1
|
Abu Shqara R, Goldinfeld G, Tenne Cohen R, Nahir Biderman S, Lowenstein L, Frank Wolf M. Birth outcomes associated with a natural delivery approach in a perinatal center: A comparative retrospective study. J Obstet Gynaecol Res 2024. [PMID: 38621773 DOI: 10.1111/jog.15952] [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: 08/19/2023] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES At our center, natural home-like delivery settings have been established in or near conventional labor wards, for the care of pregnant women who prefer little or no medical intervention during labor and birth. We compared obstetrical and neonatal outcomes of women in active spontaneous labor, between those who chose to deliver in a natural-delivery setup and those who chose a conventional setting. METHODS This retrospective study included low-risk women who delivered at term between March 1, 2020 and December 31, 2022, in a single tertiary university affiliated medical center. Birth outcomes were compared between 124 women who delivered by natural birth (the study group) and 244 who gave birth in a conventional setting (the control group). RESULTS No cesarean deliveries were performed in the study group, compared to 18 (7.4%) of the control group, p = 0.004. Intrapartum fever, postpartum hemorrhage, and uterotonic administration were similar between the groups. For the study compared to the control group, breastfeeding was more common (71.3% vs. 12.3%, p < 0.001), analgesia administration within 48 h delivery was lower (4.1% vs. 10.7%, p = 0.033), and maternal and neonatal length of hospitalization were shorter. Of the women initially admitted to the natural-delivery room, 14 (11.5%) were transferred to a conventional-delivery room. CONCLUSIONS Birth in a hospital natural-delivery setting was associated with increased likelihood of vaginal birth, increased immediate breastfeeding and breastfeeding at discharge, and lower postpartum pain.
Collapse
Affiliation(s)
- Raneen Abu Shqara
- Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Roni Tenne Cohen
- Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
| | - Sari Nahir Biderman
- Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
| | - Lior Lowenstein
- Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| |
Collapse
|
2
|
Suarez A, Yakupova V. Childbirth experiences of women with a history of physical, sexual, and child abuse: a cross-sectional study of 2,575 Russian women. BMC Pregnancy Childbirth 2024; 24:186. [PMID: 38459457 PMCID: PMC10921683 DOI: 10.1186/s12884-024-06369-3] [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: 10/16/2023] [Accepted: 02/24/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour. METHODS A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma. RESULTS Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(β) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(β) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth. CONCLUSION This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.
Collapse
Affiliation(s)
- Anna Suarez
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia.
| | - Vera Yakupova
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia
| |
Collapse
|
3
|
Dmowska A, Fielding-Singh P, Halpern J, Prata N. The intersection of traumatic childbirth and obstetric racism: A qualitative study. Birth 2024; 51:209-217. [PMID: 37849421 PMCID: PMC10922554 DOI: 10.1111/birt.12774] [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: 09/29/2022] [Revised: 06/02/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. METHODS In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. RESULTS Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. CONCLUSIONS Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.
Collapse
Affiliation(s)
- Amelia Dmowska
- Medical Student, University of California Berkeley and University of California San Francisco Joint Medical Program
| | | | - Jodi Halpern
- Professor of Bioethics and Medical Humanities, University of California Berkeley and University of California San Francisco Joint Medical Program
| | - Ndola Prata
- Professor of Maternal, Child and Adolescent Health, University of California Berkeley School of Public Health
| |
Collapse
|
4
|
Palgi-Hacker H, Sacks E, Landry M. Respectful maternity care in Israel during the Covid-19 pandemic: a cross-sectional study of associations between childbirth care practices and women's perceptions of care. BMC Pregnancy Childbirth 2024; 24:50. [PMID: 38200458 PMCID: PMC10777588 DOI: 10.1186/s12884-023-06030-5] [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: 08/22/2022] [Accepted: 09/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Respectful maternity care is a crucial part of quality care and is associated with better health outcomes. Early in the Covid-19 pandemic, reports from across the world indicated that infection containment measures were often implemented in ways that resulted in disrespectful care of women during facility-based childbirths in violation of evidence-based practices. This study aimed to explore the associations between childbirth care practices and perceptions of care as satisfactory and respectful among women who delivered in Israeli hospitals during the first six months of the Covid-19 pandemic. METHODS A cross-sectional self-administered online survey was conducted to explore women's perceptions of maternity care using an adapted version of the WHO Community Survey Tool for measuring how women are treated during facility-based childbirth. Multivariate logistic regression models evaluated the associations between sociodemographic characteristics, obstetric information, and measurements of childbirth experiences and women's perceptions of receiving respectful and satisfactory care. RESULTS The responses of 981 women were included in the analysis. While the majority of women perceived the care they received as both respectful (86.54%) and satisfactory (80.22%), almost 3 in 4 women (72.68%) reported experiencing at least one type of disrespectful care. Positive communication with the medical staff and respect for autonomy were associated with a more positive birth experience for women. Women were more likely to perceive their care as respectful if they did not feel ignored (AOR = 40.11;22.87-70.34). Perception of satisfactory care was more likely among women who had the opportunity to discuss preferences with the medical staff (AOR = 10.15; 6.93-14.86). Having Covid-19 procedures explained increased the likelihood of reporting respectful and satisfactory care (AOR = 2.89;1.91-4.36; AOR = 2.83;2.01-4). CONCLUSION Understanding which care practices are associated with women's perceptions of care at facility-based births is critical to ensuring quality care. The findings of this study can inform future work and research aimed at enhancing respectful maternity care during times of crisis and beyond.
Collapse
Affiliation(s)
- Hagar Palgi-Hacker
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C, 20052, USA.
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, E8011, Baltimore, MD, 21205, USA
| | - Megan Landry
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C, 20052, USA
| |
Collapse
|
5
|
LeMarbe K, Kusunoki Y, Seng J, Sperlich M. Continuing Education Intervention: Trauma-Informed Pain Management in Labor and Delivery. J Contin Educ Nurs 2024; 55:21-25. [PMID: 37971229 DOI: 10.3928/00220124-20231109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND There is a gap in the availability of continuing education opportunities for labor and delivery nurses regarding trauma-informed perinatal care. METHOD A continuing education module on trauma-informed pain management in labor was created and distributed to 17 nurses in an intrapartum unit at a hospital in the Midwestern United States. Changes in knowledge, attitudes, skills, and intent to use trauma-informed principles were assessed using a pretest-posttest design and paired t test analyses. RESULTS Change in knowledge (p = .043) and skills (p = .011) was statistically significant. There were no statistically significant changes in attitudes. CONCLUSION Continuing education opportunities in trauma-informed perinatal care are needed for health care team members who provide care to trauma survivors in labor. Further research on the effectiveness of trauma-informed pain management in labor and birth is necessary to provide additional resources and recommendations for labor and delivery nurses. [J Contin Educ Nurs. 2024;55(1):21-25.].
Collapse
|
6
|
Childbirth, trauma and family relationships. Eur J Psychotraumatol 2023; 14:2157481. [PMID: 37052080 PMCID: PMC9848292 DOI: 10.1080/20008066.2022.2157481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples.Method: A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured.Results: Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth.Limitations: Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression.Discussion and conclusions: Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.
Collapse
|
7
|
Williams ME, Strobino DM, Holliday CN. Measuring post-traumatic stress after childbirth: a review and critical appraisal of instruments. J Reprod Infant Psychol 2023; 41:599-613. [PMID: 35083966 PMCID: PMC9325923 DOI: 10.1080/02646838.2022.2030052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Addressing psychological trauma after childbirth requires accurate measurement of its prevalence, risk factors, and outcomes using validated instruments that distinguish perceptions of traumatic birth, subclinical post-traumatic stress (PTS) symptoms, and symptoms meeting a diagnostic threshold. OBJECTIVE The purpose of this study was to review literature on psychological trauma following childbirth and appraise instruments that measure postpartum PTS. METHODS In January 2020, the authors searched for and evaluated peer-reviewed studies that quantitatively measured PTS following hospital-based live births in the United States, United Kingdom, Canada, Australia, Norway, Sweden, and Switzerland; 37 articles were selected and evaluated. RESULTS Levels of post-traumatic stress disorder were most commonly measured, followed by PTS symptoms. Diagnostic instruments suggested lower PTS prevalence estimates than those screening for or assessing PTS symptoms. Community samples yielded lower prevalence estimates than samples recruited from the internet or settings specifically addressing mental health. Measurement sooner after birth yielded higher estimates. CONCLUSION Study design, sample characteristics, instruments, and timing of measurements likely impact postpartum PTS prevalence estimates. Variation in these characteristics make it difficult to draw conclusions on the prevalence of postpartum PTS. Researchers should consider the appraisal of measurement tools presented here and use rigorous study methodology when studying traumatic birth experiences and evaluating interventions.
Collapse
Affiliation(s)
- Meagan E Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donna M Strobino
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Charvonne N Holliday
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Bergunde L, Karl M, Schälicke S, Weise V, Mack JT, von Soest T, Gao W, Weidner K, Garthus-Niegel S, Steudte-Schmiedgen S. Childbirth-related posttraumatic stress symptoms - examining associations with hair endocannabinoid concentrations during pregnancy and lifetime trauma. Transl Psychiatry 2023; 13:335. [PMID: 37907467 PMCID: PMC10618290 DOI: 10.1038/s41398-023-02610-3] [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: 12/22/2022] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
Evidence has linked alterations of the endocannabinoid system with trauma exposure and posttraumatic stress disorder (PTSD). Childbirth-related PTSD symptoms (CB-PTSS) affect about every eighth woman and can negatively influence the entire family. While aetiological models of CB-PTSD include psychological risk factors such as maternal trauma history and negative subjective birth experience (SBE), they lack biological risk indicators. We investigated whether lifetime trauma and CB-PTSS were associated with long-term endocannabinoid concentrations during pregnancy. Further, we tested endocannabinoids as mediators between lifetime trauma and CB-PTSS and whether SBE moderated such mediational paths. Within the prospective cohort study DREAMHAIR, 263 expectant mothers completed trauma assessments and provided hair samples for quantification of long-term endocannabinoid levels (anandamide [AEA], 2-arachidonoylglycerol [1-AG/2-AG], and N-acyl-ethanolamides [NAE]) prior to their anticipated birth date. Two months postpartum, CB-PTSS and SBE were measured. Regression models controlling for relevant confounders showed no association between lifetime trauma and hair endocannabinoids during pregnancy, yet higher number of lifetime trauma events and lower hair AEA were significantly associated with CB-PTSS, with the latter finding not remaining significant when Bonferroni corrections due to multiple testing were applied. While hair AEA did not mediate the association between lifetime trauma and CB-PTSS, the effect of lower hair AEA on CB-PTSS was stronger upon negative SBE. Results suggest greater lifetime trauma and reduced maternal hair AEA during pregnancy may be associated with increased risk for CB-PTSS, particularly upon negative SBE. Findings confirm lifetime trauma as a CB-PTSS risk factor and add important preliminary insights on the role of endocannabinoid ligand alterations and SBE in CB-PTSS pathology.
Collapse
Affiliation(s)
- Luisa Bergunde
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Marlene Karl
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sarah Schälicke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Weise
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T Mack
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Wei Gao
- Institute of Biological Psychology, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg MSH, Hamburg, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
9
|
Padoa A, Tomashev R, Brenner I, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Ginzburg K. Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 288:7-11. [PMID: 37413830 DOI: 10.1016/j.ejogrb.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.
Collapse
Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roni Tomashev
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Brenner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Sackler School 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
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Weidner K, Bartmann C, Leinweber J. [Traumatic childbirth and trauma-sensitive obstetric support]. DER NERVENARZT 2023; 94:811-820. [PMID: 37351670 DOI: 10.1007/s00115-023-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
Childbirth can be a very happy and empowering experience for women but also one of suffering and despair. Biographical traumatic experiences, especially sexual, physical and emotional violence, are risk factors for a traumatic childbirth experience with the danger of subsequent trauma sequelae and impaired mother-child bonding; however, obstetrically indicated interventions or poor communication in the delivery room can also primarily be experienced as traumatic.In recent years, policies affecting traumatic childbirth experience have been controversially and sometimes emotionally discussed. In the clinical obstetric routine there is often a fine line between medically necessary rapid interventions and emotionally supportive trauma-sensitive and preventive obstetric care. The following article addresses the causes and prevention strategies of traumatic childbirth experiences from obstetric, midwifery and psychotherapeutic perspectives.
Collapse
Affiliation(s)
- Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Catharina Bartmann
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Deutschland
| | - Julia Leinweber
- Institut für Hebammenwissenschaft, Charité Universitätsmedizin Berlin, Virchowweg 23, 10117, Berlin, Deutschland
| |
Collapse
|
11
|
Soriano-Vidal FJ, Oliver-Roig A, Richart-Martínez M, Cabrero-García J. Predictors of childbirth experience: Prospective observational study in eastern Spain. Midwifery 2023; 124:103748. [PMID: 37285753 DOI: 10.1016/j.midw.2023.103748] [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: 02/12/2022] [Revised: 03/10/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. METHODS This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. RESULT The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. CONCLUSION Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.
Collapse
Affiliation(s)
- F J Soriano-Vidal
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante; Department of Nursing Universitat de València. C/Jaume Roig s/n. 46010 Valencia, Spain; Midwife, Hospital Lluis Alcanyis, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Ctra. Xàtiva-Silla, km 2, 46800 Xàtiva, Valencia, Spain
| | - A Oliver-Roig
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante.
| | - M Richart-Martínez
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante
| | - J Cabrero-García
- Department of Nursing, University of Alicante. Spain. Cta. San Vicente del Raspeig s/n 03690 San Vicente del Raspeig, Alicante
| |
Collapse
|
12
|
Ouedraogo R, Obure V, Kimemia G, Achieng A, Kadzo M, Shirima J, Dama SU, Wanjiru S, Both J. "I will never wish this pain to even my worst enemy": Lived experiences of pain associated with manual vacuum aspiration during post-abortion care in Kenya. PLoS One 2023; 18:e0289689. [PMID: 37619217 PMCID: PMC10449468 DOI: 10.1371/journal.pone.0289689] [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: 12/30/2022] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors. METHODS We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers. RESULTS Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls. CONCLUSION The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care.
Collapse
Affiliation(s)
| | - Valleria Obure
- African Population and Health Research Center, Nairobi, Kenya
| | - Grace Kimemia
- African Population and Health Research Center, Nairobi, Kenya
| | - Anne Achieng
- African Population and Health Research Center, Nairobi, Kenya
| | - Mercy Kadzo
- African Population and Health Research Center, Nairobi, Kenya
| | - Jane Shirima
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | |
Collapse
|
13
|
Weigl T, Brunton R, Dryer R, Garthus-Niegel S. Validation of the German version of the pregnancy-related anxiety scale (PrAS): psychometric properties across all trimesters of pregnancy. BMC Pregnancy Childbirth 2023; 23:472. [PMID: 37355600 DOI: 10.1186/s12884-023-05787-z] [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: 03/22/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Pregnancy-related anxiety has received greater research attention recently given its association with adverse outcomes (e.g., negative birth experiences). The Pregnancy-related Anxiety Scale (PrAS) offers the possibility to assess pregnancy-related anxiety, but no German version is available. Therefore, the aim of this study was to validate a German version of the PrAS, a comprehensive measure with eight dimensions. METHODS Pregnant women of any parity or gestation completed an online survey consisting of the PrAS, PRAQ-R2, and measures of anxiety, depression, and resilience. The PrAS was translated into German (PrAS-G) using the back-translation method. Data were subjected to confirmatory factor analysis and inferential statistics. RESULTS Complete data were provided by 443 women. Participants were predominantly German nationals, partnered, and well-educated with a planned pregnancy. Approximately half were nulliparous. The eight-factor model was well fitting and consistent with the development of the original PrAS. Criterion-related validity was demonstrated by strong correlations with similar measures (PRAQ-R2, anxiety, and depression) and lower correlations with resilience scores. Predictive validity was shown by group comparisons for: planned versus unplanned pregnancy, trimester, and parity. CONCLUSIONS The PrAS-G provides a broader assessment of pregnancy-related anxiety than existing measures. Initial evaluation has demonstrated convergent, divergent, and predictive validity, excellent internal consistency, and good model fit indicating promising psychometric properties. The PrAS-G offers a comprehensive assessment of pregnancy-related anxiety which will enable tailored interventions aiming to improve birth experience and well-being of expectant mothers.
Collapse
Affiliation(s)
- Tobias Weigl
- Psychology School, Fresenius University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Robyn Brunton
- Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Rachel Dryer
- Australian Catholic University, Strathfield, NSW, 2135, Australia
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway.
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| |
Collapse
|
14
|
Reppen K, Henriksen L, Schei B, Magnussen EB, Infanti JJ. Experiences of childbirth care among immigrant and non-immigrant women: a cross-sectional questionnaire study from a hospital in Norway. BMC Pregnancy Childbirth 2023; 23:394. [PMID: 37245035 DOI: 10.1186/s12884-023-05725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Immigrant women have higher risks for poor pregnancy outcomes and unsatisfactory birth experiences than the general population. The mechanisms behind these associations remain largely unknown, but they may result from differential care provided to immigrant women or unsatisfactory interactions with health providers. This study aimed to investigate immigrant and non-immigrant women's experiences of health care during childbirth, particularly assessing two dimensions: perceived general quality of care and attainment of health care needs during childbirth. METHODS This was a cross-sectional study carried out over 15 months in 2020 and 2021, and data were collected from a self-completed questionnaire. The labour and birth subscale from the Experience of Maternity Care questionnaire was used to assess the primary outcome of care experiences. A total of 680 women completed the questionnaire approximately within two days after birth (mean 2.1 days) at a hospital in Trondheim, in central Norway. The questionnaire was provided in eight languages. RESULTS The 680 respondents were classified as immigrants (n = 153) and non-immigrants (n = 527). Most women rated their quality of care during childbirth as high (91.5%). However, one-quarter of the women (26.6%) reported unmet health care needs during childbirth. Multiparous immigrant women were more likely than multiparous non-immigrant women to report that their health care needs were unmet during childbirth (OR: 3.31, 95% CI: 1.91-5.72, p < 0.001, aOR: 2.83, 95% CI: 1.53-5.18, p = 0.001). No other significant differences between immigrant versus non-immigrant women were found in subjective ratings of childbirth care experiences. Having a Norwegian-born partner and a high level of Norwegian language skills did not influence the immigrant women's experience of childbirth care. CONCLUSIONS Our findings indicate that many women feel they receive high-quality health care during childbirth, but a considerable number still report not having their health care needs met. Also, multiparous immigrant women report significantly more unmet health care needs than non-immigrants. Further research is required to assess immigrant women's childbirth experiences and for health care providers to give optimal care, which may need to be tailored to a woman's cultural background and individual expectations.
Collapse
Affiliation(s)
- Kristin Reppen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
| | - Elisabeth Balstad Magnussen
- Division of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jennifer Jean Infanti
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
15
|
Oskoui BS, Mehrabi E, Nourizadeh R, Esmaeilpour K. The effect of mindfulness-based counseling on the childbirth experience of primiparous women: a randomized controlled clinical trial. BMC Pregnancy Childbirth 2023; 23:274. [PMID: 37085789 PMCID: PMC10119513 DOI: 10.1186/s12884-023-05607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Unpleasant childbirth experience is considered as one of the important factors for cesarean preference. Limited studies have been investigated the impact of psycho-based interventions on the childbirth experience and the most effective counseling approach to promote a pleasant childbirth experience has not been clearly identified. OBJECTIVE The present study aimed to evaluate the impact of mindfulness-based counseling on the childbirth experience of primiparous women. METHODS AND MATERIALS This randomized controlled clinical trial was conducted on 64 primiparous with gestational age of 32 to 34 weeks referred to the perinatology clinic of Al-Zahra and Taleghani educational-treatment hospital, affiliated to Tabriz University of Medical sciences, Iran. Participants were randomly assigned into the intervention and control groups. The intervention group received eight mindfulness-based counseling sessions. The intensity of childbirth pain with VAS (Visual Analog Scale) in the active phase of labor at 8 cm dilatation and the childbirth experience questionnaire were completed by interview after childbirth. Independent t-test and ANCOVA were used to compare the outcomes between the two groups. RESULTS After controlling the effect of confounding variables, the mean score of childbirth experience in the intervention group was significantly higher than that in control group [Mean Difference (MD): 1.79, 95% CI: 2.52 to 1.07, P < 0.01]. The mean score of labor pain in the intervention group was significantly lower than that in the control group after controlling the effect of baseline score and confounding variables [MD: -2.21, 95% CL: -3.35 to -1.10, P < 0.001]. CONCLUSION The findings indicated that providing mindfulness-based counseling improves the childbirth experience and reduces labor pain during childbirth. However, further randomized clinical trials are needed before making a definitive conclusion. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N9. Date of registration: 16/03/2022, 25/12/1400.
Collapse
Affiliation(s)
- Bahare Sharegi Oskoui
- Student Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmat Mehrabi
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Roghaiyeh Nourizadeh
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | |
Collapse
|
16
|
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 2023:1-19. [PMID: 36879419 DOI: 10.1080/02646838.2023.2187357] [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: 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.
Collapse
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
| |
Collapse
|
17
|
Waldum ÅH, Lukasse M, Staff AC, Falk RS, Sørbye IK, Jacobsen AF. Intrapartum pudendal nerve block analgesia and childbirth experience in primiparous women with vaginal birth: A cohort study. Birth 2023; 50:182-191. [PMID: 36529699 DOI: 10.1111/birt.12697] [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: 11/06/2021] [Revised: 01/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND A negative childbirth experience has short- and long-term consequences for both mother and child. This study aimed to investigate the association between intrapartum pudendal nerve block (PNB) analgesia and childbirth experience. METHODS Primiparous women with a singleton cephalic vaginal live births at term at Oslo University Hospital from January 1, 2017, to June 1, 2019, were eligible for inclusion. The main outcome was total score on a childbirth experience questionnaire (range 1.0-4.0, higher score indicates better childbirth experience). An absolute risk difference of 0.10 was considered clinically relevant. Propensity score matching was used to adjust for differences in baseline characteristics between women with and without PNB. The analyses were stratified by spontaneous vs instrumental birth. Subanalyses of the questionnaire's domains (own capacity, professional support, perceived safety, and participation) were performed. RESULTS Of 979 participating women, mean age was 32 years. Childbirth experience did not differ between women with and without PNB, either in spontaneous (absolute risk difference of the mean: -0.05, P value 0.36) or in instrumental birth (absolute risk difference of the mean: 0.03, P value 0.61). There were no statistically significant differences between PNB group scores for the separate domains. CONCLUSIONS Women's childbirth experiences did not differ between birthing people with or without PNB, either in spontaneous or in instrumental births. The clinical implications of our study should be interpreted in light of the pain-relieving effects of PNB.PNB should be provided on clinical indication, including for individuals with severe labor pain.
Collapse
Affiliation(s)
- Åsa Henning Waldum
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway.,Institute of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
18
|
Staudt A, Baumann S, Horesh D, Eberhard-Gran M, Horsch A, Garthus-Niegel S. Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis. Psychiatry Res 2023; 320:115038. [PMID: 36603381 DOI: 10.1016/j.psychres.2022.115038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.
Collapse
Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
19
|
Hair glucocorticoids during pregnancy in the context of trauma exposure and their predictive value for the development of childbirth-related posttraumatic stress disorder symptoms. Psychoneuroendocrinology 2023; 148:105973. [PMID: 36481577 DOI: 10.1016/j.psyneuen.2022.105973] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/07/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childbirth-related posttraumatic stress disorder (CB-PTSD) is gaining attention as a mental disorder with negative sequela for mothers and their offspring. Maternal trauma history is a well-known vulnerability factor for CB-PTSD symptoms (CB-PTSS). Furthermore, alterations of the hypothalamus-pituitary-adrenal axis have been linked to both trauma exposure and PTSD development. Hence, we investigated whether trauma history was associated with long-term glucocorticoid (GC) levels during pregnancy and their predictive role for CB-PTSS. Further, we examined whether GCs act as a mediator in the relationship between trauma history and CB-PTSS and whether this was moderated by the subjective birth experience. METHODS 212 women participating in the prospective cohort study DREAMHAIR provided hair samples for quantification of long-term integrated cortisol and cortisone levels prior to their anticipated birth date accompanied by measures of trauma history. CB-PTSS and subjective birth experience were assessed two months postpartum. FINDINGS Trauma history predicted elevated hair cortisol and hair cortisone during the third trimester of pregnancy, however associations did not remain significant when Bonferroni correction due to multiple testing was applied. Trauma history also predicted higher CB-PTSS. Hair GC levels during pregnancy neither predicted CB-PTSS two months after birth nor mediated the relationship between trauma history and CB-PTSS. The subjective birth experience moderated the relationship of hair cortisol and cortisone with CB-PTSS. CONCLUSION Our data suggest that a history of trauma contributes to a higher risk to develop CB-PTSS and elevated long-term GC levels during the third pregnancy trimester. Further, the predictive role of hair cortisol and cortisone levels for CB-PTSS may depend on subjective birth experience. This highlights the need to consider the latter in future investigations when examining the role of stress-related biomarkers in more severely affected samples.
Collapse
|
20
|
Henriksen L, Debrecéniová J, Hrabovská A, Pufflerová Š, Blix E. Adaption and validation of the childbirth experience questionnaire (CEQ-SK) in Slovakia. Eur J Midwifery 2023; 7:6. [PMID: 36926447 PMCID: PMC10012084 DOI: 10.18332/ejm/160973] [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: 11/06/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Using validated and reliable instruments to examine women's birth experiences is important to ensure respectful care. There is a lack of validated instruments for evaluating childbirth care in the Slovak context. In this study, we aimed to adapt and validate the childbirth experience questionnaire (CEQ) in Slovakia (CEQ-SK). METHOD The CEQ-SK was developed and modified from the English version of the CEQ/CEQ2. Face validity was tested in two pre-tests. A convenience sample, recruited through social media, included 286 women who had given birth within the last six months. Reliability was assessed using Cronbach's alpha. Construct and discriminant validity was assessed by exploratory factor analysis and known-group comparison. RESULTS The exploratory factor analysis revealed a three-dimensional structure, explaining 63.3% of the total variance. The factors were labelled 'Own capacity', 'Professional support' and 'Decision making'. No items were excluded. Internal consistency was demonstrated with an overall Cronbach's alpha of 0.94 for the total scale. Primiparous women, women who had an emergency cesarean section, and women who had been exposed to the Kristeller manoeuvre had a lower overall score on the CEQ-SK compared to parous women, women having a vaginal birth and women not exposed to the Kristeller manoeuvre. CONCLUSION The CEQ-SK was found to be a valid and reliable tool for evaluating childbirth experience in Slovakia. The original CEQ is a four-dimensional questionnaire; however, factor analysis showed a three-dimensional structure in the Slovak sample. This needs to be taken into consideration when comparing the results from the CEQ-SK with studies that use the four-dimensional structure.
Collapse
Affiliation(s)
- Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Division of General Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | | | - Anna Hrabovská
- Citizen, Democracy and Accountability, Bratislava, Slovakia
| | | | - Ellen Blix
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
21
|
Mirghafourvand M, Meedya S, Mohammadi E, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Ghanbari-Homaie S. Iranian women's perception on the determinants of birth experience: a qualitative study. BMC Pregnancy Childbirth 2022; 22:751. [PMID: 36199065 PMCID: PMC9535943 DOI: 10.1186/s12884-022-05078-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women's perspective on what determines a positive or negative birth experience for them. METHODS This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women's birth experiences. The quantitative phase of the study was a cross-sectional study where women's childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis. RESULTS We extracted three main themes: (a) "Internal control", (b) "External control", and (c) "Support". Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences. CONCLUSION Considering that women's sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births.
Collapse
Affiliation(s)
- Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Shahla Meedya
- School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | | | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, 3144, Melbourne, VIC, Australia.,School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 3800, Melbourne, VIC, Australia.,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
22
|
Ghanbari-Homaie S, Meedya S, Mohammad-Alizadeh-Charandabi S, Asghari Jafarabadi M, Mohammadi E, Mirghafourvand M. Correlations Between Primiparous Women’s Perceived Internal Control, External Control, Support and Their Birth Experience. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDPerceived control and support can contribute to a positive childbirth experience. However, most studies have not differentiated between perceived internal and external control.OBJECTIVEThe present study aimed to assess primiparous women’s perceived internal control, external control, and support, including family and professional support and their association with the childbirth experience.METHODSA cross-sectional study was carried out on 800 primiparous mothers recruited from health centers across Tabriz, Iran, through cluster sampling. The childbirth experience questionnaire (2.0) and the support and control in birth scale were used to measure women’s childbirth experience and their perceived internal and external control and support. Data were collected through an interview during early postpartum and analyzed by independent t-test, one-way ANOVA, Pearson correlation and general linear model.RESULTSThe results demonstrated a significant correlation between perceived internal control (r = 0.80, p < .001), external control (r = 0.79, p < .001) and professional support (r = 0.83, p < .001) with childbirth experience. By controlling confounders such as socio-demographic and reproductive variables, internal control [β (95% CI): 0.28 (0.25 to 0.31); p < .001], external control [0.10 (0.06 to 0.14); p < .001], professional support [0.27 (0.23 to 0.30); p < .001], were independent predictors of positive childbirth experience.CONCLUSIONThese findings point to the importance of perceived internal, external control and professional support and the relationship between healthcare providers, especially midwives, with the women in improving childbirth experience. It is suggested that healthcare providers give support to women and utilize methods that enhance women’s control during labor and childbirth.
Collapse
|
23
|
Twin birth: The maternal experience. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100766. [PMID: 36027723 DOI: 10.1016/j.srhc.2022.100766] [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: 10/03/2021] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Twin birth is a special setting for women giving birth, and the experience of childbirth can be different from singleton birth. The objective of this study was to evaluate and compare the childbirth experiences of twin mothers and singleton mothers. We also aimed to identify the risk factors of a negative childbirth experience in the whole study population. METHODS All live diamniotic twin deliveries in the study hospital of at least 35+0 weeks of gestation with a plan of vaginal birth were included in this matched groups study from August 2015 to August 2019. For every twin birth, two singleton birth controls were selected and matched with parity, the actual mode of birth, and gestational weeks at birth. Six weeks after birth, a Childbirth Experience Questionnaire (CEQ) was sent to mothers, and 72 twin mothers and 126 singleton mothers returned the questionnaire. RESULTS The twin mothers' overall childbirth experience was positive. They reported a significantly lower opportunity to choose the birthing position (p < 0.001). Otherwise, there were no differences in the CEQ mean total scores between the study groups. Intrapartum cesarean section raised the risk of a negative childbirth experience and there was a high level of satisfaction with midwifery care among the whole study population. CONCLUSION The overall maternal experience in planned vaginal twin birth was positive. Twin mothers felt less often able to choose their birthing position, otherwise the childbirth experience did not differ from that of singleton mothers.
Collapse
|
24
|
Wang J, Zhao G, Song G, Liu J. Association between neuraxial labor analgesia and postpartum depression: A meta-analysis. J Affect Disord 2022; 311:95-102. [PMID: 35594971 DOI: 10.1016/j.jad.2022.05.095] [Citation(s) in RCA: 4] [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: 12/15/2021] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Labor and delivery complications, particularly pain, are important risk factors for postpartum depression (PPD). Neuraxial labor analgesia can effectively relieve labor pain; however, the association between neuraxial labor analgesia and PPD, if any, has not been established. METHODS PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library were searched. The incidence of PPD was the primary outcome. The secondary outcome was the difference in postpartum Edinburgh Postpartum Depression Scale scores between the neuraxial labor analgesia and control groups. Subgroup analyses and post-hoc meta-regression were performed. RESULTS Nineteen studies with a total of 8758 parturients were identified. Neuraxial labor analgesia did not decrease PPD risk compared to the control group (OR = 0.84, 95% CI: 0.58-1.23); however, after being stratified by PPD prevalence, neuraxial labor analgesia decreased the risk for PPD in the high prevalence (>14%) subgroup (OR = 0.61, 95% CI: 0.39-0.94) and increased the risk for PPD in the low prevalence (<14%) subgroup (OR = 1.56, 95% CI: 1.16-2.10) compared to the control group. Meta-regression analysis showed that the association between neuraxial labor analgesia and PPD was influenced by PPD prevalence. There was no difference in the postpartum Edinburgh Postpartum Depression Scale scores between the neuraxial labor analgesia and control groups (WMD = -0.11, 95% CI: -0.56-0.34). LIMITATION Heterogeneity and a limited number of randomized controlled trials may bias the interpretation of the results. CONCLUSION Neuraxial labor analgesia had a protective effect when administered to parturients in the region with a high prevalence of PPD, but became a risk factor when administered to parturients in the region with a low prevalence of PPD.
Collapse
Affiliation(s)
- Jian Wang
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Liu
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
25
|
Azarkish M, Malakouti J, Mirghafourvand M. Relationship Between Childbirth Experience and Sexual Function and Sleep Quality in Iranian Postpartum Women: A Cross-Sectional Study. J Psychosoc Nurs Ment Health Serv 2022; 60:49-55. [DOI: 10.3928/02793695-20220705-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
26
|
Joensuu J, Saarijärvi H, Rouhe H, Gissler M, Ulander VM, Heinonen S, Torkki P, Mikkola T. Maternal childbirth experience and pain relief methods: a retrospective 7-year cohort study of 85 488 parturients in Finland. BMJ Open 2022; 12:e061186. [PMID: 35534068 PMCID: PMC9086622 DOI: 10.1136/bmjopen-2022-061186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse the relation between the used labour pain relief and childbirth experience measured by Visual Analogue Scale (VAS). DESIGN A retrospective cohort study. SETTING Childbirth in five Helsinki University Hospital delivery units from 2012 to 2018. PRIMARY OUTCOME MEASURE Childbirth experience measured by VAS and classified in three groups (negative VAS=1-5, positive VAS=6-8 and highly positive=9-10). RESULTS The use of epidural or non-epidural compared with non-medical pain relief methods decreased the likelihood to experience highly positive childbirth for primiparous (adjusted OR (aOR)EPIDURAL=0.64, 95% CI 0.57 to 0.73; and aORNON-EPIDURAL=0.76, 95% CI 0.66 to 0.87) and multiparous (aOREPIDURAL=0.90, 95% CI 0.84 to 0.97 and aORNON-EPIDURAL=0.80, 95% CI 0.74 to 0.86) parturients. The effects of epidural differed between primiparas and multiparas. In multiparas epidural was associated with decreased odds for experiencing negative childbirth compared with the non-medical group (aOR=0.70, 95% CI 0.57 to 0.87), while the effect of epidural was considered insignificant in primiparas (aOR=1.28, 95% CI 0.93 to 1.77). CONCLUSION While the use of medical-epidural and non-epidural-pain relief methods were not associated with odds for experiencing negative childbirth in primiparas, using epidural helps to avoid negative experience in multiparas. However, the odds for experiencing highly positive childbirth were decreased if the parturients used any medical pain relief for both primiparas and multiparas. Consequently, the effect of pain relief on the childbirth experience is strongly confounded by indication. Thus, the use of pain relief per se plays a limited role in the complex formation of the overall childbirth experience.
Collapse
Affiliation(s)
- Johanna Joensuu
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Hannu Saarijärvi
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Mika Gissler
- Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
- Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Tomi Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| |
Collapse
|
27
|
Binyamin Y, Wainstock T, Sheiner E, Battat TL, Reuveni I, Leibson T, Pariente G. The association between epidural analgesia during labor and mother-infant bonding. J Clin Anesth 2022; 80:110795. [PMID: 35489303 DOI: 10.1016/j.jclinane.2022.110795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE This study was aimed to assess the association between the use of epidural analgesia during labor and mother-infant bonding. DESIGN A cross-sectional study. SETTING Maternity ward at Soroka University Medical Center during 2020. PATIENTS Women who delivered a singleton live-born infant vaginally in their immediate post-partum period. INTERVENTIONS Women completed questionnaires. 25 items post-partum bonding questionnaire (PBQ) to assess mother-infant bonding (A high score on the PBQ indicates impaired mother-infant bonding) and the Edinburgh postnatal depression scale (EPDS) questionnaire to assess risk for post-partum depression. MEASUREMENTS The study used PBQ questionnaire and four sub-scales to assess mother-infant bonding and the EPDS questionnaire to assess risk for post- partum depression. Generalized linear regression models (gamma) were constructed to examine the association between epidural analgesia and mother-infant bonding total score and impaired bonding sub- scale, while adjusting for confounders Additional information such as pregnancy complications and sociodemographic data was drawn from women's medical records. MAIN RESULTS A total of 234 women were included in the final analysis, of them 126 (53.8%) delivered with epidural analgesia. The total PBQ score was significantly lower among women who received epidural analgesia compared to women without epidural analgesia (7.6 vs. 10.2, p = 0.024), demonstrating a better mother -infant bonding. Using two multivariable linear regression models, controlling for confounders such as maternal age and educational status, epidural analgesia during labor was independently associated with a better mother -infant bonding total score and better impaired bonding sub-scale score (Beta coefficient-0.252, 95% CI -0.5; -0.006, p = 0.045 and Beta coefficient - 0.34, 95% CI -0.52; -0.08, p = 0.01 for mother-infant bonding total score and sub-scale score, respectively). No differences in post-partum depression risks were found between the groups (EDPS≥13, 5.7% vs. 13%, p = 0.058). CONCLUSION Our study demonstrated better mother -infant bonding among women delivering with epidural analgesia.
Collapse
Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Talya Lanxner Battat
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tom Leibson
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
28
|
Malaju MT, Alene GD, Bisetegn TA. Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method. PLoS One 2022; 17:e0266399. [PMID: 35404954 PMCID: PMC9000968 DOI: 10.1371/journal.pone.0266399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION In recent years, literatures identified childbirth as a potentially traumatic experience resulting in posttraumatic stress disorder (PTSD), with 19.7 to 45.5% of women perceiving their childbirth as traumatic. A substantial variation in PTSD symptoms has been also indicated among women who experience a traumatic childbirth. However, there has been no research that has systematically investigated these patterns and their underlying determinants in postpartum women in Ethiopia. OBJECTIVE The aim of this study was to investigate the trajectories of PTSD symptoms and mediating relationships of variables associated with it among postpartum women in Northwest Ethiopia. METHODS A total of 775 women were recruited after childbirth and were followed at the 6th, 12th and 18th week of postpartum period during October, 2020 -March, 2021. A group-based trajectory modeling and mediation analysis using KHB method were carried out using Stata version 16 software in order to determine the trajectories of PTSD symptoms and mediation percentage of each mediator on the trajectories of PTSD symptoms. RESULTS Four distinct trajectories of postpartum posttraumatic stress disorder symptoms were identified. Perceived traumatic childbirth, fear of childbirth, depression, anxiety, psychological violence, higher WHODAS 2.0 total score, multigravidity, stressful life events of health risk, relational problems and income instability were found to be predictors of PTSD with recovery and chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. In contrast, multiparity and higher mental quality of life scores were protective of belonging to the PTSD with recovery and chronic PTSD trajectory group membership. CONCLUSION Women with symptoms of depression, anxiety, fear of childbirth and perceived traumatic childbirth were at increased risk of belonging to recovered and chronic PTSD trajectories. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers' needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the postpartum period.
Collapse
Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
29
|
Junge-Hoffmeister J, Bittner A, Garthus-Niegel S, Goeckenjan M, Martini J, Weidner K. Subjective Birth Experience Predicts Mother–Infant Bonding Difficulties in Women With Mental Disorders. Front Glob Womens Health 2022; 3:812055. [PMID: 35479290 PMCID: PMC9035738 DOI: 10.3389/fgwh.2022.812055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background The subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders. Methods This study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses. Results About half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96*** (95% CI 0.94–0.98) vs. OR = 0.96** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled. Conclusions A negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.
Collapse
Affiliation(s)
- Juliane Junge-Hoffmeister
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Antje Bittner
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute for Systems Medicine, Faculty of Human Medicine, Medical School Hamburg, Hamburg, Germany
- Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Maren Goeckenjan
- Department of Gynecology and Obstetrics, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Martini
- Department for Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department for Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- *Correspondence: Kerstin Weidner
| |
Collapse
|
30
|
Mårtensson LB, Gunnarsson BM, Karlsson S, Lee N, Bergh I. Effect of topical local anaesthesia on injection pain associated with administration of sterile water injections - a randomized controlled trial. BMC Anesthesiol 2022; 22:35. [PMID: 35105307 PMCID: PMC8805377 DOI: 10.1186/s12871-022-01573-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/10/2022] [Indexed: 12/18/2022] Open
Abstract
Background Sterile water injections can provide effective pain relief during childbirth, particularly for low back pain related to childbirth. However, the pain associated administering the injections can negatively impact women’s impressions of the procedure. It may discourage women from considering repeat doses despite the quality of analgesia experienced. Determining strategies to reduce the pain related to the administration of sterile water injections would improve the acceptability of the technique. Therefore, the aim of this study was to evaluate the effect of topical local anesthesia on the pain associated with administration of sterile water injections. Methods The study was designed as a multi-arm single-blind, randomized, controlled trial and 120 female healthy students were randomly divided according to one of four groups. The Intervention group received sterile water injections with topical local anesthesia. Control group 1 received sterile water injections without topical local anesthesia, control group 2 received injections of isotonic saline 0.9% with topical local anesthesia and control group 3 received injections of isotonic saline 0.9% without topical local anesthesia. Pain Immediately after the injections and subsidence in pain were recorded using a visual analogue scale. Sensations in the injection area were reported 15 min and the day after the injections. Results The main finding of this study was that local anesthesia with EMLA® reduces the pain associated with the administration of intracutaneous sterile water injections. There was a significant difference in the self-assessed pain score immediately following the injections between the control (73.3 mm) and intervention groups (50.0 mm), p = 0.001. No adverse side effects were reported. Conclusion Local anesthesia with EMLA® reduces the pain associated with intracutaneous administration of sterile water injections. Trial registration The study was registered 08/07/2014 at ClinicalTrials.gov Identifier: NCT02213185.
Collapse
Affiliation(s)
- Lena B Mårtensson
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden. .,School of Nursing, Midwifery and Social Work University of Queensland, Chamberlain Building, University of Queensland,, St Lucia, Queensland, 4072, Australia.
| | - Britt-Marie Gunnarsson
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
| | - Sandra Karlsson
- School of Health and Welfare, Jönköping University, P.O. Box 1026, SE-551 11, Jönköping, Sweden
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work University of Queensland, Chamberlain Building, University of Queensland,, St Lucia, Queensland, 4072, Australia
| | - Ingrid Bergh
- School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden
| |
Collapse
|
31
|
Kountanis JA, Kirk R, Handelzalts JE, Jester JM, Kirk R, Muzik M. The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Arch Womens Ment Health 2022; 25:171-180. [PMID: 34250546 DOI: 10.1007/s00737-021-01154-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
Childbirth-related PTSD is generally believed to result from multiple factors, including negative objective and subjective experiences and patient predisposing factors. There is conflicting evidence regarding whether severe childbirth pain affects development of PTSD. We hypothesize that a woman's retrospective subjective appraisal of birth pain is a greater predictor of postpartum-onset PTSD than medically documented measures of pain, and that a positive subjective experience communicating with medical providers during labor also reduces risk for postpartum-onset PTSD. A sample of 112 women, who screened positive for psychopathology within a year postpartum, were interviewed probing for their subjective labor experiences. Interviews were coded for subjective labor pain perception and quality of provider communication. Regression analyses tested associations between subjective labor pain perception and quality of provider communication with postpartum PTSD. Pain scores recorded during labor were not significantly associated to probable PTSD at any recorded time point up to 12 months postpartum. Positive perception of birth pain was associated with reduced risk of probable PTSD at 6 weeks postpartum (aOR = 0.34, p = 0.03). Positive provider communication was associated with reduced risk of probable PTSD at 6 months (aOR = 0.29, p = 0.02) and 12 months (aOR = 0.2, p = 0.03) postpartum. Pain recorded during childbirth is not necessarily a negative experience leading to trauma. For some women, even severe pain may be seen positively, and lacks traumatizing elements. Interventions to positively shift women's childbirth pain appraisal and educate medical workforce in patient-provider communication may reduce rates of postpartum PTSD. ClinicalTrials.gov Indentifier: NCT03004872.
Collapse
Affiliation(s)
- Joanna A Kountanis
- Department of Anesthesiology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Robyn Kirk
- Kirk Consultancy, Edinburgh, Scotland
- School of Nursing, University College, London, UK
| | - Jonathan E Handelzalts
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
- School of Behavioral Sciences, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Jennifer M Jester
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA
| | - Ros Kirk
- Kirk Consultancy, Edinburgh, Scotland
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan Health, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- Department of Psychiatry, University of Michigan Health, 4250 Plymouth Rd, Rachel Upjohn Building, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
32
|
Molgora S, Saita E, Barbieri Carones M, Ferrazzi E, Facchin F. Predictors of Postpartum Depression among Italian Women: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031553. [PMID: 35162574 PMCID: PMC8835615 DOI: 10.3390/ijerph19031553] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Introduction: Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables. Methods: A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2–3 days, 3 months, 6 months, and 12 months postpartum. Results: Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months. Conclusion: Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.
Collapse
Affiliation(s)
- Sara Molgora
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
- Correspondence: ; Tel.: +39-0272342347; Fax: +39-0272345962
| | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
| | | | - Enrico Ferrazzi
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.C.); (E.F.)
- Department of Clinical Science and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Facchin
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
| |
Collapse
|
33
|
Prospective associations between prepartum physical activity, birth experience, and maternal depressive symptoms in the postpartum period: Insights from the population-based DREAM cohort study. J Affect Disord 2022; 297:366-374. [PMID: 34715172 DOI: 10.1016/j.jad.2021.10.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/09/2021] [Accepted: 10/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aims to examine whether physical activity (PA) before and during pregnancy and birth experience predict incident postpartum depressive (PPD) symptoms. Because PA may increase endurance and feelings of physical control, it may contribute to a positive birth experience and birth experience may mediate the association between PA before and during pregnancy and PPD symptoms. METHODS The study is part of the prospective-longitudinal cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Participants were n = 1,254 (expectant) mothers. PA was assessed during pregnancy, birth experience and PPD symptoms 8 weeks postpartum. Multiple regression analyses were performed, including potential confounders. RESULTS A negative birth experience was linked to PPD symptoms, when controlling for relevant confounders. There was no evidence for a link between PA before and during pregnancy and birth experience or between PA during pregnancy and PPD symptoms. PA at low and at vigorous intensity before pregnancy was associated with PPD symptoms, but not when controlling for confounders. Because PA was not associated with birth experience, no mediation analysis was performed. LIMITATIONS The current sample was relatively homogenous (i.e., mostly German native speakers, primiparous, highly educated). Birth experience was assessed retrospectively at 8 weeks following birth. CONCLUSIONS Our results highlight the importance of the birth experience in the development of PPD symptoms. Promoting a positive birth experience represents a promising approach to prevent PPD symptoms. Further research on the association between PA and PPD symptoms is warranted.
Collapse
|
34
|
Huschke S. 'The System is Not Set up for the Benefit of Women': Women's Experiences of Decision-Making During Pregnancy and Birth in Ireland. QUALITATIVE HEALTH RESEARCH 2022; 32:330-344. [PMID: 34852686 PMCID: PMC8727824 DOI: 10.1177/10497323211055461] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In this article, I draw on in-depth qualitative interviews with 23 women, conducted in 2019/2020, focusing on their involvement in decision-making during pregnancy and birth. The study is located in Ireland, where comparably progressive national policies regarding informed choice in labour and birth clash with the day-to-day reality of a heavily medicalised, paternalistic maternity care system. I represent the subjective experiences of a diverse group of women through in-depth interview excerpts. In my analysis, I move beyond describing what is happening in the Irish maternity system to discussing why this is happening - relating the findings of the research to the international literature on authoritative knowledge, technocratic hospital cultures and risk-based discourses around birth. In the last section of the article, I offer concrete, empirically grounded and innovative recommendations how to enhance women's involvement in decision-making.
Collapse
Affiliation(s)
- Susann Huschke
- Public and Patient Involvement (PPI) Research Unit (School of Medicine) and Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
35
|
Häggsgård C, Nilsson C, Teleman P, Rubertsson C, Edqvist M. Women's experiences of the second stage of labour. Women Birth 2021; 35:e464-e470. [PMID: 34872874 DOI: 10.1016/j.wombi.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/05/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The second stage of labour is generally considered as an intensive part of labour. Despite this, knowledge about women's experiences of the second stage of labour is scant. AIM To explore experiences of the second stage of labour in women with spontaneous vaginal birth. METHODS This is a qualitative study where twenty-one women with a spontaneous birth at term, were interviewed four to ten weeks after birth. Data were analysed using qualitative thematic analysis based on descriptive phenomenology. The participating women had experienced a vaginal birth; some for the first time, having previously given birth by caesarean section and some with a previous vaginal birth. FINDINGS Three themes emerged: "An experience of upheaval" which represents the women's experiences of intensity, power and pain during the second stage of labour. "The importance of trusting relationships" signifies the meaning of women's relationships during the second stage of labour. "Becoming a mother" which is characterised by feelings of accomplishment and the experience of the final moments of birth. CONCLUSION During the second stage of labour women experienced overwhelming sensations which made evident the importance of trusting relationships with those involved in the birth. The women were in a transformative state between pregnancy and motherhood where experiences of being involved and being provided with information and guidance were all considered crucial. Continuous support should be offered to women during the second stage of labour.
Collapse
Affiliation(s)
- Cecilia Häggsgård
- Department of Health Sciences, Medical Faculty, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Klinikgatan 12, SE-22185 Lund. Sweden.
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Pia Teleman
- Department of Obstetrics and Gynecology, Skane University Hospital, Klinikgatan 12, SE-22185 Lund. Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Jan Waldenströms Gata 47, SE-214 28 Malmö, Sweden; Department of Clinical Sciences, Lund, Lund University, Sweden.
| | - Christine Rubertsson
- Department of Health Sciences, Medical Faculty, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; Department of Obstetrics and Gynecology, Skane University Hospital, Jan Waldenströms Gata 47, SE-214 28 Malmö, Sweden.
| | - Malin Edqvist
- Department of Health Sciences, Medical Faculty, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
36
|
Deforges C, Noël Y, Eberhard-Gran M, Garthus-Niegel S, Horsch A. Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study. J Affect Disord 2021; 295:305-315. [PMID: 34488084 DOI: 10.1016/j.jad.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Certain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. METHODS This prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. RESULTS The relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LIMITATIONS This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. CONCLUSION Prenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.
Collapse
Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Yvonnick Noël
- Laboratory of Psychology, Cognition, Behavior and Communication, Univ Rennes, Rennes, France.
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
37
|
Farley E, Edwards A, Numanoglu E, Phillips TK. Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study. Women Birth 2021; 35:394-402. [PMID: 34518119 PMCID: PMC9131725 DOI: 10.1016/j.wombi.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Perceived birth experiences of parents can have a lasting impact on children. We explored the birth and new parenting experiences of South African parents in 2020 during the Covid-19 lockdown. METHODS We conducted a cross-sectional online survey with consenting parents of babies born in South Africa during 2020. Factors associated with negative birth emotions and probable depression were estimated using logistic regression. RESULTS Most of the 520 respondents were females (n = 496, 95%) who gave birth at private hospitals (n = 426, 86%). Mothers reported having overall positive birth emotions (n = 399, 80%). Multivariable analysis showed that having a preterm baby (aOR 2.89; CI 1.51-5.53) and the mother self-reporting that Covid-19 affected her birth experience (aOR 4.25; CI 2.08-8.68) increased the odds of mothers reporting predominantly negative emotions about their birth. The mother having her preferred delivery method reduced the odds of having negative birth emotions (aOR 0.41; CI 0.25-0.66). Multivariable analysis showed that having predominantly negative emotions about the birth increased the odds of probable minor depression (aOR 3.60; CI 1.93-6.70). Being older reduced the odds of having probable minor depression (25-34 years aOR 0.36; CI 0.10-1.32; 35 years or older aOR 0.25; CI 0.06-0.91). CONCLUSIONS Lockdown exacerbated many birth and parenting challenges including mental health and health care access. However, overall experiences were positive and there was a strong sense of resilience amongst parents.
Collapse
Affiliation(s)
- Elise Farley
- Nudibrink Research Consultancy, Cape Town, South Africa.
| | | | | | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| |
Collapse
|
38
|
Differential predictors of birth-related posttraumatic stress disorder symptoms in mothers and fathers - A longitudinal cohort study. J Affect Disord 2021; 292:121-130. [PMID: 34118611 DOI: 10.1016/j.jad.2021.05.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence on risk factors of birth-related posttraumatic stress disorder (PTSD) symptoms in mothers is increasing, whereas fathers are less examined. This study aims to determine differential predictors of PTSD symptoms in mothers and fathers. METHODS Data derive from the DREAM study, including 1,146 mothers and 828 fathers. We assessed mental health, work, and sociodemographic factors during pregnancy, pregnancy- and birth-related factors, and birth-related PTSD symptoms using the Impact of Event Scale-Revised 8 weeks postpartum. Structural equation models were estimated to examine associations between predictors and latent factors of PTSD symptoms for mothers and fathers simultaneously. Scaled chi-square difference tests were used to investigate differences between both groups in predictors. RESULTS Clinically relevant birth-related PTSD symptoms were found in 2.3% of mothers and 0.7% of fathers. Depressive and anxiety symptoms, pregnancy complications, and poorer subjective birth experience predicted PTSD symptoms in both groups. Additionally, lower support during birth and an unplanned cesarean section predicted PTSD symptoms in mothers, whereas lower job satisfaction, higher job burden, being first-time father, lower education, and mothers' lower support during birth were predictors for fathers. We found significant differences between groups regarding job burden during pregnancy, support during birth, and an unplanned cesarean section. LIMITATIONS Generalization of findings might be limited by self-selection bias and some systematic dropout. CONCLUSIONS Our results suggest differential predictors of PTSD symptoms in mothers and fathers. For fathers, less examined factors such as work factors may be important. Identifying differential risk factors may lead to customized prevention and treatment offers.
Collapse
|
39
|
Rosseland LA, Reme SE, Simonsen TB, Thoresen M, Nielsen CS, Gran ME. Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study. Scand J Pain 2021; 20:591-602. [PMID: 32469334 DOI: 10.1515/sjpain-2020-0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
Background and aims A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery. Methods The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital's birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience. Results The results showed that neither labor pain nor birth experience were associated with persistent pain 8 weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. A history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression 8 weeks after delivery. Conclusions and implications Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.
Collapse
Affiliation(s)
- Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Breines Simonsen
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Magne Thoresen
- Oslo Centre of Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Chronic Diseases and Ageing, National Institute of Public Health, Oslo, Norway
| | - Malin Eberhard Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| |
Collapse
|
40
|
Junge C, von Soest T, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Severe recalled labor pain and elective cesarean section in a subsequent delivery: a cohort study of Norwegian parous women. Acta Obstet Gynecol Scand 2021; 100:1678-1687. [PMID: 34115883 DOI: 10.1111/aogs.14212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/12/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co-occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association. MATERIAL AND METHODS The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. RESULTS Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24-3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS. CONCLUSIONS Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS.
Collapse
Affiliation(s)
- Carolin Junge
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany.,Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
41
|
Bay F, Sayiner FD. Perception of traumatic childbirth of women and its relationship with postpartum depression. Women Health 2021; 61:479-489. [PMID: 33980127 DOI: 10.1080/03630242.2021.1927287] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Traumatic birth has various effects on women, and postpartum depression is one of them. The present study had two aims: 1) to determine the level of traumatic childbirth perception and postpartum depression in women and the factors affecting them and 2) to reveal the relationship between traumatic childbirth perception and postpartum depression. Five hundred fifty women, recruited between March 2018 and February 2019, completed the following form and scales one month after delivery: the general and obstetric information form, the Perception of Traumatic Childbirth Scale (PTCS), and the Edinburgh Postnatal Depression Scale (EPDS). The mean PTCS scores of the women included in the study were 63.45 ± 28.116 with a median value of 65, and the prevalence of traumatic childbirth was 33.8%. The risk of postpartum depression was determined in 25.3% of the women. There was a significant relationship between the participants' traumatic childbirth perception and their EPDS scores (p < .05). It was determined that the probability of experiencing postpartum depression increased four to five times in women with a high or very high level of traumatic childbirth perception (OR = 4.31; CI 95% 1.912 to 9.701; p = .000)(OR = 5.57; CI 95% 2.090 to 14.818; p = .001). The findings revealed that one-third of the participant women had traumatic childbirth perception, and the risk of postpartum depression increased as the level of traumatic birth perception increased.
Collapse
Affiliation(s)
- Fatma Bay
- Academy of Health Sciences, Department of Midwifery, KTO Karatay University, Konya, Turkey
| | - Fatma Deniz Sayiner
- Faculty of Health Sciences, Department of Midwifery, Osmangazi University, Eskişehir, Turkey
| |
Collapse
|
42
|
A model of risk for perinatal posttraumatic stress symptoms. Arch Womens Ment Health 2021; 24:259-270. [PMID: 32995950 DOI: 10.1007/s00737-020-01068-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.
Collapse
|
43
|
Jameei-Moghaddam M, Goljaryan S, Mohammad Alizadeh Charandabi S, Taghavi S, Mirghafourvand M. Effect of plantar reflexology on labor pain and childbirth experience: A randomized controlled clinical trial. J Obstet Gynaecol Res 2021; 47:2082-2092. [PMID: 33749069 DOI: 10.1111/jog.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine the effect of plantar reflexology on the severity of labor pain and childbirth experience (primary outcomes) and the duration of labor stages (secondary outcomes). METHODS This single-blind randomized controlled trial was performed on 90 women in Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were randomly assigned into three groups; Intervention 1 (two 30-min massages at the effective point of pain for each sole), intervention 2 (one 30-min massage at the effective point of pain and one 30-min massage at the heel for each sole), and control (two 30-minute heel massages). Massage was performed once in 4-cm dilatation and the second time in 7-cm dilatation. The severity of pain and childbirth experience were measured by Visual Analogue Scale and Labor Agentry Scale, respectively. Partograph chart was used to measure the length of labor stages. RESULTS The severity of pain in intervention group 1 was significantly lower than the control group (AMD: -1.7; 9% confidence interval: -2.8 to -0.6; p = 0.001), but there was no significant difference between intervention groups 1 and 2 (p = 0.066) and intervention group 2 and control (p = 0.336). A significant difference was observed between groups in terms of length of the third stage of labor (p = 0.04). There was no significant difference between groups in terms of mean childbirth experience score (p = 0.217), duration of active phase (p = 0.099), and second stage of labor (p = 0.114). CONCLUSION The results of the study showed that plantar reflexology can reduce the severity of labor pain and the length of third stage of labor.
Collapse
Affiliation(s)
- Massoumeh Jameei-Moghaddam
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Goljaryan
- Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Simin Taghavi
- Department of Obstetrics and Gynecology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
44
|
Deforges C, Stuijfzand S, Noël Y, Robertson M, Breines Simonsen T, Eberhard-Gran M, Garthus-Niegel S, Horsch A. The relationship between early administration of morphine or nitrous oxide gas and PTSD symptom development. J Affect Disord 2021; 281:557-566. [PMID: 33421836 DOI: 10.1016/j.jad.2020.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is a debilitating mental health disorder. Certain drugs, such as morphine and nitrous oxide gas (N2O), are administered to individuals who just experienced a traumatic event (e.g., soldiers, injured civilians). It is therefore crucial to understand if they incidentally affect PTSD symptom development. Furthermore, such observations could pave the way for the development of pharmacological prevention strategies of PTSD. METHODS In this prospective population-based cohort study (n = 2,070), we examined the relationship between morphine or N2O administration during childbirth, and subsequent childbirth-related PTSD symptoms at eight weeks postpartum. Pain during labour, prior PTSD symptoms, and birth medical severity were included as covariates in the analyses. RESULTS In women who developed PTSD symptoms, N2O administration during childbirth predicted reduced PTSD symptom severity (p < .001, small to medium effect size). A similar tendency was observed for morphine, but was not significant (p < .065, null to small effect size). Both drugs predicted increased PTSD symptoms when combined with severe pain during labour. LIMITATIONS This study was observational, thus drug administration was not randomised. Additionally, PTSD symptoms were self-reported. CONCLUSIONS Peritraumatic N2O administration may reduce subsequent PTSD symptom severity and thus be a potential avenue for PTSD secondary prevention. This might also be the case for morphine. However, the role of severe peritraumatic pain in context of drug administration deserves further investigation.
Collapse
Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | | | - Moira Robertson
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Tone Breines Simonsen
- HØKH - Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
45
|
Neuraxial labor analgesia is associated with a reduced risk of postpartum depression: A multicenter prospective cohort study with propensity score matching. J Affect Disord 2021; 281:342-350. [PMID: 33348177 DOI: 10.1016/j.jad.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression is a common and serious complication in new mothers. We investigated the hypothesis that neuraxial labor analgesia is associated with a decreased risk of postpartum depression. METHODS In this multicenter prospective cohort study with propensity score matching, 599 nulliparous women with single term cephalic pregnancy who planned vaginal delivery were enrolled and self-selected neuraxial analgesia or not. The primary outcome was 6-week postpartum depression assessed with the Chinese version Edinburgh Postnatal Depression Scale; a score of ≥10 was set as the threshold of postpartum depression. Logistic regression models were established to assess the association between neuraxial labor analgesia and postpartum depression. RESULTS Of the 577 parturients who completed the study, 417 (72.3%) received neuraxial analgesia and 160 (27.7%) did not. After propensity score matching, 433 parturients were included in the analysis; of whom, 279 (64.4%) received neuraxial analgesia and 154 (35.6%) did not. The incidence of postpartum depression was lower in parturients with neuraxial analgesia than in those without (14.9% [62/417] vs. 23.8% [38/160], P=0.012 before matching; 13.3% [37/279] vs. 23.4% [36/154], P=0.007 after matching). After adjustment for confounding factors, neuraxial analgesia was associated with decreased odds of postpartum depression (odds ratio [OR] 0.50, 95% CI 0.28-0.88, P=0.015 before matching; OR 0.40, 95% CI 0.21-0.77, P=0.006 after matching). LIMITATIONS As an observational study, unidentified confounders might influence the results. CONCLUSIONS In nulliparae with single term cephalic pregnancy preparing to give vaginal delivery neuraxial analgesia during labor was associated with a decreased risk of 6-week postpartum depression.
Collapse
|
46
|
Associations of rooming-in with maternal postpartum bonding: the impact of mothers' pre-delivery intentions. Midwifery 2021; 95:102942. [PMID: 33607604 DOI: 10.1016/j.midw.2021.102942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/22/2020] [Accepted: 02/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Full rooming-in, that is, mother and baby staying together for 24 hours per day after birth in the hospital, has been suggested as beneficial for positive maternal bonding. However, it has never been studied directly. We aimed to examine the association of full versus partial rooming-in and maternal bonding to her infant during the post-childbirth hospital stay. STUDY DESIGN Longitudinal questionnaire study. SETTING Maternity ward of a large tertiary health care center in Israel. PARTICIPANTS The sample consisted of postpartum women (N = 293) in a maternity ward of a tertiary health care center who were fully or partially rooming-in. MEASUREMENTS AND FINDINGS Questionnaires were administered at two time points, immediately after childbirth (T1; days 1-4) and 2 months postpartum (T2). The Childbirth Experience Questionnaire (CEQ), breastfeeding questions, and the Postpartum Bonding Questionnaire (PBQ) were administered at T1; the PBQ was repeated at T2. Regression analysis revealed that the rooming-in mode did not significantly predict bonding at 1-4 days postpartum. However, the rooming-in mode was a significant predictor of bonding at two months postpartum only for women who practiced the rooming-in mode they had initially planned (Beta = 0.12, p < .05), while controlling for other demographic as well as obstetric variables. Women who chose and practiced partial rooming-in manifested more bonding difficulties than those who chose and practiced full rooming-in. These distinctions in bonding were not manifested when including in the analysis women who partially rooming-in, but not in accordance with their intentions. CONCLUSIONS Mother-infant bonding may be optimally supported when women's pre-labor desires to participate in full rooming-in are fulfilled. IMPLICATIONS FOR PRACTICE Hospital staff should be aware of the mothers' intentions regarding full rooming-in requests and make sincere efforts to accommodate and support their wishes.
Collapse
|
47
|
Dawson P, Hay-Smith J, Jaye C, Gauld R, Auvray B. Do maternity services in New Zealand's public healthcare system deliver on equity? Findings from structural equation modelling of national maternal satisfaction survey data. Midwifery 2021; 95:102936. [PMID: 33592369 DOI: 10.1016/j.midw.2021.102936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/18/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Birthing outcomes in New Zealand are demonstrably inequitable based on governmental reports and research. However, the last Ministry of Health maternal satisfaction survey in 2014 indicated that 77% of women were satisfied or very satisfied with care. This study used data from the maternal satisfaction survey to examine aspects of inequity in reported satisfaction with care. METHODS Structural Equation Modelling (SEM) was used to infer latent variables of satisfaction with equity domains from responses to the satisfaction survey. Additional data (residential location and deprivation score), not used in the Ministry of Health primary analysis, were provided and included in this modelling. RESULTS SEM showed that satisfaction was not equitably distributed. Younger women, those from areas of high socio-economic deprivation, and remote rural women were most likely to be affected by dissatisfaction associated with physical access, cultural care, information provided, and/or barriers to equity associated with additional costs (all p<0.05). Financial burden of additional costs was also unevenly distributed. CONCLUSION While these findings are congruent with other research on the association between social determinants and maternal satisfaction, it is concerning that they remain sources of inequity in New Zealand twenty years after they were first identified as priorities to address. On the basis of this study, urgent attention needs to be paid to removing sources of inequity within the health system and maternity care in particular.
Collapse
Affiliation(s)
- Pauline Dawson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Jean Hay-Smith
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Chrys Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand; Centre for Health Systems and Technology, University of Otago, Dunedin, New Zealand
| | - Benoit Auvray
- Iris Data Science, Dunedin, New Zealand; Airmed Limited, Dunedin, New Zealand
| |
Collapse
|
48
|
Gao Y, Li Y, Zhang L, Bu Y, Yang F, Jiang L, Zhao J, Tian Y. An psychoeducation programme based on self-efficacy theory to improve experience of natural birth for primigravid women: Study protocol for a randomised controlled trial. J Clin Nurs 2021; 30:2469-2479. [PMID: 32533742 DOI: 10.1111/jocn.15370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To present a study protocol for estimating the feasibility, effectiveness and safety of an individual (five sessions), group (one session) and face-to-face psychoeducation programme based on self-efficacy theory to improve childbirth experience of primigravid women. BACKGROUND In present China, fertility rates are falling and ageing is accelerating. How to improve the fertility level of childbearing women is of great significance. However, about 10%-20% of women have negative childbirth experience after birth, which seriously affects maternal and child health and family functions, and even fertility desires and intentions in the future. Nevertheless, due to the lack of a series of well-designed randomised controlled trials(RCTs), there is no specific methodology to guide the most effective intervention for primigravid women. In this regard, based on Bandura's self-efficacy theory, an intervention programme to promote a positive childbirth experience for primigravid women has been designed and will be evaluated to determine its impact on primigravid women. DESIGN A non-blinded randomised controlled trial. METHODS We report the study protocol for this randomised controlled trial based on the SPIRIT2013 statement. A total of 238 eligible primigravid women will be randomly divided into the control group (n = 119) or the intervention group (n = 119). The control group will receive care as usual, that is, six routine prenatal examinations. In addition to the routine examinations, the intervention group will also receive six face-to-face interventions. Baseline assessment will occur at about 24th week of gestation and follow up at 37th weeks of gestation, intrapartum, 1-3 days postpartum and 42 days postpartum. The primary outcomes are childbirth experience, childbirth self-efficacy; others are fear of childbirth, labour control, labour pain and labour satisfaction. IMPACT From the perspective of clinical work, this protocol provides practical guidance for cultivating the positive childbirth experience of the primigravid women. From the perspective of sociology, the positive experience and emotion of primigravid women can improve the fertility intention of women of childbearing age, which is relatively conducive to optimising Chinese demographic structure and reducing the pressure of ageing population in the long term.
Collapse
Affiliation(s)
- Yaqin Gao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yuhong Li
- School of Nursing, Anhui Medical University, Hefei, China
| | - Liu Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yanggao Bu
- Department of Obstetrics and Gynecology, 901 Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Fangfang Yang
- Department of Obstetrics and Gynecology, 901 Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Lulu Jiang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Jingjing Zhao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yun Tian
- School of Nursing, Anhui Medical University, Hefei, China
| |
Collapse
|
49
|
Seefeld L, Weise V, Kopp M, Knappe S, Garthus-Niegel S. Birth Experience Mediates the Association Between Fear of Childbirth and Mother-Child-Bonding Up to 14 Months Postpartum: Findings From the Prospective Cohort Study DREAM. Front Psychiatry 2021; 12:776922. [PMID: 35126197 PMCID: PMC8811166 DOI: 10.3389/fpsyt.2021.776922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience. DESIGN Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth. PARTICIPANTS A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study. RESULTS In a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders. KEY CONCLUSIONS This study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience. IMPLICATIONS FOR PRACTICE Findings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.
Collapse
Affiliation(s)
- Lara Seefeld
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine TU Dresden, Dresden, Germany.,Faculty of Medicine of the Technische Universität Dresden, Institute and Policlinic of Occupational and Social Medicine, Dresden, Germany
| | - Victoria Weise
- Faculty of Medicine of the Technische Universität Dresden, Institute and Policlinic of Occupational and Social Medicine, Dresden, Germany
| | - Marie Kopp
- Faculty of Medicine of the Technische Universität Dresden, Institute and Policlinic of Occupational and Social Medicine, Dresden, Germany
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Faculty of Medicine of the Technische Universität Dresden, Institute and Policlinic of Occupational and Social Medicine, Dresden, Germany.,Faculty of Human Medicine, Institute for Systems Medicine (ISM), Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
50
|
Jomeen J, Martin CR, Jones C, Marshall C, Ayers S, Burt K, Frodsham L, Horsch A, Midwinter D, O'Connell M, Shakespeare J, Sheen K, Thomson G. Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research. J Reprod Infant Psychol 2020; 39:2-15. [PMID: 33206580 DOI: 10.1080/02646838.2020.1843908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.
Collapse
Affiliation(s)
- J Jomeen
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C R Martin
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK.,School of Nursing and Allied Health, Buckinghamshire New University , High Wycombe, UK
| | - C Jones
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C Marshall
- Perinatal Mental Health Team, Humber Teaching NHS Foundation Trust , Hull, UK
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London , London, UK
| | - K Burt
- Expert by Experience , UK
| | - L Frodsham
- Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - A Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne , Lausanne, Switzerland.,Department Woman-Mother-Child, University Hospital , Lausanne, Switzerland
| | - D Midwinter
- Maternity and Midwifery Services, North Lincolnshire and Goole NHS Foundation Trust , Scunthorpe, UK
| | - M O'Connell
- School of Nursing and Midwifery, Royal College of Surgeons Ireland in Bahrain , Adliya, Bahrain
| | | | - K Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University , Liverpool, UK
| | - G Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire , Lancashire, UK.,School of Education, Health and Social Studies, Dalarna University , Falun, Sweden
| |
Collapse
|