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Hadid S, Tomsis Y, Perez E, Sharabi L, Shaked M, Haze S. The role of expectations, subjective experience, and pain in the recovery from an elective and emergency caesarean section: A structural equation model. J Reprod Infant Psychol 2024; 42:915-933. [PMID: 36879419 DOI: 10.1080/02646838.2023.2187357] [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: 03/02/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. OBJECTIVE This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. METHODS Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. RESULTS Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. CONCLUSION The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted.
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Affiliation(s)
- Salam Hadid
- Nursing school, Zefat academic college, Zefat, Israel
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Yeela Tomsis
- Nursing school, Zefat academic college, Zefat, Israel
| | - Ester Perez
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Limor Sharabi
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Moshit Shaked
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Shani Haze
- Maternity ward, Galilee medical center, Nahariya, Israel
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Liu XY, Chen XB, Wen YL, Guo XP, Zhou XB. Effect of psychological nursing intervention combined with acupressure on postoperative recovery of women after cesarean section. World J Clin Cases 2024; 12:4527-4535. [PMID: 39070839 PMCID: PMC11235511 DOI: 10.12998/wjcc.v12.i21.4527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/09/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Psychological intervention nursing (PIN) has been considered to have a curative effect on cesarean section (CS) postoperative recovery. However, the therapeutic mechanisms remain obscure. AIM To explore the effects of PIN combined with acupressure massage on CS postoperative recovery. METHODS A retrospective study was conducted on 150 pregnant women admitted to an obstetrics department between January 2020 and January 2023. The control group (CG) received acupressure therapy (n = 73), and the intervention group (IG) received acupressure therapy and PIN therapy (n = 77). Postoperative recovery time was assessed by anal-exhausting, defecation, bed activity, breastfeeding, and hospital stay times. Adverse effects, including infection, bleeding, limb numbness, intrauterine hematoma, urinary retention, and venous thromboembolism, were recorded. the pain visual analogue scale (VAS) was used to evaluate the degree of pain. Anxiety and depression status were qualitatively assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Edinburgh postpartum depression scale (EPDS). The Pittsburgh sleep quality index (PSQI) was used to compare sleep quality between the groups. RESULTS The baseline data and SAS, SDS, EPDS, and PSQI scores did not significantly differ before CS (P > 0.05) and neither did complication rates between the two groups after CS (P > 0.05). However, anal-exhausting, defecation, waking up, breastfeeding, and hospitalization times were significantly shorter for participants in the IG than those for participants in the CG (P < 0.05). The VAS, SAS, SDS, EPDS, and PSQI scores of the IG were significantly lower than those of the CG (P < 0.05). CONCLUSION PIN, combined with acupressure massage, effectively promotes maternal recovery, reduces post-CS pain, and improves postoperative negative emotions and sleeping quality.
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Affiliation(s)
- Xing-Ying Liu
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Bo Chen
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - You-Liang Wen
- Rehabilitation Therapy Teaching and Research Office, Rehabilitation College of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Ping Guo
- Department of Rehabilitation Medicine, Second Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
| | - Xiao-Bin Zhou
- Dermatology and Plastic Surgery Department, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
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Hajure M, Alemu SS, Abdu Z, Tesfaye GM, Workneh YA, Dule A, Adem Hussen M, Wedajo LF, Gezimu W. Resilience and mental health among perinatal women: a systematic review. Front Psychiatry 2024; 15:1373083. [PMID: 39104881 PMCID: PMC11298415 DOI: 10.3389/fpsyt.2024.1373083] [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: 01/19/2024] [Accepted: 06/28/2024] [Indexed: 08/07/2024] Open
Abstract
Objective This review aimed to assess the current evidence on the relationship between resilience and mental health employed in response to the impacts of mental health. Method This review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). The protocol of this review was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023470966). Three authors searched peer-reviewed articles using several electronic databases, including Scopus, PubMed/MEDLINE, Psych Info, EMBASE, and Web of Science, from September to October 2023 and included all the studies from any time until November 1, 2023. The review included all eligible quantitative observational and qualitative studies, irrespective of geographical boundaries. Result Depression, anxiety, and post-traumatic stress disorders were found to be the most common, but not the only, mental health disorders during the perinatal period, and higher maternal resilience during perinatal periods was found to reduce mental health disorders. It was also found that pregnant women were more resilient to mental health disorders than postpartum women. Tolerance of uncertainty and a positive cognitive appraisal, women's self-behavior and family functioning, and protective psychosocial resources such as dispositional optimism, parental sense of mastery, self-esteem, gratitude, and forgiveness were found to be the most common mechanisms of resilience among perinatal women. Older age, having an adolescent partner, family income, and distress were found to affect resilience. Conclusion Noting that women's resilience is an important tool to prevent perinatal mental health disorders, maternal healthcare providers need to counsel perinatal women on resilience-boosting mechanisms, such as applying self-behavior and having social support or close family relationships. It is recommended to counsel or provide psychosocial interventions for the woman's companion or partner to give strong support for the woman in each of the perinatal periods. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=470966, identifier CRD42023470966.
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Affiliation(s)
| | | | - Zakir Abdu
- Department of Psychiatry, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | | | | | - Aman Dule
- Department of Psychiatry, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Mustefa Adem Hussen
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Lema Fikadu Wedajo
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Wubishet Gezimu
- Department of Nursing, College of Health Sciences, Mattu University, Mattu, Ethiopia
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Miller ML, Laifer LM, Thomas EBK, Grekin R, O'Hara MW, Brock RL. From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women. J Affect Disord 2024; 357:11-22. [PMID: 38663559 PMCID: PMC11149003 DOI: 10.1016/j.jad.2024.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Department of Psychiatry, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St., Indianapolis, IN 46202, United States of America; University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America.
| | - Lauren M Laifer
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| | - Emily B K Thomas
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca Grekin
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Michael W O'Hara
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca L Brock
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
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Kahalon R, Handelzalts JE. Investigating the under-recognition of childbirth-related post-traumatic stress disorder among the public and mental health professionals. J Anxiety Disord 2024; 106:102897. [PMID: 39002510 DOI: 10.1016/j.janxdis.2024.102897] [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: 02/21/2024] [Revised: 06/13/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Childbirth posttraumatic stress disorder (PTSD) poses significant challenges, impacting both mothers and infants. This work investigates whether childbirth PTSD is less recognized than PTSD caused by other index events. METHODS In two preregistered experimens we investigated the public and professional perception of PTSD resulting from childbirth compared to other traumatic events (i.e., sexual assault, car accident, terror attack, and an earthquake). FINDINGS Study 1, conducted among the general population in the U.S. revealed that a woman depicted as experiencing PTSD symptoms due to childbirth, was less likely to be recognized as suffering from PTSD than a woman with the same symptoms resulting from other traumatic events. Study 2 demonstrated that mental health professionals worldwide are also less inclined to diagnose PTSD when childbirth is the index event in comparison to other index events. DISCUSSION Due to the importance of social recognition in the treatment of PTSD, the findings underscore the urgent need for heightened awareness and education regarding childbirth PTSD to bridge the recognition gap among the general population and mental health professionals.
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Affiliation(s)
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, Tel-Aviv Yafo Academic College, Israel; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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Tenne Y, Kahalon R, Daari L, Preis H, Eisner M, Chen R, Mor P, Grisaru Granovsky S, Samueloff A, Benyamini Y. Is Oxytocin Administration During Childbirth Associated With Increased Risk for Postpartum Posttraumatic Stress Symptoms?: A Preliminary Investigation. J Perinat Neonatal Nurs 2024; 38:315-325. [PMID: 38050984 DOI: 10.1097/jpn.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum ( N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.
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Affiliation(s)
- Yaara Tenne
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Tenne); The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel (Drs Tenne, Preis, and Benyamini and Ms Daari); The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel (Dr Kahalon); Department of Psychology, Stony Brook University, Stony Brook, New York (Dr Preis); Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Eisner and Chen); Department of Obstetrics and Gynecology, Medical Genetics Institute, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Dr Mor); and Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Drs Grisaru Granovsky and Samueloff)
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Suchanecki L, Goutaudier N. Childbirth as an anticipated trauma during pregnancy: pretraumatic stress symptoms in primiparous women. J Reprod Infant Psychol 2024; 42:668-680. [PMID: 36266766 DOI: 10.1080/02646838.2022.2137118] [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: 04/06/2022] [Accepted: 10/09/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Women can develop anticipated traumatic reactions related to the forthcoming delivery through "pretraumatic stress" symptoms. The present study aims at: a) exploring the frequency of probable pretraumatic stress disorder in primiparous pregnant women, b) evidencing associated features of pretraumatic stress symptoms and c) exploring which specific components of antenatal anxiety are associated with pretraumatic stress symptoms. METHODS A sample of 100 primiparous pregnant women completed an online questionnaire assessing pretraumatic stress, fear of childbirth, depressive and anxiety symptoms. Socio-demographic and pregnancy-related data were also gathered. RESULTS 8 % of women met all criteria for probable pretraumatic stress disorder. Increased depressive symptoms (ß = 0.48, p< .05), childbirth concerns (ß = 0.47, p< .05) and worry about self (ß = 0.74; p< .05) were associated with the intensity of pretraumatic stress disorder symptoms. CONCLUSION This study contributes to the very limited literature on pretraumatic stress symptoms. Thus, it is noteworthy that pretraumatic stress is not a reactivation of a former postpartum PTSD or associated with a prior negative experience of childbirth. Future studies conducted on primiparous women with no history of traumatic exposure could allow to provide additional evidences of the existence of anticipated traumatic reactions of childbirth.
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Affiliation(s)
- Lara Suchanecki
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
| | - Nelly Goutaudier
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
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Arora IH, Woscoboinik GG, Mokhtar S, Quagliarini B, Bartal A, Jagodnik KM, Barry RL, Edlow AG, Orr SP, Dekel S. A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study. Am J Obstet Gynecol 2024; 231:134.e1-134.e13. [PMID: 37981091 PMCID: PMC11175478 DOI: 10.1016/j.ajog.2023.11.1229] [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: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing posttraumatic stress disorder. Postpartum posttraumatic stress disorder, or childbirth-related posttraumatic stress disorder, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related posttraumatic stress disorder are lacking. OBJECTIVE We examined the diagnostic validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for detecting posttraumatic stress disorder among women who have had a traumatic childbirth. This Checklist assesses the 20 Diagnostic and Statistical Manual of Mental Disorders, posttraumatic stress disorder symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy for detecting childbirth-related posttraumatic stress disorder is unknown. STUDY DESIGN The sample included 59 patients who reported a traumatic childbirth experience determined in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder criterion A for exposure involving a threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) of the participants were less than 1 year postpartum (for full sample: median, 4.67 months; mean, 1.5 years) and were recruited via the Mass General Brigham's online platform, during the postpartum unit hospitalization or after discharge. Patients were instructed to complete the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, concerning posttraumatic stress disorder symptoms related to childbirth. Other comorbid conditions (ie, depression and anxiety) were also assessed. They also underwent a clinician interview for posttraumatic stress disorder using the gold-standard Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A second administration of the Checklist was performed in a subgroup (n=43), altogether allowing an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the Checklist. The diagnostic accuracy of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in reference to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was determined using the area under the receiver operating characteristic curve; an optimal cutoff score was identified using the Youden's J index. RESULTS One-third of the sample (35.59%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a posttraumatic stress disorder diagnosis stemming from childbirth. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptom severity score was strongly correlated with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, total score (ρ=0.82; P<.001). The area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.87-0.99), indicating excellent diagnostic performance of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A cutoff value of 28 optimized the sensitivity (0.81) and specificity (0.90) and correctly diagnosed 86% of women. A higher value (32) identified individuals with more severe posttraumatic stress disorder symptoms (specificity, 0.95), but with lower sensitivity (0.62). Checklist scores were also stable over time (intraclass correlation coefficient, 0.73), indicating good test-retest reliability. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores were moderately correlated with the depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale: ρ=0.58; P<.001 and the Brief Symptom Inventory, anxiety subscale: ρ=0.51; P<.001). CONCLUSION This study demonstrates the validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a screening tool for posttraumatic stress disorder among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related posttraumatic stress disorder on a large scale and help identify women who might benefit from further diagnostics and services. Replication of the findings in larger, postpartum samples is needed.
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Affiliation(s)
- Isha Hemant Arora
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Georgia G Woscoboinik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Salma Mokhtar
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Beatrice Quagliarini
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alon Bartal
- The School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Kathleen M Jagodnik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA; Harvard Medical School, Boston, MA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston MA
| | - Scott P Orr
- Department of Psychiatry, Harvard Medical School, Boston MA; Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Sharon Dekel
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA.
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Scott J, Hauspurg A, Davis EM, Bryan S, Catov JM. Maternal Mental Health, COVID-19-Related Distress, and Disruptions in Lifestyle Behaviors Among Postpartum Mothers With a Previous Hypertensive Disorder of Pregnancy. J Cardiovasc Nurs 2024; 39:318-324. [PMID: 37723619 PMCID: PMC10948378 DOI: 10.1097/jcn.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Many perinatal people experienced pandemic-related distress and changes in health behaviors at the onset of the COVID-19 pandemic, but less is known about how the pandemic continued to impact their health. OBJECTIVE The authors of this study examined the influence of pandemic-related distress and maternal mental health on postpartum lifestyle behaviors of mothers with a previous hypertensive disorder of pregnancy. METHODS Between September 2021 and March 2022, 82 postpartum (19.2 ± 5.5 months) mothers with a hypertensive disorder of pregnancy completed measures of pandemic-related distress and pandemic-related disruption in lifestyle behaviors from the Coronavirus Perinatal Experiences Impact Survey. A Patient Health Questionnaire-9 score ≥ 10 and a score ≥ 3 on the Breslau scale indicated significant depressive and posttraumatic stress disorder (PTSD) symptoms, respectively. RESULTS Twenty-two (27.2%) and 30 (36.6%) participants had significant depressive or PTSD symptoms, respectively. In models adjusted for education, income, parity, delivery prepandemic or peripandemic, intervention group, and prepregnancy mental health history, both PTSD symptoms ( B = 0.229, P = .029) and pandemic-related distress ( B = 0.492, P < .001) associated with greater disruption in health behaviors. Depressive symptoms did not associate with greater disruption in health behaviors ( B = 0.169, P = .135). CONCLUSION Monitoring PTSD symptoms may be vital in supporting mothers with hypertensive disorders of pregnancy in making lifestyle changes to prevent cardiovascular disease.
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Handelzalts JE, Kalfon-Hakhmigari M, Raichin A, Peled Y. Postpartum acute stress disorder symptoms, social support, and quality of couple's relationship associations with childbirth PTSD. Front Psychiatry 2024; 15:1310114. [PMID: 38915847 PMCID: PMC11194715 DOI: 10.3389/fpsyt.2024.1310114] [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: 10/09/2023] [Accepted: 05/09/2024] [Indexed: 06/26/2024] Open
Abstract
Background We aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple's relationship quality at 8-12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables. Methods Participants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1-4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8-12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS). Results In partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p <.001) and the total score (β = .29, p <.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple's relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms. Conclusion Our study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple's relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.
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Affiliation(s)
- Jonathan E. Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | | | - Adi Raichin
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Osório FL, Borges MM. Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic. Arch Womens Ment Health 2024; 27:337-357. [PMID: 38265513 DOI: 10.1007/s00737-024-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
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Affiliation(s)
- Flávia L Osório
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
- National Institute of Science and Technology (INCT-TM, CNPq), Brasília, Brazil.
| | - Maira Morena Borges
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil
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Hjorth S, Skov SK, Kirkegaard H, Olsen J, Nohr EA. Mode of birth and long-term maternal mental health: A follow-up study in the Danish National Birth Cohort. Birth 2024; 51:441-449. [PMID: 38078482 DOI: 10.1111/birt.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/17/2023] [Accepted: 10/26/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND Cesarean birth has been associated with increased risks of short-term mental health problems. Little is known about whether these associations persist in the long term. This study aimed to estimate the associations between mode of birth and maternal mental health in midlife while considering mental health before and during pregnancy. METHODS Cohort study among mothers in the Danish National Birth Cohort. Birth mode for each woman's entire reproductive history was obtained from Danish national registries. Symptoms of depression and stress in midlife were self-reported using validated scales. Log binomial regression was used to calculate risk ratios (RR) with 95% confidence intervals (CI) for the association between birth mode and depressive symptoms. Linear regression was used to calculate mean difference in stress score by birth mode. RESULTS Among 42,872 women, 15.5% reported depressive symptoms at follow-up, where they were, on average, 43.9 years and 11.2 years after their last birth. Compared with women who only ever had spontaneous vaginal births, women who only had cesarean births, or had both cesarean and vaginal births with the last birth by cesarean, reported slightly more symptoms of depression (RR 1.10, 95% CI 1.01;1.20) and stress (mean difference 0.68 on a 100-point scale, 95% CI 0.10;1.26). CONCLUSION Whether due to the birth experience or underlying factors, depression and stress in midlife were more frequent in women with only cesarean births or whose last birth was by cesarean compared with women with vaginal births.
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Affiliation(s)
- Sarah Hjorth
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stina Kruse Skov
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helene Kirkegaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Dekel S, Papadakis JE, Quagliarini B, Pham CT, Pacheco-Barrios K, Hughes F, Jagodnik KM, Nandru R. Preventing posttraumatic stress disorder following childbirth: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:610-641.e14. [PMID: 38122842 PMCID: PMC11168224 DOI: 10.1016/j.ajog.2023.12.013] [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: 08/17/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Women can develop posttraumatic stress disorder in response to experienced or perceived traumatic, often medically complicated, childbirth; the prevalence of these events remains high in the United States. Currently, no recommended treatment exists in routine care to prevent or mitigate maternal childbirth-related posttraumatic stress disorder. We conducted a systematic review and meta-analysis of clinical trials that evaluated any therapy to prevent or treat childbirth-related posttraumatic stress disorder. DATA SOURCES PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible trials published through September 2023. STUDY ELIGIBILITY CRITERIA Trials were included if they were interventional, if they evaluated any therapy for childbirth-related posttraumatic stress disorder for the indication of symptoms or before posttraumatic stress disorder onset, and if they were written in English. METHODS Independent coders extracted the sample characteristics and intervention information of the eligible studies and evaluated the trials using the Downs and Black's quality checklist and Cochrane's method for risk of bias evaluation. Meta-analysis was conducted to evaluate pooled effect sizes of secondary and tertiary prevention trials. RESULTS A total of 41 studies (32 randomized controlled trials, 9 nonrandomized trials) were reviewed. They evaluated brief psychological therapies including debriefing, trauma-focused therapies (including cognitive behavioral therapy and expressive writing), memory consolidation and reconsolidation blockage, mother-infant-focused therapies, and educational interventions. The trials targeted secondary preventions aimed at buffering childbirth-related posttraumatic stress disorder usually after traumatic childbirth (n=24), tertiary preventions among women with probable childbirth-related posttraumatic stress disorder (n=14), and primary prevention during pregnancy (n=3). A meta-analysis of the combined randomized secondary preventions showed moderate effects in reducing childbirth-related posttraumatic stress disorder symptoms when compared with usual treatment (standardized mean difference, -0.67; 95% confidence interval, -0.92 to -0.42). Single-session therapy within 96 hours of birth was helpful (standardized mean difference, -0.55). Brief, structured, trauma-focused therapies and semi-structured, midwife-led, dialogue-based psychological counseling showed the largest effects (standardized mean difference, -0.95 and -0.91, respectively). Other treatment approaches (eg, the Tetris game, mindfulness, mother-infant-focused treatment) warrant more research. Tertiary preventions produced smaller effects than secondary prevention but are potentially clinically meaningful (standardized mean difference, -0.37; -0.60 to -0.14). Antepartum educational approaches may help, but insufficient empirical evidence exists. CONCLUSION Brief trauma-focused and non-trauma-focused psychological therapies delivered early in the period following traumatic childbirth offer a critical and feasible opportunity to buffer the symptoms of childbirth-related posttraumatic stress disorder. Future research that integrates diagnostic and biological measures can inform treatment use and the mechanisms at work.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | | | | | - Christina T Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Francine Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kathleen M Jagodnik
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rasvitha Nandru
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Khademi K, Kaveh MH. Social support as a coping resource for psychosocial conditions in postpartum period: a systematic review and logic framework. BMC Psychol 2024; 12:301. [PMID: 38807228 PMCID: PMC11131291 DOI: 10.1186/s40359-024-01814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE This review seeks to examine the current state of postpartum social support and psychosocial conditions among women around the world, as well as explore the relationship between these factors. Additionally, it aims to propose a logical framework for enhancing postpartum social support and psychosocial conditions in this population. METHODS Following the development of a search strategy, two databases, PubMed and Science Direct, were searched for studies published between January 2019 and May 2023. The search was conducted throughout the entire month of May 2023. The risk of bias in the included cross-sectional studies was assessed using the Newcastle-Ottawa Quality Assessment Scale, which was adapted for this specific study design. To determine if the main objective of the cross-sectional studies was to investigate the relationship between social support and postpartum psychosocial conditions, a review was conducted based on the AMSTAR checklist, PRISMA checklist and PRISMA flow diagram. Data extraction was performed with the consensus of two authors, and a narrative synthesis approach was chosen for data synthesis, following the guidelines provided by the Centre for Reviews and Dissemination (CRD). RESULTS Eleven cross-sectional studies were included in the final analysis. Our findings revealed that all reviewed studies provided evidence of a positive association between social support and healthy psychosocial conditions in postpartum period. However, due to the absence of standardized measurement indicators to identify and compare the outcomes of various studies, there was a need to develop a conceptual framework that could enhance our understanding of the postpartum psychosocial condition including anxiety, depression, unfavorable quality of life and social support status up to 24 month after child birth. This framework aimed to incorporate childbirth and motherhood as "stressful events," while considering social support as a crucial "coping resource." Furthermore, it acknowledged empowerment, help-seeking behavior, and peer support as important "coping actions," alongside implementing client-centered interventions. Lastly, it recognized postpartum mental health and optimal quality of life as significant "effects" of these factors. CONCLUSIONS The proposed conceptual framework could define postpartum women's health as "the ability to adapt and self-manage."
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Affiliation(s)
- Khadijeh Khademi
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, 71536-75541, Iran.
| | - Mohammad Hossein Kaveh
- Research Center for Health Sciences, Department of Health Promotion, School of Health, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Canet-Vélez O, Besa ME, Sanromà-Ortíz M, Espada-Trespalacios X, Escuriet R, Prats-Viedma B, Cobo J, Ollé-Gonzalez J, Vela-Vallespín E, Casañas R. Incidence of Perinatal Post-Traumatic Stress Disorder in Catalonia: An Observational Study of Protective and Risk Factors. Healthcare (Basel) 2024; 12:826. [PMID: 38667588 PMCID: PMC11050101 DOI: 10.3390/healthcare12080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Pregnancy and childbirth have a great impact on women's lives; traumatic perinatal experiences can adversely affect mental health. The present study analyzes the incidence of perinatal post-traumatic stress disorder (PTSD) in Catalonia in 2021 from data obtained from the Registry of Morbidity and Use of Health Resources of Catalonia (MUSSCAT). The incidence of perinatal PTSD (1.87%) was lower than in comparable studies, suggesting underdiagnosis. Poisson regression adjusting for age, income, gestational weeks at delivery, type of delivery, and parity highlighted the influence of sociodemographics, and characteristics of the pregnancy and delivery on the risk of developing perinatal PTSD. These findings underline the need for further research on the risk factors identified and for the early detection and effective management of PTSD in the perinatal setting.
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Affiliation(s)
- Olga Canet-Vélez
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain
| | - Meritxell Escalé Besa
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Institute, 08007 Barcelona, Spain
- Department of Gynegology and Obstetrics, Parc Taulí University Hospital, 08208 Sabadell, Spain
| | - Montserrat Sanromà-Ortíz
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Igualada Health Campus, University of Lleida, 25002 Igualada, Spain
| | - Xavier Espada-Trespalacios
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain
| | - Ramón Escuriet
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain
| | - Blanca Prats-Viedma
- Public Health Agency of Catalonia (ASPCAT), Catalan Department of Health, 08005 Barcelona, Spain;
| | - Jesús Cobo
- Perinatal Mental Health Program, Mental Health Department, Parc Taulí University Hospital, 08208 Sabadell, Spain;
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Júlia Ollé-Gonzalez
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
| | - Emili Vela-Vallespín
- Information Systems, CatSalut, 08028 Barcelona, Spain;
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, 08908 Barcelona, Spain
| | - Rocio Casañas
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain
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Long T, Aggar C, Grace S. Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care? Midwifery 2024; 131:103950. [PMID: 38359645 DOI: 10.1016/j.midw.2024.103950] [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: 04/02/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. METHOD A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). RESULTS The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. CONCLUSION To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.
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Affiliation(s)
- Trish Long
- Northern NSW Local Health District, Australia.
| | - Christina Aggar
- Northern NSW Local Health District, Australia; Southern Cross University, Faculty of Health, Australia
| | - Sandra Grace
- Southern Cross University, Faculty of Health, Australia
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Jagodnik KM, Ein-Dor T, Chan SJ, Titelman Ashkenazy A, Bartal A, Barry RL, Dekel S. Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory. J Affect Disord 2024; 348:17-25. [PMID: 38070747 PMCID: PMC10872536 DOI: 10.1016/j.jad.2023.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/04/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown. METHODS 3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification. RESULTS Factor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88 % with a positive CB-PTSD screen in the first postpartum months and 93 % with a negative screen. LIMITATIONS In this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries. CONCLUSIONS Brief self-report screening concerning a woman's emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.
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Affiliation(s)
- Kathleen M Jagodnik
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Tsachi Ein-Dor
- School of Psychology, Reichman University, Herzliya, Israel
| | - Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alon Bartal
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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18
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Harris NR. Systematic Reviews to Inform Practice, March/April 2024. J Midwifery Womens Health 2024; 69:304-312. [PMID: 38553829 DOI: 10.1111/jmwh.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Chervenak FA, McLeod-Sordjan R, Pollet SL, De Four Jones M, Gordon MR, Combs A, Bornstein E, Lewis D, Katz A, Warman A, Grünebaum A. Obstetric violence is a misnomer. Am J Obstet Gynecol 2024; 230:S1138-S1145. [PMID: 37806611 DOI: 10.1016/j.ajog.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Monique De Four Jones
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Hospital, Manhasset, NY
| | | | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Dawnette Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
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VanWiel L, Unke M, Samuelson RJ, Whitaker KM. Associations of pelvic floor dysfunction and postnatal mental health: a systematic review. J Reprod Infant Psychol 2024:1-22. [PMID: 38357811 DOI: 10.1080/02646838.2024.2314720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period. METHODS A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality. RESULTS A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions. DISCUSSION Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.
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Affiliation(s)
- Lisa VanWiel
- Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Mackenzie Unke
- Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | | | - Kara M Whitaker
- Health and Human Physiology, University of Iowa, Iowa City, IA, USA
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Beck-Hiestermann FML, Hartung LK, Richert N, Miethe S, Wiegand-Grefe S. Are 6 more accurate than 4? The influence of different modes of delivery on postpartum depression and PTSD. BMC Pregnancy Childbirth 2024; 24:118. [PMID: 38331809 PMCID: PMC10851577 DOI: 10.1186/s12884-024-06267-8] [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: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Empirical evidence shows that 4.6-6.3% of all women develop a post-traumatic stress disorder (PTSD) and approximately 10-15% postpartum depression (PPD) following childbirth. This study explores the relationship between delivery mode and the occurrence of PTSD and PPD, specifically examining four distinct caesarean section (CS) modes: primary on maternal request (Grade 4), medically indicated primary (Grade 3), secondary CS from relative indication (Grade 2) and emergency secondary CS (Grade 1), compared to vaginal and assisted vaginal delivery (AVD). The research aims to understand how these six subcategories of delivery modes impact PPD and PTSD levels. Common predictors, including the need for psychological treatment before childbirth, fear of childbirth, planning of pregnancy, induction of labor, birth debriefing, and lack of social support after childbirth, will be analyzed to determine their association with postpartum mental health outcomes. METHODS The study was planned and carried out by a research team of the psychology department at the Medical School Hamburg, Germany. Within an online-study (cross-sectional design) N = 1223 German speaking women with a baby who did not die before, during or after birth were surveyed once between four weeks and twelve months postpartum via an anonymous online questionnaire on demographic and gynecological data, delivery mode, PTSD (PCL-5) and PPD (EPDS). RESULTS For both psychiatric disorders, ANOVA revealed significant differences between delivery mode and PPD and PTSD. With weak effects for PPD and medium to strong effects for PTSD. Post-hoc tests showed increased levels of PPD for two CS types (Grade 1, Grade 3) compared to vaginal delivery. For PTSD, secondary CS from relative indication (Grade 2), emergency secondary CS (Grade 1) and assisted vaginal delivery (AVD) were associated with elevated levels of PTSD. Regression analysis revealed delivery mode as a significant predictor of EPDS- (medium effect size) and PCL-5-Score (medium to high effect size). LIMITATION Delivery was considered as the potential traumatic event, and any previous traumas were not documented. Additionally, the categorization of delivery modes relied on subjective reports rather than medical confirmation. CONCLUSION The study highlights the influence of delivery mode on the mental health of postpartum mothers: different modes influence postpartum disorders in various ways. However, the definition of delivery mode was only stated subjectively and not medically confirmed. Further research should investigate which aspects of the different delivery modes affect maternal mental health and explore how the perception of childbirth may be influenced by specific delivery experiences.
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Affiliation(s)
- Franziska Marie Lea Beck-Hiestermann
- Department of Psychology, Medical School Hamburg, Hamburg, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.
| | - Lisa Kathrin Hartung
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nadine Richert
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Sandra Miethe
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
- Institute for Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Brenner I, Ginzburg K, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Tomashev R, Padoa A. Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment. Arch Womens Ment Health 2024; 27:127-136. [PMID: 37851078 DOI: 10.1007/s00737-023-01379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023]
Abstract
Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.
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Affiliation(s)
- Inbal Brenner
- Lev-Hasharon Mental Health Center, Tzur-Moshe, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael Reicher
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel
- Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Talmon
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Roni Tomashev
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - Anna Padoa
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
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23
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Vogel JP, Jung J, Lavin T, Simpson G, Kluwgant D, Abalos E, Diaz V, Downe S, Filippi V, Gallos I, Galadanci H, Katageri G, Homer CSE, Hofmeyr GJ, Liabsuetrakul T, Morhason-Bello IO, Osoti A, Souza JP, Thakar R, Thangaratinam S, Oladapo OT. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. Lancet Glob Health 2024; 12:e317-e330. [PMID: 38070535 PMCID: PMC10805007 DOI: 10.1016/s2214-109x(23)00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024]
Abstract
Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Tina Lavin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Grace Simpson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dvora Kluwgant
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Soo Downe
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Geetanjali Katageri
- S Nijalingappa Medical College and HSK Hospital & Research Centre, Bagalkot, India
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Tippawan Liabsuetrakul
- Department of Epidemiology and Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences and Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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24
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Eichinger J, Büchler A, Arnold L, Rost M. Women's and Provider's Moral Reasoning About the Permissibility of Coercion in Birth: A Descriptive Ethics Study. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00480-4. [PMID: 38261096 DOI: 10.1007/s10728-024-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women's autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers' and women's moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women's decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women's autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women's enfranchisement in their own care.
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Affiliation(s)
- Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Andrea Büchler
- Faculty of Law, Human Reproduction Reloaded|H2R, University of Zurich, Zürich, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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25
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Ionio C, Ciuffo G, Colombo C, Melani O, Figlino MF, Landoni M, Castoldi F, Cavigioli F, Lista G. Preterm Birth and Maternal Mood States: What Is the Impact on Bonding? Pediatr Rep 2024; 16:35-45. [PMID: 38251313 PMCID: PMC10801593 DOI: 10.3390/pediatric16010004] [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: 11/15/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Preterm birth is a significant global health issue affecting millions of infants each year, with potential implications for their developmental outcomes. This study investigated the impact of preterm birth on maternal mood states during the early postpartum period and its subsequent effects on mother-infant bonding. Mothers of 90 preterm infants were involved in the assessment of maternal mood states, examined with the Profile of Mood States (POMS) questionnaire and the evaluation of mother-infant bonding, carried out through the Postpartum Bonding Questionnaire (PBQ). Contrary to expectations, there was no significant correlation between preterm birth characteristics and maternal mood states. On the other hand, significant correlations emerged between specific maternal mood states and the quality of mother-child bonding. More specifically, regression analyses showed that feelings of tension, anger, and confusion experienced by the mother tend to negatively affect the quality of her bond with her child. These findings emphasize the crucial role of maternal mental well-being in shaping the mother-infant relationship in the early postpartum period. The study highlights the importance of identifying and addressing maternal mood disorders to promote positive mother-infant bonding and child development, further underlining the need for comprehensive support and interventions for mothers of preterm infants.
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Affiliation(s)
- Chiara Ionio
- Unità di ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy (O.M.); (M.F.F.)
| | - Giulia Ciuffo
- Unità di ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy (O.M.); (M.F.F.)
| | - Caterina Colombo
- Neonatologia Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, Via Castelvetro 32, 20154 Milano, Italy (F.C.); (F.C.); (G.L.)
| | - Olivia Melani
- Unità di ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy (O.M.); (M.F.F.)
| | - Maria Francesca Figlino
- Unità di ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy (O.M.); (M.F.F.)
| | - Marta Landoni
- Unità di ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy (O.M.); (M.F.F.)
| | - Francesca Castoldi
- Neonatologia Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, Via Castelvetro 32, 20154 Milano, Italy (F.C.); (F.C.); (G.L.)
| | - Francesco Cavigioli
- Neonatologia Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, Via Castelvetro 32, 20154 Milano, Italy (F.C.); (F.C.); (G.L.)
| | - Gianluca Lista
- Neonatologia Patologia e Terapia Intensiva Neonatale, Ospedale dei Bambini “Vittore Buzzi”, ASST Fatebenefratelli Sacco, Via Castelvetro 32, 20154 Milano, Italy (F.C.); (F.C.); (G.L.)
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26
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Frankham LJ, Thorsteinsson EB, Bartik W. Birth related PTSD and its association with the mother-infant relationship: A meta-analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 38:100920. [PMID: 37847956 DOI: 10.1016/j.srhc.2023.100920] [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: 05/18/2023] [Revised: 08/02/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE There is a growing body of research showing that birth related posttraumatic stress disorder (PTSD) symptoms may impact the mother-infant relationship. The present study assessed the strength of the association between birth related PTSD symptoms and the mother-infant relationship. METHOD A total of twelve studies (5,572 participants) were included based on database searches using PubMed, EBSCO and ProQuest. RESULTS The findings showed that greater levels of birth related PTSD symptoms were associated with poorer mother-infant relationship, r = -0.36, 95% CI: [-0.43 - -0.28], random effects model. The outcomes appeared to be heterogeneous (Q(11) = 81.63, p <.001, tau2 = 0.0123, I2 = 80.73%), despite all outcomes being in the same direction as the overall outcome. CONCLUSIONS The results indicated that birth related PTSD symptoms are negatively associated with the mother-infant relationship. Further investigation into the prevention of birth related trauma is suggested. Improving birthing experiences for mothers is likely to contribute to improved infant mental health, thereby reducing overall social and economic costs.
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Affiliation(s)
- Lucy J Frankham
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia.
| | - Einar B Thorsteinsson
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia
| | - Warren Bartik
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia
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27
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Rost M, Stuerner Z, Niles P, Arnold L. Between "a lot of room for it" and "it doesn't exist"-Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland. Birth 2023; 50:1068-1080. [PMID: 37593797 DOI: 10.1111/birt.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal-focused decision-making framework and a maternal-fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy-depriving decision-making, it is important to understand how autonomy can be enhanced. METHODS We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality. RESULTS We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person-practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision-making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants. DISCUSSION The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision-making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a "mother-blame" narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights-based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Zelda Stuerner
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
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28
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Kömürcü Akik B. Obstetric Violence Questionnaire: Adaptation of a Turkish Self-Report Tool. Violence Against Women 2023; 29:3288-3301. [PMID: 37309169 DOI: 10.1177/10778012231181050] [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] [Indexed: 06/14/2023]
Abstract
Obstetric violence has started to attract attention as a form of violence against women. This study aimed to determine and analyze the psychometric properties of a Turkish version of the Obstetric Violence Questionnaire (OVQ). Four hundred sixty-eight women from 19 to 59 years of age (M = 35.28, SD = 7.22) participated. The confirmatory factor analysis confirmed a multifactorial structure of two factors. The Cronbach's α internal consistency coefficients were .72, .70, and .73 obtained for the total scale, abuse and violence, and non-consented care subscale, respectively. The OVQ consisted of 11 items, proving to be a reliable and brief measure.
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Affiliation(s)
- Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
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29
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Futterman ID, Grace H, Weingarten S, Borjian A, Clare CA. Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2199345. [PMID: 37031972 DOI: 10.1080/14767058.2023.2199345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters. METHODS A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants. RESULTS Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%. CONCLUSION Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.
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Affiliation(s)
- Itamar D Futterman
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Holly Grace
- School of Medicine, New York Medical College, NY, USA
| | - Sarah Weingarten
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
| | - Alborz Borjian
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
| | - Camille A Clare
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
- School of Medicine, New York Medical College, NY, USA
- New York City Health + Hospitals/Metropolitan, NY, USA
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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30
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Bainton J, Trachtenberg F, McCrindle BW, Wang K, Boruta R, Brosig CL, Egerson D, Sood E, Calderon J, Doman T, Golub K, Graham A, Haas K, Hamstra M, Lindauer B, Sylvester D, Woodard F, Young-Borkowski L, Mussatto KA. Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease. Cardiol Young 2023; 33:2171-2180. [PMID: 36601959 DOI: 10.1017/s1047951122004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease. MATERIALS AND METHODS A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised. RESULTS The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder. DISCUSSION Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.
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Affiliation(s)
- Jessica Bainton
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ke Wang
- HealthCore, Watertown, MA, USA
| | | | - Cheryl L Brosig
- Herma Heart Institute, Children's Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Erica Sood
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Tammy Doman
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Katrina Golub
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Karen Haas
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michelle Hamstra
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Lisa Young-Borkowski
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Limmer CM, Stoll K, Vedam S, Leinweber J, Gross MM. Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool. Midwifery 2023; 126:103809. [PMID: 37689053 DOI: 10.1016/j.midw.2023.103809] [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: 06/12/2022] [Revised: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. RESEARCH AIM The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. METHODS A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FINDINGS More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). CONCLUSIONS This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.
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Affiliation(s)
- Claudia M Limmer
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Department Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Science, Alexanderstr. 1, Hamburg D-20099, Germany
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Saraswathi Vedam
- UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Julia Leinweber
- Institute of Midwifery, University Medicine Berlin, Charite, Oudenarder Strasse 16, Berlin 13347, Germany
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany.
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Butterworth S, Butterworth R, Law GU. Birth trauma: the elephant in the nursery. J Reprod Infant Psychol 2023:1-22. [PMID: 37791520 DOI: 10.1080/02646838.2023.2264877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
METHOD The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. RESULTS Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. DISCUSSION Parents described a shared experience of birth trauma during birth. However, fathers' perceived trauma ended in the delivery room whilst mothers' continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. CONCLUSION The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
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Affiliation(s)
| | - Ruth Butterworth
- Northwest Neonatal ODN, Alder Hey Children's NHS Foundation Trust, liverpool, UK
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Rousseau S, Feldman T, Shlomi Polachek I, Frenkel TI. Persistent symptoms of maternal post-traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother. INFANCY 2023; 28:882-909. [PMID: 37329252 DOI: 10.1111/infa.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). The current study examines whether stable symptoms of PTS-FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social-engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother-infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS-FC was assessed at 3-day, 1-month and 4-month postpartum, via self-report and clinician-administered interview. Latent Profile Analysis generated two profiles of symptomology: "Stable-High-PTS-FC" (17.0%), and "Stable-Low-PTS-FC" (83%). Membership in the "Stable-High-PTS-FC" profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect β = -0.15). Results suggest the need for early screening and inform the planning of early preventive interventions.
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Affiliation(s)
- Sofie Rousseau
- School of Education, Ariel University, Ariel, Israel
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
| | - Tamar Feldman
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
| | - Inbal Shlomi Polachek
- Be'er Ya'akov Medical Center, Beer Yaakov, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tahl I Frenkel
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
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Shorey S, Lalor J, Pereira TLB, Jarašiūnaitė-Fedosejeva G, Downe S. Decision-making and future pregnancies after a positive fetal anomaly screen: A scoping review. J Clin Nurs 2023; 32:5534-5549. [PMID: 36707923 DOI: 10.1111/jocn.16628] [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: 07/13/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis of an actual anomaly in a previous pregnancy. BACKGROUND Prenatal screening consists of any diagnostic modality that is aimed at acquiring information about a fetus or an embryo; however, the entire process is highly stressful for parents, especially if there was a previous screen positive result, but no abnormality was detected in the final result. METHODS Eight electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Theses and Dissertations and ClinicalTrials.gov) were searched from each database's inception until February 2022. This scoping review was guided by Arksey and O'Malley's framework and was reported in accordance with the PRISMA-ScR checklist. Braun and Clarke's thematic analysis framework was utilised. RESULTS Thirty-one studies were eligible for inclusion. Two main themes (reliving the fear while maintaining hope, and bridging the past and future pregnancies) and six subthemes were identified. CONCLUSIONS A fetal anomaly diagnosis in pregnancy had a mixed impact on the attitudes of parents toward a future pregnancy. Some parents were fearful of reliving a traumatic experience, while others were determined to have a healthy child and grow their family. Parents generally expressed a greater preference for non-invasive over invasive prenatal testing due to the procedural risks involved. RELEVANCE TO CLINICAL PRACTICE There is a need for healthcare professionals to provide psychosocial and emotional support to parents so that they can achieve resolution for their previous pregnancy. Healthcare professionals' ability to provide informational support also enables these parents to make informed decision and understand their reproductive outcomes. Additionally, healthcare administration and policymakers should reconsider current neonatal or pregnancy loss bereavement guidelines to improve the inclusivity of fathers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Travis Lanz-Brian Pereira
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Soo Downe
- THRIVE Centre, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Dekel S, Papadakis JE, Quagliarini B, Jagodnik KM, Nandru R. A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.17.23294230. [PMID: 37693410 PMCID: PMC10485880 DOI: 10.1101/2023.08.17.23294230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Objective Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. Data Sources We conducted a systematic review of PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, and Scopus through December 2022 to identify clinical trials involving CB-PTSD prevention and treatment. Study Eligibility Criteria Trials were included if they were interventional, evaluated CB-PTSD preventive strategies or treatments, and reported outcomes assessing CB-PTSD symptoms. Duplicate studies, case reports, protocols, active clinical trials, and studies of CB-PTSD following stillbirth were excluded. Study Appraisal and Synthesis Methods Two independent coders evaluated trials using a modified Downs and Black methodological quality assessment checklist. Sample characteristics and related intervention information were extracted via an Excel-based form. Results A total of 33 studies, including 25 randomized controlled trials (RCTs) and 8 non-RCTs, were included. Trial quality ranged from Poor to Excellent. Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies. Therapies' utility to aid women with severe acute traumatic stress symptoms or reduce incidence of CB-PTSD diagnosis is unclear, as is whether they are effective as tertiary intervention. Educational birth plan-focused interventions during pregnancy may improve maternal health outcomes, but studies remain scarce. Conclusions An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. Rather than one treatment being suitable for all, effective therapy should consider individual-specific factors. As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joanna E. Papadakis
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beatrice Quagliarini
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathleen M. Jagodnik
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rasvitha Nandru
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lathan EC, Britt A, Ravi M, Ash MJ, McAfee E, Wallace S, Johnson CB, Woods-Jaeger B, Powers A, Michopoulos V. WHEN REPRODUCTION IS NO LONGER AUTONOMOUS: FEELING RESPECTED BY MATERNITY CARE PROVIDERS MODERATES THE ASSOCIATION BETWEEN AUTONOMY IN DECISION MAKING AND BIRTH-RELATED PTSD SYMPTOMS IN A COMMUNITY SAMPLE OF POSTPARTUM BLACK WOMEN. J Trauma Dissociation 2023; 24:520-537. [PMID: 37233983 PMCID: PMC10330569 DOI: 10.1080/15299732.2023.2212406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons' risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=-.43, p < .01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=-.23, SE=.14, p = .10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B = .05, SE=.01, p < .01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers' ability to convey respect to pregnant patients when they cannot lead care decisions.
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Affiliation(s)
- Emma C. Lathan
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abby Britt
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Meghna Ravi
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcia J. Ash
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth McAfee
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shimarith Wallace
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Colin B. Johnson
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Briana Woods-Jaeger
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Abigail Powers
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
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Vatanparast A, Kamrani A, Shakiba S, Amouchie R, Akbari E, Ayers S. The latent factor structure and assessment of childbirth-related PTSD: psychometric characteristics of the City Birth Trauma Scale-Persian version (City-BiTS-P). Front Psychiatry 2023; 14:1204392. [PMID: 37409157 PMCID: PMC10318432 DOI: 10.3389/fpsyt.2023.1204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Objective There is no validated Persian questionnaire to measure childbirth-related PTSD (CB-PTSD) symptoms. To cover this gap, the present study aimed to provide a Persian version of the City Birth Trauma Scale (CityBiTS-Pr) and to determine its psychometric properties. Method Since this is a cross-sectional study, sampling was done using a convenient sampling method. In total, 300 Persian-speaking women took part in this study and completed the City Birth Trauma Scale (CityBiTS-Pr), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Edinburgh Postnatal Depression Scale (EPDS), the Anxiety Subscale of the Depression, and the Anxiety and Stress Scale (DASS-21). In addition, sociodemographic information was completed. A confirmatory factor analysis of two- and four-factor models and a bi-factor model with a general factor and two specific factors were tested. Fit indices were calculated for all three models. Reliability, convergent, divergent, and discriminant validity also were examined. R v4.2.1 and SPSS v23 were used for data analysis. Results The four-factor model comprised intrusion, avoidance, negative cognitions and mood, and hyper-arousal showed a poor fit. The two-factor model composed of "birth-related symptoms" and "general symptoms" provided the best results based on all fit indices. The bi-factor result was relatively good, but the loadings indicated that the general symptoms factor is not well defined. Conclusion The Persian version of the City Birth Trauma Scale (CityBiTS-Pr) is a valid and reliable questionnaire for evaluating postpartum PTSD.
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Affiliation(s)
- Amin Vatanparast
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Kamrani
- Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shima Shakiba
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ramin Amouchie
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elnaz Akbari
- Paramedical Department, Islamic Azad University, Rasht Branch, Rasht, Iran
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, University of London, London, United Kingdom
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Latt SM, Alderdice F, Elkington M, Awng Shar M, Kurinczuk JJ, Rowe R. Primary postpartum haemorrhage and longer-term physical, psychological, and psychosocial health outcomes for women and their partners in high income countries: A mixed-methods systematic review. PLoS One 2023; 18:e0274041. [PMID: 37315027 PMCID: PMC10266652 DOI: 10.1371/journal.pone.0274041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Most research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings. METHODS The review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH. RESULTS Data were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH. CONCLUSION This review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth. PROSPERO REGISTRATION PROSPERO registration number: CRD42020161144.
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Affiliation(s)
- Su Mon Latt
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Madeline Elkington
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mahkawnghta Awng Shar
- Health and Nutrition Specialist, United Nations International Children Fund, Myanmar
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Suarez A, Yakupova V. Past Traumatic Life Events, Postpartum PTSD, and the Role of Labor Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6048. [PMID: 37297652 PMCID: PMC10252538 DOI: 10.3390/ijerph20116048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
The aim of this study was to investigate the association of postpartum post-traumatic stress disorder (PP-PTSD) symptoms and subjective rates of traumatic birth experience with past traumatic life events (physical and sexual assault, child abuse, perinatal loss, previous traumatic birth experience, and the cumulative traumatic experience). A sample of Russian women (n = 2579) who gave birth within the previous 12 months, filled in a web-based survey, where they reported demographic and obstetric characteristics and past traumatic experiences, evaluated their birth experience (0 = not traumatic, 10 = extremely traumatic), and completed the City Birth Trauma Scale (CBiTS). We found that PP-PTSD symptoms were higher among women who previously experienced physical (F = 22.02, p < 0.001) and sexual (F = 15.98, p < 0.001) assault and child abuse (F = 69.25, p < 0.001), with only associations with child abuse (F = 21.14, p < 0.001) remaining significant for subjective rates of traumatic birth experience. Perinatal loss and previous traumatic birth showed moderate but inconsistent effects. Support during labor did not have a buffering effect for participants with past traumatic experiences but showed a universally protective effect against PP-PTSD. Trauma-informed practices and allowing women to have a supportive birth team of choice during childbirth are promising avenues to minimize the incidence of PP-PTSD and improve the childbirth experience for all women.
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Affiliation(s)
- Anna Suarez
- Department of Psychology, Lomonosov Moscow State University, Moscow 119991, Russia;
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Tomita Y, Kiriya J, Silwal RC, Ong KIC, Shibanuma A, Jimba M. Association between the person-centered maternity care experience and mental health after delivery in urban and rural Dhading, Nepal: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:398. [PMID: 37254041 DOI: 10.1186/s12884-023-05709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Person-centered maternity care is a component of quality care, which includes effective communication, respect, and dignity. Supportive care has a positive effect on mothers' perinatal experience. In contrast, negative childbirth experiences can cause psychological problems. However, the impact of person-centered maternity care experience on mothers' mental health after delivery remains unknown. Therefore, in this study, we examined the association between person-centered maternity care experience at healthcare facilities and maternal mental health after delivery among Nepali women. METHODS We conducted a cross-sectional study in urban and rural areas in Dhading District, Nepal. Participants were women who gave birth at public healthcare facilities, and their baby's age was between 1 and 12 months. After purposively selecting the target areas, we recruited the women from July to August 2019 and interviewed them using questionnaires. We conducted multiple regression analyses to analyze the association between delivery care experience and depressive symptoms and the association between delivery care experience and mental well-being. RESULTS In total, 595 women were included in the data analysis. The experience of better person-centered maternity care was associated with lower depressive symptom scores in urban (unstandardized coefficient [B]= - 0.09, p < 0.001) and rural areas (B= - 0.10, p < 0.001). Moreover, the experience of better person-centered maternity care was associated with higher mental well-being scores in both urban (B= 0.30, p < 0.001) and rural areas (B= 0.15, p = 0.017). CONCLUSIONS Person-centered maternity care was associated with lower depressive symptom scores and higher mental well-being, regardless of the setting in Nepal. Person-centered maternity care during childbirth can potentially improve mental health after delivery. Maternity care should be improved with more attention to person-centered maternity care aspects.
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Affiliation(s)
- Yuri Tomita
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Kiriya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ram Chandra Silwal
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Green Tara Nepal, Kathmandu, Nepal
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Laifer LM, O'Hara MW, DiLillo D, Brock RL. Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum. Arch Womens Ment Health 2023; 26:191-200. [PMID: 36719513 PMCID: PMC10083078 DOI: 10.1007/s00737-023-01296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2 years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2 years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6 months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6 months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2 years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2 years postpartum, particularly among women who experience greater labor/delivery complications.
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Affiliation(s)
- Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA.
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA
| | - Rebecca L Brock
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA
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Hulsbosch LP, Boekhorst MGBM, Lodder P, Potharst ES, Nyklíček I, Bergink V, Oei SG, Verhoeven CJM, Pop VJM. Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study. BJOG 2023; 130:495-505. [PMID: 35974689 DOI: 10.1111/1471-0528.17273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. DESIGN Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. SETTING Primary care, in the Netherlands. POPULATION Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. METHODS Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. MAIN OUTCOME MEASURES Trajectories of CAD symptoms and physiological birth. RESULTS Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. CONCLUSIONS This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.
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Affiliation(s)
- Lianne P Hulsbosch
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Myrthe G B M Boekhorst
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Paul Lodder
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Eva S Potharst
- UvA Minds, Academic Outpatient (child and adolescent) Treatment Center of the University of Amsterdam, Amsterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivan Nyklíček
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Veerle Bergink
- Departments of Psychiatry and Obstetrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Guid Oei
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Corine J M Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, VU Medical Centre, Amsterdam, The Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Victor J M Pop
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Bartal A, Jagodnik KM, Chan SJ, Babu MS, Dekel S. Identifying women with postdelivery posttraumatic stress disorder using natural language processing of personal childbirth narratives. Am J Obstet Gynecol MFM 2023; 5:100834. [PMID: 36509356 PMCID: PMC9995215 DOI: 10.1016/j.ajogmf.2022.100834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Maternal mental disorders are considered a leading complication of childbirth and a common contributor to maternal death. In addition to undermining maternal welfare, untreated postpartum psychopathology can result in child emotional and physical neglect and associated significant pediatric health costs. Some women may experience traumatic childbirth and develop posttraumatic stress disorder symptoms after delivery (childbirth-related posttraumatic stress disorder). Although women are routinely screened for postpartum depression in the United States, there is no recommended protocol to inform the identification of women who are likely to experience childbirth-related posttraumatic stress disorder. Advancements in computational methods of free text have shown promise in informing the diagnosis of psychiatric conditions. Although the language in narratives of stressful events has been associated with posttrauma outcomes, whether the narratives of childbirth processed via machine learning can be useful for childbirth-related posttraumatic stress disorder screening is unknown. OBJECTIVE This study aimed to examine the use of written narrative accounts of personal childbirth experiences for the identification of women with childbirth-related posttraumatic stress disorder. To this end, we developed a model based on natural language processing and machine learning algorithms to identify childbirth-related posttraumatic stress disorder via the classification of birth narratives. STUDY DESIGN Overall, 1127 eligible postpartum women who enrolled in a study survey during the COVID-19 pandemic provided short written childbirth narrative accounts in which they were instructed to focus on the most distressing aspects of their childbirth experience. They also completed a posttraumatic stress disorder symptom screen to determine childbirth-related posttraumatic stress disorder. After the exclusion criteria were applied, data from 995 participants were analyzed. A machine learning-based Sentence-Transformers natural language processing model was used to represent narratives as vectors that served as inputs for a neural network machine learning model developed in this study to identify participants with childbirth-related posttraumatic stress disorder. RESULTS The machine learning model derived from natural language processing of childbirth narratives achieved good performance (area under the curve, 0.75; F1 score, 0.76; sensitivity, 0.8; specificity, 0.70). Moreover, women with childbirth-related posttraumatic stress disorder generated longer narratives (t test results: t=2.30; p=.02) and used more negative emotional expressions (Wilcoxon test: sadness: p=8.90e-04; W=31,017; anger: p=1.32e-02; W=35,005.50) and death-related words (Wilcoxon test: p=3.48e-05; W=34,538) in describing their childbirth experience than those with no childbirth-related posttraumatic stress disorder. CONCLUSION This study provided proof of concept that personal childbirth narrative accounts generated in the early postpartum period and analyzed via advanced computational methods can detect with relatively high accuracy women who are likely to endorse childbirth-related posttraumatic stress disorder and those at low risk. This suggests that birth narratives could be promising for informing low-cost, noninvasive tools for maternal mental health screening, and more research that used machine learning to predict early signs of maternal psychiatric morbidity is warranted.
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Affiliation(s)
- Alon Bartal
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel (Drs Bartal and Jagodnik)
| | - Kathleen M Jagodnik
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel (Drs Bartal and Jagodnik)
| | - Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Mses Chan and Babu)
| | - Mrithula S Babu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Mses Chan and Babu)
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Drs Dekel and Jagodnik).
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Fameli AL, Costa DSJ, Coddington R, Hawes DJ. Assessment of childbirth-related post traumatic stress disorder in Australian mothers: Psychometric properties of the City Birth Trauma Scale. J Affect Disord 2023; 324:559-565. [PMID: 36586608 DOI: 10.1016/j.jad.2022.12.123] [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: 05/27/2022] [Revised: 11/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The City Birth Trauma Scale (BiTS; Ayers, Wright & Thornton, 2018) is self-report measure of Post-Traumatic Stress Disorder (PTSD) symptoms following childbirth, based on DSM-5 criteria. We report on the first study of the psychometric properties of the BiTS in the Australian population. METHODS Participants were mothers of infants aged 0-12 months (N = 705), who completed the BiTS and measures of related constructs. Confirmatory factor analysis was performed to assess the factor structure of the BiTS. Examination of the reliability, convergent, divergent and discriminant validity and acceptability of the BiTS was also examined. RESULTS Confirmatory factor analysis supported a bi-factor model of Birth-related Symptoms (BRS) and General Symptoms (GS) of post-partum PTSD as well as a global CB-PTSD factor. Internal consistency was found for the BiTS total scale and two proposed subscales (BRS and GS). BiTS total scores were significantly associated with an established measure of PTSD, providing support for convergent validity. Evidence of discriminant validity was examined by comparing the BiTS to an established measure of postpartum depression. LIMITATIONS The present sample may over-represent participants with traumatic birth experiences in comparison to the general public. Furthermore, use of self-report measures limits the capacity to confirm the diagnostic status of participants. CONCLUSION These findings suggest that the BiTS is a valid and reliable measure of childbirth-related PTSD, suited for use in postpartum populations. Total scores on the measure may be informative for clinical and research purposes, while evidence suggests strong support for interpretation of subscale scores.
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Affiliation(s)
| | - Daniel S J Costa
- School of Psychology, University of Sydney, Australia; Pain Management Research Institute, Royal North Shore Hospital, St Leonards, Australia
| | - Rebecca Coddington
- School of Nursing and Midwifery, University of Technology Sydney, Australia
| | - David J Hawes
- School of Psychology, University of Sydney, Australia.
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46
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Leiße A, Dötzer J, Ruhnau A, Aschentrup L, Fischer F, Wrona KJ. Pregnancy Care during the COVID-19 Pandemic in Germany: A Public Health Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2721. [PMID: 36768087 PMCID: PMC9916077 DOI: 10.3390/ijerph20032721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic.
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Affiliation(s)
- Antonia Leiße
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Julia Dötzer
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Alice Ruhnau
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Leona Aschentrup
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Faculty of Engineering and Mathematics, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
| | - Florian Fischer
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Kamil J. Wrona
- Faculty of Engineering and Mathematics, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
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Gutiérrez Hermoso L, Catalá Mesón P, Écija Gallardo C, Marín Morales D, Peñacoba Puente C. Mother-Child Bond through Feeding: A Prospective Study including Neuroticism, Pregnancy Worries and Post-Traumatic Symptomatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2115. [PMID: 36767481 PMCID: PMC9915468 DOI: 10.3390/ijerph20032115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a common postpartum problem and influences maternal bonding with the infant. However, the relationship between this disorder, maternal personality, and the infant's emotional state during feeding is not clear. The aim of the present study was to explore the contribution of neuroticism on the infant's emotional state during feeding, by attending to the mediating role of postpartum PTSD (P-PTSD) symptoms and the moderating role of worries during pregnancy. A prospective design study was developed with 120 women with a low pregnancy risk. They responded to a questionnaire assessing maternal personality (first trimester), worries during pregnancy (third trimester), P-PTSD symptoms, and mother-baby bonding (4 months postpartum). The results showed a positive association among neuroticism, infant irritability during feeding, and P-PTSD symptoms, suggesting the latter plays a mediating role in the relationship between neuroticism and infant irritability (B = 0.102, standard error (SE) = 0.03, 95% coefficient interval (CI) [0.038, 0.176]). Excessive worries, related to coping with infant care, played a moderating role between neuroticism and P-PTSD symptoms (B = 0.413, SE = 0.084, p = 0.006, 95% CI [0.245, 0.581]). This relationship was interfered with by depressive symptoms in the first trimester (covariate) (B = 1.820, SE = 0.420, p = 0.016, ci [2.314, 0.251]). This study contributes to a better understanding of the role of neuroticism as an influential factor in the occurrence of P-PTSD symptoms, and in the impairment of infant bonding during feeding. Paying attention to these factors may favor the development of psychological support programs for mothers, with the aim of strengthening the bond with their child.
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Affiliation(s)
- Lorena Gutiérrez Hermoso
- Department of Psychology, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Spain
| | - Patricia Catalá Mesón
- Department of Psychology, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Spain
| | - Carmen Écija Gallardo
- Department of Psychology, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Spain
| | - Dolores Marín Morales
- Obstetric Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942 Fuenlabrada, Spain
| | - Cecilia Peñacoba Puente
- Department of Psychology, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Spain
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Endres K, Razavi N, Tian Z, Zhou S, Krawiec C, Jasani S. A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231211094. [PMID: 37966026 PMCID: PMC10652806 DOI: 10.1177/17455057231211094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND/OBJECTIVES There is limited research on the associated immediate and long-term outcomes of postpartum hemorrhage. Mothers with a pre-existing psychiatric disease prior to delivery may be especially vulnerable to postpartum hemorrhage outcomes but little is known on this topic. Barriers to studying this population exist and add to knowledge gaps. The goal of this study is to determine the clinical characteristics and frequency of complications within 1 year of a postpartum hemorrhage diagnosis and the psychiatric sequelae within 7 days of a postpartum hemorrhage diagnosis in mothers with a pre-existing mental health diagnosis prior to delivery versus those without. METHODS/DESIGN This is a multicenter retrospective observational cohort study using TriNetX, a de-identified electronic health record database. The following electronic health record data were collected and evaluated in postpartum females who were billed for either a vaginal or cesarean delivery: age, race, ethnicity, diagnostic codes, medication codes, and number of deaths. RESULTS We included 10,649 subjects (6994 (65.7%) no mental health diagnosis and 3655 (34.3%) pre-existing mental health diagnosis). Haloperidol administration (118 (3.2%) versus 129 (1.8%), p < 0.001) was more prevalent in subjects with a pre-existing mental health diagnosis. Adjusting for demographics, pre-existing mental health diagnoses were associated with complications within 1 year after postpartum hemorrhage diagnosis (OR = 1.39, 95% CI: 1.26-1.52, p < 0.001). CONCLUSION Having a mental health disorder history is associated with a higher odds of developing subsequent complications within 1 year of postpartum hemorrhage diagnosis. Mothers with a pre-existing mental health disorder have a significantly higher frequency of certain severe postpartum hemorrhage sequelae, including acute respiratory distress syndrome, retained placenta, sickle cell crisis, and need for mechanical ventilation/tracheostomy up to 1 year after delivery. Medications such as haloperidol were ordered more frequently within 7 days of a postpartum hemorrhage diagnosis in these mothers as well. Further research is needed to understand and manage the unique consequences of postpartum hemorrhage in this vulnerable maternal population.
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Affiliation(s)
- Kodi Endres
- Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Nina Razavi
- Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Zizhong Tian
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Sona Jasani
- Division of Obstetric Specialties and Midwifery, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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49
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Leinweber J, Fontein-Kuipers Y, Thomson G, Karlsdottir SI, Nilsson C, Ekström-Bergström A, Olza I, Hadjigeorgiou E, Stramrood C. Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth 2022; 49:687-696. [PMID: 35403241 DOI: 10.1111/birt.12634] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. AIM To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. METHODS After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. RESULTS The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing." CONCLUSIONS This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.
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Affiliation(s)
- Julia Leinweber
- Institut of Midwifery, Charité-University Medicine Berlin, Berlin, Germany
| | - Yvonne Fontein-Kuipers
- School of Midwifery, Health and Social Work, University College Antwerp, Antwerp, Belgium.,Edinburgh Napier University, School of Health and Social Care, Edinburgh, Scotland
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | | | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University in Borås, Borås, Sweden
| | | | - Ibone Olza
- European Institute of Perinatal Mental Health, Madrid, Spain
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Science, Cyprus University of Technology, Limassol, Cyprus
| | - Claire Stramrood
- Department of Obstetrics and Gynaecology, OLVG Hospital, Amsterdam, The Netherlands
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50
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Attanasio LB, Paterno MT, Kjerulff KH. Factors associated with labor after cesarean in a prospective cohort. Birth 2022; 49:833-842. [PMID: 35608986 PMCID: PMC9649839 DOI: 10.1111/birt.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The goals of this study were (a) to determine how experiences in the first perinatal period shape birth mode preference among individuals with a first birth by cesarean; and (b) to examine the relationship between birth mode preference and other factors and subsequent labor after cesarean (LAC). METHODS Data are from the First Baby Study, a prospective cohort of 3006 primiparous individuals. The analytic sample includes individuals with a first cesarean birth and a second birth during the 5-year follow-up period (n = 394). We used multivariable logistic regression to examine the relationship between experiences in the first perinatal period and subsequent preference for vaginal birth, and between preference for vaginal birth and LAC in the second birth. RESULTS About a third of the sample preferred vaginal birth in a future birth, and 20% had LAC. Factors associated with higher odds of future vaginal birth preference were favorable prenatal attitude toward vaginal birth, lower perceived maternal-infant bonding at 1 month after the first birth, post-traumatic stress symptoms after the first birth, and desiring more than 1 additional child after the first birth. Odds of LAC were nearly 8 times higher among those who preferred vaginal birth (AOR = 7.69, P < .001). Fatigue after the first birth, post-traumatic stress symptoms after the first birth, and having higher predicted chances of vaginal birth after cesarean were also associated with higher odds of LAC. CONCLUSIONS Our findings suggest that the formation of preferences around vaginal birth may present a modifiable target for future counseling and shared decision-making interventions.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mary T Paterno
- Midwifery Services at Cooley Dickinson ObGyn & Midwifery, Cooley Dickinson Medical Group, Northampton, MA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
- Department of Obstetrics and Gynecology, College of Medicine, Hershey, PA, USA
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