A multilevel developmental psychopathology model of childbirth and the perinatal transition

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

The intersection of traumatic childbirth and obstetric racism: A qualitative study

BACKGROUND

Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences.

METHODS

In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis.

RESULTS

Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children.

CONCLUSIONS

Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.

Determinants of Psychosocial Health Status in Pregnant and Postpartum Women Experiencing Earthquake in Turkey

OBJECTIVE

It is well known that natural disasters such as earthquakes negatively affect physical and mental health by exposing people to excessive stress. The aim of this study was to investigate determinants of psychosocial health status among the pregnant and postpartum women who experienced earthquake in Türkiye.

METHODS

Pregnant and postpartum women (n = 125) living in tent cities in the Kahramanmaraş region formed the study sample. Data were collected between February 20 and 26, 2023, through face-to-face interviews. The instruments used for data collection were the Introductory Form, the Depression Anxiety Stress Scale, the Traumatic Childbirth Perception Scale, and the Post-Traumatic Stress Disorder-Short Scale.

RESULTS

A moderate positive relationship was found between stress and posttraumatic stress and traumatic childbirth perception in pregnant and postpartum women, and a high positive relationship was found between anxiety and depression. A high level of relationship was found between anxiety and stress and depression.

CONCLUSIONS

It is seen that the psychosocial health of pregnant and postpartum women, who belong to the risk group in the earthquake zone, is at high risk. Psychological support is urgently needed to preserve and improve their psychosocial health.

The impact on midwives and their practice after caring for women who have a traumatic childbirth: A systematic review

BACKGROUND

Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question.

METHODS

Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes.

RESULTS

A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down".

CONCLUSIONS

Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).

Reducing the Adverse Effects of Birth Trauma Among Birth Companions

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.

Maternal childbirth-related posttraumatic stress symptoms, bonding, and infant development: a prospective study

BACKGROUND

Childbirth-related posttraumatic stress symptoms (CB-PTSS) including general symptoms (GS, i.e., mainly negative cognitions and mood and hyperarousal symptoms) and birth-related symptoms (BRS, i.e., mostly re-experiencing and avoidance symptoms) may disrupt mother-infant bonding and infant development. This study investigated prospective and cross-sectional associations between maternal CB-PTSS and mother-infant bonding or infant development (language, motor, and cognitive).

METHOD

We analysed secondary data of the control group of a randomised control trial (NCT03576586) with full-term French-speaking mother-infant dyads (n = 55). Maternal CB-PTSS and mother-infant bonding were assessed via questionnaires at six weeks (T1) and six months (T2) postpartum: PTSD Checklist for DSM-5 (PCL-5) and Mother-Infant Bonding Scale (MIBS). Infant development was assessed with the Bayley Scales of Infant Development at T2. Sociodemographic and medical data were collected from questionnaires and medical records. Bivariate and multivariate regression were used.

RESULTS

Maternal total CB-PTSS score at T1 was associated with poorer bonding at T2 in the unadjusted model (B = 0.064, p = 0.043). In the adjusted model, cross-sectional associations were found at T1 between a higher total CB-PTSS score and poorer bonding (B = 0.134, p = 0.017) and between higher GS and poorer bonding (B = 0.306, p = 0.002). Higher BRS at T1 was associated with better infant cognitive development at T2 in the unadjusted model (B = 0.748, p = 0.026).

CONCLUSIONS

Results suggest that CB-PTSS were associated with mother-infant bonding difficulties, while CB-PTSS were not significantly associated with infant development. Additional studies are needed to increase our understanding of the intergenerational consequences of perinatal trauma.

Cross-Sectional Study of the Frequency and Severity of Traumatic Childbirth Events and How They Affect Maternity Care Clinicians

OBJECTIVE

To describe the frequency and severity of traumatic childbirth events (TCEs) and how they affected the professional practice and personal lives of maternity care clinicians, including registered nurses (RNs), certified nurse-midwives, attending physicians, and resident physicians.

DESIGN

Descriptive cross-sectional study.

SETTING

Maternity units across five hospitals in the Baltimore metropolitan area.

PARTICIPANTS

Maternity care clinicians (N = 160) including RNs (n = 104), certified nurse-midwives (n = 17), attending physicians (n = 28), and resident physicians (n = 11).

METHODS

Participants completed an online survey to measure the frequency and severity of TCEs and how they affect participants' professional practice and personal lives. We used descriptive statistics to characterize maternity care clinicians and bivariate analysis and linear regression to examine relationships.

RESULTS

Most participants were women (92.5%), White (62.5%), between the ages of 21 and 54 years (89.4%), RNs (65.0%), and employed full-time (79.2%). Shoulder dystocia was the most frequently observed TCE (90.6%), and maternal death was the most severe TCE (M = 4.82, SD = 0.54). Attending physicians (50.0%) reported a significantly greater frequency of exposure to TCEs than the other participants, χ²(6) = 23.8 (n = 159), p <. 001. The frequency of TCEs had a significant medium correlation with perceived effect on professional practice, r(154) = 0.415, p < .001, and personal life, r(155) = 0.386, p < .001. Perception of severity was strongly associated with professional practice, β = 0.52, p < .001, and personal life, β = 0.46, p < .001.

CONCLUSION

If severe, TCE exposure can affect the professional practice and personal life of maternity care clinicians.

The incidence of post-traumatic stress disorder following traumatic childbirth: A systematic review and meta-analysis

BACKGROUND

Although birth trauma may be a risk factor for postpartum post-traumatic stress disorder (PTSD), no systematic review regarding the incidence of postpartum PTSD in women with traumatic childbirth has been reported.

OBJECTIVE

To estimate the incidence of PTSD in women following traumatic childbirth by systematically reviewing and synthesizing all available evidence.

SEARCH STRATEGY

Six databases were searched using a combination of related terms for birth trauma and PTSD.

SELECTION CRITERIA

Cohort and cross-sectional studies that were related to traumatic childbirth and PTSD were included.

DATA COLLECTION AND ANALYSIS

Two reviewers independently screened potentially relevant studies and extracted key data elements. A series of meta-analyses were conducted using STATA 17.0 software, with pooled incidence rates estimated using random effects models.

MAIN RESULTS

A total of nine studies were included in this study. The pooled incidence of PTSD after traumatic childbirth was 19.4% (95% confidence interval 11.9%-26.5%). The incidence of PTSD varied with the scales used to assess traumatic birth and PTSD, evaluation times of PTSD after childbirth, and types of study participants.

CONCLUSIONS

The incidence of PTSD in women with traumatic childbirth is about 19%, higher than the general obstetric population, suggesting that trauma-related care for them should be enhanced.

Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper

INTRODUCTION

Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research.

AIM

To formulate a woman-centered, inclusive definition of a traumatic childbirth experience.

METHODS

After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback.

RESULTS

The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing."

CONCLUSIONS

This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.

Traumatic Childbirth and Birth-Related Post-Traumatic Stress Disorder in the Time of the COVID-19 Pandemic: A Prospective Cohort Study

BACKGROUND

Birth-related post-traumatic stress disorder occurs in 4.7% of mothers. No previous study focusing precisely on the stress factors related to the COVID-19 pandemic regarding this important public mental health issue has been conducted. However, the stress load brought about by the COVID-19 pandemic could have influenced this risk.

METHODS

We aimed to estimate the prevalence of traumatic childbirth and birth-related PTSD and to analyze the risk and protective factors involved, including the risk factors related to the COVID-19 pandemic. We conducted a prospective cohort study of women who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022 with an assessment within 3 days of delivery and a clinical interview at one month post-partum.

RESULTS

Among the 254 participants included, 35 (21.1%, 95% CI: 15.1-28.1%) experienced a traumatic childbirth and 15 (9.1%, 95% CI: 5.2-14.6%) developed a birth-related PTSD at one month post-partum according to DSM-5. Known risk factors of birth-related PTSD such as antenatal depression, previous traumatic events, neonatal complications, peritraumatic distress and peritraumatic dissociation were confirmed. Among the factors related to COVID-19, only limited access to prenatal care increased the risk of birth-related PTSD.

CONCLUSIONS

This study highlights the challenges of early mental health screening during the maternity stay when seeking to provide an early intervention and reduce the risk of developing birth-related PTSD. We found a modest influence of stress factors directly related to the COVID-19 pandemic on this risk.

Traumatic Childbirth Experiences of New Parents: A Meta-Synthesis

Childbirth is usually a joyous occasion. However, a significant proportion of parents experienced traumatic childbirths and suffered post-traumatic consequences, which needs urgent attention. Therefore, this review aimed to explore and understand the traumatic childbirth experiences of parents. A systematic review of qualitative studies was done. The consolidated evidence was meta-summarized and meta-synthesized based on Sandelowski and Barroso's approach for synthesizing qualitative research. Seven electronic databases, including PubMed, CINAHL, Embase, PsycINFO, Cochrane, Scopus, and Web of Science, were searched from each database's inception to April 2020. Retrieved studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and 19 studies were included in this review. All included studies were meta-summarized and meta-synthesized. An overarching theme, "traumatic birth: an evolving voyage," with three main themes, (1) "proceedings to traumatic birth," (2) "internal and external battles," and (3) "muddling through to beating the odds," and 10 subthemes were identified. Overall, parents felt fluctuations of emotions that seemed to be never-ending journeys. They expressed that various factors led to their traumatic birth experiences, especially health care providers' dismissive attitudes. Parents commonly reported feelings of powerlessness and fear for the safety of mothers and infants. Their constant battles to overcome traumatic experiences affected some of their relationships. To deal with the trauma, some mothers displayed avoidance behaviors while others relied on social support. As health care providers play important roles in influencing outcomes of childbirth, they should be mindful of the care provided during labors and childbirths.

Postpartum Psychosis after Traumatic Cesarean Delivery

An emergency cesarean delivery can be a traumatic childbirth experience for a woman and a risk factor for postpartum psychosis, especially in a patient with a history of bipolar disorder. This article describes the case of a pregnant woman with an unknown history of bipolar disorder who developed an acute psychotic reaction during the procedure of an emergency caesarian section and switched to mania. The purpose of this case study is for perinatal health care professionals to identify suspicious symptoms and promptly refer to psychiatric services so as to ensure the mother's and the newborn's safety. This case study highlights the importance of assessing women with bipolar disorder or a previous psychotic episode for the risk of psychiatric complications in pregnancy and after childbirth. Midwifery education on perinatal mental health is crucial for the detection of suspicious symptoms and early referral to a specialist.

Perception of traumatic childbirth of women and its relationship with postpartum depression

Traumatic birth has various effects on women, and postpartum depression is one of them. The present study had two aims: 1) to determine the level of traumatic childbirth perception and postpartum depression in women and the factors affecting them and 2) to reveal the relationship between traumatic childbirth perception and postpartum depression. Five hundred fifty women, recruited between March 2018 and February 2019, completed the following form and scales one month after delivery: the general and obstetric information form, the Perception of Traumatic Childbirth Scale (PTCS), and the Edinburgh Postnatal Depression Scale (EPDS). The mean PTCS scores of the women included in the study were 63.45 ± 28.116 with a median value of 65, and the prevalence of traumatic childbirth was 33.8%. The risk of postpartum depression was determined in 25.3% of the women. There was a significant relationship between the participants' traumatic childbirth perception and their EPDS scores (p < .05). It was determined that the probability of experiencing postpartum depression increased four to five times in women with a high or very high level of traumatic childbirth perception (OR = 4.31; CI 95% 1.912 to 9.701; p = .000)(OR = 5.57; CI 95% 2.090 to 14.818; p = .001). The findings revealed that one-third of the participant women had traumatic childbirth perception, and the risk of postpartum depression increased as the level of traumatic birth perception increased.

Negative Childbirth Experience and Post-traumatic Stress Disorder - A Study Among Postpartum Women in South India

Purpose: Negative childbirth experience has been associated with post-traumatic stress disorder (PTSD) and depression in the postpartum period with a significant impact on the mother as well as the infant. Methods: The current study aimed at studying the association of negative child birth experience with PTSD and depressive symptoms among primiparous mothers within 6 weeks of child birth. The Childbirth Experience Questionnaire (CEQ), PTSD checklist (PCL), and Edinburgh Postnatal Depression scale (EPDS) were used to assess negative childbirth experience, symptoms of PTSD, and depression respectively. Results: Of the 95 women in the study, fifty women (52.6%) had a score below the median of CEQ score (score of 72) indicating a negative childbirth experience. Lower Scores on CEQ indicating negative childbirth experience correlated with PTSD scores on the PCL (r = -0.560, p = 0.001) and depression scores on the EPDS (r = -0.536, p = 0.001). Of the sample of 95 women, 7.36% (N = 7) met the criteria for probable PTSD and 3.16% (N = 3) met criteria for partial PTSD. Twelve women (12.6%) had EPDS scores above 13 indicating probable clinical depression. Median CEQ scores were lower among the women who had PTSD or partial PTSD (N = 10) and among the women who had probable depression (N = 12) than those who did not. Childbirth experience emerged as the only predictor of PTSD on logistic regression (p = 0.03) (95% CI 1.17-79.61). Conclusions: Negative childbirth experiences are common and appear to be associated with depressive and PTSD symptoms. These findings emphasize the need to provide good intrapartum care including respectful maternity care for a positive childbirth experience.

The EMDR Recent Birth Trauma Protocol: a pilot randomised clinical trial after traumatic childbirth

Objective: This pilot study investigated the effectiveness of brief EMDR intervention as compared to treatment-as-usual (TAU) in women with post-partum PTSD symptoms.Design: A pilot randomised controlled trial was conducted to evaluate possible differences between one EMDR session (n = 19) and one TAU session (n = 18) delivered in a maternity ward in the aftermath of childbirth.Main Outcome Measures: The primary outcome measure was the rate of remission of post-partum post-traumatic stress symptoms (i.e. IES-R score <23) in both groups at 6-weeks (T1) and 12-weeks' post-partum (T2). Secondary outcome measures were mother-to-infant bonding, post-partum depressive symptoms, the presence of flashbacks and level of distress.Results: Most of the women improved their post-partum post-traumatic stress symptoms after only one treatment session. EMDR resulted more effective than TAU in reducing the proportion of women with post-partum post-traumatic stress symptoms at 6-weeks' post-partum (78.9% EMDR vs. 39.9% TAU; p = .020). Moreover, women treated with EMDR experienced less flashbacks and distress as compared to TAU. No significant difference was found between treatments on mother-to-infant bonding and post-partum depressive symptoms.Conclusions: These findings, although preliminary, suggest that a brief EMDR intervention could be a viable and promising tool in the early treatment of post-traumatic stress related to traumatic childbirth.

Women's Perceptions of Living a Traumatic Childbirth Experience and Factors Related to a Birth Experience

Although identified by the World Health Organization (WHO) as a global health priority, maternal mental health does not receive much attention even in the health systems of developed countries. With pregnancy monitoring protocols placing priority on the physical health of the mother, there is a paucity of literature documenting the traumatising effects of the birth process. To address this knowledge gap, this qualitative descriptive study aimed to investigate women perceptions of living a traumatic childbirth experience and the factors related to it. Qualitative data, collected via semi-structured interviews with 32 participants recruited from parent support groups and social media in Spain, were analyzed through a six-phase inductive thematic analysis. Data analysis revealed five major themes―“Birth Plan Compliance”, “Obstetric Problems”, “Mother-Infant Bond”, “Emotional Wounds” and “Perinatal Experiences”—and 13 subthemes. The majority of responses mentioned feelings of being un/misinformed by healthcare personnel, being disrespected and objectified, lack of support, and various problems during childbirth and postpartum. Fear, loneliness, traumatic stress, and depression were recurrent themes in participants’ responses. As the actions of healthcare personnel can substantially impact a birth experience, the study findings strongly suggest the need for proper policies, procedures, training, and support to minimise negative consequences of childbirth.

Traumatic Childbirth and Its Aftermath: Is There Anything Positive?

Up to 45% of new mothers have reported experiencing birth trauma. For some individuals who have experienced a traumatic event, there can be a positive legacy called posttraumatic growth. Using Tedeschi and Calhoun's Posttraumatic Growth Model as the theoretical framework, the purpose of this pilot study was to determine levels of posttraumatic stress, core beliefs disruption, and posttraumatic growth in women who have experienced traumatic childbirth. Thirty mothers completed the Posttraumatic Stress Disorder Symptom Scale-Self Report, Core Beliefs Inventory, and Posttraumatic Growth Inventory. Type of birth and length of time since the traumatic birth occurred predicted 38% of the variance in posttraumatic growth. In order to help mothers, childbirth educators need to understand the process involved in posttraumatic growth.

Commentary on a Cochrane Review of Debriefing Interventions for the Prevention of Psychological Trauma in Women After Childbirth

Childbirth can be a traumatic event for some women, with psychological effects that can be significant and long-lasting. Authors of a Cochrane Review of seven randomized controlled trials concluded that debriefing interventions for women after childbirth are not well-defined in the literature and that not enough evidence exists to conclude that there is a positive or adverse effect from using these interventions.

Blame and guilt - a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth

INTRODUCTION

When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns.

MATERIAL AND METHODS

A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants.

RESULTS

The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about the meaning of life. Sixty-five percent felt that they had become a better midwife or doctor due to the traumatic incident.

CONCLUSIONS

The results of this large, exploratory study suggest that obstetricians and midwives struggle with issues of blame, guilt and existential concerns in the aftermath of a traumatic childbirth.

An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder

Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centered maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD? This review includes a description of key variables associated with P-PTSD. Socioeconomic, environmental and genetic determinants are discussed, as are evidence-based prevention and treatment approaches.

Women's experiences, emotional responses, and perceptions of care after emergency peripartum hysterectomy: a qualitative survey of women from 6 months to 3 years postpartum

BACKGROUND

Little is known of the experience and perceptions of care for survivors of emergency peripartum hysterectomy (EPH), an obstetric event that is increasing in incidence. We sought to explore women's experiences of EPH to make recommendations for care.

METHODS

This qualitative study utilized purposive sampling through an online support group of women who experienced EPH. Eligible participants were at least 18 years old, had their hysterectomy at least 6 months but no more than 3 years before the interview, had a surviving infant associated with the delivery, and did not report suicidal ideation. In-depth, semi-structured telephone interviews were conducted and analyzed using Constant Comparative Analysis. Kappa statistics assessed interrater reliability for two independent coders.

RESULTS

Fifteen women participated with a mean age of 32.5 years. Most had a cesarean section, with uterine atony as the most common indication for EPH. Kappa statistics indicated near-perfect interrater agreement between two coders, ranging from .82 to .89. Seven major themes were identified: fear; pain; death and dying; numbness or delay in emotional reaction; bonding with baby; communication; and the need for information. Psychological upset occurred postpartum and was often delayed. A major finding is the need for additional follow-up visits to address the emotional after-effects and to fill in gaps in women's understanding and memory of what had occurred.

CONCLUSION

Understanding women's experiences with EPH can help practitioners address not only women's initial complications but provide needed long-term support.

Construct validity of the childbirth trauma index for adolescents

The potentially traumatic nature of childbirth for adult mothers has been confirmed in research; however, adolescent childbirth trauma is unexplored. This article presents research on the construct validity of the Childbirth Trauma Index by providing a conceptual analysis of psychological childbirth trauma, factor validity of the Childbirth Trauma Index, and discussion of testing the Childbirth Trauma Index via contrasted-groups approach. Childbirth trauma can result in an acute stress reaction or actual posttraumatic stress disorder. Using subjective reports, the Impact of Event Scale, and the Childbirth Trauma Index, an appraisal of birth trauma, trauma impact, and indicators associated with childbirth trauma were revealed among 112 adolescents. Clinical implications and research recommendations are offered.