The impact of birth trauma on the couple relationship and related support requirements; a framework analysis of parents' perspectives

A scoping review of effective health practices for the treatment of birth trauma

BACKGROUND

There is currently no consensus on the most effective health practices to manage or reduce the effects of birth trauma (BT) and childbirth-related posttraumatic stress disorder (CB-PTSD).

AIM

The aim was to map the current literature on effective health practices for BT/CB-PTSD, identify key elements (the what, when and how) important for effective health practices, and highlight gaps in maternity care.

METHODS

A systematic search was conducted across key nursing, allied, and medical databases (MEDLINE, Scopus, PubMed) for key terms related to (1) birth trauma and (2) intervention. Only peer-reviewed, English-language papers published since 2000 were included to ensure the relevance and timeliness of the findings. Following PRISMA-ScR guidelines, 6,347 articles were identified through databases/registers and citation searching. After removing 1,342 duplicates, 5,005 were screened by title and abstract. A further 4,544 were excluded, leaving 461 for full-text screening. Afterf excluding another 433, 28 papers met inclusion for this review.

FINDINGS

The first session delivered early (within the first 72 h of birth) by a clinician (midwife/psychologist/counsellor) significantly reduced BT/CB-PTSD in the short-term. Both trauma-focused and non-trauma-focused were supported at this stage, provided they were structured. If intervention is delayed (weeks to months post-birth), a trauma-focused, multi-session approach is recommended.

DISCUSSION

Early, structured interventions should be considered routine care for women with BT/CB-PTSD, with more intensive, structured, trauma-focused approach for persistent symptoms. The potential role of digital mental health tools is promising, particularly for women in low-resource settings, but requires further research to evaluate feasibility, acceptability, and sustainability.

Evaluation of a participatory action project to improve safety and outcomes in maternity care

BACKGROUND

Maternal violence, in terms of obstetric violence and/or the disrespect and abuse of women and birthing people accessing maternity care, is a global concern. This mistreatment and experience of maternal violence and harm has negative physical and psychological impacts on women, birthing people and their babies. This paper evaluates a multipartner project which aimed to co-produce specialist resources to support women and birthing people who had experienced violence and harm. The evaluation sought to understand the collaborative and co-production processes employed and to identify recommendations and learning from the project.

METHODS

An ethnographic-based evaluation based on action research and participatory action research principles was undertaken using qualitative interviews, documentary review and observations. The data were analysed using reflexive thematic analysis.

RESULTS

A total of 18 interviews were conducted with 21 participants from the lead, project partner and onward grant recipient organizations. In addition, 80 documents were reviewed, and 9 collaborative group meetings and 2 in-person events were observed. Factors which supported and inhibited effective collaborative working and co-production were identified in five aspects: ensuring inclusivity, clarity and transparency, building and maintaining relationships, collaboration and cooperation and active learning.

CONCLUSIONS

Effective collaborative co-production needs to consider issues of inclusivity and diversity and to ensure clarity and transparency in terms of remit, commitments and finances. Building and maintaining relationships between partners and communities by creating a safe space for participation and inclusive leadership was crucial. Recommendations from the evaluation include the need to ensure mechanisms for clear communication within projects from their inception as well as the need to acknowledge and proactively address issues of diversity and inclusivity throughout all aspects of the co-production process to support the fullest participation from diverse stakeholders.

The traumatic childbirth experience of mothers after emergency cesarean section(EmCS) in China: a descriptive qualitative study

BACKGROUND

Emergency cesarean section (EmCS) is an effective means to save the lives of the mother and fetus. Women who undergo EmCS experience sudden physiological changes and high level of psychological stress response due to its complexity, risks, and urgency. They may consider their delivery as traumatic childbirth. This study aims to understand the traumatic childbirth experience among women who underwent EmCS, as well as providing evidence for developing preventive measures in future.

METHODS

Sixteen women who underwent an EmCS in the past year and experienced traumatic childbirth in a tertiary hospital in Luoyang, Henan Province had participated in semi-structured, in-depth interviews between February and May 2023. Thematic analysis was used to analyze the data.

RESULTS

Four themes and ten sub-themes were extracted from the data: Theme 1: Journey from crisis to renewal: the psychological recovery process of women experienced traumatic childbirth after EmCS (stress phase, reaction phase, emotional processing and adjustment phase, and stabilization and reconstruction phase); Theme 2: Empowering mothers and families: addressing the multifaceted needs of comprehensive perinatal health education (insufficient individualized care: diversity and challenges of maternal needs, the gap in spousal involvement in perinatal health education); Theme 3: The barriers between patient-professional communication in healthcare (breaking the silence: needs to address the ineffective communication, beyond the diagnosis: needs for empathy in healthcare); and Theme 4: Limited family support (the forgotten mothers, husbands' emotional absence).

CONCLUSIONS

This study contributed to our understanding of the childbirth process for women undergoing EmCS. Women in this period experienced a range of negative emotions, they were lacking in sufficient health education, good communication between healthcare professionals and adequate family support. The research findings are valuable for us to identify their difficulties and needs, enabling us to provide assistance.

Psychometric properties of self-reported measures of psychological birth trauma in puerperae: A COSMIN systematic review

PURPOSE

To identify and evaluate the psychometric properties of available patient-reported outcome measures (PROMs) of psychological birth trauma (PBT) in postpartum women.

METHODS

A literature search was carried out across eight databases-PubMed, Embase, Web of Science, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals-covering studies published from the inception of each database up to 21 May 2024. English and Chinese language studies employing any research design and reporting at least one psychometric property of PBT in puerperae were included. Independent reviewers extracted data and followed the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines to evaluate three aspects of the included instruments: methodological quality, psychometric properties, and level of evidence assessed using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

RESULTS

Thirty-one studies with twelve PROMs were included, measurement error, cross-cultural validity, and responsiveness were not reported for most PROMs. Nine PROMs received a Class B recommendation, based on their measurement attribute ratings and overall evidence quality. In contrast, the CTI, IES-R, and PBTAS with high-quality evidence for insufficient measurement properties, so received a Class C recommendation.

CONCLUSIONS

This systematic review provisionally recommends the City BiTS as credible tool for assessing PBT in both clinical practice and research involving puerperae. However, further comprehensive studies are needed to conduct more comprehensive validations of the psychometric properties of existing PROMs.

'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.

"I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing

BACKGROUND

Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice.

AIM

To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented.

METHOD

A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews.

RESULTS

Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period.

CONCLUSION

The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.

Birth trauma: the elephant in the nursery

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.