Mode of birth and development of maternal postnatal post-traumatic stress disorder: A mixed-methods systematic review and meta-analysis

Evaluating a midwife-led consultation for women after a traumatic birth experience: Preliminary results

BACKGROUND

Approximately 9 to 50 % of women report a traumatic birth experience and 12 % develop childbirth-related posttraumatic stress disorder symptoms (CB-PTSS). A recent study using a postpartum midwifery-led counselling session showed promising results in reducing CB-PTSS, but more evidence is needed.

OBJECTIVES

The main objective of the study was to evaluate the impact of a midwifery-led counselling session 6 weeks post-partum or later, on depression and CB-PTSS.

STUDY DESIGN

The pre-post-intervention study, including 159 women, took place in a Swiss 18 university hospital. It was designed as a healthcare service quality project and therefore was therefore not registered a priori in a clinical trial registry. Ethical approval from the institutional board was obtained (n° 2020-06). A midwifery-led counselling session, six weeks or more after birth, allowed women to discuss their childbirth experience and to receive additional information about childbirth. Women completed the Edinburgh Postnatal Depression Scale (EPDS) and the PTSD Checklist for DSM-5 (PCL-5) two weeks before and three months after the consultation.

RESULTS

Results showed a significant decrease in depression and CB-PTSS, and in cases with probable childbirth-related posttraumatic stress disorder diagnosis (CB-PTSD): 24.7 % (36/146) before counselling versus 6.3 % (5/80) three months after (p < 0.01). The session was rated as extremely/very satisfactory by 91 % of women and extremely/very useful by >87 % of women. No associations were found between depression and CB-PTSD scores and obstetrical or neonatal data.

CONCLUSION

A midwifery-led single-session offered to women 6 weeks or more after birth seemed to be associated with a decrease of depression and CB-PTSS. However, the attrition rate (49 %) made definitive conclusions difficult. More research is needed with a larger sample, a randomized design, and a wait-list control group to consider the effect of time on depression or CB-PTSS.

A longitudinal study of the subjective birth experience and the relationship to mental health

BACKGROUND

A satisfying birth experience has positive effects on the well-being of mother and child. The birth experience depends on subjective expectations and objective birth parameters, and the view of birth can also change over time. However, it is still unclear how birth anxiety and mode of birth affect the different dimensions of the birth experience in the first months after childbirth.

METHODS

In this prospective longitudinal study, 307 first-time mothers, planning to give birth vaginally, were assessed for fear of childbirth at approximately 34 weeks of gestation and for obstetric information. Postpartum birth experience and psychological stress was evaluated 2 days, 6 weeks and 6 months postpartum using the validated Childbirth Experience Questionnaire which comprises the four dimensions emotional experience, participation, professional support and coping possibilities, and a visual analogue scale for a global birth judgement, supplemented by the Edinburgh postpartum depression scale and the Impact of Event Scale.

RESULTS

The individual dimensions of the birth experience changed differently within the first six months. Mixed factorial ANOVAs identified a main effect of fear of childbirth for all four dimensions of the birth experience and the global birth judgment. Mode of birth influenced the dimension participation and the global judgement. For emotional experience, a complex interplay between fear of birth, birth mode and time was revealed. Correlation analyses showed significant associations between the birth experience and the psychological distress symptoms resulting from childbirth.

CONCLUSIONS

Prepartum fear of childbirth affects all dimensions of the subjective birth experience, even after six months. Birth mode, on the other hand, only affects the global birth judgement and participation. The stable correlations between the different dimensions of the birth experience and maternal mental health highlight the importance of the birth experience for clinical practise.

TRAIL REGISTRATION

Registered in the German Clinical Trials Register ("DRKS") (No. DRKS00022177) on 22 June 2020 ( https://drks.de/search/en/trial/DRKS00022177 ).

A prospective cohort study of the association between mode of delivery and postpartum posttraumatic stress disorder

Previous studies investigating the correlation between mode of delivery and posttraumatic stress disorder (PTSD) have yielded inconsistent results. This study aims to investigate the association between mode of delivery and PTSD in a cohort of Chinese women with a high rate of cesarean section (CS). We conducted a prospective cohort study in China between October 2019 and June 2021. Women aged 20-45 years who give birth at The Seventh Hospital of the Southern Medical University during the study period were enrolled. PTSD was assessed by the Posttraumatic Stress Disorder Checklist-Civilian Version at 42 days postpartum. We examined the independent association between mode of birth and PTSD by log-binomial regression analysis. A total of 759/800 (94.88%) women completed questionnaire. The prevalence of postpartum PTSD was 12.12% in included women, 8.18% in women with vaginal delivery (VD), 17.55% in women with CS. After adjusting for confounding factors, it was found that women with elective CS (RR = 1.70, 95%CI, 1.03 to 2.87) and emergency CS (RR = 1.95, 95%CI, 1.08 to 3.83) had an increased risk of developing postpartum PTSD compared with women with VD. CS is identified as an independent risk factor for PTSD in a cohort of Chinese women with a high prevalence of CS.

The Validation of the Perinatal Post-Traumatic Questionnaire in the Italian Population: Risk and Protective Factors

Background: Postpartum Post-Traumatic Stress Disorder (P-PTSD) symptoms develop after experiencing childbirth as traumatic. Several individual and environmental factors influence the childbirth experience. However, in Italy, this phenomenon remains unexplored due to the lack of screening tools. This project aims to validate the Italian version of the Perinatal PTSD Questionnaire (PPQ-II) and to identify maternal, pregnancy, childbirth, and postpartum risk and protective factors associated with P-PTSD. Methods: A total of 702 women (6-24 months postpartum) participated in an online cross-sectional study. They completed the PPQ-II, Depression Anxiety Stress Scales-21 (DASS-21), Big Five Inventory-10 (BFI-10), and a questionnaire to assess sociodemographic and perinatal factors. Factor structure was estimated with an exploratory (EFA) and confirmatory factor analysis (CFA). Internal consistency of the scale, convergent and divergent analyses were computed. Associations between perinatal factors and P-PTSD were also investigated. Results: The EFA revealed a two-factor structure: "Arousal and Mood alteration" and "Avoidance and Intrusion". CFA supported the factor structure, showing a good fit of the data. The validity was confirmed by a significant association between the PPQ-II and the DASS-21 and a lower correlation with the BFI-10. Significant associations were found between P-PTSD symptoms and factors across the maternal, pregnancy, childbirth, and postpartum periods. Conclusions: The Italian PPQ-II is a valid screening tool to include in maternity care protocols for the early identification of P-PTSD. This study also contributes to identifying perinatal factors for symptom detection and the promotion of maternal well-being.

Understanding factors influencing safety and team functionality at operative vaginal birth through multidisciplinary perspectives: a mixed methods study

BACKGROUND

Operative vaginal birth (OVB) relies on effective teamwork to optimise outcomes. This study aims to explore providers' perspectives of factors influencing safety and team functionality at OVB.

METHODS

This mixed methods study involved four maternity sites at Monash Health, Australia. Surveys sent to healthcare providers invited quantitative and qualitative appraisal of safety and team functionality at OVB. Semi-structured interviews further explored themes emerging from survey responses. Categorical survey data were compared between staff roles using Pearson's chi-squared tests. Thematic analysis of free-text survey responses and interviews identified themes influencing safety and team functionality at OVB.

FINDINGS

We received 100 survey responses from obstetric (n = 41), midwifery (n = 52) and paediatric (n = 7) staff, including senior (n = 49) and junior (n = 51) roles. Overall, 99% thought team communication should improve and 82% had witnessed practices outside protocol. Obstetric versus midwifery or paediatric staff were less likely to rate communication as low or very low quality (5% vs. 29%, p = 0.010). Reporting being extremely or very confident to escalate concerns was more likely in obstetric versus midwifery or paediatric staff (49% vs.12%, p = 0.003) and senior versus junior staff (44% vs. 10%, p = 0.008). Five overarching themes impacted on team functionality at OVB; (1) Quality of communication, (2) Preparation and risk assessment, (3) Leadership and interpersonal dynamics, (4) Transfer from Birth Unit to Operating Theatre, (5) Variation in clinical practice.

DISCUSSION

Some care providers perspectives of team functionality at OVB differed, with midwifery and paediatric staff more likely to report challenges with communication and were less empowered to escalate concerns. Training in factors impacting team functionality at OVB should be considered.

Perception of traumatic childbirth of women, influencing factors and its relationship with post-traumatic stress disorder

Objectives

Some of individuals with psychological birth trauma (PBT) develop into postpartum post-traumatic stress disorder (PP-PTSD) further. Study investigated the prevalence and influencing factors of PBT and its correlation with PP-PTSD, to fill the literature gap in the prevention of postpartum related psychological birth trauma.

Methods

A total of 306 women who gave birth vaginally from Chongqing, China participated in this study. Pregnant women filled the basic information when they entered the delivery room and waited for delivery. The psychological birth trauma and posttraumatic stress scales were completed during 1-3 days postpartum. Information on labor and delivery outcomes is available in the hospital's electronic medical record. Variation analysis and Pearson correlation were used on the influencing factors of PBT and the correlation with PP-PTSD.

Results

The median PBT score of the subjects in this study was 41 points; the incidence rate of PTSD (scores greater than 38) is 5%, with an average score of (22.38 ± 7.126). All dimensions of PBT positively correlated with post-traumatic stress disorder, respectively. Lower score of perceived PBT is associated with work, exercise and learning about delivery; is also associated with less vaginal examinations, the use of pain relief and doula accompaniment.

Conclusion

This study suggests that every dimension of PBT should be taken seriously to prevent PP-PTSD. Work, exercise and learning about delivery during pregnancy may be promising protective factors for perceived PBT; the use of pain relief or doula accompaniment are still effective ways to Improve the delivery experience.

Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis

OBJECTIVES

During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS.

DESIGN

Dyadic longitudinal data from the Self-Hypnosis IntraPartum Trial.

METHODS

Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum).

RESULTS

Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS.

CONCLUSIONS

Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

Interpregnancy interval after vacuum delivery and subsequent perinatal outcomes

OBJECTIVE

To evaluate whether a short interpregnancy interval (IPI) after vacuum extraction (VE), poses similar perinatal risks in a subsequent pregnancy.

METHODS

This was a retrospective, single-center cohort study between 2011 and 2021. Nulliparous women with term, singleton VE deliveries and with known pregnancy outcomes in their subsequent pregnancy were eligible for inclusion in the study. Each woman was allocated into one of two groups based on the IPI, <18 months and between 18 and 60 months. The primary outcome was the risk of spontaneous preterm birth (PTB) <37 weeks in the consecutive birth.

RESULTS

We included 1094 pregnancies: 212 (19.4%) with IPI <18 months and 882 (80.6%) with IPI between 18 and 60 months following the previous VE delivery. The VE characteristics were comparable between the groups. Young maternal age was a risk factor for a short IPI (28.0 ± 4.8 vs 30.3 ± 4 years, P < 0.01). Spontaneous PTB <37 weeks was significantly higher in the IPI <18 months group with 18-60 months (7.1% vs 2.6%, P = 0.002). Polynomial regression analysis also confirmed a significantly increased risk of preterm birth <37 weeks (P < 0.01). Short IPI <18 months was also associated with an increase in the risk of low birthweight <2500 g (6.1% vs 2.8%, P = 0.02) and admission to the neonatal intensive care unit (6.1% vs 2.6%, P = 0.013). The incidence of recurrent VE, albeit significant (2.3% vs 4.9%, P = 0.049), was low in both groups. No differences were noted in any of the other secondary outcomes.

CONCLUSION

Short IPI (<18 months) following term VE delivery is associated with higher neonatal risks, particularly PTB, in the subsequent pregnancy. These findings are particularly important when counseling women planning an optimal IPI.

Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study

BACKGROUND

The prevalence and risk factors of posttraumatic stress disorder after cesarean delivery, outside high-risk contexts, remain unclear.

OBJECTIVE

This study aimed to assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery.

STUDY DESIGN

This was a prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals from 2018 to 2020, enrolling women expected to undergo cesarean delivery before or during labor at ≥34 weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of posttraumatic stress disorder symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a posttraumatic stress disorder) were assessed by 2 self-administered questionnaires (Impact of Event Scale - Revised and Traumatic Event Scale). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable.

RESULTS

In total, 2785 of 4431 women returned the Impact of Event Scale - Revised questionnaire and 2792 the Traumatic Event Scale (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval, 7.8%-10.3%) and of provisional diagnosis 1.7% (95% confidence interval, 1.2%-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors (young age, high body mass index, and African-born migrant) and cesarean delivery-related obstetrical factors (cesarean delivery after induced labor [adjusted odds ratio, 1.81; 95% confidence interval, 1.14-2.87], postpartum hemorrhage [adjusted odds ratio, 1.61; 95% confidence interval, 1.04-2.46] and high-intensity pain during the postpartum stay [adjusted odds ratio, 1.90; 95% confidence interval, 1.17-3.11]). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (adjusted odds ratio, 0.66; 95% confidence interval, 0.46-0.98), and women with bad memories of delivery on day 2 postpartum were at higher risk (adjusted odds ratio, 3.20; 95% confidence interval, 1.97-5.12). The Impact of Event Scale - Revised and the Traumatic Event Scale yielded consistent results.

CONCLUSION

Approximately 1 in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetrical interventions and components of cesarean delivery management may influence this risk.

A nomogram for predicting postpartum post-traumatic stress disorder: a prospective cohort study

BACKGROUND

Postpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.

METHODS

Recruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.

RESULTS

A total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.

CONCLUSIONS

With its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

Effectiveness of Psychological Counseling Intervention in High-Risk Pregnancies in Italy

BACKGROUND

The longitudinal study examines the effectiveness of a psychological support treatment for high-risk pregnancies using a between-groups design. It assesses the treatment's impact on depression and fear of COVID-19 at three time points, and on prenatal attachment between the 20th and 24th weeks of gestation (T0), postnatal attachment 15-20 days after birth (T1), and three months after birth (T2). Additionally, the study evaluates the treatment's effectiveness on PTSD related to childbirth and parental distress at T1 and T2.

METHODS

The study involved 117 parents experiencing high-risk pregnancies from a Sicilian hospital: 84 mothers (40 in the experimental group, 44 in the control group) and 33 fathers (19 in the experimental group, 14 in the control group).

RESULTS

ANOVA results showed that the psychological treatment was effective for maternal variables such as postnatal attachment and parental distress, and for paternal variables such as depression, prenatal attachment, PTSD symptoms, and parental distress (ANOVA, p < 0.05).

CONCLUSIONS

The study highlights the growing evidence for providing continuous psychological support to couples with high-risk pregnancies, emphasizing that this support should extend beyond childbirth to assist families through this transition.

Post-traumatic stress syndromes following childbirth influenced by birth mode-is an emergency cesarean section worst?

PURPOSE

The experience of birth is an emotional challenge for women. Traumatic birth experiences can cause psychological stress symptoms up to post-traumatic stress disorders (PTSD), with impact on women's wellbeing. Primarily unplanned interventions can trigger birth-mode-related traumatization. The aim of the study was to evaluate whether an emergency cesarean section (ECS) is the most traumatizing.

METHODS

A retrospective case-control study was undertaken. Therefore, data were collected by standardized questionnaires (Impact of Event Scale-Revised and City Birth Trauma Scale) that were sent to women with singleton pregnancies > 34 weeks of gestation who either give birth by ECS (case group, n = 139), unplanned cesarean section (UCS), operative vaginal birth (OVB), or natural birth (NB) (three control groups, n = 139 each). The investigation period was 5 years.

RESULTS

Overall, 126 of 556 (22%) sent questionnaires were returned and could be analyzed (32 ECS, 38 UCS, 36 OVB, and 20 NB). In comparison to other birth modes, women with ECS were associated with a higher degree of traumatization as revealed by statistically significant differences regarding the DSM-5 criteria intrusion and stressor. In addition, women who underwent ECS declared more frequently a demand for professional debriefing compared to other birth modes.

DISCUSSION

ECS is associated with more post-traumatic stress symptoms compared to other birth modes. Therefore, early interventions are recommended to reduce long-term psychological stress reactions. In addition, outpatient follow-ups by midwives or emotional support programs should be implemented as an integral component of postpartum debriefings.

The relationship between maternal functioning and birth memory and trauma

AIM

This study aimed to determine the relationship between birth memory and trauma and maternal functioning in the postpartum period.

METHODS

This cross-sectional study included 584 mothers in the postpartum period between 1 January 2022 and 1 April 2022. Data were collected using a personal information form, the Barkin Index of Maternal Functioning (BIMF), the Birth Memories and Recall Questionnaire (BirthMARQ) and the City Birth Trauma Scale (CityBiTS).

RESULTS

The participants' mean scores for the overall BIMF, BirthMARQ and CityBiTS were 81.41 ± 9.28, 80.30 ± 21.21 and 15.85 ± 11.30, respectively. Their sociodemographic characteristics did not affect their maternal functioning; however, maternal functioning improved with the number of pregnancies. While emotional memory (BirthMARQ subscale) negatively affected maternal functioning (p < 0.001), the centrality of memory (BirthMARQ subscale) positively affected maternal functioning (p < 0.001). The hyperarousal (CityBiTS subscale) score significantly and negatively affected the total maternal functioning score, explaining 6 % of its variance (F = 9.176, p = 0.001).

CONCLUSION

This study demonstrated that birth memory and trauma affected maternal functioning. The mother's functional status in the postpartum period reflects the physical and psychosocial changes associated with pregnancy and birth. Therefore, for women to have positive birth memories and emotions when recalling the birth, their emotional health and physical care should be supported during labour and the postpartum period.

Incidence of Perinatal Post-Traumatic Stress Disorder in Catalonia: An Observational Study of Protective and Risk Factors

Pregnancy and childbirth have a great impact on women's lives; traumatic perinatal experiences can adversely affect mental health. The present study analyzes the incidence of perinatal post-traumatic stress disorder (PTSD) in Catalonia in 2021 from data obtained from the Registry of Morbidity and Use of Health Resources of Catalonia (MUSSCAT). The incidence of perinatal PTSD (1.87%) was lower than in comparable studies, suggesting underdiagnosis. Poisson regression adjusting for age, income, gestational weeks at delivery, type of delivery, and parity highlighted the influence of sociodemographics, and characteristics of the pregnancy and delivery on the risk of developing perinatal PTSD. These findings underline the need for further research on the risk factors identified and for the early detection and effective management of PTSD in the perinatal setting.

Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment

Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.

Fathers' subjective childbirth stress predicts depressive symptoms at six months postpartum

BACKGROUND

Childbirth is a seminal experience in parents' lives. However, little research has investigated the link between fathers' birth experiences and their postpartum mental health. We hypothesized that a more subjectively stressful birth will predict greater self-reported depressive symptoms in fathers at six months postpartum. We also investigated the association between mode of delivery and paternal subjective stress.

METHODS

Seventy-seven heterosexual fathers expecting their first child and cohabiting with their pregnant partners participated in the study. Depressive symptoms were assessed in pregnancy and again at six months postpartum. Subjective birth stress was measured within the first few days of the birth, and birth charts were collected to examine mode of delivery.

RESULTS

Fathers' ratings of subjective birth stress significantly predicted postpartum depressive symptoms at six months postpartum. Subjective birth stress ratings varied significantly for fathers whose partners delivered via emergency cesarean section compared to those whose partners gave birth via both medicated and the unmedicated vaginal delivery.

LIMITATIONS

The study was limited by its small community (non-clinical) sample, which was restricted to heterosexual, cohabitating couples. Additionally, births were mostly uncomplicated and only 14 mothers underwent emergency cesarean section.

CONCLUSION

These findings highlight that the days immediately following childbirth are a window of opportunity for early intervention in new fathers at risk for postpartum depression.

["Helplessness, Giving up of Any Self-Responsibility and Self-Determination" - a Qualitative Evaluation of Traumatizing Birth Experiences in Relation to Birth Mode]

Background Childbirth is combined with emotional challenges and individual anxiety. Unexpected birth experiences can trigger stress reactions and even post-traumatic stress disorders. Aim of the study The aim of the study was the qualitative evaluation of stressful perceived birth experiences and desired interventions.Methods A content-analytic evaluation of 117 free-text answers was conducted regarding stressful birth experiences and desired interventions using categories and frequencies in relation to birth mode.Findings Five themes emerged from the structured free text analysis: 1) Stressful experiences describing fear concerning the child and separation from the child after an emergency caesarean section; 2) Inadequate communication after an operative vaginal birth and unplanned caesarean section; 3) Feelings of failure and guilt after unplanned birth modes; 4) Helplessness with loss of personal control and the feeling of being at the mercy after an emergency caesarean section; 5) Inadequate support due to the absence of empathy or insufficient care. Expected interventions include immediate debriefing and professional psychological support.Conclusion Women-centered communication during childbirth and debriefing of stressful birth experiences are significant interventions for strengthening maternal well-being and mental health. They can have a positive impact on the development of a healthy mother-child relationship.