | - Ana Berástegui
- University Institute of Family Studies, Comillas Pontifical University, Madrid, Spain
| | - Álvaro Sánchez-López
- Department of Personality, Evaluation and Psychological Treatments, Complutense University of Madrid, Madrid, Spain
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Eichinger J, Büchler A, Arnold L, Rost M. Women's and Provider's Moral Reasoning About the Permissibility of Coercion in Birth: A Descriptive Ethics Study. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00480-4. [PMID: 38261096 DOI: 10.1007/s10728-024-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women's autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers' and women's moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women's decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women's autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women's enfranchisement in their own care.
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Affiliation(s)
- Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Andrea Büchler
- Faculty of Law, Human Reproduction Reloaded|H2R, University of Zurich, Zürich, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Devita S, Deforges C, Bickle-Graz M, Tolsa JF, Sandoz V, Horsch A. Maternal childbirth-related posttraumatic stress symptoms, bonding, and infant development: a prospective study. J Reprod Infant Psychol 2023:1-15. [PMID: 37740725 DOI: 10.1080/02646838.2023.2261057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Childbirth-related posttraumatic stress symptoms (CB-PTSS) including general symptoms (GS, i.e., mainly negative cognitions and mood and hyperarousal symptoms) and birth-related symptoms (BRS, i.e., mostly re-experiencing and avoidance symptoms) may disrupt mother-infant bonding and infant development. This study investigated prospective and cross-sectional associations between maternal CB-PTSS and mother-infant bonding or infant development (language, motor, and cognitive). METHOD We analysed secondary data of the control group of a randomised control trial (NCT03576586) with full-term French-speaking mother-infant dyads (n = 55). Maternal CB-PTSS and mother-infant bonding were assessed via questionnaires at six weeks (T1) and six months (T2) postpartum: PTSD Checklist for DSM-5 (PCL-5) and Mother-Infant Bonding Scale (MIBS). Infant development was assessed with the Bayley Scales of Infant Development at T2. Sociodemographic and medical data were collected from questionnaires and medical records. Bivariate and multivariate regression were used. RESULTS Maternal total CB-PTSS score at T1 was associated with poorer bonding at T2 in the unadjusted model (B = 0.064, p = 0.043). In the adjusted model, cross-sectional associations were found at T1 between a higher total CB-PTSS score and poorer bonding (B = 0.134, p = 0.017) and between higher GS and poorer bonding (B = 0.306, p = 0.002). Higher BRS at T1 was associated with better infant cognitive development at T2 in the unadjusted model (B = 0.748, p = 0.026). CONCLUSIONS Results suggest that CB-PTSS were associated with mother-infant bonding difficulties, while CB-PTSS were not significantly associated with infant development. Additional studies are needed to increase our understanding of the intergenerational consequences of perinatal trauma.
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Affiliation(s)
- Sella Devita
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Myriam Bickle-Graz
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Tolsa
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vania Sandoz
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Department Woman-Mother-Child, Child Abuse and Neglect Team, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Nishimura E, Shoki R, Kato M, Yoneoka D, Okawa S, Tabuchi T, Ota E. Factors associated with father-infant bonding during the COVID-19 pandemic: an internet-based cross-sectional study in Japan. Sci Rep 2023; 13:13653. [PMID: 37608013 PMCID: PMC10444891 DOI: 10.1038/s41598-023-40225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
The COVID-19 pandemic has forced lifestyles changes and affected the relationships between fathers and their infants. However, the factors associated with paternal-infant bonding have not been clarified. This study aimed to explore the factors associated with father-infant bonding during the COVID-19 pandemic in Japan. This cross-sectional study used data from a nationwide survey and the Japanese version of the Mother-to-Infant Bonding Scale (MIBS) to measure father-infant bonding. The participants were divided into two groups depending on their partners' parity. A linear regression model (Gauss-Markov-type) was used for both groups. A total of 1055 men were included in the analysis. Of these men, 521 (49.4%) had a primipara partner, and 534 (50.6%) had a multipara partner. No significant differences were found between the two groups' MIBS-J scores. Fathers' mental health, relationship with the partner and family members, abusive behavior towards children, wanted pregnancy, and the youngest child's Neonatal Intensive Care Unit admission history were associated with father-infant bonding. Regarding factors related to COVID-19, caring for the child while the partner is at home has a negative impact on bonding, while fear related to infection with COVID-19 has no negative impact on bonding.
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Affiliation(s)
- Etsuko Nishimura
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Rina Shoki
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Mika Kato
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
- Tokyo Foundation for Policy Research, Tokyo, Japan.
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
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Marsh A, Hundley VA, Luce A, Richens Y. The perfect birth: a content analysis of midwives' posts about birth on Instagram. BMC Pregnancy Childbirth 2023; 23:422. [PMID: 37286939 DOI: 10.1186/s12884-023-05706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND There is limited research into how midwives use social media within their professional role. Small pilot studies have explored the introduction of social media into maternity practice and teaching but there is little evidence around how midwives use social media professionally. This is important as 89% of pregnant women turn to social media for advice during pregnancy, and how midwives use social media could be influencing women, their perception of birth and their decision making. METHODS AIM: To analyse how popular midwives portray birth on the social media platform Instagram. This is an observational mixed methods study using content analysis. Five 'popular' midwives from each country (UK, New Zealand, USA and Australia) were identified and their posts about birth collated from a one-year period (2020-21). Images/videos were then coded. Descriptive statistics enabled comparison of the posts by country. Categorisation was used to analyse and understand the content. RESULTS The study identified 917 posts from the 20 midwives' accounts, containing 1216 images/videos, with most coming from USA (n = 466), and UK (n = 239), Australia (n = 205) and New Zealand (n = 7) respectively. Images/videos were categorised into 'Birth Positivity', 'Humour', 'Education', 'Birth Story' and 'Advertisement'. Midwives' portrayals of birth represented a greater proportion of vaginal births, waterbirths and homebirths than known national birth statistics. The most popular midwives identified mainly had private businesses (n = 17). Both the midwives and women portrayed in images were primarily white, demonstrating a disproportionate representation. CONCLUSION There is a small midwifery presence on Instagram that is not representative of the broader profession, or the current picture of midwifery care. This paper is the first study to explore how midwives are using the popular social media platform Instagram to portray birth. It provides insight into how midwives post an un-medicalised, low risk representation of birth. Further research is recommended to explore midwives' motivation behind their posts, and how pregnant and postnatal women engage with social media.
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Affiliation(s)
- Anna Marsh
- Centre for Midwifery Maternal & Perinatal Health, Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth, BH8 8GP, UK.
- Elizabeth Garrett Anderson Unit, University College London Hospitals NHS Foundation Trust, 25 Grafton Way, London, WC1E 6DB, UK.
| | - Vanora A Hundley
- Centre for Midwifery Maternal & Perinatal Health, Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth, BH8 8GP, UK
| | - Ann Luce
- Department of Journalism and Communication, Bournemouth University, Weymouth House, Talbot Campus, Fern Barrow, Poole, BH12 5BB, UK
| | - Yana Richens
- Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK
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Carney JR, Miller-Graff LE, Napier TR, Howell KH. Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women. CHILD ABUSE & NEGLECT 2023; 136:105995. [PMID: 36566706 DOI: 10.1016/j.chiabu.2022.105995] [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: 05/05/2022] [Revised: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities. OBJECTIVE, PARTICIPANTS, AND SETTING In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure. METHODS The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test. RESULTS The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR2 = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p = .140) or HD (β = -0.10, p = .238) ACEs subscales on PTSS. CONCLUSIONS Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.
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Affiliation(s)
- Jessica R Carney
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA.
| | - Laura E Miller-Graff
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA; Kroc Institute for International Peace Studies, University of Notre Dame, 1110 Jenkins Nanovic Halls, Notre Dame, IN 46556, USA
| | - Taylor R Napier
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
| | - Kathryn H Howell
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
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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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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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Kjerulff KH, Attanasio LB, Sznajder KK, Brubaker LH. A prospective cohort study of post-traumatic stress disorder and maternal-infant bonding after first childbirth. J Psychosom Res 2021; 144:110424. [PMID: 33756149 PMCID: PMC8101703 DOI: 10.1016/j.jpsychores.2021.110424] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate risk factors for childbirth-related post-traumatic stress disorder (CR-PTSD) measured 1-month after first childbirth, and the association between CR-PTSD and maternal-infant bonding. METHODS In this prospective cohort study 3006 nulliparous women living in Pennsylvania, USA, were asked about CR-PTSD at 1-month postpartum, and maternal-infant bonding at 1, 6 and 12-months postpartum. Multivariable logistic regression models identified risk factors for CR-PTSD and associations between CR-PTSD and maternal-infant bonding at 1, 6 and 12-months postpartum, controlling for confounding variables - including postpartum depression, stress and social support. RESULTS Nearly half (47.5%) of the women reported that during labor and delivery they were afraid that they or their baby might be hurt or die, and 225 women (7.5%) reported experiencing one or more CR-PTSD symptoms at 1-month postpartum. Depression, stress and low social support during pregnancy were associated with CR-PTSD, as well as labor induction, delivery complications, poor pain control, and unplanned cesarean delivery. Women with CR-PTSD reported a less positive childbirth experience, less shared decision-making, and were more likely to score in the bottom third on maternal-infant bonding at 1-month postpartum (adjusted odds ratio [aOR] 2.5, 95% CI 1.8-3.3, p < 0.001); at 6-months postpartum (aOR 2.1, 95% CI 1.5-2.8, p < 0.001); and at 12-months postpartum (aOR 2.2, 95% CI 1.6-3.0, p < 0.001). CONCLUSION In this large-scale prospective cohort study we found that CR-PTSD was consistently associated with lower levels of maternal-infant bonding over the course of the first year after first childbirth.
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Affiliation(s)
- Kristen H. Kjerulff
- Departments of Public Health Sciences and Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Laura B. Attanasio
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kristin K. Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Laura H. Brubaker
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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