1
|
Charman C, Masterson C, Russell AM. 'Would I risk it again?' The long-term impacts of a traumatic birth, as experienced by fathers. J Reprod Infant Psychol 2024:1-15. [PMID: 38676931 DOI: 10.1080/02646838.2024.2346893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Extensive research has explored the impact of traumatic births on mothers, capturing enduring adverse outcomes as well as post-traumatic growth. The literature on fathers' experiences of birth trauma is more limited and little is known of the ongoing impact. The present study aimed to investigate the long-term effects of attending a traumatic birth. METHOD Semi-structured interviews were completed with fathers who identified as having a traumatic birth experience two or more years ago. Thematic analysis was conducted on eight interview transcripts. RESULTS Despite the time since the birth trauma, fathers described ongoing impact, which is captured in five themes. Four of these focus on the negative impacts: their attempts to cope by boxing away emotions, which they thought they should not feel; anxieties over having further children; negative effects on parenting; and ongoing distress or negative impact on their wellbeing. The final theme highlighted some positives from the experience, primarily a strengthened relationship with their partner. CONCLUSIONS Traumatic birth can result in fathers experiencing difficulties beyond the perinatal period, whilst thinking that they should not feel or discuss their distress. As a result of a traumatic birth fathers can experience ongoing guilt and poor mental health, which may lead them to delay subsequent pregnancies. Most participants had not accessed support regarding the traumatic birth, instead coping by trying to avoid their memories and emotional reaction. These findings highlight the need for increased acknowledgement of the impact of birth trauma and intervention for fathers, during and after the perinatal period.
Collapse
Affiliation(s)
- Clare Charman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ciara Masterson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amy M Russell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
2
|
Isobel S, Emerton A, Lim-Gibson S. Birth trauma in a population requiring inpatient mental health care in the postpartum period. Australas Psychiatry 2024:10398562241246150. [PMID: 38616574 DOI: 10.1177/10398562241246150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE This study explores rates of birth-related symptoms of trauma in a population of parents experiencing severe perinatal mental illness. METHOD Birthing-parents admitted to a perinatal inpatient unit completed birth trauma measures on admission which were descriptively analyzed. RESULTS The population had higher rates of birth-related potentially traumatic events and trauma-related symptoms than the general population. CONCLUSIONS The findings highlight that assessing for and responding to experiences of birth trauma is highly relevant to an inpatient perinatal population.
Collapse
Affiliation(s)
- Sophie Isobel
- Naamuru Parent and Baby Unit, Sydney Local Health District, Camperdown, NSW, Australia; and
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Alexandra Emerton
- Naamuru Parent and Baby Unit, Sydney Local Health District, Camperdown, NSW, Australia
| | - Sylvia Lim-Gibson
- Naamuru Parent and Baby Unit, Sydney Local Health District, Camperdown, NSW, Australia
| |
Collapse
|
3
|
Gilbert L, Sandoz V, Deforges C, Horsch A. A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies. Front Psychiatry 2024; 15:1360189. [PMID: 38654730 PMCID: PMC11036539 DOI: 10.3389/fpsyt.2024.1360189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study investigated prospective relationships between the perception of threat to one's own life or to that of one's infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample. Methods Study samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed. Results Globally, mothers were significantly more likely to perceive their infant's life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05. Conclusion The type of perceived threat differently influences maternal CB-PTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool.
Collapse
Affiliation(s)
- Leah Gilbert
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Charles Perkins Center, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW, Australia
| | - Vania Sandoz
- Child Abuse and Neglect Team, Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Orovou E, Antoniou E. Voices of Women With Emergency Cesarean Section Experience: A Qualitative Approach. Cureus 2024; 16:e53429. [PMID: 38435160 PMCID: PMC10909072 DOI: 10.7759/cureus.53429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
The midwifery psychoeducation, relationship with the midwives, feelings from the surgery, and delivery expectations are major factors that affect the birth experiences of mothers following an emergency cesarean section. This study aimed to give voice to mothers to express the feelings they had before, during, and after an emergency cesarean section and primarily to express whether their expectations were met after the surgery. The research was conducted on mothers who gave birth through an emergency cesarean section in a public hospital by completing specific questionnaires. This study was carried out with 15 mothers. The data was collected through a semi-structured questionnaire form, including socio-demographic characteristics. From the research, four main themes and 11 sub-themes emerged. The main themes described are "midwifery psychoeducation," "relationship with the midwives," "feelings from the C-section," and "delivery expectations." The majority of women did not attend parenting preparation classes either because they did not consider it necessary or because they were unaware of their existence. The presence of a midwife remains valuable during the perinatal period for most mothers. However, feelings vary between fear, shock, terror, disappointment, pain, and in some cases happiness. In the majority of cases, emergency cesarean section did not meet the expectations of mothers, who described it as a violent and sudden experience. The results highlight the need to strengthen midwives in order to promote psychosocial education, support during childbirth, and counseling for traumatic experiences.
Collapse
Affiliation(s)
- Eirini Orovou
- Midwifery, University of Western Macedonia, Ptolemaida, GRC
- Midwifery, University of West Attica, Athens, GRC
| | | |
Collapse
|
5
|
Ketley R, Darwin Z, Masterson C, McGowan L. Women's experience of post-traumatic growth following a traumatic birth: an interpretive phenomenological analysis. J Reprod Infant Psychol 2024; 42:126-137. [PMID: 35475719 DOI: 10.1080/02646838.2022.2070608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Approximately 3-5% of women experience post-traumatic stress disorder following birth; positive experiences that can follow traumatic birth are under-researched. AIMS AND OBJECTIVES To explore how women experience post-traumatic growth following a traumatic birth. METHODS Interpretative Phenomenological Analysis was used to explore experiences of women who self-identified as having found positive benefits through coping with a traumatic birth. Eight women who had birthed in the past five years in the UK were recruited online and interviewed face-to-face. RESULTS Three superordinate themes were developed: 'The total opposite to what I'd expected' (participants' struggle to understand and integrate their birth experience in the postnatal period); 'I see it a bit differently now' (processes experienced in coming to a place of growth); and 'A much better place' (experienced growth 'outcomes'). DISCUSSION Faced with shattered assumptions whereby their birth experiences contrasted with their expectations, participants felt their identities as women and mothers were challenged. In overcoming these challenges, participants described actively striving to cope and make sense of their experience. Multiple factors facilitated this, notably partner support, telling their birth story, acknowledging the impact and developing a compassionate narrative. Although growth was experienced in ways commonly reported by survivors of challenging life events, some aspects appeared pertinent to birth trauma. CONCLUSIONS Widening our understanding of the range of experiences following traumatic birth and making these narratives public may offer hope for some women and families and inform health professionals' education and practice. Further research would be needed before advocating interventions to foster post-traumatic growth.
Collapse
Affiliation(s)
- Rhianna Ketley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Sexual Health Psychology Service., Central and North West London NHS Foundation Trust, London, UK
| | - Zoe Darwin
- School of Human and Health Sciences, University of Huddersfield, UK
| | - Ciara Masterson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
| |
Collapse
|
6
|
Gregory EF, Johnson GT, Barreto A, Zakama AK, Maddox AI, Levine LD, Lorch SA, Fiks AG, Cronholm PF. Communication and Birth Experiences Among Black Birthing People Who Experienced Preterm Birth. Ann Fam Med 2024; 22:31-36. [PMID: 38253494 DOI: 10.1370/afm.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Physically or psychologically distressing birth experiences can influence postpartum health, parenting efficacy, and future pregnancy plans. Communication deficits contribute to negative birth experiences. This qualitative analysis explored themes related to communication and negative birth experiences among Black birthing people who experienced preterm birth. METHODS We conducted qualitative interviews with non-Hispanic Black, English language-proficient birthing people with Medicaid-insured preterm infants. Interviews were designed to explore experiences with health care access and well-being after birth. Interviews were audio recorded, transcribed, and coded following an integrated approach where we applied a priori codes and captured emergent themes from the data. RESULTS We interviewed 30 participants from October 2018 to July 2021. Median gestational age at birth was 30 weeks (range 22-36 weeks). Interviews occurred a median of 7 months postpartum (range 2-34 months). Themes emerged related to negative birth experiences and communication: (1) communication gaps during urgent or emergent intrapartum procedures contributed to negative birth experiences; (2) postpartum opportunities to share birth experiences, particularly with peers, sometimes mitigated the psychological consequences of negative birth experiences; (3) participants did not consistently discuss concerns about future pregnancy risk related to negative birth experiences with clinical teams. CONCLUSIONS Themes from this sample of Black birthing people who experienced preterm birth suggest 3 ways health systems might intervene to improve communication to mitigate the consequences of negative birth experiences. Improvement efforts in these areas may improve postpartum health, future pregnancy outcomes, and long-term health.
Collapse
Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alejandra Barreto
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arthurine K Zakama
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, Center for Public Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Zhang D, Gao J. Neonatal PURA syndrome mimicking cervical spinal cord injury after a cesarean section for a breech presentation: A case report. Int J Gynaecol Obstet 2023; 163:1033-1035. [PMID: 37724818 DOI: 10.1002/ijgo.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
SynopsisThe neonatal PURA syndrome manifesting as hypotonia, dyspnea, and feeding difficulties mimic the birth trauma of the spinal cord but can only be diagnosed with sequencing.
Collapse
Affiliation(s)
- Duoduo Zhang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jinsong Gao
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| |
Collapse
|
8
|
van Gemert MJC, Vlaming M, Gabaeff SC, Nikkels PGJ, Neumann HAM. Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse. Children (Basel) 2023; 10:1827. [PMID: 38002918 PMCID: PMC10670409 DOI: 10.3390/children10111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recent systematic literature review (searched in Cochran, Embase, PubMed and Sociological Abstracts), Güvensel questioned the diagnostic accuracy of rib fractures to be caused by abuse, due to lack of sufficient scientific evidence. Further, there is currently a world-wide disagreement between physicians considering themselves child abuse specialized, and physicians that explore non-abuse-related symptoms that may mimic physical abuse, which, it is hoped, will significantly reduce current unjustified child abuse diagnoses. In an attempt to help resolving this disagreement, we hypothesize that the probability of physical child abuse-related infant rib fractures is significantly lower than the probability of all other possible non-abuse-related causes of occult asymptomatic infant rib fractures, e.g., from birth trauma, prematurity, osteogenesis imperfecta, hypermobile Ehlers-Danlos Syndrome, severe chronic placental pathology (e.g., massive perivillous fibrin depositions and severe chronic histiocytic intervillositis), and vitamin-D deficiency. As method, we attempted to assess the incidence of these various causes of infant rib fractures, in the Netherlands and the USA. The results are that the estimated Dutch and USA physical abuse-related infant rib fracture incidences are at least about 250 and 45 times lower than the sum of all the non-abuse-related estimates. Because these latter rib fractures are occult and asymptomatic, it is likely that (many) more could be out there. In conclusion, occult asymptomatic rib fractures develop perinatally, virtually always as birth trauma, in infants with sufficiently weak bones due to vitamin D deficiency, transmitted by their vitamin D deficient pregnant mothers. This group also includes cortical rib cracks due to deformation forces, with an estimated 186/100,000 incidence. And, despite obvious uncertainties in all estimated incidences, we provided strong evidence that our hypothesis has relevance, implying that the abundant occult asymptomatic rib fractures, when found in infants, should not be used to assess potential physical child abuse.
Collapse
Affiliation(s)
- Martin J. C. van Gemert
- Department of Biomedical Engineering & Physics, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marianne Vlaming
- Private Practice, Criminal Psychology and Law, 6986 CL Angerlo, The Netherlands;
| | | | - Peter G. J. Nikkels
- Department of Pathology, Wilhelmina Children’s Hospital, University Medical Center, 3584 CX Utrecht, The Netherlands;
| | | |
Collapse
|
9
|
Kinrade SH. Reducing the Adverse Effects of Birth Trauma Among Birth Companions. J Obstet Gynecol Neonatal Nurs 2023; 52:509-519. [PMID: 37634544 DOI: 10.1016/j.jogn.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Birth trauma affects the entire family, yet limited attention has been directed to how nurses influence the experiences of birth companions. Therefore, the purpose of this article is to increase awareness of birth trauma among birth companions and provide nursing strategies to reduce the adverse effects of traumatic childbirth among birth companions. I review background information describing birth companions' perceptions of childbirth as traumatic and the implications of birth trauma. I then present protective nursing strategies before, during, and after birth, followed by a discussion on implications. Lastly, I offer a summary of protective nursing strategies, an example of postnatal debriefing using the adapted ASSIST communication tool, and available online birth companion resources.
Collapse
|
10
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
11
|
Butterworth S, Butterworth R, Law GU. Birth trauma: the elephant in the nursery. J Reprod Infant Psychol 2023:1-22. [PMID: 37791520 DOI: 10.1080/02646838.2023.2264877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
METHOD The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. RESULTS Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. DISCUSSION Parents described a shared experience of birth trauma during birth. However, fathers' perceived trauma ended in the delivery room whilst mothers' continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. CONCLUSION The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
Collapse
Affiliation(s)
| | - Ruth Butterworth
- Northwest Neonatal ODN, Alder Hey Children's NHS Foundation Trust, liverpool, UK
| | | |
Collapse
|
12
|
Runyon MC, Irby MN, Pascucci C, Rojas Landivar P. Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence. Nurs Womens Health 2023; 27:330-336. [PMID: 37572697 DOI: 10.1016/j.nwh.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/08/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
Obstetric violence is an issue of global scope and magnitude. Its widespread and continued presence indicates cultural tolerance enabled by policies and procedures that uphold paternalism. Labor and delivery nurses are the health care professionals who spend the most time at the point of care during birth, and their role must be examined. As active bystanders, labor and delivery nurses are uniquely positioned to prevent or perpetuate obstetric violence during labor and birth. Reflection on the nurse role is necessary to provide optimal care, enhance relationships with patients, and continue to evolve as a professional discipline. Perinatal nurses must lead the change to trauma-informed care practices to mitigate obstetric violence and reduce birth trauma.
Collapse
|
13
|
Siddiqui YS, Abbas MB, Anwer A, Abbas M, Chowdhry M, Khurana S. Bilateral Distal Humeral Physeal Separation-From Birth Trauma to Family Trauma. J Orthop Case Rep 2023; 13:88-92. [PMID: 37753136 PMCID: PMC10519309 DOI: 10.13107/jocr.2023.v13.i09.3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/20/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Chondro-epiphyseal separation of the distal humerus is a rare injury, which can occur as a consequence of excessive traction on the upper extremity accompanying a dystocic birth or one complicated by cephalopelvic disproportion. Such fracture patterns can also result from a combination of rotatory and shear forces, also typically seen following child abuse. It can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. Since unossified cartilage cannot be seen radiographically, these injuries are better appreciated by ultrasound or magnetic resonance imaging. Case Report We present a case of an 8-day-old neonate who presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow joint was identified on the radiograph. On ultrasound, a trans-physical supracondylar distal humerus fracture was identified. This was presumed as trauma secondary to a difficult delivery. At the 11th week of follow-up, the patient presented with a fracture of the right proximal tibia, followed by a fracture shaft left femur at 5 months of follow-up. Chest X-ray at this time revealed uniting rib fractures with callus formation. After ruling out any congenital collagen disorder (osteogenesis imperfecta), the patient was diagnosed with a case of battered baby syndrome. The case was reported to child protection services and parents were questioned and counseled for the same. Conclusion This case report highlights the importance of a high degree of suspicion of child abuse in any child with a rare fracture pattern, uncommon serial fracture occurrence, and unconventional clinic-radiological presentation.
Collapse
Affiliation(s)
- Yasir Salam Siddiqui
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Baqar Abbas
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Adnan Anwer
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mazhar Abbas
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Madhav Chowdhry
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shivank Khurana
- Department of Orthopaedic Surgery, J.N.M.C.H., Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| |
Collapse
|
14
|
Balis B, Diriba Hunde A, Lami M. Prevalence and Patterns of Neonatal Birth Trauma in Ethiopia: Systematic Review and Meta-Analysis. Glob Pediatr Health 2023; 10:2333794X231191982. [PMID: 37602141 PMCID: PMC10434842 DOI: 10.1177/2333794x231191982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction. Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common contributing factors for the death. Nevertheless, there is no aggregate evidence on the prevalence and patterns of neonatal birth trauma in Ethiopia. Therefore, this study aimed to assess the pooled prevalence and patterns of neonatal birth trauma in Ethiopia. Methods. Searching databases including PubMed, MEDLINE, Popline, SCOPUS, Web of Science, EMBASE, CINHAL (EBSCO), Google, Google Scholar, and lists of references were used to search literatures in Ethiopia. STATA version 14 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for I2 and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias. Results. A total of 6 studies with a sample size of 3663 were included in this study. The overall prevalence of neonatal birth trauma was 15% (95% CI: 13-16). Subgaleal hemorrhage (39%), cephalohematoma (27%), and caput succedaneum (24%) were the most common neonatal birth trauma in Ethiopia. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios, and the funnel plots did not show publication bias. Conclusion. This systematic review and meta-analysis revealed a high prevalence of neonatal birth trauma in Ethiopia. Moreover, most of the neonatal birth injuries were severe and life-threatening that need medical attention to safe the neonates and its life long complications.
Collapse
Affiliation(s)
- Bikila Balis
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aboma Diriba Hunde
- Department of Midwifery, College of Health Sciences, Mettu University, Mettu, Oromia, Ethiopia
| | - Magarsa Lami
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
15
|
Marshall CA, Jones C, Burt K, Lappin V, Martin CR, Jomeen J, Webb A. Practitioner perspectives on the use of selected fear of childbirth screening tools within a clinical context. J Reprod Infant Psychol 2023:1-13. [PMID: 37530393 DOI: 10.1080/02646838.2023.2243286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Fear of childbirth (FOC), or tokophobia, can influence several medical and obstetric variables, and is a significant predictor of maternal and mental health outcomes and birth experiences. Current practice in the UK does not include initial screening for tokophobia, rather, assessment and support occur under extreme circumstances e.g. maternal requests for caesarean sections or pregnancy termination requests in order to avoid childbirth. Moreover, while there are several candidate outcome measures for FOC, none have been evaluated in terms of their perceived suitability by specialist practitioners within perinatal healthcare pathways. The present study explores the perceived barriers and facilitators reported by health professionals working within the maternity and mental health services for the use of FOC candidate outcome measures. Evaluated measures included the Fear of Birth Scale, the Oxford Worries about Labour Scale, The Wijma Delivery Expectancy Scale, the Slade-Pais Expectations of Childbirth Scale the Tokophobia Severity Scale. The Tokophobia Severity Scale, followed by the Slade-Pais Expectations of Childbirth Scales were the most favourable scales selected for use according to clinicians. The identification of preferred scales and how they can be used in the local maternity system is a step towards the application of these consistently in clinical practice, to aid in the identification and assessment of FOC. The use of the correct tool at each stage of contact with the local maternity system will improve clinician confidence in the identification of FOC and facilitate the efficient implementation of treatment and support through the development of pathways of care.
Collapse
Affiliation(s)
- Claire A Marshall
- Perinatal Mental Health Team Humber Teaching NHS Foundation Trust, Beverley, UK
| | | | - Kate Burt
- Humber Teaching NHS Foundation Trust - Expert by Experience, Beverley, UK
| | - Victoria Lappin
- Humber Teaching NHS Foundation Trust - Expert by Experience, Beverley, UK
| | - Colin R Martin
- Institute for Health and Wellbeing, University of Suffolk, Norfolk, UK
| | - Julie Jomeen
- Health and Human Sciences, Southern Cross University, Gold Coast, Queensland, Australia
| | - Abigail Webb
- Institute for Health and Wellbeing, University of Suffolk, Norfolk, UK
| |
Collapse
|
16
|
Tolosa G, Assefa N, Keneni M, Lonsako AA, Desalew A. Neonatal Birth Trauma and Its Predisposing Factors Among Newborns Admitted to Public Hospitals in Eastern Ethiopia: A Cross-Sectional Study. Glob Pediatr Health 2023; 10:2333794X231183814. [PMID: 37424537 PMCID: PMC10328037 DOI: 10.1177/2333794x231183814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives: This study is to investigate the magnitude and predisposing factors for neonatal birth trauma in public hospitals in eastern Ethiopia. It is a major cause of neonatal morbidity and mortality. Despite its higher burden, evidence is limited in eastern Ethiopia. Methods: A cross-sectional study was conducted on 492 newborns selected using systematic random sampling. Data were analyzed using a binary logistic regression model. Statistical significance was set at P < .05. Results: The magnitude of neonatal birth trauma was 16.9% with 95% CI: 13.7-20.5%). In multivariable analysis, instrumental delivery, early preterm (<34 weeks), macrosomia, fetal malpresentation, male sex and, facility-based delivery such as hospital and health center-based delivery were factors associated with neonatal birth trauma. Conclusions: The magnitude of neonatal birth trauma was relatively high. Promoting health facilities-based delivery, prevention of preterm birth, the early decision on the mode, and minimizing instrumental deliveries help reduce neonatal birth trauma.
Collapse
|
17
|
Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
Collapse
Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| |
Collapse
|
18
|
Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Chatzopoulou M, Arampatzi C, Rigas N, Palaska E, Dagla M, Iliadou M, Antoniou E. The Involvement of Neonatal Intensive Care Unit and Other Perinatal Factors in Postpartum PTSD After Cesarean Section. J Mother Child 2023; 27:158-167. [PMID: 37920113 PMCID: PMC10623112 DOI: 10.34763/jmotherandchild.20232701.d-23-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The experience of a neonate hospitalised in the Neonatal Intensive Care Unit (NICU) is an understandably traumatic experience for the parents, especially, for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalisation can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual-5 version. The aim of this study is to investigate the impact of the admission of a neonate to the NICU (from any reason) on the development of postpartum post-traumatic stress disorder (PTSD) in a sample of women after cesarean sections. MATERIAL AND METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study, from the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire, the past traumatic Life Events Checklist, the perinatal stressor Criterion A, and the Post-Traumatic Stress Checklist from the Diagnostic and Statistical Manual-5 version. RESULTS A percentage of 46.64% of sample experienced postpartum PTSD. Factors associated with PTSD were placenta previa type4, abruption, bleeding (β = .07, p = .049), premature contractions (β = .08, p = .039), heavy medical history or previous gynecological history and preeclampsia (β = .08, p = .034), abnormal heart rate, premature rupture of membrane, premature contractions, infections (β = .14, p = .004), life of child in danger (β = .12, p = .025), complications involving child (β = .15, p = .002), complications involving both (child and mother) (β = .12, p = .011), traumatic cesarean section (β = .041, p < .001) and prematurity (β = .12, p = .022). CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the NICU with psychological support interventions and reassessment of their mental state.
Collapse
Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | | | | | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, Ptolemaida, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Egaleo, Greece
| | | |
Collapse
|
19
|
Roberts C, Montgomery E, Richens Y, Silverio SA. (Re)activation of survival strategies during pregnancy and childbirth following experiences of childhood sexual abuse. J Reprod Infant Psychol 2023; 41:152-164. [PMID: 34510971 DOI: 10.1080/02646838.2021.1976401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To explore the pregnancy and childbearing experiences of women-survivors of childhood sexual abuse [CSA]. We aimed to generate a theory explaining those experiences for this population (women), this phenomenon (pregnancy and childbirth), and this context (those who have survived CSA). METHOD Participants (N=6) were recruited to semi-structured interviews about their experiences of CSA and subsequent pregnancy and childbirth. Data saturated early, and were analysed using Grounded Theory (appropriate to cross-disciplinary health research). Coding was inductive and iterative, to ensure rigour and achieve thematic saturation. RESULTS Open and focused coding led to the generation of super-categories, which in-turn were collapsed into three distinct, but related themes. These themes were: Chronicity of Childhood (Sexual) Abuse; Pregnancy and Childbirth as Paradoxically (Un)safe Experiences; Enduring Nature of Survival Strategies. The relationship between these themes was explained as the theory of: (Re)activation of Survival Strategies during Pregnancy and Childbirth following Experiences of Childhood Sexual Abuse. CONCLUSION Pregnancy and childbirth can be triggering for women-survivors of CSA. Survival strategies learnt during experiences of CSA can be (re)activated as a way of not only coping, but surviving (the sometimes unconsented) procedures, such as monitoring and physical examinations, as well as the feelings of lack of control and bodily agency.
Collapse
Affiliation(s)
- Chelsey Roberts
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Elsa Montgomery
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Yana Richens
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Maternity Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sergio A Silverio
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Women & Children's Health, King's College London, London, UK
| |
Collapse
|
20
|
Bank TC, Macones G, Sciscione A. The "30-minute rule" for expedited delivery: fact or fiction? Am J Obstet Gynecol 2023; 228:S1110-S1116. [PMID: 36934051 DOI: 10.1016/j.ajog.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 03/18/2023]
Abstract
Initially developed from hospital feasibility data from the 1980s, the "30-minute rule" has perpetuated the belief that the decision-to-incision time in an emergency cesarean delivery should be <30 minutes to preserve favorable neonatal outcomes. Through a review of the history, available data on delivery timing and associated outcomes, and consideration of feasibility across several hospital systems, the use and applicability of this "rule" are explored, and its reconsideration is called for. Moreover, we have advocated for balanced consideration of maternal safety with rapidity of delivery, encouraged process-based approaches, and proposed standardization of terminology regarding delivery urgency. Furthermore, a standardized 4-tier classification system for delivery urgency, from class I, for a perceived threat to maternal or fetal life, to class IV, a scheduled delivery, and a call for further research with a standardized structure to facilitate comparison have been proposed.
Collapse
Affiliation(s)
| | - George Macones
- Department of Obstetrics and Gynecology, The University of Texas at Austin, Austin, TX
| | | |
Collapse
|
21
|
Pop-Jordanova N, Jakovska-Maretti T, Zorcec T. Perceived Birth Trauma in Macedonian Women. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:37-46. [PMID: 36987764 DOI: 10.2478/prilozi-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Although the childbearing is perceived as a normal and happy event, new research shows that psychological birth trauma is, however, a universal and not so rare phenomenon. Traumatic birth experiences can cause postnatal mental health disturbances, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to possible impaired child development. The purpose of this research was to evaluate collected data from several obstetric clinics, as well as from primary paediatric settings related to 'Birth Trauma' in order to review women with symptoms of post-traumatic stress disorder (PTSD) following childbirth. The study is prospective, starting from January 2021 and ending in December 2022. The psychological instrument used in this research is the Intersect Questionnaire, composed of 59 questions grouped in 8 parts. The obtained results from our study confirmed that birth trauma is not a rare phenomenon in our country. Symptoms correlated with PTSD were present as follows: unpleasant memories (2.7%), anxiety (38.54%), panic (6.47%), trying not to remember the delivery (4.04%), self-accusation (2.16%), negative emotions (1.89%), alienation (4.31%), irritation/aggression (1.89%), self-destruction (1.89%), impulsiveness (4.31%), problems with concentration (3.23%), and sleeping problems (21.88%). These results are alarming. It is imperative to better understand this vulnerable period in a woman's life. As a general conclusion, we must highlight the importance of perceived birth trauma in women, phenomena which has been confirmed worldwide and which must be overcome as quickly and as successfully as possible.
Collapse
Affiliation(s)
| | | | - Tatjana Zorcec
- 3University Children's Hospital, Medical Faculty, Skopje
| |
Collapse
|
22
|
Shorey S, Jarašiūnaitė-Fedosejeva G, Akik BK, Holopainen A, Isbir GG, Chua JS, Wayt C, Downe S, Lalor J. Trends and motivations for freebirth: A scoping review. Birth 2023; 50:16-31. [PMID: 36598288 DOI: 10.1111/birt.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Even when maternity care facilities are available, some women will choose to give birth unassisted by a professional (freebirth). This became more apparent during the pandemic of coronavirus disease 2019 (COVID-19), as women were increasingly concerned they would contract the virus in health care facilities. Several studies have identified the factors that influence women to seek alternative places of birth to hospitals, but research focusing specifically on freebirth is limited. METHODS Eight databases were searched from their respective inception dates to April 2022 for studies related to freebirth. Data from the studies were charted and a thematic analysis was subsequently conducted. RESULTS Four themes were identified based on findings from the 25 included studies: (1) Geographical and socio-demographic determinants influencing freebirth, (2) Reasons for choosing freebirth, (3) Factors hindering freebirth, and (4) Preparation for and varied experiences of freebirth. DISCUSSION More women chose to give birth unassisted in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Overall, motivation for freebirth included previous negative birth experiences with health care professionals, a desire to adhere to their birth-related beliefs, and fear of contracting the COVID-19 virus. Included studies reported that study participants were often met with negative responses when they revealed that they were planning to freebirth. Most women in the included studies had positive freebirth experiences. Future research should explore the different motivators of freebirth present in LMICs or HICs to help inform effective policies that may improve birth experiences while maintaining safety.
Collapse
Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | | | - Gozde Gokce Isbir
- Mersin University Midwifery Department, Mersin Universitesi İçel Sağlık Yüksekokulu Ebelik bölümü, Çiftlikköy, Turkey
| | - Jing Shi Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carly Wayt
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Joan Lalor
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| |
Collapse
|
23
|
Yim SLY, Petersen TW, Uppal MT, Quinlivan JA. Compliance with clinical guidelines increases the safety of vacuum-assisted delivery. Aust N Z J Obstet Gynaecol 2023; 63:13-18. [PMID: 35587573 DOI: 10.1111/ajo.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. AIM The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. MATERIALS AND METHODS Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. RESULTS There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P = 0.0002), major birth trauma (3% vs 22%, P = 0.0001), requirement for neonatal resuscitation (14% vs 35%, P = 0.0026) and Apgar scores at one minute less than six (5% vs 22% P = 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P = 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P = 0.02) and birth requiring instrument change (4% vs 13% P = 0.031). CONCLUSION Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.
Collapse
Affiliation(s)
- Stephen L Y Yim
- Northern Beaches Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia
| | - Tomas W Petersen
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Munawwara Talat Uppal
- Northern Beaches Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,School of Medicine, Sydney University, Sydney, New South Wales, Australia
| | - Julie A Quinlivan
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,School of Medicine, Australia National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
24
|
Ayalde J, Epee-Bekima M, Jansen B. A review of placenta accreta spectrum and its outcomes for perinatal mental health. Australas Psychiatry 2023; 31:73-75. [PMID: 36375814 DOI: 10.1177/10398562221139130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Placenta accreta spectrum conditions are rare, life-threatening disorders of placentation encountered in the perinatal period, with lasting impacts on maternal quality of life and psychological wellbeing. Although the obstetric outcomes are well-known, further review is warranted to explore the psychological sequelae that may accompany these conditions. CONCLUSIONS The occurrence of placenta accreta spectrum during pregnancy is a major life stressor that can contribute to the development of psychiatric co-morbidity including posttraumatic stress disorder, depression and anxiety disorders. Early recognition of psychological distress and symptomatic profile is recommended at all stages of perinatal care complicated by this rare spectrum of conditions.
Collapse
Affiliation(s)
- Jeremiah Ayalde
- Medical School, 172098The University of Western Australia, Crawley, WA, Australia
| | - Mathias Epee-Bekima
- Obstetrics and Gynaecology, 60082King Edward Memorial Hospital for Women Perth, Subiaco, WA, Australia
| | - Brendan Jansen
- Department of Psychological Medicine, Mother and Baby Unit, 60082King Edward Memorial Hospital for Women Perth, Subiaco, WA, Australia
| |
Collapse
|
25
|
O'Leary BD, Kelly L, Fitzpatrick M, Keane DP. Underdiagnosis of internal anal sphincter trauma following vaginal delivery. Ultrasound Obstet Gynecol 2023; 61:251-256. [PMID: 36722430 PMCID: PMC10108077 DOI: 10.1002/uog.26049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Damage to the anal sphincter during childbirth remains the leading cause of fecal incontinence in women. Defects in the internal (IAS) or external anal sphincter, alongside symptoms and sphincter tone, will generally dictate the suggested mode of delivery in any successive pregnancy. This study aimed to examine using endoanal ultrasonography the prevalence of IAS damage in women referred with Grade-3a or -3b obstetric anal sphincter injury (OASI) in a tertiary-referral perineal clinic. METHODS This was a retrospective observational study of all women referred to a tertiary-referral perineal clinic after primary repair of OASI (Grade 3a-c, 4) diagnosed for the first time following vaginal delivery between January 2016 and December 2019, inclusive. Women were assessed using the Wexner bowel continence questionnaire, digital examination of sphincter tone and endoanal ultrasound. Injuries in each sphincter were classified as a scar (≤ 30°) or defect (> 30-90° or > 90°) on endoanal imaging in the axial plane. RESULTS In total, 615 women were referred following primary repair of OASI. Sonographic evidence of damage to the IAS was seen in 9.1% (46/506) of women diagnosed with a Grade-3a/3b injury. In women referred with a Grade-3a/3b tear, symptom scores were statistically higher (P = 0.025) in those with an IAS defect > 30° compared to those with an intact or scarred IAS, although the median score was zero in both groups. The proportion of women in each group with severe symptoms (score > 9) was similar (2.6% vs 6.5%; P = 0.148). Among women referred with a Grade-3a/3b tear, sphincter tone was reduced more frequently in those with a defect of the IAS than in those with an intact or scarred IAS (52.2% vs 11.7%; odds ratio, 8.14 (95% CI, 4.26-15.67); P < 0.001). Regardless of the reason for referral, women with reduced sphincter tone on rectal examination were four times as likely to have had an IAS defect > 30° than were those with normal resting tone (risk ratio, 4.58 (95% CI, 3.25-6.45); P < 0.001). CONCLUSIONS One in 11 women diagnosed with a Grade-3a or -3b tear have evidence of damage to their IAS on endoanal ultrasound. Damage to this muscle is linked to fecal incontinence in women and can have a significant impact on the planning of any future deliveries. This study highlights the importance of established perineal clinics with access to ultrasound. Nonetheless, if reduced sphincter tone is felt on rectal examination, a clinician should have a high index of suspicion for an occult IAS injury. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- B. D. O'Leary
- Perineal ClinicNational Maternity HospitalDublinIreland
- UCD Perinatal Research CentreNational Maternity HospitalDublinIreland
| | - L. Kelly
- Perineal ClinicNational Maternity HospitalDublinIreland
| | | | - D. P. Keane
- UCD Perinatal Research CentreNational Maternity HospitalDublinIreland
- Royal College of Surgeons IrelandNational Maternity HospitalDublinIreland
| |
Collapse
|
26
|
Giacchino T, Karkia R, Ahmed H, Akolekar R. Maternal and neonatal complications following Kielland's rotational forceps delivery: A systematic review and meta-analysis. BJOG 2023. [PMID: 36694989 DOI: 10.1111/1471-0528.17402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour. OBJECTIVES To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non-rotational forceps delivery (NRFD) or a second-stage caesarean section (CS), from a systematic review and meta-analysis of the literature. SEARCH STRATEGY Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. SELECTION CRITERIA Case series, prospective or retrospective cohort studies and population-based studies. DATA COLLECTION AND ANALYSIS A meta-analysis using a random-effects model was used to derive weighted pooled estimates of maternal and neonatal complications. MAIN RESULTS Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non-rotational forceps (RR 0.79, 95% CI 0.65-0.95) and second-stage CS (RR 0.45, 95% CI 0.36-0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR 1.79, 95% CI 1.08-2.98), but rates of neonatal birth trauma were lower (RR 0.49, 95% CI 0.26-0.91). There were no differences seen in the rates of 5-min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second-stage CS (RR 0.47, 95% CI 0.23-0.97). CONCLUSIONS Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour.
Collapse
Affiliation(s)
- Tara Giacchino
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Kent, UK.,Institute of Medical Sciences, Canterbury Christ Church University, Kent, UK
| | - Rebecca Karkia
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Kent, UK
| | - Hasib Ahmed
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Kent, UK
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Kent, UK.,Institute of Medical Sciences, Canterbury Christ Church University, Kent, UK
| |
Collapse
|
27
|
Tzitiridou-Chatzopoulou M, Orovou E, Skoura R, Eskitzis P, Dagla M, Iliadou M, Palaska E, Antoniou E. Traumatic Birth Experience and Breastfeeding Ineffectiveness - a Literature Review. Mater Sociomed 2023; 35:325-333. [PMID: 38380281 PMCID: PMC10875946 DOI: 10.5455/msm.2023.35.325-333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Background A traumatic birth experience can affect the breastfeeding process and make it ineffective. The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature. There are several factors responsible for a traumatic birth experience, such as obstetric violence, postpartum complications and complications induced by doctors, invasive vaginal deliveries, emergency caesarean sections, admission of a neonate to the Neonatal Intensive Unit, past traumatic life events and mental health problems. Objective The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature. Methods An extended search was conducted to identify relevant for breastfeeding and traumatic birth experiences manuscripts for this study. Databases including PubMed, PsycINFO and Google Scholar. The search was limited to articles published in English the last decade. Results Factors that contribute to the ineffectiveness of breastfeeding after a traumatic birth are hormonal, medication, insufficient support from the partner, reliving the traumatic birth experience, past traumatic experiences in the woman's life and her mental state. Conclusion The mental trauma during childbirth is complex and multifactorial. Therefore, it is necessary to take measures on the one hand to prevent mental trauma during childbirth and on the other hand to make interventions to deal with the consequences of the trauma on the mental health of the mother and on breastfeeding which is directly affected.
Collapse
Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Rafailia Skoura
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 0200 Ptolemaida, Greece; (E.O); (M.T-C); (R.S); (P.E)
| | - Maria Dagla
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Maria Iliadou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Ermioni Palaska
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| | - Evangelia Antoniou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str.,12243 Egaleo, Greece; (M.D); (M.I); (E.P); (E.A)
| |
Collapse
|
28
|
Dietz HP, Shek KL, Low GK. Validation of new ultrasound algorithm for estimating prevalence of anal sphincter trauma in a urogynecological population. Ultrasound Obstet Gynecol 2022; 60:800-804. [PMID: 36350233 DOI: 10.1002/uog.26052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To estimate the prevalence of major perineal trauma in a urogynecological population, to test the predictive value of sonographic tear grading (Gillor algorithm) for anal incontinence (AI), AI bother score and St Mark's score, and to compare the predictive power of the Gillor algorithm with that of the residual-defect method. METHODS This was a retrospective study of 721 women attending a tertiary urogynecology unit between February 2019 and May 2021. All women underwent a standardized interview, including determination of St Mark's score and visual analog scale (VAS) bother score for AI, as well as exoanal (translabial) ultrasound with later offline analysis. Results were reported as the presence of a residual defect of the external anal sphincter (EAS), i.e. a discontinuity of ≥ 30° in ≥ 4/6 tomographic slices, and according to the Gillor algorithm (normal, Grade 3a, Grade 3b or Grade 3c/4). RESULTS Mean age at assessment was 57 (range, 19-93) years and mean body mass index was 30 (range, 17-57) kg/m2 . Six hundred and thirty-six (88.2%) women were vaginally parous and 161 (22.3%) had undergone at least one forceps delivery. AI was reported by 186/721 (25.8%) women, with a median St Mark's score of 10 (interquartile range (IQR), 6-14) and a median VAS score of 6.3 (IQR, 3.9-10). EAS defects were detected in 261 (36.2%) women, with a residual defect diagnosed in 88 (12.2%). On sonographic grading according to the Gillor algorithm, we identified 532 (73.8%) women with a normal sphincter, 66 (9.2%) with Grade-3a tear, 87 (12.1%) with Grade-3b tear and 36 (5.0%) with Grade-3c/4 tear. In total, the Gillor algorithm classified 189 (26.2%) women as having suffered a major perineal tear. The two grading systems were in moderate agreement (κ, 0.537 (95% CI, 0.49-0.56); P < 0.001). There were weak, albeit significant, associations between EAS defects and measures of AI (P = 0.009 to P = 0.047), both for residual defect as well as the Gillor algorithm. CONCLUSION Neither the Gillor algorithm nor the residual-defect method of quantifying sphincter trauma on imaging is clearly superior in terms of predicting AI. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- H P Dietz
- Sydney Urodynamic Centres, Penrith, NSW, Australia
| | - K L Shek
- Western Sydney University, Liverpool, NSW, Australia
| | - G K Low
- Research Operations, Nepean Hospital, Nepean Blue Mountain Local Health District, Kingswood, NSW, Australia
- Professorial Unit, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
29
|
Malvasi A, Vinciguerra M, Lamanna B, Cascardi E, Damiani GR, Muzzupapa G, Kosmas I, Beck R, Falagario M, Vimercati A, Cicinelli E, Trojano G, Tinelli A, Cazzato G, Dellino M. Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review. Diagnostics (Basel) 2022; 12:2998. [PMID: 36553005 PMCID: PMC9776610 DOI: 10.3390/diagnostics12122998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Asynclitism, the most feared malposition of the fetal head during labor, still represents to date an unresolved field of interest, remaining one of the most common causes of prolonged or obstructed labor, dystocia, assisted delivery, and cesarean section. Traditionally asynclitism is diagnosed by vaginal examination, which is, however, burdened by a high grade of bias. On the contrary, the recent scientific evidence highly suggests the use of intrapartum ultrasonography, which would be more accurate and reliable when compared to the vaginal examination for malposition assessment. The early detection and characterization of asynclitism by intrapartum ultrasound would become a valid tool for intrapartum evaluation. In this way, it will be possible for physicians to opt for the safest way of delivery according to an accurate definition of the fetal head position and station, avoiding unnecessary operative procedures and medication while improving fetal and maternal outcomes. This review re-evaluated the literature of the last 30 years on asynclitism, focusing on the progressive imposition of ultrasound as an intrapartum diagnostic tool. All the evidence emerging from the literature is presented and evaluated from our point of view, describing the most employed technique and considering the future implication of the progressive worldwide consolidation of asynclitism and ultrasound.
Collapse
Affiliation(s)
- Antonio Malvasi
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Marina Vinciguerra
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
- Department of Maternal and Child Health, Madonna delle Grazie Hospital, 75100 Matera, Italy
| | - Bruno Lamanna
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
- Fetal Medicine Research Institute, King’s College Hospital, London SE5 9RS, UK
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, Str. Provinciale 142 km 3.95, 10060 Candiolo, Italy
| | - Gianluca Raffaello Damiani
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Giuseppe Muzzupapa
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, 45332 Ioannina, Greece
| | - Renata Beck
- Department of Anesthesia and Intensive Care, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy
| | - Maddalena Falagario
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
- Department of Obstetric and Gynecology, Lund University, SE-221 00 Lund, Sweden
| | - Antonella Vimercati
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Giuseppe Trojano
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris Delli Ponti Hospital, 73020 Scorrano, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, 73100 Lecce, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Miriam Dellino
- Unit of Obstetrics and Gynaecology, Department of Biomedical Sciences and Human Oncology, 70124 Bari, Italy
- Department of Obstetrics and Gynecology, San Paolo Hospital, 70124 Bari, Italy
| |
Collapse
|
30
|
Keedle H, Keedle W, Dahlen HG. Dehumanized, Violated, and Powerless: An Australian Survey of Women's Experiences of Obstetric Violence in the Past 5 Years. Violence Against Women 2022:10778012221140138. [PMID: 36452982 DOI: 10.1177/10778012221140138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Globally, significant numbers of women report obstetric violence (OV) during childbirth. The United Nations has identified OV as gendered violence. OV can be perpetrated by any healthcare professional (HCP) and is impacted by systemic issues such as HCP education, staffing ratios, and lack of access to continuity of care. The current study explored the experiences of OV reported in a national survey in 2021 by Australian women who had a baby in the previous 5 years. A content analysis of 626 open text comments found three main categories: "I felt dehumanised," "I felt violated," and "I felt powerless." Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments.
Collapse
Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Warren Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
31
|
Dietz HP, Shek KL, Low GK. All or nothing? A second look at partial levator avulsion. Ultrasound Obstet Gynecol 2022; 60:693-697. [PMID: 35872659 DOI: 10.1002/uog.26034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP). METHODS This was a retrospective study of 3484 women attending a tertiary urogynecology unit for symptoms of pelvic floor dysfunction between January 2012 and February 2020. All women underwent a standardized interview, clinical pelvic organ prolapse quantification (POP-Q) examination and tomographic ultrasound imaging of the pelvic floor. Women with full levator avulsion were excluded from analysis. Partial levator avulsion was quantified using the tomographic trauma score (TTS), in which slices 3-8 are scored bilaterally for abnormal insertions. Binomial multiple logistic regression was analyzed independently for the outcome variables prolapse symptoms, symptom bother and objective prolapse on clinical examination and imaging, with age and body mass index as covariates. Two continuous outcome variables, prolapse bother score and hiatal area on Valsalva, were analyzed using multiple linear regression. RESULTS Of the 3484 women, ultrasound data were missing or incomplete in 164 due to lack of equipment, clerical error and/or inadequate image quality. Full levator avulsion was diagnosed in 807 women, leaving 2513 for analysis. TTS ranged from 0-10, with a median of 0. Partial trauma (TTS > 0) was observed in 667/2513 (26.5%) women. All subjective and objective measures of POP were associated significantly with TTS, most strongly for cystocele. Associations were broadly linear and similar for all slice locations but disappeared after accounting for hiatal area on Valsalva. CONCLUSION Partial avulsion is associated with POP and prolapse symptoms. This association was strongest for cystocele, both on POP-Q and ultrasound imaging. The effect of partial avulsion on POP and prolapse symptoms is explained fully by its effect on hiatal area. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- H P Dietz
- Sydney Urodynamic Centres, Penrith, NSW, Australia
| | - K L Shek
- Western Sydney University, Liverpool, NSW, Australia
| | - G K Low
- Research Operations, Nepean Hospital, Nepean Blue Mountain Local Health District, Kingswood, NSW, Australia
- Professorial Unit, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
32
|
Chan SJ, Thiel F, Kaimal AJ, Pitman RK, Orr SP, Dekel S. Validation of childbirth-related posttraumatic stress disorder using psychophysiological assessment. Am J Obstet Gynecol 2022; 227:656-659. [PMID: 35640702 PMCID: PMC9529868 DOI: 10.1016/j.ajog.2022.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022]
Abstract
Women with posttraumatic stress disorder (PTSD) related to traumatic childbirth show similarly elevated psychophysiological responses as individuals with PTSD related to other traumatic events.
Collapse
Affiliation(s)
- Sabrina J Chan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Freya Thiel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Anjali J Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, 120 2nd Ave., Boston, MA 02129; Department of Psychiatry, Harvard Medical School, Boston, MA.
| |
Collapse
|
33
|
Gupta R, Cabacungan ET. Neonatal Birth Trauma: Analysis of Yearly Trends, Risk Factors, and Outcomes. J Pediatr 2021; 238:174-180.e3. [PMID: 34242670 DOI: 10.1016/j.jpeds.2021.06.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the trends, proportions, risk factors, resource utilization, and outcomes of neonatal birth trauma in the US. STUDY DESIGN This cross-sectional study of in-hospital births used the Nationwide Inpatient Sample for 2006-2014. We divided the cases by type of birth trauma: scalp injuries and major birth trauma. Linear regression for yearly trends and logistic regression were used for risk factors and outcomes. A generalized linear model was used, with a Poisson distribution for the length of stay and a gamma distribution for total spending charges. RESULTS A total of 982 033 weighted records with neonatal birth trauma were found. The prevalence rate increased by 23% from (from 25.3 to 31.1 per 1000 hospital births). Scalp injuries composed 80% of all birth traumas and increased yearly from 19.87 to 26.46 per 1000 hospital births. Major birth trauma decreased from 5.44 to 4.67 per 1000 hospital births due to decreased clavicular fractures, brachial plexus injuries, and intracranial hemorrhage. There were significant differences in demographics and risk factors between the 2 groups. Compared with scalp injuries, major birth trauma was associated with higher odds of hypoxic-ischemic encephalopathy, seizures, need for mechanical ventilation, meconium aspiration, and sepsis. Length of stay was increased by 56%, and total charges were almost doubled for major birth trauma. CONCLUSIONS Neonatal birth trauma increased over the study period secondary to scalp injuries. Major birth trauma constitutes a significant health burden. Scalp injuries are also associated with increased morbidity and might be markers of brain injury in some cases.
Collapse
Affiliation(s)
- Ruby Gupta
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
| | - Erwin T Cabacungan
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
34
|
Madathil S, Priyadarshi M, Antony S, Rauf Kk A, John ST. Respiratory Distress in a Newborn with Severe Birth Asphyxia. J Pediatr 2021; 237:312-313. [PMID: 34146547 DOI: 10.1016/j.jpeds.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Shamnad Madathil
- Department of Pediatrics, Baby Memorial Hospital, Kozhikode, Kerala
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Surya Antony
- Department of Pediatrics, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Abdul Rauf Kk
- Department of Pediatrics, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Shaji Thomas John
- Department of Pediatrics, Baby Memorial Hospital, Kozhikode, Kerala, India
| |
Collapse
|
35
|
Webb R, Smith AM, Ayers S, Wright DB, Thornton A. Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version). Front Psychol 2021; 12:596779. [PMID: 33746826 PMCID: PMC7966709 DOI: 10.3389/fpsyg.2021.596779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice.
Collapse
Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Ann M Smith
- Neonatal Intensive Care Unit, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Daniel B Wright
- Department of Educational Psychology and Higher Education, University of Nevada, Las Vegas, NV, United States
| | - Alexandra Thornton
- Perinatal Mental Health Service, West London NHS Trust, St Bernard's Hospital, London, United Kingdom
| |
Collapse
|
36
|
Kyrou M. Mode of delivery and traumatic birth experience: The role of the midwife. Eur J Midwifery 2021; 4:39. [PMID: 33537640 PMCID: PMC7839155 DOI: 10.18332/ejm/127264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maria Kyrou
- National School of Public Health, Athens, Greece
| |
Collapse
|
37
|
Hickman LC, Propst K, Swenson CW, Lewicky-Gaupp C. Subspecialty care for peripartum pelvic floor disorders. Am J Obstet Gynecol 2020; 223:709-14. [PMID: 32888923 DOI: 10.1016/j.ajog.2020.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/03/2023]
Abstract
Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.
Collapse
|
38
|
Delicate A, Ayers S, McMullen S. Health care practitioners' views of the support women, partners, and the couple relationship require for birth trauma: current practice and potential improvements. Prim Health Care Res Dev 2020; 21:e40. [PMID: 33004100 DOI: 10.1017/S1463423620000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To examine health care practitioners' views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements. BACKGROUND Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined. METHOD An online survey of health care practitioners' views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110. RESULTS Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested. CONCLUSIONS Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners' perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.
Collapse
|
39
|
Vlasyuk V, Malvasi A. The importance of asynclitism in birth trauma and intrapartum sonography. J Matern Fetal Neonatal Med 2020; 35:2188-2194. [PMID: 32538217 DOI: 10.1080/14767058.2020.1777270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Asynclitism is malposition and malpresentation of the head in the pelvis. It is shown that asynclitism during the configuration (molding) of the head leads to an uneven distribution of the tension forces of the tentorium cerebelli (TC) and to its one-sided ruptures, mainly in the left half. It is indicated that with asynclitism larger more than 15 mm (moderate degree of asynclitism), the risk of birth trauma to the skull and brain increases. It was shown that not only severe degree of asynclitism, but also a moderate degree are pathological due to possible complications. The data on the sonographic diagnosis of asynclitism are presented. The negative effects of vacuum extraction (VE), the forceps application are considered. The mechanism of subaponeurotic hemorrhages is described. The importance of timely asynclitism diagnosis in labor to prevent its complication is shown. The cesarean section is practiced as extreme solution to the problem. The widespread use of sonography for the asynclitism diagnosis will prevent the birth trauma and reduce the incidence of mobility and mortality of the children and mother.
Collapse
Affiliation(s)
- Vasily Vlasyuk
- Department of Forensic Medicine, S. M. Kirov Military Medical Academy, St Petersburg, Russia
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care and Research, Bari, Italy.,Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), International Translational Medicine and Biomodelling Research Group, Moscow, Russia
| |
Collapse
|
40
|
Kimmich N, Yeo AT, Zimmermann R, Furrer E. How do sustained birth tears after vaginal birth affect birth tear patterns in a subsequent birth? J Perinat Med 2020; 48:/j/jpme.ahead-of-print/jpm-2020-0007/jpm-2020-0007.xml. [PMID: 32191625 DOI: 10.1515/jpm-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
Background Tears are common after vaginal birth, and different impact factors are known. However, the impact of tears from a previous birth to the tears of a subsequent birth is unknown. Therefore, we aimed to evaluate the distribution of birth tear patterns according to the sustained tears in a previous birth, in addition to other impact factors. Methods In a retrospective cohort study, we evaluated all women up to parity 4 with subsequent vaginal, singleton births of vertex presentation at ≥37 + 0 gestational weeks between 1/2005 and 12/2016. Their tears were grouped into tear patterns and were analyzed by parity. Tear patterns in the subsequent births were analyzed in association to the patterns of the previous births and impact factors were evaluated. Results We counted 4017 births in 1855 women [P1: 1368 (34.1%), P2: 1730 (43.1%), P3: 741 (18.4%), P4: 178 (4.4%)]. The frequency of tears and episiotomies decreased with higher parity, whereas the frequency of intact perineum increased. Twenty-eight different unique tear patterns were found. We could show that birth tear patterns changed with increasing parity and were associated with sustained tears in a previous birth. In addition, some impact factors on tear patterns could be identified. Conclusion The distribution of the single tear types is in accordance with the current literature. However, it is new that distinct tear patterns are associated to sustained tear patterns of previous births. Furthermore, we demonstrated some weak associations of tear patterns to certain impact factors, such as more episiotomies, low-grade perineal or vaginal tears isolated or in combination with other tears with increasing fetal weight and head circumference in the higher parities, and with a longer duration of the second stage and the pushing phase in lower parities.
Collapse
Affiliation(s)
- Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Audrey, T. Yeo
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute (EPBI), Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Eva Furrer
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute (EPBI), Zurich, Switzerland
| |
Collapse
|
41
|
Sahrphillips JF, Van Hoover C. Maneuvering Through a Birth Complicated by Shoulder Dystocia. J Midwifery Womens Health 2020; 65:395-403. [PMID: 32124553 DOI: 10.1111/jmwh.13087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Abstract
Shoulder dystocia is an unpredictable intrapartum emergency with potentially devastating consequences. In this article, the etiology, pathophysiology, and clinical management of shoulder dystocia are reviewed; institutional readiness and potential legal implications are discussed. Also considered are posttraumatic stress disorder and secondary traumatic stress, adverse psychological consequences that may be experienced by women, midwives, and other intrapartum care providers, including staff.
Collapse
Affiliation(s)
| | - Cheri Van Hoover
- Midwifery & Women's Health Programs, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| |
Collapse
|
42
|
Wang H, Luo B, Tong XM. [A single-center study of the incidence of neonatal birth trauma and its risk factors]. Zhongguo Dang Dai Er Ke Za Zhi 2019; 21:249-252. [PMID: 30907349 PMCID: PMC7389357 DOI: 10.7499/j.issn.1008-8830.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the incidence of neonatal birth trauma in the department of obstetrics in a single-center medical institution and the risk factors for neonatal birth trauma. METHODS The maternal and infant medical records of all full-term singleton neonates delivered in the Department of Obstetrics, Peking University International Hospital, from October 2015 to September 2018 were collected. The neonates with birth trauma were assigned to case group, and those without birth trauma were assigned to control group. The risk factors for neonatal birth trauma were identified by multivariate logistic regression analysis. RESULTS Of the 4 682 full-term singleton neonates delivered during the study period, 201 (4.29%) were diagnosed with birth trauma. The most frequent type of birth trauma was cephalohematoma (81.7%), followed by facial nerve palsy (9.1%). The multivariate logistic regression analysis identified vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference as the risk factors for birth trauma (OR=5.020, 23.294, 1.409, 1.928 and 2.295 respectively; P<0.05). CONCLUSIONS The most frequent type of neonatal birth trauma is cephalohematoma. Vaginal delivery, forceps-assisted delivery, induction of labor by oxytocin, premature rupture of membranes and a large neonatal head circumference may increase the risk of neonatal birth trauma, and forceps-assisted delivery is the strongest independent risk factor for birth trauma.
Collapse
Affiliation(s)
- Hui Wang
- Department of Pediatrics, Peking University International Hospital, Beijing 102206, China.
| | | | | |
Collapse
|
43
|
Sainz JA, García-Mejido JA, Aquise A, Borrero C, Bonomi MJ, Fernández-Palacín A. A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps. Am J Obstet Gynecol 2019; 220:193.e1-193.e12. [PMID: 30391443 DOI: 10.1016/j.ajog.2018.10.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Complicated operative vaginal deliveries are associated with high neonatal morbidity and maternal trauma, especially if the procedure is unsuccessful and a cesarean delivery is needed. The decision to perform an operative vaginal delivery has traditionally been based on a subjective assessment by digital vaginal examination combined with the clinical expertise of the obstetrician. Currently there is no method for objectively quantifying the likelihood of successful delivery. Intrapartum ultrasound has been introduced in clinical practice to help predict the progression and final method of delivery. OBJECTIVE The aim of this study was to compare predictive models for identifying complicated operative vaginal deliveries (vacuum or forceps) based on intrapartum transperineal ultrasound in nulliparous women. STUDY DESIGN We performed a prospective cohort study in nulliparous women at term with singleton pregnancies and full dilatation who underwent intrapartum transperineal ultrasound evaluation prior to operative vaginal delivery. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound (angle of progression, progression distance, and midline angle) was performed immediately before instrument application, both at rest and concurrently with pushing. Intrapartum evaluation of fetal biometric parameters (estimated fetal weight, head circumference, and biparietal diameter) was also carried out. An operative vaginal delivery was classified as complicated when 1 or more of the following complications occurred: ≥3 tractions needed; third- to fourth-degree perineal tear; severe bleeding during episiotomy repair (decrease of ≥2.5 g/dL in the hemoglobin level); or significant traumatic neonatal lesion (subdural-intracerebral hemorrhage, epicranial subaponeurotic hemorrhage, skeletal injuries, injuries to spine and spinal cord, or peripheral and cranial nerve injuries). Six predictive models were evaluated (information available in Table 2). RESULTS We recruited 84 nulliparous patients, of whom 5 were excluded because of the difficulty of adequately evaluating the biparietal diameter and head circumference. A total of 79 nulliparous patients were studied (47 vacuum deliveries, 32 forceps deliveries) with 13 cases in the occiput-posterior position. We identified 31 cases of complicated operative vaginal deliveries (19 vacuum deliveries and 12 forceps deliveries). No differences were identified in obstetric, neonatal, or intrapartum characteristics between the 2 study groups (operative uncomplicated vaginal delivery vs operative complicated vaginal delivery), with the following exceptions: estimated fetal weight (3243 ± 425 g vs 3565 ± 330 g; P = .001), biparietal diameter (93.2 ± 2.1 vs 95.2 ± 2.3 mm; P = .001), head circumference (336 ± 12 vs 348 ± 6.4 mm; P = .001), sex (female 62.5% vs 29.0%; P = .010), newborn weight (3258 ± 472 g vs 3499 ± 383 g; P = .027), and number of tractions (median, interquartile range) (1 [1-2] vs 4 [3-5]; P < .0005). To predict complicated operative deliveries, all 6 of the studied models presented an area under the receiver-operating characteristics curve between 0.863 and 0.876 (95% confidence intervals, 0.775-0.950 and 0.790-0.963; P < .0005). The results of the study met the criteria of interpretability and parsimony (simplicity), allowing us to identify a binary logistic regression model based on the angle of progression and head circumference; this model has an area under the receiver-operating characteristics curve of 0.876 (95% confidence interval, 0.790-0.963; P < .0005) and a calibration slope B of 0.984 (95% confidence interval, 0.0.726-1.243; P < .0005). CONCLUSION The combination of the angle of progression and the head circumference can predict 87% of complicated operative vaginal deliveries and can be performed in the delivery room.
Collapse
|
44
|
Abstract
Objective: Shoulder dystocia is an obstetric emergency, occurring in 0.2-3% of vaginal deliveries. Research has mainly focused on the neonatal morbidity arising from shoulder dystocia, such as brachial plexus injury and hypoxic-ischemic encephalopathy. Maternal morbidity is thought to be increased with shoulder dystocia though is much less commonly reported. Obstetric anal sphincter injury remains the leading cause of fecal incontinence in women and shares several antenatal and intrapartum risk factors with shoulder dystocia. The aim of this study was to identify risk factors for sphincter injury associated with shoulder dystocia.Methods: This retrospective analysis included all cases of shoulder dystocia from 2008 to 2017 in a single unit in North-East Ireland. Maternal characteristics and delivery outcomes were analyzed. Two groups were compared, those with and without anal sphincter injury in our shoulder dystocia cohort and those with and without shoulder dystocia, regardless of sphincter injury. Univariate and multivariate logistic regression models were used to examine risk factors for sphincter injury.Results: There were 24,159 singleton cephalic vaginal deliveries over the study period, with 495 cases of shoulder dystocia, giving an incidence of 2.1% (495/24 159). The rate of anal sphincter injury in those with shoulder dystocia was 4.4% (22/495), with 7.6% (12/158) in nulliparas, and 3.0% (10/337) among multiparas. Women with sphincter damage were more likely to be nulliparous than those with an intact sphincter (54.5% [12/22] vs. 30.9% [146/473]; p = .036) and have an operative vaginal delivery (72.7% [16/22] vs. 39.1% [185/473]; p = .004). Episiotomy was more common in those with a sphincter injury (68.2% [15/22] vs. 37.0% [175/473]; p = .007). On univariate regression analysis, nulliparity (OR 2.69) and operative vaginal delivery (OR 4.15) were associated with sphincter injury. No risk factors were identified on multivariate regression analysis.Discussion: In our population, the risk of anal sphincter injury with shoulder dystocia is 4.4%. Risk factors include nulliparity and operative vaginal delivery. After controlling for other factors, these associations became nonsignificant. Further research into sphincter injury at shoulder dystocia is warranted.
Collapse
Affiliation(s)
- Bobby D O'Leary
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Vineta Ciprike
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| |
Collapse
|
45
|
Greenfield M, Jomeen J, Glover L. "It Can't Be Like Last Time" - Choices Made in Early Pregnancy by Women Who Have Previously Experienced a Traumatic Birth. Front Psychol 2019; 10:56. [PMID: 30740076 PMCID: PMC6355667 DOI: 10.3389/fpsyg.2019.00056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 01/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12–20 weeks. Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust. Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control.
Collapse
Affiliation(s)
- Mari Greenfield
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Julie Jomeen
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Lesley Glover
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| |
Collapse
|
46
|
Caudwell-Hall J, Kamisan Atan I, Guzman Rojas R, Langer S, Shek KL, Dietz HP. Atraumatic normal vaginal delivery: how many women get what they want? Am J Obstet Gynecol 2018; 219:379.e1-379.e8. [PMID: 30063899 DOI: 10.1016/j.ajog.2018.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Trauma to the perineum, levator ani complex, and anal sphincter is common during vaginal childbirth, but often clinically underdiagnosed, and many women are unaware of the potential for long-term damage. OBJECTIVE In this study we use transperineal ultrasound to identify how many women will achieve a normal vaginal delivery without substantial damage to the levator ani or anal sphincter muscles, and to create a model to predict patient characteristics associated with successful atraumatic normal vaginal delivery. STUDY DESIGN This is a retrospective, secondary analysis of data sets gathered in the context of an interventional perinatal imaging study. A total of 660 primiparas, carrying an uncomplicated singleton pregnancy, underwent an antepartum and postpartum interview, vaginal exam (Pelvic Organ Prolapse Quantification), and 4-dimensional translabial ultrasound. Ultrasound data were analyzed for levator trauma and/or overdistention and residual sphincter defects. Postprocessing analysis of ultrasound volumes was performed blinded against clinical data and analyzed against obstetric data retrieved from the local maternity database. Levator avulsion was diagnosed if the muscle insertion at the inferior pubic ramus at the plane of minimal hiatal dimensions and within 5 mm above this plane on tomographic ultrasound imaging was abnormal, ie the muscle was disconnected from the inferior pubic ramus. Hiatal overdistensibility (microtrauma) was diagnosed if there was a peripartum increase in hiatal area on Valsalva by >20% with the resultant area ≥25 cm2. A sphincter defect was diagnosed if a gap of >30 degrees was seen in ≥4 of 6 tomographic ultrasound imaging slices bracketing the external anal sphincter. Two models were tested: a first model that defines severe pelvic floor trauma as either obstetric anal sphincter injury or levator avulsion, and a second, more conservative model, that also included microtrauma. RESULTS A total of 504/660 women (76%) returned for postpartum follow-up as described previously. In all, 21 patients were excluded due to inadequate data or intercurrent pregnancy, leaving 483 women for analysis. Model 1 defined nontraumatic vaginal delivery as excluding operative delivery, obstetric anal sphincter injuries, and sonographic evidence of levator avulsion or residual sphincter defect. Model 2 also excluded microtrauma. Of 483 women, 112 (23%) had a cesarean delivery, 103 (21%) had an operative vaginal delivery, and 17 (4%) had a third-/fourth-degree tear, leaving 251 women who could be said to have had a normal vaginal delivery. On ultrasound, in model 1, 27 women (6%) had an avulsion and 31 (6%) had a residual defect, leaving 193/483 (40%) who met the criteria for atraumatic normal vaginal delivery. In model 2, an additional 33 women (7%) had microtrauma, leaving only 160/483 (33%) women who met the criteria for atraumatic normal vaginal delivery. On multivariate analysis, younger age and earlier gestation at time of delivery remained highly significant as predictors of atraumatic normal vaginal delivery in both models, with increased hiatal area on Valsalva also significant in model 2 (all P ≤ .035). CONCLUSION The prevalence of significant pelvic floor trauma after vaginal child birth is much higher than generally assumed. Rates of obstetric anal sphincter injury are often underestimated and levator avulsion is not included as a consequence of vaginal birth in most obstetric text books. In this study less than half (33-40%) of primiparous women achieved an atraumatic normal vaginal delivery.
Collapse
Affiliation(s)
- Jessica Caudwell-Hall
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia
| | - Ixora Kamisan Atan
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia; Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Rodrigo Guzman Rojas
- Departamento de Ginecología y Obstetricia, Clínica Alemana de Santiago-Universidad del Desarrollo, Chile; Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Susanne Langer
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia
| | - Ka Lai Shek
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia; Liverpool Clinical School, Western Sydney University, Australia
| | - Hans Peter Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Liverpool, Australia.
| |
Collapse
|
47
|
Wen Q, Muraca GM, Ting J, Coad S, Lim KI, Lisonkova S. Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study. BMJ Open 2018; 8:e020578. [PMID: 29500215 PMCID: PMC5855201 DOI: 10.1136/bmjopen-2017-020578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 01/31/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN A retrospective observational study. SETTINGS AND PARTICIPANTS All hospital singleton live births in Washington State, USA, 2004-2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.
Collapse
Affiliation(s)
- Qi Wen
- BC Children's Hospital Research Institute, Children's Hospital, Vancouver, Canada
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, Canada
| | - Giulia M Muraca
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Department of Pediatrics, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarah Coad
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Kenneth I Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
48
|
Abstract
Since its introduction in the early 1990s, endoanal sonography has become the mainstay of morphologic assessment of the anal canal and sphincter, especially for obstetric anal sphincter trauma. Lack of availability of suitable systems and the invasive nature of the method have limited uptake and clinical utility. More recently, exoanal or transperineal/translabial tomographic imaging has been developed as a noninvasive alternative. This pictorial overview aims to introduce the reader to this new diagnostic modality and to demonstrate common findings in asymptomatic and symptomatic women.
Collapse
Affiliation(s)
- Hans Peter Dietz
- Department of Obstetrics and Gynecology, Sydney Medical School Nepean, Penrith, New South Wales, Australia
| |
Collapse
|
49
|
Varghese J, Teng M, Huang M, Balsam D. Birth injuries to growth plates: A sheep in wolves' clothing. J Clin Ultrasound 2017; 45:511-514. [PMID: 28198550 DOI: 10.1002/jcu.22444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 06/06/2023]
Abstract
Growth plate injuries (Salter-Harris type 1 or physeal fractures) of the long bones in the newborn are easily misdiagnosed as joint fractures with dislocations due to their nonossified epiphyses on plain radiographs. Diagnosis with musculoskeletal ultrasound (US) is advantageous due to its ability to visualize the nonossified epiphysis. We present two cases of humeral growth plate fractures in newborns, one at the shoulder (proximal humerus) and the other at the elbow (distal humerus). These cases emphasize the importance of quick and noninvasive diagnosis with US to avoid unnecessary intervention. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:511-514, 2017.
Collapse
Affiliation(s)
- Jerrin Varghese
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Matthew Teng
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Mingqian Huang
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Dvorah Balsam
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY
| |
Collapse
|
50
|
Elmir R, Pangas J, Dahlen H, Schmied V. A meta-ethnographic synthesis of midwives' and nurses' experiences of adverse labour and birth events. J Clin Nurs 2017; 26:4184-4200. [PMID: 28722761 DOI: 10.1111/jocn.13965] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Health professionals are frequently exposed to traumatic events due to the nature of their work. While traumatic and adverse labour and birth events experienced by women are well researched, less attention has been given to midwives' and nurses' experiences of these events and the impact it has on their lives. AIMS AND OBJECTIVES To undertake a meta-ethnographic study of midwives' and nurses' experiences of adverse labour and birth events. METHODS Scopus, CINHAL PLUS, MEDLINE and PUBMED databases were searched using subject headings and keywords. The search was limited to papers published in peer-reviewed journals from 2004-October 2016. Quality appraisal was undertaken using the Critical Appraisal Skills Programme tool. INCLUSION CRITERIA Papers had to be qualitative or have a substantial qualitative component. Studies were included if they primarily focused on midwives' or nurses' perspectives or experiences of complicated, traumatic or adverse labour and birth events. ANALYTIC STRATEGY A meta-ethnographic approach was used incorporating methods of reciprocal translation guided by the work of Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies (Vol. 11). Newbury Park: Sage publications). FINDINGS Eleven qualitative studies were included in the final sample. Four major themes were (i) feeling the chaos; (ii) powerless, responsible and a failure; (iii) "It adds another scar to my soul"; and (iv) finding a way to deal with it. CONCLUSION Midwives and nurses feel relatively unprepared when faced with a real-life labour and birth emergency event. While many of the midwives and nurses were traumatised by the experience, some were able to view their encounter as an opportunity to develop their emergency response skills. RELEVANCE TO CLINICAL PRACTICE Witnessing and being involved in a complicated or adverse labour and birth event can be traumatic for nurses and midwives. Organisational and collegial support needs to be available to enable these health professionals to talk about their feelings and concerns.
Collapse
Affiliation(s)
- Rakime Elmir
- School of Nursing and Midwifery, Affiliate Centre of Applied Nursing Research (CANR), Western Sydney University, Penrith, NSW, Australia
| | - Jackie Pangas
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, Australia
| |
Collapse
|