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Buyukcan-Tetik A, Seefeld L, Bergunde L, Ergun TD, Dikmen-Yildiz P, Horsch A, Garthus-Niegel S, Oosterman M, Lalor J, Weigl T, Bogaerts A, Van Haeken S, Downe S, Ayers S. Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis. Br J Health Psychol 2024; 29:925-942. [PMID: 38926081 DOI: 10.1111/bjhp.12738] [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: 05/06/2023] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS. DESIGN Dyadic longitudinal data from the Self-Hypnosis IntraPartum Trial. METHODS Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum). RESULTS Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS. CONCLUSIONS Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.
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Affiliation(s)
- Asuman Buyukcan-Tetik
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Psychology Program, Sabanci University, Istanbul, Turkey
| | - Lara Seefeld
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Luisa Bergunde
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Turan Deniz Ergun
- Psychology Program, Sabanci University, Istanbul, Turkey
- Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | | | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Tobias Weigl
- Psychology School, Fresenius - University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
- Faculty of Health, University of Plymouth, Devon, UK
| | - Sarah Van Haeken
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Research & Expertise, Resilient People, UC Leuven-Limburg, Diepenbeek, Belgium
| | - Soo Downe
- University of Central Lancashire, Preston, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
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Chen C, Li B, Chai L, Liu K, Zhang S. The amplitude of low-frequency fluctuations is correlated with birth trauma in patients with postpartum post-traumatic stress disorder. Transl Psychiatry 2024; 14:332. [PMID: 39143051 PMCID: PMC11324796 DOI: 10.1038/s41398-024-03018-3] [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] [Received: 07/13/2023] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
Postpartum post-traumatic stress disorder (PP-PTSD) is a severe mental disorder worldwide. In recent years, some studies have reported that PP-PTSD stems from birth trauma. The present study was dedicated in finding ways to predict the occurrence of emergency caesarean section (ECS), trying to analyze the methods to reduce incidence of PP-PTSD on this basis, further exploring the neuroimaging changes in PP-PTSD. A total of 245 primiparas with intention of vaginal delivery were recruited. The internal tocodynamometry measurement was performed during labor for all mothers, and respectively taken at 3-5 cm, 5-8 cm, and 8-10 cm of cervical dilation. The receiver operating characteristic (ROC) curve and Binary logistic regression analyses were also performed to identify fetal head descending thrust that might help in the prediction of ECS. Resting-state magnetic resonance imaging (MRI) was performed on 26 patients diagnosed with PP-PTSD of 245 mothers, the amplitude of low-frequency fluctuations (ALFF) technology was used to observe the spontaneous neural activity of all PP-PTSD patients and correlation analyses were performed. We found that the natural delivery rate of mothers with fetal head descending thrust <16.29 N (5-8 cm), 26.36 N (8-10 cm) were respectively lower than other mothers with fetal head descending thrust ≥16.29 N (5-8 cm), 26.36 N (8-10 cm) (P < 0.05). The ROC curve analysis showed that the area under the receiver operating characteristic curve (AUC) value of thrust (5-8 cm) was 0.896 (95% CI: 0.854-0.938, p < 0.001), AUC of thrust(8-10 cm) was 0.786 (95% CI: 0.714-0.858, p < 0.001), which showed strong potential for predicting ECS. In addition, the Binary logistic regression analysis showed thrust (5-8 cm) and thrust (8-10 cm) were independent correlates of ECS. The resting-state functional magnetic resonance imaging (rs-fMRI) results indicated that PP-PTSD group showed decreased ALFF in the bilateral insula cortex (IC), right anterior cingulate cortex (ACC), and left midcingulate cortex (MCC) compared with healthy postpartum women (HPW) (false discovery rate (FDR) correction q-value < 0.05). The ALFF value of the right ACC was positively correlated with the Perinatal Post-traumatic stress disorder Questionnaire (PPQ) score (r = 0.4046 p = 0.0403) and Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) score (r = 0.3909 p = 0.0483). The internal tocodynamometry measurement can serve as a predictive tool for ECS, on this basis, the implementation of effective emotional support may help to reduce the incidence of PP-PTSD. Besides, this study has verified the presence of altered ALFF in the brain regions of PP-PTSD patients, mainly involving the bilateral IC, right ACC, and left MCC, that might be associated with emotion, cognition, and memory disorders functions in PP-PTSD patients.
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Affiliation(s)
- Chunlian Chen
- Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Bo Li
- Department of Radiology, The 960th Hospital of the PLA Joint Logistic Support Force, Jinan, Shandong, China
| | - Liping Chai
- Department of Obstetrics, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Kai Liu
- Department of Radiology, The 960th Hospital of the PLA Joint Logistic Support Force, Jinan, Shandong, China.
| | - Shufen Zhang
- Department of Obstetrics, Shandong Second Provincial General Hospital, Jinan, Shandong, China.
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Hüner B, Friedl T, Schütze S, Polasik A, Janni W, Reister F. Post-traumatic stress syndromes following childbirth influenced by birth mode-is an emergency cesarean section worst? Arch Gynecol Obstet 2024; 309:2439-2446. [PMID: 37391646 PMCID: PMC11147887 DOI: 10.1007/s00404-023-07114-5] [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: 03/25/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE The experience of birth is an emotional challenge for women. Traumatic birth experiences can cause psychological stress symptoms up to post-traumatic stress disorders (PTSD), with impact on women's wellbeing. Primarily unplanned interventions can trigger birth-mode-related traumatization. The aim of the study was to evaluate whether an emergency cesarean section (ECS) is the most traumatizing. METHODS A retrospective case-control study was undertaken. Therefore, data were collected by standardized questionnaires (Impact of Event Scale-Revised and City Birth Trauma Scale) that were sent to women with singleton pregnancies > 34 weeks of gestation who either give birth by ECS (case group, n = 139), unplanned cesarean section (UCS), operative vaginal birth (OVB), or natural birth (NB) (three control groups, n = 139 each). The investigation period was 5 years. RESULTS Overall, 126 of 556 (22%) sent questionnaires were returned and could be analyzed (32 ECS, 38 UCS, 36 OVB, and 20 NB). In comparison to other birth modes, women with ECS were associated with a higher degree of traumatization as revealed by statistically significant differences regarding the DSM-5 criteria intrusion and stressor. In addition, women who underwent ECS declared more frequently a demand for professional debriefing compared to other birth modes. DISCUSSION ECS is associated with more post-traumatic stress symptoms compared to other birth modes. Therefore, early interventions are recommended to reduce long-term psychological stress reactions. In addition, outpatient follow-ups by midwives or emotional support programs should be implemented as an integral component of postpartum debriefings.
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Affiliation(s)
- Beate Hüner
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Thomas Friedl
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Sabine Schütze
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Arkadius Polasik
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Frank Reister
- Department for Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
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Watters A, Ekpe E, Okafor A, Donelan E. Patient Perspectives on Outpatient versus Inpatient Cervical Ripening for Induction of Labor. Am J Perinatol 2024. [PMID: 38569508 DOI: 10.1055/a-2298-5166] [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: 04/05/2024]
Abstract
OBJECTIVE Our objective was to compare patient perceived control and experience with outpatient versus inpatient cervical ripening. STUDY DESIGN This is a retrospective mixed-methods analysis of a quality improvement initiative focused on the impact to patients of incorporating outpatient cervical ripening into routine practice. Postpartum inpatients who had elected for outpatient cervical ripening (outpatients) and those who met criteria for outpatient cervical ripening but opted for an inpatient setting (inpatients) were invited to participate in the study. Patients completed the Perceived Control in Childbirth Scale, and scores were compared between outpatient and inpatient groups using Mann-Whitney U test. In addition, semistructured questions elicited feedback prior to hospital discharge, and these qualitative data were analyzed using iterative thematic analysis. RESULTS The study population consisted of 36 outpatients and 38 inpatients. The median score on the Perceived Control in Childbirth Scale was 69 for outpatients and 67 for inpatients (p-value = 0.49), out of a maximum score of 72 (representing the highest level of perceived control). Both groups reported similarly high levels of perceived control, regardless of cervical ripening setting. In the qualitative analysis, pain was the most common theme in both groups. Inpatients reported more distress despite access to stronger pain medications. Outpatients utilized a variety of distraction techniques and expressed gratitude for their setting more than inpatients. CONCLUSION Outpatient cervical ripening can be a patient-centered solution to obstetric throughput challenges arising from increased numbers of inductions. Those who underwent outpatient cervical ripening had similar perceived control to those who underwent inpatient cervical ripening, suggesting that individual patient preferences are most important in determining the optimal setting for care. The patients' reported experiences identified focus areas for process improvement efforts and future research, including improving patient education regarding expectations and innovating new pain management strategies for cervical ripening. KEY POINTS · Patient experiences must inform patient-centered care.. · Perceived control with cervical ripening was high.. · Pain with cervical ripening was the most cited theme..
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Affiliation(s)
- Amber Watters
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Etoroabasi Ekpe
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Illinois
| | - Annette Okafor
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- University of Illinois College of Medicine, Chicago, Illinois
| | - Emily Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Gilbert L, Sandoz V, Deforges C, Horsch A. A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies. Front Psychiatry 2024; 15:1360189. [PMID: 38654730 PMCID: PMC11036539 DOI: 10.3389/fpsyt.2024.1360189] [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: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study investigated prospective relationships between the perception of threat to one's own life or to that of one's infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample. Methods Study samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed. Results Globally, mothers were significantly more likely to perceive their infant's life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05. Conclusion The type of perceived threat differently influences maternal CB-PTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool.
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Affiliation(s)
- Leah Gilbert
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Charles Perkins Center, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW, Australia
| | - Vania Sandoz
- Child Abuse and Neglect Team, Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
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Mäkelä T, Saisto T, Salmela-Aro K, Rouhe H. How do different childbirth experience scales predict childbirth-related posttraumatic stress symptoms and disorder? J Psychosom Obstet Gynaecol 2023; 44:2210750. [PMID: 37186516 DOI: 10.1080/0167482x.2023.2210750] [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] [Indexed: 05/17/2023] Open
Abstract
PURPOSE Post-traumatic stress disorder (PTSD) after childbirth causes severe and lasting effects. Screening of childbirth experience may expedite early PTSD recognition. Systematic reviews have not provided consensus on how and when to measure childbirth experience and the clinical implications of such measurements. We aimed to identify a reliable and simple scale for screening the childbirth experience with minimum risk of missing PTSD. MATERIALS AND METHODS This cohort study evaluated the childbirth experience of 1527 unselected women with Wijma Delivery Experience Questionnaire (W-DEQ-B), Delivery Satisfaction Scale (DSS), and Visual Analogue Scale (VAS). VAS was measured first <1 week (VAS1) and then, together with the other scales, a few months after childbirth (VAS2). The scales' ability to identify PTSD (measured with Traumatic Event Scale) was evaluated and compared with receiver operating characteristic (ROC) analysis. Diagnostic accuracy and clinical usefulness were used to suggest cutoff values for scales. RESULTS W-DEQ-B showed highest recognition of partial or full PTSD (area under the ROC curve 0.96 in W-DEQ-B, 0.92 in VAS2, 0.91 in DSS and 0.82 in VAS1). CONCLUSIONS All included scales recognized partial or full PTSD well. Although W-DEQ-B performed best, VAS (measured twice) with cutoff value of 50 mm is most suitable for screening in clinical circumstances.
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Affiliation(s)
- Tia Mäkelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Hanna Rouhe
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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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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Shorey S, Downe S, Chua JYX, Byrne SO, Fobelets M, Lalor JG. Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:1238-1253. [PMID: 34894877 DOI: 10.1177/15248380211060808] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3-8 weeks' follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore
| | | | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
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Ghanbari-Homaie S, Mohammad-Alizadeh-Charandabi S, Asghari-Jafarabadi M, Meedya S, Mohammadi E, Mirghafourvand M. Persian version of the support and control in birth questionnaire among Iranian women. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:191. [PMID: 37546006 PMCID: PMC10402777 DOI: 10.4103/jehp.jehp_322_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/23/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women. MATERIALS AND METHODS Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool. RESULTS Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items. CONCLUSION Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population.
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Affiliation(s)
- Solmaz Ghanbari-Homaie
- Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, VIC 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Corbaz F, Boussac E, Lepigeon K, Gomes Dias D, Marcadent S, Desseauve D, Horsch A. 'connEcted caesarean section': creating a virtual link between MOthers and their infanTs to ImprOve maternal childbirth experieNce - study protocol for a PILOT trial (e-motion-pilot). BMJ Open 2023; 13:e065830. [PMID: 37286319 DOI: 10.1136/bmjopen-2022-065830] [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] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION One-third of mothers rate their childbirth as traumatic. The prevalence of childbirth-related post-traumatic stress disorder (CB-PTSD) is 4.7%. Skin-to-skin contact is a protective factor against CB-PTSD. However, during a caesarean section (CS), skin-to-skin contact is not always feasible and mothers and infants are often separated. In those cases, there is no validated and available solution to substitute this unique protective factor. Based on the results of studies using virtual reality and head-mounted displays (HMDs) and studies on childbirth experience, we hypothesise that enabling the mother to have a visual and auditory contact with her baby could improve her childbirth experience while she and her baby are separated. To facilitate this connection, we will use a two-dimensional 360° camera filming the baby linked securely to an HMD that the mother can wear during the end of the surgery. METHODS AND ANALYSIS This study protocol describes a monocentric open-label controlled pilot trial with minimal risk testing the effects of a visual and auditory contact via an HMD worn by the mother airing a live video of her newborn compared with treatment-as-usual in 70 women after CS. The first 35 consecutive participants will be the control group and will receive the standard care. The next 35 consecutive participants will have the intervention. The primary outcome will be differences in maternal childbirth experience (Childbirth Experience Questionnaire 2) at 1-week postpartum between the intervention and control groups. Secondary outcomes will be CB-PTSD symptoms, birth satisfaction, mother-infant bonding, perceived pain and stress during childbirth, maternal anxiety and depression symptoms, anaesthesiological data and acceptability of the procedure. ETHICS AND DISSEMINATION Ethics approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2022-00215). Dissemination of results will occur via national and international conferences, peer-reviewed journals, public conferences and social media. TRIAL REGISTRATION NUMBER NCT05319665.
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Affiliation(s)
- Fiona Corbaz
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Boussac
- Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Karine Lepigeon
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Diana Gomes Dias
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | | | - David Desseauve
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
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11
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Hüner B, Schmiedhofer M, Derksen C, Polasik A, Janni W, Reister F, Lippke S. ["Helplessness, Giving up of Any Self-Responsibility and Self-Determination" - a Qualitative Evaluation of Traumatizing Birth Experiences in Relation to Birth Mode]. Z Geburtshilfe Neonatol 2023. [PMID: 36921615 DOI: 10.1055/a-2039-3017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background Childbirth is combined with emotional challenges and individual anxiety. Unexpected birth experiences can trigger stress reactions and even post-traumatic stress disorders. Aim of the study The aim of the study was the qualitative evaluation of stressful perceived birth experiences and desired interventions.Methods A content-analytic evaluation of 117 free-text answers was conducted regarding stressful birth experiences and desired interventions using categories and frequencies in relation to birth mode.Findings Five themes emerged from the structured free text analysis: 1) Stressful experiences describing fear concerning the child and separation from the child after an emergency caesarean section; 2) Inadequate communication after an operative vaginal birth and unplanned caesarean section; 3) Feelings of failure and guilt after unplanned birth modes; 4) Helplessness with loss of personal control and the feeling of being at the mercy after an emergency caesarean section; 5) Inadequate support due to the absence of empathy or insufficient care. Expected interventions include immediate debriefing and professional psychological support.Conclusion Women-centered communication during childbirth and debriefing of stressful birth experiences are significant interventions for strengthening maternal well-being and mental health. They can have a positive impact on the development of a healthy mother-child relationship.
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Affiliation(s)
- Beate Hüner
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Christina Derksen
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | | | | | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
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12
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Carter J, Bick D, Gallacher D, Chang Y. Mode of birth and development of maternal postnatal post-traumatic stress disorder: A mixed-methods systematic review and meta-analysis. Birth 2022; 49:616-627. [PMID: 35561055 PMCID: PMC9790679 DOI: 10.1111/birt.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) affects approximately 3% of women in the postnatal period, but less is known about risk factors for PTSD than other postnatal mental illnesses. This review aimed to analyze the literature on the impact of mode of birth on postnatal PTSD. METHODS Searches were undertaken of CINAHL, the Cochrane Library, MEDLINE, PsycINFO, and Scopus for studies investigating the link between mode of birth and postnatal PTSD in high-resource countries from January 1990 to February 2021. Quantitative and qualitative data were collected and synthesized. Meta-analysis was performed with four of the studies, and the rest were analyzed narratively. RESULTS Twelve quantitative studies, presenting data on 5567 women, and two qualitative studies, with 92 women, were included in the review. Most studies found a significant relationship between mode of birth and maternal PTSD symptoms. Meta-analysis found cesarean birth was more closely associated with PTSD than vaginal delivery (VD) (P = 0.005), emergency cesarean birth (EmCB) more than elective cesarean birth (ElCB) (P < 0.001), instrumental vaginal delivery (IVD) more than spontaneous vaginal delivery (SVD) (P < 0.001), and EmCB more than SVD (P < 0.001). Women who developed PTSD after EmCB felt less in control and less supported than those who did not develop it after the same procedure. Request for repeat ElCB appeared more common among women with pre-existing postnatal PTSD, but this may subsequently leave them feeling dissatisfied and their fears of childbirth unresolved. CONCLUSIONS Modes of birth involving emergency intervention may be risk factors for the development of postnatal PTSD. Ensuring that women feel supported and in control during emergency obstetric interventions may mediate against this risk.
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Affiliation(s)
- Jemima Carter
- Faculty of Life Sciences and MedicineKing's College LondonLondonUK,St Richard's HospitalChichesterUK
| | - Debra Bick
- Warwick Medical SchoolUniversity of WarwickWarwickUK
| | | | - Yan‐Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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13
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Orovou E, Dagla M, Eskitzis P, Savvidis GS, Rigas N, Papatrechas A, Sarella A, Arampatzi C, Antoniou E. The Involvement of Past Traumatic Life Events in the Development of Postpartum PTSD after Cesarean Delivery. Healthcare (Basel) 2022; 10:1761. [PMID: 36141373 PMCID: PMC9498371 DOI: 10.3390/healthcare10091761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although childbirth is considered a natural process, a high percentage of postpartum women consider it traumatic. Any previous traumatic event in a woman's life can be revived through a traumatic birth experience, especially after a complicated vaginal delivery or cesarean delivery. The purpose of this study was to clarify the relationship between previous traumatic life events and posttraumatic stress disorder (PTSD) in postpartum women after cesarean section and which specific events exerted the greatest influence. METHODS A sample of 469 women who had undergone cesarean sections at a Greek university hospital consented to participate in this prospective study. Data from a medical/demographic questionnaire, life events checklist, perinatal stressor criterion A, and posttraumatic stress checklist were used to evaluate past traumatic life events and diagnose postpartum posttraumatic stress. RESULTS Out of 469 women, 25.97% had PTSD and 11.5% a PTSD profile, while 2.7% had PTSD and 2.7% a PTSD profile. Also, it appeared that only specific direct exposure to a traumatic event and/or witnessing one were predictors of postpartum PTSD. CONCLUSIONS This survey identified specific traumatic life events, psychiatric history, stressor perinatal criterion A, preterm birth, and emergency cesarean section as risk factors for the development of PTSD or a PTSD profile in women after cesarean delivery.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios S. Savvidis
- Department of Occupational Therapy, University of Western Macedonia, 50100 Kozani, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | | | - Angeliki Sarella
- 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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14
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Rajani F, Vaziri F, Yektatalab S, Sharifi N, Mani A, Akbarzadeh M. The correlation between postpartum stress disorder and maternal anxiety in different types of delivery (vaginal and cesarean section). CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2022.13.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Ginter N, Takács L, Boon MJM, Verhoeven CJM, Dahlen HG, Peters LL. The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148830. [PMID: 35886682 PMCID: PMC9316477 DOI: 10.3390/ijerph19148830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023]
Abstract
(1) Background: A traumatic birth can lead to the development of childbirth-related posttraumatic stress symptoms or disorder (CB-PTS/D). Literature has identified the risk factors for developing CB-PTS/D within the first six months postpartum thoroughly. However, the impact of mode of birth on CB-PTS/D beyond 6 months postpartum is scarcely studied. (2) Methods: A systematic search of the literature was conducted in the databases PubMed, Embase and CINAHL and PRISMA guidelines were followed. Studies were included if they reported the impact of mode of birth on CB-PTS/D beyond 6 months postpartum. (3) Results: In total, 26 quantitative and 2 qualitative studies were included. In the quantitative studies the percentage of women with CB-PTS/D ranged from 0.7% to 42% (between six months and five years postpartum). Compared with vaginal birth, operative vaginal birth, and emergency caesarean section were associated with CB-PTS/D beyond 6 months postpartum. Qualitative studies revealed that some women were suffering from CB-PTS/D as long as 18 years after birth. (4) Conclusions: Long- term screening of women for PTSD in the postnatal period could be beneficial. More research is needed on models of care that help prevent CB-PTS/D, identifying women at risk and factors that maintain CB-PTS/D beyond 6 months postpartum.
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Affiliation(s)
- Nicole Ginter
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Correspondence:
| | - Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, 116 42 Prague, Czech Republic;
| | - Martine J. M. Boon
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Lilian L. Peters
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
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16
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Junge-Hoffmeister J, Bittner A, Garthus-Niegel S, Goeckenjan M, Martini J, Weidner K. Subjective Birth Experience Predicts Mother–Infant Bonding Difficulties in Women With Mental Disorders. Front Glob Womens Health 2022; 3:812055. [PMID: 35479290 PMCID: PMC9035738 DOI: 10.3389/fgwh.2022.812055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background The subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders. Methods This study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses. Results About half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96*** (95% CI 0.94–0.98) vs. OR = 0.96** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled. Conclusions A negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.
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Affiliation(s)
- Juliane Junge-Hoffmeister
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Antje Bittner
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute for Systems Medicine, Faculty of Human Medicine, Medical School Hamburg, Hamburg, Germany
- Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Maren Goeckenjan
- Department of Gynecology and Obstetrics, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Martini
- Department for Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- *Correspondence: Kerstin Weidner
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17
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Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: A narrative review. Int J Gynaecol Obstet 2022; 159:356-364. [PMID: 35277971 DOI: 10.1002/ijgo.14175] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
Lumbar epidural is the most effective form of pain relief in labor with around 30% of laboring women in the UK and 60% in the USA receiving epidural analgesia. Associations of epidural on maternal, obstetric, and neonatal outcomes have been the subject of intense study, though a number of uncertainties persist. The present narrative review explores important areas of research surrounding epidural analgesia in obstetric patients including methods of initiation and administration, choice of local anesthetic solution, and the addition of adjuvants. Key meta-analyses exploring associations of epidural analgesia on maternal and neonatal outcomes are identified and summarized.
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Affiliation(s)
- Lucy Halliday
- School of Medicine, University of Glasgow, Glasgow, UK
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18
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Rottenstreich M, Rotem R, Hankin A, Rottenstreich A, Sela HY, Shen O, Grisaru-Granovsky S. Outcomes of attempted vaginal births after previous recurrent operative vaginal deliveries: An individual cumulative risk analysis. Birth 2022; 49:80-86. [PMID: 34254704 DOI: 10.1111/birt.12576] [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: 03/31/2020] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data about the risk of recurrence of vacuum extraction (VE) in multiple consecutive deliveries are scarce. We aimed to evaluate the pattern and individual cumulative risk of recurrence of VE in consecutive term deliveries. STUDY DESIGN A retrospective cohort study based on a validated electronic database at a single center between 2005 and 2019. For the purpose of the study, we focused on consecutive term deliveries of all primiparas (P1) that had a record of at least one additional delivery during the study period. We identified P1 VE deliveries (reference group) and calculated the individual cumulative risk of repeated VE for three consecutive deliveries. Multivariate analysis was conducted adjusting for potential confounders. RESULTS We identified 35 113 primiparas that met inclusion criteria. The overall VE rate for P1 was 17.9% (6969 parturient). The cumulative rates of repeated VEs at the 2nd, 3rd, and 4th deliveries were 8.6%, 26.8%, and 25.0%, respectively. The risk of recurrent VE for each of the consecutive deliveries was confirmed after adjustment for confounders (aOR [95% CI]: 5.8 [4.76-7.04], 34.2 [18.59-62.81], and 113.9 [9.77-1328.69] for the 2nd, 3rd, and 4th consecutive deliveries, respectively). CONCLUSION Women with VE at the first and second deliveries have a substantially increased risk of VE in their following deliveries; this finding may influence woman's preference when choosing future mode of delivery.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Aviel Hankin
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Ori Shen
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
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19
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Kountanis JA, Kirk R, Handelzalts JE, Jester JM, Kirk R, Muzik M. The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Arch Womens Ment Health 2022; 25:171-180. [PMID: 34250546 DOI: 10.1007/s00737-021-01154-z] [Citation(s) in RCA: 2] [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: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
Childbirth-related PTSD is generally believed to result from multiple factors, including negative objective and subjective experiences and patient predisposing factors. There is conflicting evidence regarding whether severe childbirth pain affects development of PTSD. We hypothesize that a woman's retrospective subjective appraisal of birth pain is a greater predictor of postpartum-onset PTSD than medically documented measures of pain, and that a positive subjective experience communicating with medical providers during labor also reduces risk for postpartum-onset PTSD. A sample of 112 women, who screened positive for psychopathology within a year postpartum, were interviewed probing for their subjective labor experiences. Interviews were coded for subjective labor pain perception and quality of provider communication. Regression analyses tested associations between subjective labor pain perception and quality of provider communication with postpartum PTSD. Pain scores recorded during labor were not significantly associated to probable PTSD at any recorded time point up to 12 months postpartum. Positive perception of birth pain was associated with reduced risk of probable PTSD at 6 weeks postpartum (aOR = 0.34, p = 0.03). Positive provider communication was associated with reduced risk of probable PTSD at 6 months (aOR = 0.29, p = 0.02) and 12 months (aOR = 0.2, p = 0.03) postpartum. Pain recorded during childbirth is not necessarily a negative experience leading to trauma. For some women, even severe pain may be seen positively, and lacks traumatizing elements. Interventions to positively shift women's childbirth pain appraisal and educate medical workforce in patient-provider communication may reduce rates of postpartum PTSD. ClinicalTrials.gov Indentifier: NCT03004872.
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Affiliation(s)
- Joanna A Kountanis
- Department of Anesthesiology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Robyn Kirk
- Kirk Consultancy, Edinburgh, Scotland
- School of Nursing, University College, London, UK
| | - Jonathan E Handelzalts
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
- School of Behavioral Sciences, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Jennifer M Jester
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
| | - Ros Kirk
- Kirk Consultancy, Edinburgh, Scotland
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA.
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20
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He Z, Chiu JWT, Lin Y, Akinwunmi B, Wong TH, Zhang CJP, Ming WK. The Construct Structures of Psychological and Behavioral Responses to COVID-19 Pandemic in Pregnant Women. Front Psychiatry 2022; 13:796567. [PMID: 35903641 PMCID: PMC9323087 DOI: 10.3389/fpsyt.2022.796567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
AIM The present study aimed to investigate the construct structure behind the psychosocial response, behavioral response, prenatal depression, and post-traumatic stress disorder (PTSD) in pregnant women during the COVID-19 pandemic in China. METHOD The validated Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), PTSD CheckList (PCL)-6, and two newly established scales for COVID-19-related psychological and behavioral responses were used. Structural equation modeling (SEM) analysis was applied to evaluate the structural relationships of psychological and behavioral responses during the COVID-19 pandemic. RESULTS Of the 1,908 mothers who completed the questionnaires, 1,099 met the criteria for perinatal depression, and 287 were positively screened for PTSD, where 264 women exceed the cut-off points for both. Pregnant women with full-time or part-time jobs tended to have the lowest scores of EPDS (10.07 ± 5.11, P < 0.001) and stress levels (23.85 ± 7.96, P = 0.004), yet they were more likely to change their behavior in accordance with the COVID-19 outbreak (13.35 ± 3.42, P = 0.025). The structural model fit the data (χ2 = 43.260, p < 0.001) and resulted in satisfactory fit indices (CFI = 0.984, TLI = 0.959, RMSEA = 0.072, and χ2/df = 10.815), all path loadings were significant (p < 0.05). The SEM indicates that the level of QoL was attributable to the occurrence of PND, leading to PTSD, and COVID-19 related behavioral and psychological responses. CONCLUSION The inter-relationships between the COVID-19-related psychosocial and behavioral responses have been assessed, indicating that the pandemic increased the burden of perinatal depression. Psychoeducation, as well as other psychological interventions, may be needed to alleviate the COVID-19-based anxiety and increase their engagement in protective behaviors.
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Affiliation(s)
- Zonglin He
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong SAR, China
| | - Joyce Wai-Ting Chiu
- International School, Jinan University, Guangzhou, China.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Psychology, University of York, York, United Kingdom
| | - Yuchen Lin
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Tak Hap Wong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Casper J P Zhang
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
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21
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Postpartum Post-Traumatic Stress Symptoms Following Cesarean Section-the Mediating Effect of Sense of Control. Psychiatr Q 2021; 92:1839-1853. [PMID: 34491482 DOI: 10.1007/s11126-021-09949-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
Our aim is to clarify the differences in post-traumatic symptom levels between women who had emergency cesarean sections (C-sections) and women who had elective ones and investigate the function of sense of control in post-traumatic symptoms development. On the fourth day after the C-section, participants were recruited and completed a demographic and background questionnaire. Six to eight weeks later, they received continuation questionnaires. A total of 161 women who underwent Cesarean-sections participated in the study's final sample. Women above the age of 18, who gave birth by elective or emergency cesarean-sections were included. Post-traumatic symptoms were measured by the post-traumatic stress disorder checklist for DSM-5 (PCL-5), and sense of control was measured by the Support and Control in Birth (SCIB) questionnaire. Demographic and background data were also taken. The relationship between the type of cesarean section and the post-traumatic symptom levels was fully mediated by the sense of internal control. Women who underwent emergency cesarean-sections experienced lower levels of internal control than women who had elective ones, which in turn, correlated negatively with post-traumatic symptom levels. The mediation model explained 38.5% of the variance in post-traumatic symptoms levels. An internal sense of control is important in reducing post-traumatic symptoms, especially among women undergoing emergency cesarean-sections. The medical team should develop an awareness of the importance of gaining an internal sense of control by including the antenatal woman in decision-making as much as possible. By explaining and normalizing physical and mental feelings, physicians can possibly reduce the prevalence and severity of postpartum post-traumatic symptoms.
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22
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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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23
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Martinez-Vázquez S, Rodríguez-Almagro J, Hernández-Martínez A, Delgado-Rodríguez M, Martínez-Galiano JM. Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth. Birth 2021; 48:406-415. [PMID: 33909303 DOI: 10.1111/birt.12550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.
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Affiliation(s)
| | - Julián Rodríguez-Almagro
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Miguel Delgado-Rodríguez
- Department of Health Sciences, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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24
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Sommerlad S, Schermelleh-Engel K, La Rosa VL, Louwen F, Oddo-Sommerfeld S. Trait anxiety and unplanned delivery mode enhance the risk for childbirth-related post-traumatic stress disorder symptoms in women with and without risk of preterm birth: A multi sample path analysis. PLoS One 2021; 16:e0256681. [PMID: 34464408 PMCID: PMC8407573 DOI: 10.1371/journal.pone.0256681] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
Childbirth-related post-traumatic stress disorder (CB-PTSD) occurs in 3-7% of all pregnancies and about 35% of women after preterm birth (PTB) meet the criteria for acute stress reaction. Known risk factors are trait anxiety and pain intensity, whereas planned delivery mode, medical support, and positive childbirth experience are protective factors. It has not yet been investigated whether the effects of anxiety and delivery mode are mediated by other factors, and whether a PTB-risk alters these relationships. 284 women were investigated antepartum and six weeks postpartum (risk-group with preterm birth (RG-PB) N = 95, risk-group with term birth (RG-TB) N = 99, and control group (CG) N = 90). CB-PTSD symptoms and anxiety were measured using standardized psychological questionnaires. Pain intensity, medical support, and childbirth experience were assessed by single items. Delivery modes were subdivided into planned vs. unplanned delivery modes. Group differences were examined using MANOVA. To examine direct and indirect effects on CB-PTSD symptoms, a multi-sample path analysis was performed. Rates of PTS were highest in the RG-PB = 11.58% (RG-TB = 7.01%, CG = 1.1%). MANOVA revealed higher values of CB-PTSD symptoms and pain intensity in RG-PB compared to RG-TB and CG. Women with planned delivery mode reported a more positive birth experience. Path modeling revealed a good model fit. Explained variance was highest in RG-PB (R2 = 44.7%). Direct enhancing effects of trait anxiety and indirect reducing effects of planned delivery mode on CB-PTSD symptoms were observed in all groups. In both risk groups, CB-PTSD symptoms were indirectly reduced via support by medical staff and positive childbirth experience, while trait anxiety indirectly enhanced CB-PTSD symptoms via pain intensity in the CG. Especially in the RG-PB, a positive birth experience serves as protective factor against CB-PTSD symptoms. Therefore, our data highlights the importance of involving patients in the decision process even under stressful birth conditions and the need for psychological support antepartum, mainly in patients with PTB-risk and anxious traits. Trial registration number: NCT01974531 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Sarah Sommerlad
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
| | | | | | - Frank Louwen
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
| | - Silvia Oddo-Sommerfeld
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
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25
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Sandoz V, Stuijfzand S, Lacroix A, Deforges C, Quillet Diop M, Ehlert U, Rubo M, Messerli-Bürgy N, Horsch A. The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder. J Pers Med 2021; 11:472. [PMID: 34073240 PMCID: PMC8228424 DOI: 10.3390/jpm11060472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic-pituitary-adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.
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Affiliation(s)
- Vania Sandoz
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Alain Lacroix
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Magali Quillet Diop
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, 8050 Zurich, Switzerland;
| | - Marius Rubo
- Clinical Child Psychology & Biological Psychology, University of Fribourg, 1701 Fribourg, Switzerland; (M.R.); (N.M.-B.)
| | - Nadine Messerli-Bürgy
- Clinical Child Psychology & Biological Psychology, University of Fribourg, 1701 Fribourg, Switzerland; (M.R.); (N.M.-B.)
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (S.S.); (A.L.); (C.D.); (M.Q.D.)
- Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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26
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Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Khan KS, Delgado-Rodríguez M, Martínez-Galiano JM. Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period. Sci Rep 2021; 11:5567. [PMID: 33692452 PMCID: PMC7946897 DOI: 10.1038/s41598-021-85144-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/25/2021] [Indexed: 11/09/2022] Open
Abstract
To determine the psychometric properties of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ) in Spanish. A cross-sectional study of 432 Spanish puerperal women was conducted, following ethical approval. The PPQ was administered online through midwives' associations across Spain. The Edinburgh Postnatal Depression Scale was used to diagnose postnatal depression for examining criterion validity. Data were collected on sociodemographic, obstetric, and neonatal variables. An exploratory factorial analysis (EFA) was performed with convergence and criterion validation. Internal consistency was evaluated using Cronbach's α. The EFA identified three components that explained 63.3% of variance. The PPQ's convergence validation associated the risk of PTSD with variables including birth plan, type of birth, hospital length of stay, hospital readmission, admission of the newborn to care unit, skin-to-skin contact, maternal feeding at discharge, maternal perception of partner support, and respect shown by healthcare professionals during childbirth and puerperium. The area under the ROC curve for the risk of postnatal depression (criterion validity) was 0.86 (95% CI 0.82-0.91). Internal consistency with Cronbach's α value was 0.896. The PPQ used when screening for PTSD in postpartum Spanish women showed adequate psychometric properties.
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Affiliation(s)
- Antonio Hernández-Martínez
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, C/Cuadras nº 8 Bajo, Ciudad Real, Spain
| | | | - Julian Rodríguez-Almagro
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, C/Cuadras nº 8 Bajo, Ciudad Real, Spain.
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Miguel Delgado-Rodríguez
- Department of Health Sciences, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaén, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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27
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Elaboration and Validation of Two Predictive Models of Postpartum Traumatic Stress Disorder Risk Formed by Variables Related to the Birth Process: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010092. [PMID: 33374483 PMCID: PMC7795639 DOI: 10.3390/ijerph18010092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022]
Abstract
This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67–0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63–0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79–0.85) and 0.83 (95% CI: 0.78–0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.
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28
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Malmquist A, Nieminen K. Negotiating who gives birth and the influence of fear of childbirth: Lesbians, bisexual women and transgender people in parenting relationships. Women Birth 2020; 34:e271-e278. [PMID: 32418651 DOI: 10.1016/j.wombi.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied. AIM The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC. METHODS Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis. RESULTS FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care. CONCLUSIONS It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Katri Nieminen
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
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29
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Benton M, Salter A, Tape N, Wilkinson C, Turnbull D. Women's psychosocial outcomes following an emergency caesarean section: A systematic literature review. BMC Pregnancy Childbirth 2019; 19:535. [PMID: 31888530 PMCID: PMC6937939 DOI: 10.1186/s12884-019-2687-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Given the sudden and unexpected nature of an emergency caesarean section (EmCS) coupled with an increased risk of psychological distress, it is particularly important to understand the psychosocial outcomes for women. The aim of this systematic literature review was to identify, collate and examine the evidence surrounding women’s psychosocial outcomes of EmCS worldwide. Methods The electronic databases of EMBASE, PubMed, Scopus, and PsycINFO were searched between November 2017 and March 2018. To ensure articles were reflective of original and recently published research, the search criteria included peer-reviewed research articles published within the last 20 years (1998 to 2018). All study designs were included if they incorporated an examination of women’s psychosocial outcomes after EmCS. Due to inherent heterogeneity of study data, extraction and synthesis of both qualitative and quantitative data pertaining to key psychosocial outcomes were organised into coherent themes and analysis was attempted. Results In total 17,189 articles were identified. Of these, 208 full text articles were assessed for eligibility. One hundred forty-nine articles were further excluded, resulting in the inclusion of 66 articles in the current systematic literature review. While meta-analyses were not possible due to the nature of the heterogeneity, key psychosocial outcomes identified that were negatively impacted by EmCS included post-traumatic stress, health-related quality of life, experiences, infant-feeding, satisfaction, and self-esteem. Post-traumatic stress was one of the most commonly examined psychosocial outcomes, with a strong consensus that EmCS contributes to both symptoms and diagnosis. Conclusions EmCS was found to negatively impact several psychosocial outcomes for women in particular post-traumatic stress. While investment in technologies and clinical practice to minimise the number of EmCSs is crucial, further investigations are needed to develop effective strategies to prepare and support women who experience this type of birth.
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Affiliation(s)
- Madeleine Benton
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Amy Salter
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicole Tape
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Chris Wilkinson
- Maternal Fetal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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30
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Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2019; 29:200-209. [PMID: 31532326 DOI: 10.1089/jwh.2019.7750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
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Affiliation(s)
- Yanfang Chen
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lixing Guo
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
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31
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Hernández-Martínez A, Rodríguez-Almagro J, Molina-Alarcón M, Infante-Torres N, Donate Manzanares M, Martínez-Galiano JM. Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life. J Affect Disord 2019; 249:143-150. [PMID: 30772741 DOI: 10.1016/j.jad.2019.01.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/31/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied. OBJECTIVE Determine the prevalence of PTSD at postpartum weeks 4 and 6, and its relation with perinatal variables and quality of life METHOD: A cross-sectional study with 2990 Spanish puerperal women in Spain. Data were collected on socio-demographic and obstetric variables, and on newborns. An online ad hoc questionnaire was used, including the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) and SF-36. The crude and adjusted odds ratios were estimated by binary logistic regression. RESULTS 10.6% (318) of the women appeared at risk for PTSD symptoms. Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD, among others. Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors, among others. The area under the ROC curve in this model was 0.79 (95%CI: 0.76, 0.81). The women with PTSD presented a mean difference for QoL of -13.37 points less than those without PTSD (95%CI: -11.08, -15.65). CONCLUSIONS The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.
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Affiliation(s)
| | | | | | | | | | - Juan Miguel Martínez-Galiano
- Department of Health Sciencies, University of Jaen, Jaen, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Madrid, Spain
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Hernández-Martínez A, Rodríguez-Almagro J, Molina-Alarcón M, Infante-Torres N, Rubio-Álvarez A, Martínez-Galiano JM. Perinatal factors related to post-traumatic stress disorder symptoms 1-5 years following birth. Women Birth 2019; 33:e129-e135. [PMID: 30954482 DOI: 10.1016/j.wombi.2019.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between perinatal variables and post-traumatic stress disorder (PTSD) symptoms was studied. However, the role of some variables in PTSD symptoms is unclear. AIM Determine the prevalence of PTSD symptoms after 1 year postpartum and their relationship with perinatal variables. METHODS A cross-sectional study with 1531 puerperal women in Spain. Data were collected on socio-demographic variables, perinatal variables (maternal characteristics, procedures during labour and birth, birth outcomes and time since birth) and the newborn. An online questionnaire was used, which included the Perinatal Post-traumatic Stress Questionnaire (PPQ). Crude and adjusted odds ratios (OR) were calculated using binary logistic regression. FINDINGS 7.2% (110) of the women were identified as being at risk for probable PTSD symptoms. Protective factors were having a birth plan respected (aOR 0.44; 95%CI 0.19-0.99), use of epidural analgesia (aOR 0.44; 95%CI 0.24-0.80) and experiencing skin-to-skin contact (aOR 0.33; 95%CI 0.20-0.55). Risk factors were instrumental birth (aOR 3.32; 95%CI1.73-3.39), caesarean section (aOR 4.80; 95%CI 2.51-9.15), receiving fundal pressure (aOR 1.72; 95%CI 1.08-2.74) and suffering a third/fourth degree perineal tear (aOR 2.73; 95%CI 1.27-5.86). The area under the model's ROC curve was 0.82 (95%CI 0.79-0.83). CONCLUSIONS Women who experience a normal birth, are psychologically prepared for birth (for example, through use of a birth plan), experience skin-to-skin contact with their newborn, and had a sense of physical control through the use of epidural analgesia, are less likely to experience childbirth as traumatic.
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Abdollahpour S, Motaghi Z. Lived Traumatic Childbirth Experiences of Newly Delivered Mothers Admitted to the Postpartum Ward: a Phenomenological Study. J Caring Sci 2019; 8:23-31. [PMID: 30915310 PMCID: PMC6428162 DOI: 10.15171/jcs.2019.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/02/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: Childbirth is a stressful event in every woman's life, leading to traumatic deliveries in half of the cases. This study aimed at describing mothers’ lived experiences which make them perceive their childbirth as traumatic. Methods: In this descriptive phenomenological study, based on the DSM-V-A criteria, 32 mothers who had perceptions of a traumatic event during their labor and delivery were explored through semi-structured interviews, and the collected data were analyzed using the Colaizzi’s method. Results: Four main themes could be extracted from the experiences of the mothers. The first theme was sensational and emotional experiences followed by clinical experiences, legal experiences and human dignity, and environmental experiences. The sensational and emotional experiences included four main categories (anxiety, fear, sorrow, anger). The theme of clinical experiences included two main categories (avoidable and unavoidable childbirth complications). The theme of legal experiences and human dignity included two main categories (non-observance of the charter of patient rights, and non-observance of human rights). The theme of environmental experiences also included two main categories (lack of proper supervision and management). Conclusion: To prevent traumatic childbirth and its negative effects, different psychological aspects of childbirth need to be identified.
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Affiliation(s)
- Sedigheh Abdollahpour
- Department of Midwifery, Nursing and Midwifery Faculty, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zahra Motaghi
- Reproductive Studies and Women'S Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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Yalnız Dilcen H, Genc R. The effects of Psychoeducation on the Traumatic Perception of the Birth Phenomenon in women with Substance-use Disorders. Subst Use Misuse 2019; 54:2066-2074. [PMID: 31268377 DOI: 10.1080/10826084.2019.1618335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The present study evaluates the traumatic perception of the birth phenomenon in women with substance-use disorders (SUD) and to investigate the effects of psychoeducation on this perception. Material and Methods: The study was conducted between January and July 2017, and involved 60 women with SUD who were divided into two groups: intervention (n = 30) and control (n = 30). The study was carried out using the semi-experimental "pre-post test matched group model," and the Traumatic Perception of Birth Psychoeducation Program (TPBPP) was applied. Results: Traumatic birth perception was found to be decreased after TPBPP was applied in four modules to women with SUD. Conclusion: TPBPP is an effective psychoeducation model in the reduction of the traumatic perception of birth in women with SUD.
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Affiliation(s)
- Hacer Yalnız Dilcen
- Bartın University Faculty of Health Sciences, Midwifery Department , Turkey.,Hurma Mah Hurma Cad No: 88 , Antalya , Türkiye
| | - Rabia Genc
- Faculty of Health Sciences , Midwifery Department, Ege University , Izmir , Turkey
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MacKinnon AL, Houazene S, Robins S, Feeley N, Zelkowitz P. Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress. Front Psychol 2018; 9:2379. [PMID: 30618902 PMCID: PMC6279867 DOI: 10.3389/fpsyg.2018.02379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022] Open
Abstract
Childbirth-related post-traumatic stress has potentially negative and enduring consequences for the well-being of women and their families. Although research to date has identified attachment style and trauma history as individual risk factors, they have yet to be examined as integrative processes in the development and maintenance of childbirth-related post-traumatic stress. The current investigation aimed to examine whether attachment style may moderate the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology across the first 6 months of the postpartum period. A large community sample of women were recruited from two Canadian urban hospitals. Childbirth-related post-traumatic stress symptoms were assessed longitudinally at 5 weeks, 2 months, and 6 months postpartum. Latent growth curve modeling (n = 251) revealed that attachment style moderated the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology, while controlling for other well-established psychosocial (e.g., trait anxiety, previous psychopathology, lack of perceived support) and childbirth-related (e.g., mode of birth, labor pain, subjective experience) risk factors. More secure attachment conferred resiliency and more fearful attachment conferred vulnerability among women without a history of interpersonal trauma, while more preoccupied and more dismissing attachment conferred resiliency among women with a history of interpersonal trauma. These findings highlight the importance of understanding the integrative processes among risk and protective factors underlying the development of and ability to cope with childbirth-related post-traumatic stress. Attachment style and trauma history, which can be quickly measured, should be considered as targets in antenatal screening.
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Affiliation(s)
- Anna L. MacKinnon
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Houazene
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Nancy Feeley
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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Martínez AH, Almagro JR, Alarcón MM, Torres NI, Alvarez AR, Galiano JMM. WITHDRAWN: Post-traumatic stress disorder-related perinatal factors after the first postpartum year. Midwifery 2018. [DOI: 10.1016/j.midw.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Horsch A, Vial Y, Favrod C, Harari MM, Blackwell SE, Watson P, Iyadurai L, Bonsall MB, Holmes EA. Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behav Res Ther 2017; 94:36-47. [PMID: 28453969 PMCID: PMC5466064 DOI: 10.1016/j.brat.2017.03.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/02/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513.
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Affiliation(s)
- Antje Horsch
- Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland; Department of Endocrinology, Diabetes, and Metabolism, University Hospital Lausanne, Lausanne, Switzerland.
| | - Yvan Vial
- Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland
| | - Céline Favrod
- Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland
| | - Mathilde Morisod Harari
- Department of Child and Adolescent Psychiatry, University Hospital Lausanne, Lausanne, Switzerland
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | | | | | - Emily A Holmes
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Tomsis Y, Gelkopf M, Yerushalmi H, Zipori Y. Different coping strategies influence the development of PTSD among first-time mothers. J Matern Fetal Neonatal Med 2017; 31:1304-1310. [PMID: 28372468 DOI: 10.1080/14767058.2017.1315658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the different coping strategies for post-traumatic stress disorder (PTSD), described in the non-obstetric trauma literature, with respect to first time postpartum women. STUDY DESIGN This was a prospective cohort study conducted between 2011 and 2013. Eligible women had a singleton pregnancy and delivered a healthy newborn at term. Five sets of relevant questionnaires were sent to the participants six weeks postpartum. Posttraumatic stress disorder was defined as per DSM-V criteria. RESULTS One hundred and eighty eight completed questionnaires were considered for the final analysis. Two women (1.1%) had PTSD and nine women (4.8%) had partial PTSD. Coping by self-blame and/or rumination together with perception of resource loss emerged as independent variables that were significantly associated with post-traumatic symptomatology (PTS) severity. Objective birth factors such as participation in birth classes or the different modes of delivery seem to have no significant impact on postpartum PTS in our study. CONCLUSIONS Cognitive coping styles such as self-blame and rumination, as well as perception of resource loss, were all related to postpartum PTS. Redirecting resources to address postpartum negative coping mechanisms may reduce the overall incidence of full and partial postpartum PTSD.
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Affiliation(s)
- Yeela Tomsis
- a Department of Community Mental Health, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel.,b Nursing School, Zefat Academic College , Zefat , Israel
| | - Marc Gelkopf
- a Department of Community Mental Health, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Hanoch Yerushalmi
- a Department of Community Mental Health, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Yaniv Zipori
- c Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , St. Michael's Hospital, University of Toronto , Toronto , Canada
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MacKinnon AL, Yang L, Feeley N, Gold I, Hayton B, Zelkowitz P. Birth setting, labour experience, and postpartum psychological distress. Midwifery 2017; 50:110-116. [PMID: 28412526 DOI: 10.1016/j.midw.2017.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 03/25/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE although psychosocial risk factors have been identified for postpartum depression (PPD) and perinatal posttraumatic stress disorder (PTSD), the role of labour- and birth-related factors remains unclear. The present investigation explored the impact of birth setting, subjective childbirth experience, and their interplay, on PPD and postpartum PTSD. METHOD in this prospective longitudinal cohort study, three groups of women who had vaginal births at a tertiary care hospital, a birthing center, and those transferred from the birthing centre to the tertiary care hospital were compared. Participants were followed twice during pregnancy (12-14 and 32-34 weeks gestation) and twice after childbirth (1-3 and 7-9 weeks postpartum). RESULTS symptoms of PPD and PTSD did not significantly differ between birth groups; however, measures of subjective childbirth experience and obstetric factors did. Moderation analyses indicated a significant interaction between pain and birth group, such that higher ratings of pain among women who were transferred was associated with greater symptoms of postpartum PTSD. CONCLUSION AND IMPLICATIONS FOR PRACTICE women who are transferred appear to have a unique experience that may put them at greater risk for postpartum psychological distress. It may be beneficial for care providers to help prepare women for pain management and potential unexpected complications, particularly if it is their first childbirth.
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Affiliation(s)
- Anna L MacKinnon
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Lisa Yang
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada; Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Ian Gold
- Department of Philosophy, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Barbara Hayton
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada.
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Preis H, Benyamini Y. The birth beliefs scale - a new measure to assess basic beliefs about birth. J Psychosom Obstet Gynaecol 2017; 38:73-80. [PMID: 27766924 DOI: 10.1080/0167482x.2016.1244180] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Basic beliefs about birth as a natural and safe or a medical and risky process are central in the decisions on where and how to birth. Despite their importance, they have not been studied separately from other childbirth-related constructs. Our aim was to develop a measure to assess these beliefs. METHOD Pregnant Israeli women (N = 850, gestational week ≥14) were recruited in women's health centers, in online natural birth forums, and through home midwives. Participants filled in questionnaires including sociodemographic and obstetric background, the Birth Beliefs Scale (BBS), dispositional desire for control (DC) and planned mode of delivery. RESULTS Factor analyses revealed that the BBS is composed of two factors: beliefs about birth as a natural process and beliefs about birth as a medical process. Both subscales showed good internal and test-retest reliability. They had good construct validity, predicted birth choices, and were weakly correlated with DC. Women's medical obstetric history was associated with the BBS, further supporting the validity of the scale. DISCUSSION Beliefs about birth may be the building blocks that make up perceptions of birth and drive women's preferences. The new scale provides an easy way to distinctly assess them so they can be used to further understand planned birth behaviors. Additional studies are needed to comprehend how these beliefs form in different cultural contexts and how they evolve over time.
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Affiliation(s)
- Heidi Preis
- a Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
| | - Yael Benyamini
- a Bob Shapell School of Social Work , Tel Aviv University , Tel Aviv , Israel
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Scheepstra KWF, van Steijn ME, Dijksman LM, van Pampus MG. Post-traumatic stress disorder in women and their partners, following severe post-partum hemorrhage: A study protocol for a prospective cohort study. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1278840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Karel Willem Frank Scheepstra
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090 HM, 95500 Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Minouk Esmée van Steijn
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090 HM, 95500 Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lea Magdalena Dijksman
- Department of Research and Epidemiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090 HM, 95500 Amsterdam, The Netherlands
- Department of Research and Epidemiology, St. Antoniusziekenhuis, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Maria Gabriel van Pampus
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1090 HM, 95500 Amsterdam, The Netherlands
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Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord 2017; 208:634-645. [PMID: 27865585 DOI: 10.1016/j.jad.2016.10.009] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/04/2016] [Accepted: 10/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. METHODS PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. RESULTS 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. LIMITATIONS Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. CONCLUSIONS PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
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Affiliation(s)
- Pelin Dikmen Yildiz
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Louise Phillips
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
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Abdollahpour S, Mousavi SA, Motaghi Z, Keramat A, Khosravi A. Prevalence and risk factors for developing traumatic childbirth in Iran. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0783-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study. Midwifery 2016; 44:14-23. [PMID: 27865160 DOI: 10.1016/j.midw.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/16/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas. DESIGN a longitudinal, observational survey. SETTING participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum. MEASUREMENTS The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth. FINDINGS of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001). KEY CONCLUSIONS antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women. IMPLICATION FOR PRACTICE the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.
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Gökçe İsbİr G, İncİ F, Bektaş M, Dikmen Yıldız P, Ayers S. Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey. Midwifery 2016; 41:96-103. [DOI: 10.1016/j.midw.2016.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 06/08/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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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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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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Gosselin P, Chabot K, Béland M, Goulet-Gervais L, Morin AJS. [Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms]. Encephale 2016; 42:191-6. [PMID: 26924001 DOI: 10.1016/j.encep.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested. METHOD Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum). RESULTS Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD. CONCLUSIONS These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.
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Affiliation(s)
- P Gosselin
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada.
| | - K Chabot
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - M Béland
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - L Goulet-Gervais
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - A J S Morin
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australie
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Mahmoodi Z, Dolatian M, Shaban Z, Shams J, Alavi-Majd H, Mirabzadeh A. Correlation between Kind of Delivery and Posttraumatic Stress Disorder. Ann Med Health Sci Res 2016; 6:356-361. [PMID: 28540103 PMCID: PMC5423335 DOI: 10.4103/amhsr.amhsr_397_15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a very common mental condition and a unique anxiety disorder. Aim: The present study tried to examine the correlation between kind of delivery and PTSD. Subjects and Methods: This prospective study evaluated 240 Iranian female residents of Tehran, Iran, during the third trimester of their pregnancy and 6–8 weeks after labor. Data were collected using the customized screening form, the Symptom Checklist-90, PTSD Symptom Scale (PSS), and Social Support Questionnaire. The collected data were then analyzed with SPSS software. Results: According to the participants' responses to the subscales of the PSS, reexperiencing, avoidance, and hyperarousal symptoms were present in 100, 25, and 77 participants, respectively. Moreover, 15 individuals manifested all three groups of symptoms. Therefore, the prevalence of PTSD in the studied population was 6.2%. The logistic regression analysis revealed PTSD to be 0.06 times more prevalent in women with poor social support after delivery than in those enjoying a desirable level of support (P < 0.01; odds ratio = 0.06). Based onChisquare test results, there was no significant correlation between the kind of delivery and the incidence of PTSD after delivery (P = 0.48). Conclusion: Since PTSD was more common after cesarean sections (than after vaginal deliveries), health policymakers need to develop efficient strategies to promote vaginal delivery.
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Affiliation(s)
- Z Mahmoodi
- Social Determinant of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - M Dolatian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Shaban
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J Shams
- Department of Psychiatry, Behavioral Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Alavi-Majd
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Mirabzadeh
- Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Psychiatric, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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