What is the impact of birth trauma on women's mental health and how can therapy help?

Background Psychological birth trauma has persistent adverse effects on the performance and health of women during and after childbirth. Therefore, Interventions to prevent and mitigate psychological birth trauma are of paramount importance. Objective The present study aimed to investigate the effects of counseling based on Gamble’s approach on psychological birth trauma in primiparous women. Materials and methods This randomized clinical trial was conducted on 60 primiparous women referring to the health centers in Mashhad, Iran in 2018. In the intervention group, counseling was provided by an obstetrician based on Gamble’s strategy to each participant in three sessions before delivery and one session postpartum. The participants in the control group only received routine prenatal care. Data were collected using demographic and obstetrics characteristics questionnaire and psychological birth trauma questionnaire. The data were analyzed using SPSS, version 21 and chi-square and independent t-test. p-value less than .05 was considered significant. Results The mean age of the women in the intervention and control groups was 23.3 ± 3.9 and 24.4 ± 4.4, and the mean prenatal age upon delivery was 40.8 ± 5.7 and 39.8 ± 1.2 weeks respectively. The mean score of psychological birth trauma in the intervention (counseling) and control groups was 37.2 ± 10.4 and 47.6 ± 16.3, respectively, which was significantly lower in the intervention group (p = .003). Conclusion According to the results, counseling based on Gamble’s approach could reduce psychological birth trauma in primiparous women. Therefore, this effective, simple, cost-effective, and harmless approach could be employed to reduce intrapartum and postpartum maternal traumas and prevent adverse events for the mother and the newborn.

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6weeks, 6 and 12months. At 12months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95% confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95% CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.

This discussion article considers how an emotion-focused approach can be adopted to prevent psychological birth trauma and to optimize perinatal wellbeing for women and their families. Emotion-focused approaches have a different perspective when compared to other classic psychotherapy methods. This approach may help women to resolve the negative impacts of psychological birth trauma; to prevent posttraumatic stress disorder onset; to lead to better results for mother and baby well-being; and may be cost effective. Mental health nurses/midwives should receive education about emotion-focused approaches in addition to gaining competence in basic counseling skills so that they can utilize these approaches with women.

Objective: To evaluate routinely collected service data from a ‘Birth Trauma’ psychology clinic integrated into maternity services, in order to review effectiveness for women with symptoms of Post-Traumatic Stress Disorder (PTSD) following childbirth.Background: Prevalence of PTSD after child-birth has been estimated to be around 3% for women meeting full diagnostic criteria and up to 9% for sub-threshold symptoms. This can occur even in response to deliveries considered to be medically straightforward. NICE guidelines (2018) recommend psychological therapy as a first line treatment for symptoms of PTSD.Methods: The sample included 114 women referred post-natally for psychological assessment and intervention following a traumatic birth experience. Measures were routinely administered as part of initial assessment (T1) and at completion of intervention (T2). Data from these measures were collated and analyzed using a series of paired sample t tests. Following assessment 101 women were taken on for psychological intervention and of these, 74 completed both T1 and T2 measures.Results: There were highly significant reductions across all measures of PTSD, anxiety and negative mood symptoms. The treatment effect sizes were very large. Mean total score on a measure of PTSD symptomatology was no longer clinically significant following interventions.Conclusion: This evaluation suggests an integrated Birth Trauma psychology clinic using a small number of contact sessions is a highly efficient and effective model of care for women experiencing symptoms of PTSD following childbirth.

Abstract Background The detrimental impact of psychological birth trauma is far-reaching for women. This study aimed to identify the relationship between social support, childbirth readiness, and psychological birth trauma and to further explore whether childbirth readiness can play a mediating role. Methods A nationwide online cross-sectional study was conducted among 751 primiparous women in seven provinces in China from November 2021 to March 2022. The questionnaire consisted of questions on demographic characteristics, the Psychological Birth Trauma Scale (PBTS), the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM), and the Childbirth Readiness Scale (CRS). Hierarchical multiple regression was used to explore the associate factors and mediating role of childbirth readiness in the relationship between social support and psychological birth trauma. The mediating model was examined by the PROCESS macro for SPSS. Results After adjusting for demographic variables, social support was negatively associated with psychological birth trauma (r=-0.242, P<0.01). Childbirth readiness had a positive correlation with social support (r = 0.206, P<0.01) and a negative correlation with psychological birth trauma (r=-0.351, P<0.01). The hierarchical multiple regression model indicated that social support and childbirth readiness explained 3.9% and 7.7% of the variance in psychological birth trauma, respectively. Childbirth readiness partly mediated the association between social support and psychological birth trauma for primiparas. Conclusions Childbirth readiness played a mediating role between social support and psychological birth trauma among primiparas. Strategies and interventions to enhance childbirth readiness levels may be expected to improve the impact of social support on women's psychological birth trauma.

Abstract Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes. Key learning aims (1) To recognise and understand the development of PTSD following childbirth and baby loss. (2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD. (3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth. (4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.

Minimizing the risk of women experiencing a subsequent birth as another traumatic event needs to be a priority for psychiatric-mental health nurses. One approach to identifying women struggling with a subsequent pregnancy is to be attentive to metaphors women use to describe what they are experiencing. The purpose of this secondary qualitative data analysis was to identity the metaphorical expressions women use to describe a subsequent birth after a prior birth trauma. The following five metaphors identified paint a vivid picture of what women experienced: a head buried in the sand, mental baggage, emotional torture, waves of panic, and a back and forth battle. Being knowledgeable about metaphors childbearing women use during a pregnancy following a previous birth trauma can help clinicians to recognize struggling mother-infant dyads and to initiate appropriate interventions. Necessary referrals can be made to psychiatric-mental health nurse practitioners.

Traumatic birth experiences can cause postnatal mental health disturbance, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to impaired child development. Some women may develop postnatal Post Traumatic Stress Disorder, which is a particularly undesirable outcome. This paper aimed to gain a better understanding of factors contributing to birth trauma, and the efficacy of interventions that exist in the literature. A literature search was undertaken in April 2015. Articles were limited to systematic reviews or original research of either high to moderate scientific quality. A total of 21 articles were included in this literature review. Women with previous mental health disorders were more prone to experiencing birth as a traumatic event. Other risk factors included obstetric emergencies and neonatal complications. Poor Quality of Provider Interactions was identified as a major risk factor for experiencing birth trauma. Evidence is inconclusive on the best treatment for Post Traumatic Stress Disorder; however midwifery-led antenatal and postnatal interventions, such as early identification of risk factors for birth trauma and postnatal counselling showed benefit. Risk factors for birth trauma need to be addressed prior to birth. Consideration needs to be taken regarding quality provider interactions and education for maternity care providers on the value of positive interactions with women. Further research is required into the benefits of early identification of risk factors for birth trauma, improving Quality of Provider Interactions and how midwifery-led interventions and continuity of midwifery carer models could help reduce the number of women experiencing birth trauma.

One in five women in the UK develop mental health problems during pregnancy or in the first year after childbirth. ‘Birth trauma’ is a common birth-related mental health issue which stems from perceiving childbirth as a traumatic experience; the term ‘birth trauma’ also encompasses living with and experiencing the accompanying symptoms of trauma after childbirth. A mini focus group study was conducted with two experienced perinatal counsellors to discuss their experiences working with parents struggling with birth trauma. Analysis of the focus group revealed five key themes: the complexity of birth trauma; the power of communication; changes in culture; falling through the gaps and coping with trauma. The themes identified reflect previous academic research on parent and clinician experiences of birth trauma as well as national reports aimed at improving maternity care for parents.

To define and analyze the concept of psychological birth trauma. The concept analysis method of Walker and Avant was used. Eight databases (PubMed, CINAHL Complete, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP Information Chinese Journal Service Platform, and Chinese BioMedicine Literature Database) were searched from inception to July 2022 for studies focused on psychological birth trauma. Of the 5,372 studies identified, 44 ultimately met the inclusion criteria. The attributes identified were (1) women's subjective feelings, (2) intertwined painful emotional experiences, (3) originating in the birth process, and (4) lasting until postpartum. Antecedents were divided into two groups: pre-existing antecedents and birth-related antecedents. Consequences were identified as negative and positive. Psychological birth trauma is a more complex and comprehensive concept than previously thought, and should be regarded as a separate postpartum mental health problem. This study deepens the understanding of psychological birth trauma through a comprehensive concept analysis and also puts forward some suggestions for the prevention, identification, and intervention of psychological birth trauma, which provides a basis for assisting in the identification of psychological birth trauma and provides a reference for the development of rigorous assessment tools and the design of appropriate interventions in the future. Further research is needed to update and refine this concept.