Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression, anxiety, and childbirth-related posttraumatic stress disorder

Childbirth-related posttraumatic stress symptoms: exploring the predictive potential of intrapartum hotspots

Childbirth-related posttraumatic stress symptoms (CB-PTSS) affect around 12% of postpartum individuals. While the subjective experience of childbirth is a key predictor of CB-PTSS, the specific defining characteristics of negative birth experiences remain poorly understood. This study aims to refine our understanding of negative birth experiences by investigating intrapartum hotspots, i.e. moments of extreme distress, and their association with CB-PTSS. In a cross-sectional study of N = 1,140 individuals who had given birth eight to ten weeks before, we examined the following: the types of hotspots, differences in hotspot-related distress, interpersonal difficulties during the hotspot, and CB-PTSS between the various types of hotspots and whether hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Participants completed several items based on previous qualitative work [1] to assess the worst hotspot, hotspot-related distress, and interpersonal difficulties during the hotspot and the City Birth Trauma Scale to measure CB-PTSS, alongside relevant pregnancy- and birth-related questions. Medical interventions were the most frequently experienced worst hotspot and separation from the child was associated with the highest levels of hotspot-related distress, interpersonal difficulties, and CB-PTSS. Hotspot-related distress and interpersonal difficulties independently predicted CB-PTSS. Examining intrapartum hotspots poses a promising approach to define highly negative birth experiences.

Birthing partners - validation of a questionnaire to assess the well-being of support persons

BACKGROUND

There is little research on the well-being of the persons giving support during childbirth and how they feel when doing this. The aim of this study is to validate a questionnaire that assesses the well-being of those support persons during childbirth. This publication focuses on the validation of the questionnaire; the development is described in more detail in a previous publication.

METHODS

After the questionnaire had been developed, it was sent online to a sample for validation. Subsequently, the internal consistency was determined to assess the reliability and the correlation with an external criterion in order to assess the criterion validity. Known-groups validation was used to assess the construct validity of the questionnaire. Linear regressions were carried out to analyse which variables influence well-being.

RESULTS

The results show good reliability and high criterion validity. The known-groups analyses identified group differences between the different birth modes regarding the different domains of well-being of the support persons. Factors influencing well-being are whether it is a first time or repeated support, whether the birthing woman is a primiparous or multiparous woman and whether the birth is vaginal or operative.

CONCLUSION

Our results suggest that this questionnaire adequately captures important aspects of the well-being of support persons during childbirth. The questionnaire is designed for all birth experiences. In the case of negative experience it can be used to assess additional support and counselling and thus potentially promote the mental health of the support persons preventively.

Beyond birth trauma: A scoping review on childbirth-related post-traumatic stress disorder and early relational health in the family system

BACKGROUND

To promote optimal development for families negatively impacted by traumatic birth experiences, research is needed to understand the potentially unique effects of childbirth-related post-traumatic stress disorder (CB-PTSD) symptoms on early relational health (ERH) in the family system.

OBJECTIVE

To examine the nature and extent of current knowledge on the effect of CB-PTSD on early relational health of the family.

SEARCH STRATEGY

We utilized previously published scoping review framework and followed PRISMA-ScR reporting guidelines. Databases searched included Google Scholar, PubMed, EMBASE, and CINAHL. Search terms included Boolean strings such as "childbirth-related PTSD" AND "mother-infant relationship", OR "early relational health".

SELECTION CRITERIA

Eligible articles quantitatively assessed the predictive relationship between CB-PTSD and an early relational health construct and adequately distinguished PTSD symptoms related to childbirth from symptoms related to other traumatic experiences.

DATA COLLECTION AND ANALYSIS

Initial search yielded N = 695 records. The final study sample included N = 22 records published from 2007 to 2023. Data were charted and synthesized based on methodological characteristics and main findings.

MAIN RESULTS

Current research specifically examining adverse effects of CB-PTSD symptoms on both the mother-infant relationship and co-parent relational health is limited and has produced conflicting results. Variation in study characteristics and methodology are discussed.

CONCLUSIONS

CB-PTSD symptoms may have a significant impact on early relational health, although findings are unclear and vary by methodology used. Clinical relevance of findings related to prevention, screening, and treatment are discussed.

Infant development at 14 months in the context of maternal objective and subjective birth experience and infant hair glucocorticoids

BACKGROUND

Evidence suggests maternal birth experience impacts infant health. Alterations of the infant's hypothalamus-pituitary-adrenal (HPA) axis are discussed as one possible underlying mechanism. This study aimed to investigate both objective and subjective birth experience as potential predictors of offspring's hair glucocorticoid concentrations (GCs) and infant development, respectively. Further, we examined the role of hair GCs for prospective infant development in different domains.

METHODS

n = 263 mothers participating in the prospective cohort study DREAMHAIR completed questionnaires about their objective and subjective birth experience approximately eight weeks after birth. Additionally, hair samples from n = 286 infants were taken around ten days (neonatal hair GCs) and eight weeks after birth (infant hair GCs) and long-term integrated hair cortisol and cortisone levels were measured in scalp-near 2-cm segments. Infant development (communication, gross motor, fine motor, problem-solving, personal-social) was assessed 14 months after birth using the Ages and Stages Questionnaire - 3 (ASQ-3).

RESULTS

No significant associations were found between objective or subjective birth experience and most domains of infant development, except that a more negative objective birth experience predicted poorer fine motor skills. Additionally, a more negative objective birth experience was linked to lower infant hair cortisone levels and a higher cortisol/cortisone ratio, while a more negative subjective experience was associated with higher neonatal hair cortisol. Lower neonatal hair cortisone showed a link to poorer personal-social development. However, after correction for multiple testing, only the associations between a more negative objective birth experience and lower hair cortisone and a higher cortisol/cortisone ratio at eight weeks remained significant.

CONCLUSIONS

Objective aspects of the birth experience may have a more enduring impact on infant hair GCs than maternal subjective perceptions, particularly with higher birth complications being linked to lower infant cortisone and a higher infant cortisol/cortisone ratio. Given that this ratio may indicate reduced enzymatic activity in converting cortisol to its inactive form, results suggest that birth complications could affect the infant's glucocorticoid metabolism. No robust associations were found between birth experiences or hair GCs and infant development. Further research in more diverse, at-risk populations is needed to clarify these complex relationships.

Association Between Postpartum Depression and Personality Traits Among Japanese Postpartum Mothers and Fathers

Background/Objectives: Although numerous investigations have been conducted on postpartum depression, studies on the association between postpartum depression and personality traits of mothers and fathers are lacking. This study aimed to examine the association between postpartum depression and the Big Five personality models among Japanese mothers and fathers at one-month health check-ups. Methods: The participants were 82 couples, and they responded to the Edinburgh Postnatal Depression Scale (EPDS), the Japanese version of the Ten-Item Personality Inventory, and the Quality of Marriage Index (QMI). We examined the correlations among variables and analyzed the data using structural equation modeling (SEM). Results: Maternal neuroticism was significantly associated with maternal depression (β = 0.50, p < 0.001), and maternal extraversion was significantly associated with paternal depression (β = -0.64, p < 0.001). In addition, we found that maternal postpartum depression was associated with maternal marital satisfaction (r = -0.29, p = 0.037); however, this association disappeared in SEM. Conclusions: Our findings suggest that health practitioners should pay attention to depression and personality traits in both postpartum mothers and fathers. Moreover, we should consider the different associations between depression and personality in parents when initiating interventions.

Psychometric properties of the Maternal Postnatal Attachment Scale and the Postpartum Bonding Questionnaire in three German samples

BACKGROUND

Forming an emotional bond towards the infant is an important developmental aspect of the mother-child relationship. Two questionnaires frequently used for the assessment of mother-infant bonding, namely the Maternal Postnatal Attachment Scale (MPAS) and the Postpartum Bonding Questionnaire (PBQ), have shown inconclusive psychometric properties. To ensure comparability of results across studies, it is crucial to examine the replicability of psychometric properties and previously proposed factor structures of measurements when adapted to other languages.

AIM

The study aim was to investigate the psychometric properties of the German versions of both MPAS and PBQ, across three different German-speaking study samples.

METHODS

Maternal data from three longitudinal studies from Hamburg, Germany (PAULINE-PRINCE study, N = 229), and Dresden, Germany (MARI study, N = 286; DREAM study, N = 1,968), were used to investigate the psychometric properties (descriptive statistics, item difficulty, inter-item correlations) and the factorial structure (confirmatory factor analysis, CFA; principal axis factoring, PAF) of both MPAS and PBQ. Correlations with maternal-fetal bonding, adult romantic attachment style, attachment style to one's own mother, postpartum depressive symptoms, and education level were investigated.

RESULTS

Across the three samples, both MPAS and PBQ showed convincing results regarding the psychometric properties for their total scores, with satisfying to excellent internal consistencies. A strong correlation between the MPAS and PBQ total scores was observed (r=-.71, p < .001). In PAF, for both questionnaires, factor structures on subscale level differed across samples and assessment points. For MPAS and PBQ total scores, significant small to medium-sized associations in the expected directions with maternal-fetal bonding and depressive symptoms, as well as for MPAS with adult romantic attachment style, and for PBQ with attachment towards one's own mother were found. In two samples, higher educated participants reported less optimal MIB.

CONCLUSION

The results across the three included samples provide evidence for the validity of the construct assessed with the German adaptations of both MPAS and PBQ. However, the factor analytical results on subscale level highlight the need to further investigate the concept of mother-infant bonding in the first year after birth as well as to develop instruments applicable for use in clinical and community samples with satisfying psychometric properties.

Relationship between dyadic coping, resilience and fear of childbirth in expectant couples: An actor-partner interdependence model approach

BACKGROUND

Fear of childbirth is a common concern in pregnant women and their spouses due to the unpredictability of the process and outcome of a delivery, which results in adverse effects on mental health, birth outcomes and family intimacy. However, there is a lack of studies that explore the influencing factors of fear of childbirth among expectant couples from a dyadic perspective. The aim of this study is to explore the correlation of dyadic coping, resilience and fear of childbirth in pregnant couples and to construct an actor-partner interdependence model to verify dyadic effects.

METHODS

This cross-sectional survey included 420 couples and was conducted between November 2022 and March 2023 in the obstetric department at two hospitals in China. Convenience sampling and an actor-partner interdependence model was used.

FINDINGS

The prevalence of fear of childbirth among pregnant women and their spouses is 37.4 % and 33.1 %, respectively. Women's resilience and dyadic coping had a partner effect on spouses' fear of childbirth, in addition to an actor effect on their own fear of childbirth. Spouses' resilience and dyadic coping had only actor effects on themselves, and no partner effect was found on the pregnant women.

CONCLUSION

Women's fear of childbirth was positively associated with spouses' fear of childbirth. Interventions for fear of childbirth should include improving resilience and enhancing dyadic stress support and coping. This study provides empirical evidence for future clinical research and interventions on the psychological status of pregnant women and their partners during pregnancy.

'Would I risk it again?' The long-term impacts of a traumatic birth, as experienced by fathers

BACKGROUND

Extensive research has explored the impact of traumatic births on mothers, capturing enduring adverse outcomes as well as post-traumatic growth. The literature on fathers' experiences of birth trauma is more limited and little is known of the ongoing impact. The present study aimed to investigate the long-term effects of attending a traumatic birth.

METHOD

Semi-structured interviews were completed with fathers who identified as having a traumatic birth experience two or more years ago. Thematic analysis was conducted on eight interview transcripts.

RESULTS

Despite the time since the birth trauma, fathers described ongoing impact, which is captured in five themes. Four of these focus on the negative impacts: their attempts to cope by boxing away emotions, which they thought they should not feel; anxieties over having further children; negative effects on parenting; and ongoing distress or negative impact on their wellbeing. The final theme highlighted some positives from the experience, primarily a strengthened relationship with their partner.

CONCLUSIONS

Traumatic birth can result in fathers experiencing difficulties beyond the perinatal period, whilst thinking that they should not feel or discuss their distress. As a result of a traumatic birth fathers can experience ongoing guilt and poor mental health, which may lead them to delay subsequent pregnancies. Most participants had not accessed support regarding the traumatic birth, instead coping by trying to avoid their memories and emotional reaction. These findings highlight the need for increased acknowledgement of the impact of birth trauma and intervention for fathers, during and after the perinatal period.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

The Effect of Familism Emotions on Post-Traumatic Growth Among the Elderly in China: The Mediating Roles of Taoist Personality and Sense of Community

Purpose

Post-traumatic growth is a significant social issue in the management of active aging in elderly people. This study investigates the influence of familism emotions on post-traumatic growth (PTG) of the elderly, and the mediating role of Taoist personality and sense of community (SOC) therein, to provide a scientific basis for the development of positive aging in the elderly.

Methods

A cross-sectional study was conducted in several communities of Hubei Province in China. A total of 338 elderly people were investigated with the Familism Emotion Scale, PTG Scale, Taoist Personality Scale and SOC Scale. SPSS 23.0 was used to derive descriptive statistics and conduct a common method bias test, Pearson correlation analysis, and multiple stepwise regression analysis. Mplus 7.3 was used for structural equation modeling to test the significance of parallel mediation effects on the data.

Results

The results show that: (1) Familism emotions, Taoist personality and SOC are positively correlated with PTG; (2) Familism emotions, Taoist personality and SOC can all positively predict PTG in the elderly; (3) Both Taoist personality and SOC partially mediated the link between familism emotions and PTG in the elderly.

Conclusion

In the context of particularly constraining societal events such as COVID-19, it is necessary to pay careful attention to the impact of external environmental influences upon the elderly, such as family and community, and to encourage elderly people to cultivate a more Taoist personality. The formation of a Taoist personality offers a promising new focus for research in elderly healthcare.