Birth Trauma Research Articles

P37 - Enhancing Woman-Centred Care in a Subsequent Pregnancy after a Previous Psychologically Traumatic Birth: A Modified Delphi Study

P37 - Enhancing Woman-Centred Care in a Subsequent Pregnancy after a Previous Psychologically Traumatic Birth: A Modified Delphi Study

Embryonic, Fetal, and Neonatal Complications in Infants of Diabetic Mothers: Insights from the Cincinnati Diabetes in Pregnancy Program Project Grant.

This study aimed to review how the Cincinnati Diabetes in Pregnancy Program Project Grant (PPG) contributed to the understanding and treatment of neonatal complications in infants of diabetic mothers (IDMs). This is a retrospective review of all PPG work on glycemic control at different pregnancy time points and its association with embryonic, fetal, and neonatal complications, such as congenital malformations (CMs), intrauterine growth restriction, macrosomia, hypoglycemia, respiratory distress syndrome (RDS), asphyxia, and polycythemia. We found that maternal vasculopathy and poor glycemic control during embryogenesis, but not frequency of maternal hypoglycemic episodes or insulin therapy, are independent risk factors for major CMs. A suggestive association of major CMs with maternal Magnesium deficiency was also observed. Poor glycemic control during late embryogenesis and early fetal development was associated with an increased risk of minor CMs. We described a biphasic pattern of fetal growth whereby early growth delay was followed by enhanced fetal growth associated with neonatal macrosomia. Macrosomia was associated with poorer glycemic control in the third trimester and an increased risk of birth trauma. Macrosomia was also correlated with animal-origin insulin concentrations in cord blood, demonstrating that insulin bound to antibodies can cross the placenta and may affect the fetus. We also showed that neonatal hypoglycemia was significantly associated with third-trimester glycemic control, in addition to hyperglycemia occurring during labor. With modern management and adequate prenatal care, IDMs are no longer at increased risk for RDS. Perinatal asphyxia was associated with increased proteinuria appearing in pregnancy, maternal hyperglycemia before delivery, and prematurity. Polycythemia in IDMs is prevalent and correlates with proxy measurements of fetal hypoxemia (nucleated red blood cells at delivery) and poorer glycemic control in late pregnancy. The PPG in its various phases revealed the important role of glycemic control at nearly every stage of pregnancy including labor. KEY POINTS: · Poor glycemic control during embryogenesis is a major risk factor for CMs.. · Magnesium deficiency might contribute to major malformations.. · Macrosomia is associated with poor glycemic control in the third trimester.. · Strict glycemic control reduces fetal and neonatal morbidity in pregnancies with insulin-dependent diabetes mellitus..

Risk of Postpartum Sexual Dysfunction: A Link to Posttraumatic Stress Disorder Symptoms and Depression Symptoms

The aim of this study is to determine the association of the risk of postpartum sexual dysfunction (SD) with posttraumatic stress disorder (PTSD) and depression symptoms. This cross-sectional study was conducted by collecting data from eight different family health centers (n = 147). Data were collected with ‘Descriptive Information Form’, ‘City Birth Trauma Scale (CityBiTS)’, ‘Edinburg Postpartum Depression Scale (EPDS)’ and ‘Female Sexual Function Index (FSFI)’. Data were evaluated with Chi-square test, Fisher’s exact test, Student’s t-test, Spearman’s correlation and logistic regression analysis. The risk of SD in women between 6 and 12 months postpartum was 53.1%, and the risk of depression was 19%. Based on self-report data, 16.3% of women met all Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD in relation to birth-specific events. There was a negative correlation between the FSFI and the CityBiTS (r=-0.208) and EPDS total scores (r=-0.335). It was found that CityBiTS scores were not a significant factor affecting the risk of SD (p > 0.05), but an increase in EDPS scores increased the likelihood of SD (OR:1.22, p < 0.05). Half of the women are at risk of SD in the first postpartum year. As postpartum depression and PTSD symptoms increase, sexual function decreases.

Neonatal Adverse Outcomes among Hospital Livebirths in Canada: A National Retrospective Study

Introduction: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking. Methods: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks’ gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information’s Discharge Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia’s NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5). Results: Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6–9.5) with 1, 118.1 (108.4–128.4) with 3, and 395.3 (367.2–425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6–6.7), 11.2 (10.9–11.3), and 11.9 (11.6–12.2), and RR for extended hospital stay were 6.6 (6.4–6.7), 12.2 (11.7–12.7), and 26.4 (25.2–27.5). International comparison suggested that Canada had a higher prevalence of NAOI. Conclusion: The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.

Birth Trauma: Incidence and Associated Risk Factors: A Case–Control Study

Obstetric trauma refers to injuries that occur to the newborn during the birth process and can occur despite proper perinatal care. Limiting risk factors could reduce its incidence and avoid significant morbidity and mortality to the infant. The aim of our study was to determine the incidence of birth injury in our setting and to discover its associated risks factors. For this case–control study, all births that took place in our center during the year 2021 were systematically reviewed. A total of 231 full-term newborns, with 77 cases and 154 controls, were included. For each case, two controls of similar sex and gestational age, born during the same shift before and after the case were selected. Preterm infants, outborn patients, twins, and infants with major congenital anomalies were excluded. The incidence of birth injury was 22.8‰ of singleton births. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. After the adjusted logistic regression analysis, the variables that were independently associated with obstetric trauma were (aOR; 95% CI) breech presentation: 10.6 (1.2, 92.6), p = 0.032; dystocia: 7.8 (3.8, 16.2), p &lt; 0.001; forceps instrumentation: 3.1 (1.0, 9.1), p = 0.043; induced labor: 3.0 (1.6, 5.5), p &lt; 0.001; and newborn birthweight (per each 100 g): 1.1 (1.0, 1.2), p = 0.004. In conclusion, the incidence of birth trauma in our setting was 22.8‰ of singletons. The most frequent injuries were cephalohematoma, peripheral facial paralysis, and clavicle fracture. There was an independent association between birth trauma and breech presentation, dystocia, forceps instrumentation, labor induction, and infant birthweight.

The amplitude of low-frequency fluctuations is correlated with birth trauma in patients with postpartum post-traumatic stress disorder

Postpartum post-traumatic stress disorder (PP-PTSD) is a severe mental disorder worldwide. In recent years, some studies have reported that PP-PTSD stems from birth trauma. The present study was dedicated in finding ways to predict the occurrence of emergency caesarean section (ECS), trying to analyze the methods to reduce incidence of PP-PTSD on this basis, further exploring the neuroimaging changes in PP-PTSD. A total of 245 primiparas with intention of vaginal delivery were recruited. The internal tocodynamometry measurement was performed during labor for all mothers, and respectively taken at 3–5 cm, 5–8 cm, and 8–10 cm of cervical dilation. The receiver operating characteristic (ROC) curve and Binary logistic regression analyses were also performed to identify fetal head descending thrust that might help in the prediction of ECS. Resting-state magnetic resonance imaging (MRI) was performed on 26 patients diagnosed with PP-PTSD of 245 mothers, the amplitude of low-frequency fluctuations (ALFF) technology was used to observe the spontaneous neural activity of all PP-PTSD patients and correlation analyses were performed. We found that the natural delivery rate of mothers with fetal head descending thrust <16.29 N (5–8 cm), 26.36 N (8–10 cm) were respectively lower than other mothers with fetal head descending thrust ≥16.29 N (5–8 cm), 26.36 N (8–10 cm) (P < 0.05). The ROC curve analysis showed that the area under the receiver operating characteristic curve (AUC) value of thrust (5–8 cm) was 0.896 (95% CI: 0.854–0.938, p < 0.001), AUC of thrust(8–10 cm) was 0.786 (95% CI: 0.714–0.858, p < 0.001), which showed strong potential for predicting ECS. In addition, the Binary logistic regression analysis showed thrust (5-8 cm) and thrust (8–10 cm) were independent correlates of ECS. The resting-state functional magnetic resonance imaging (rs-fMRI) results indicated that PP-PTSD group showed decreased ALFF in the bilateral insula cortex (IC), right anterior cingulate cortex (ACC), and left midcingulate cortex (MCC) compared with healthy postpartum women (HPW) (false discovery rate (FDR) correction q-value < 0.05). The ALFF value of the right ACC was positively correlated with the Perinatal Post-traumatic stress disorder Questionnaire (PPQ) score (r = 0.4046 p = 0.0403) and Posttraumatic Stress Disorder Checklist–Civilian Version (PCL–C) score (r = 0.3909 p = 0.0483). The internal tocodynamometry measurement can serve as a predictive tool for ECS, on this basis, the implementation of effective emotional support may help to reduce the incidence of PP-PTSD. Besides, this study has verified the presence of altered ALFF in the brain regions of PP-PTSD patients, mainly involving the bilateral IC, right ACC, and left MCC, that might be associated with emotion, cognition, and memory disorders functions in PP-PTSD patients.

Психологическая и фармакологическая помощь при послеродовой депрессии и послеродовом ПТСР в России: социоэкономические факторы

&lt;p&gt;&lt;strong&gt;Aim.&lt;/strong&gt; This study examined socio-economic factors and their relationship to access to professional care (pharmaceutical and psychological), as well as the relationship between the presence/absence of psychological and pharmacological care and the severity of symptoms of postpartum depression (PD) and PTSD after childbirth. &lt;strong&gt;Materials and methods&lt;/strong&gt;. The study involved 2,574 women aged 18&amp;ndash;43 years (M=31,03, SD=4,29) who gave birth to one or more children during the 12 months preceding the survey. Depression was assessed using the Edinburgh Postpartum Depression Scale [11] in Yakupova's adaptation [35]. Postpartum PTSD was assessed using the City Birth Trauma Scale [8] in Yakupova's adaptation [2]. In addition, socio-demographic data were collected (education level, income level, family status, place of residence), information about previously diagnosed and current mental health problems, and the types of assistance received. &lt;strong&gt;Results and conclusions.&lt;/strong&gt; The data obtained show that only a small percentage of women with severe symptoms of postpartum depression and postpartum PTSD seek psychological or pharmacological help (11% and 9.3%, respectively). Socio-economic factors such as higher education, higher economic status, residence in Moscow and St. Petersburg, as well as the presence of a spouse are associated with a rarer manifestation of PD and PTSD after childbirth and more frequent seeking psychological and pharmacological help. In Russia, there is an urgent issue of informing about postpartum mood disorders, their diagnosis, as well as the issue of access to professional help.&lt;/p&gt;

"Who cares about us?" Results of a cross-sectional study on the psychosocial health of obstetricians and midwives after traumatic birth experiences

Traumatic births not only cause emotional stress for expectant parents but can also affect the psychosocial health of midwives and obstetricians due to their professional demands. To evaluate the impact of traumatic birth experiences on the psychosocial health of obstetric healthcare professionals. A cross-sectional study using validated measurement tools (Impact of Event Scale Revised IES-R, Copenhagen Burnout Inventory CBI) and assessing post-traumatic growth (PGI-SF) through an online survey of midwives and obstetricians in German-speaking areas. The study included 700 participants with peripartum and/or personal traumas. Of the 528 participants who completed the IES-R, 33 (6.3%) with post-traumatic stress disorder (PTSD) received less support from colleagues (p = 0.007) and were more likely to experience workplace consequences (p < 0.001) than participants without PTSD. A moderate to high level of burnout was found in 66.2% of the 542 participants who completed the CBI. Personal growth through experiencing trauma was reported by 75.9% of the 528 participants who completed the PGI-SF. The psychosocial health of midwives and obstetricians is at risk due to traumatic birth experiences. Screening tests and the provision of collegial and professional debriefings to strengthen resilience are essential preventive interventions.

Mother-infant attachment from the perspective of young mothers: Does the data support a maternal instinct?

Some conceptualizations of attachment imply an instinctual behavior that occurs naturally. Mothers who endorse this view are at greater risk for psychological stress, depression, and harsh parenting styles if they do not feel an immediate bond with their infant postpartum. The purpose of this study is to explore actual experiences of attachment from the perspective of young mothers (N = 75, Mage = 19.45 years) and based on these findings the extent to which there is empirical support for a maternal instinct. Mothers were interviewed at home three times (2 weeks, four months, and seven months postpartum), and interviews were thematically analyzed using an open coding method. Three broad themes and six sub-themes emerged: 1) experiences with the immediacy of attachment at birth are diverse (traumatic birth experience, sense of a maternal identity), 2) contextual factors on the bonding experience (physical touch-based caretaking, parenting stress and depression), and 3) time spent parenting influences attachment (reciprocity, parental confidence/knowledge). In conclusion, we could not find empirical evidence to support an innate maternal instinct. Despite diverse experiences with felt attachment at birth, all mothers perceived that the mother-infant connection was influenced by contextual factors after birth and was strengthened over time with more care-taking experience. This suggests that mothers likely developed a “maternal instinct” through repetitive interaction with their infant as the primary caretaker rather than a genetic predisposition to be superior nurturing parents.

Narrative Exposure Therapy for a Traumatic Birth Experience With the Non-Birthing Parent: A Single Case Study

Traumatic birth experiences are common and can be extremely damaging to an individual’s health and well-being. Perinatal posttraumatic stress disorder (PTSD) is a common complication following a traumatic birth experience. While emerging literature has focused on interventions to reduce maternal PTSD, there is virtually no clinical information on interventions targeting perinatal PTSD for the nonbirthing person following a traumatic birth experience. This case series is presented to demonstrate how Narrative Exposure Therapy (NET) can be used to address the unique needs of a non-birthing person following a traumatic birth experience.A patient sought treatment following witnessing his wife’s unexpected traumatic birth experience and subsequent placement of his daughter in the neonatal intensive care unit. Treatment was conducted at a specialty PTSD clinic through an urban academic medical center in the Midwestern United States. An advanced clinical psychology student conducted 10 sessions of NET under the supervision of a licensed clinical psychologist. NET treatment included psychoeducation, laying the lifeline (i.e., outlining significant events related to the birth experience), 6 imaginal exposures, a final reading of exposure transcripts, and a termination session. Patient-reported outcome measures were collected at baseline, week 8, and following treatment termination. The patient demonstrated a substantial reduction in PTSD, depressive, and dissociation symptoms and reported subjective improvement with NET. At termination, the patient no longer met criteria for PTSD. This case study provides guidance for a valuable treatment option for a nonbirthing partner’s PTSD following childbirth and highlights future directions for parental PTSD treatment.

Relationship Between Early-Pregnancy Glycemia and Adverse Outcomes: Findings From the TOBOGM Study.

We evaluated associations between early-pregnancy oral glucose tolerance test (OGTT) glucose and complications in the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) cohort to inform prognostic OGTT thresholds. Individuals with risk factors for hyperglycemia were recruited for an international, multicenter, randomized controlled gestational diabetes mellitus (GDM) (World Health Organization 2013 criteria) treatment trial. A 2-h 75-g OGTT was performed at <20 weeks' gestation. Individuals with early treated hyperglycemia in pregnancy were excluded from the primary analysis. Early OGTT glucose concentrations were analyzed continuously and in glycemic categories (normal, low band, and high band). Overall, 3,645 individuals had an OGTT at (mean ± SD) 15.6 ± 2.5 weeks. For each 1-SD increase in fasting, 1-h, and 2-h glucose values, there were continuous positive associations with late GDM: adjusted odds ratio (aOR) 2.04 (95% CI 1.82-2.27), 3.05 (2.72-3.43), and 2.21 (1.99-2.45), respectively. There were continuous positive associations between 1-h and 2-h glucose and the perinatal composite (birth <37 + 0 weeks, birth trauma, birth weight ≥4,500 g, respiratory distress, phototherapy requirement, stillbirth/neonatal death, and shoulder dystocia), with aOR 1.15 (95% CI 1.04-1.26) and 1.14 (1.04-1.25), respectively, and with large-for-gestational-age offspring, with aOR 1.18 (1.06-1.31) and 1.26 (1.01-1.25), respectively. Significant associations were also observed between 1-h glucose and cesarean section and between fasting and 2-h glucose and neonatal hypoglycemia. In categorical analysis, only the high-band 1-h glucose (≥10.6 mmol/L [191 mg/dL]) predicted the perinatal composite. There is a continuous positive association between early-pregnancy OGTT glucose and complications. In individuals with hyperglycemia risk factors, only the high-glycemic-band 1-h glucose corresponded to increased risk of major perinatal complications.

The Red Reflex Test and Leukocoria in Childhood.

The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.

The Impact of Prenatal or Perinatal Education by Primary Healthcare Providers on Traumatic Birth Experiences

The Impact of Prenatal or Perinatal Education by Primary Healthcare Providers on Traumatic Birth Experiences

Measuring childbirth-related posttraumatic stress disorder: Psychometric properties of the Italian version of the City Birth Trauma Scale (City BiTS).

The City Birth Trauma Scale (City BiTS) assesses postpartum posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Although it has been validated worldwide, predictive validity has not been previously examined. Moreover, no Italian version of the scale exists. This study aimed to test the bifactor latent structure and alternative models, internal consistency, test-retest reliability, convergent validity, divergent validity, and predictive validity of the City BiTS. Women (N = 629) who had given birth within the past 3 months completed an online survey including sociodemographic and obstetric characteristics, the City BiTS, the Impact of Event Scale-Revised, and the Edinburgh Postnatal Depression Scale. After 3 months, women completed the City BiTS again and reported their intention to breastfeed during the 1-year postpartum. Exploratory factor analysis confirmed the two-factorial structure. In confirmatory factor analysis, the two-factorial solution showed the best model fit. Internal consistency was good to excellent for the subscales and the total scale. Correlation analyses showed strong convergent validity with the Impact of Event Scale-Revised, high divergent validity with the Edinburgh Postnatal Depression Scale, high test-retest reliability, and good predictive validity with the intention to exclusively breastfeed. Moreover, the Birth-Related Symptoms subscale distinguished between different types of delivery. The City BiTS-Italian is the first measure evaluating and diagnosing childbirth-related PTSD symptoms based on Diagnostic and Statistical Manual of Mental Disorders (5th ed.) in Italy. The factorial structure and validity reported in other cultural contexts were confirmed; moreover, findings add evidence to the scale's temporal stability and predictive validity. Besides contributing to clinical purposes, the City BiTS-Italian will facilitate international comparability regarding the prevalence of PTSD following childbirth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in being able to donate human milk impacts upon maternal wellbeing: Lessons for scaling up milk bank service provision.

Receiving donor human milk for a baby can have a protective effect upon parental wellbeing. A growing body of research also finds that being able to donate milk to a milk bank, particularly after infant loss, can also boost maternal wellbeing through feelings of altruism and purpose. However, most studies are qualitative, with small sample sizes outside the United Kingdom, and often do not include the experiences of those who have been unable to donate. Our aim was therefore to examine the impact of being able to donate milk, as well as the impact of not being able to do so, using a survey containing open and closed questions in a large UK sample. Overall, 1149 women completed the survey, 417 (36.3%) who donated their milk and 732 (63.7%) who did not. Most women who donated found it had a positive impact upon their wellbeing, feeling proud, useful and that they had achieved something important. Conversely, those unable to donate often felt rejected, frustrated, and excluded, especially if they received no response or felt that restrictions were unfair. Thematic analysis found that being able to donate could help women heal from experiences such as birth trauma, difficult breastfeeding experiences, neonatal unit stays, and infant loss; however, being unable to donate could exacerbate negative emotions arising from similar experiences. A minority of women who donated experienced raised anxiety over following guidelines. These findings further extend the impacts of milk banking services beyond infant health and development and support expanded service delivery.

Machine learning opportunities to predict obstetric haemorrhages

Obstetric hemorrhages (OH) are the main preventable cause of morbidity, mortality and cases of "near miss" among obstetric complications worldwide. Early preventive measures based on the OH prediction allow to profoundly reduce the rate of female mortality and morbidity as well as prevent the economic costs of patient intensive care, blood transfusion, surgical treatment and long-term hospitalization. Postpartum haemorrhage (PPH) is the most frequent obstetric haemorrhage determined by one of the four causes: a uterine tonus disorder, maternal birth trauma, retention of placenta parts and blood-clotting disorder. There is still a need for the continued search for an accurate and reliable prediction method despite multiple attempts to develop an effective system for predicting OH. The solution to this may be reasonably considered an innovative method such as artificial intelligence (AI) including computer technologies capable of obtaining conclusions similar to human thinking. One of the particular AI variants is presented by machine learning (ML), which develops accurate predictive models using computer analysis. Machine learning is based on computer algorithms, the most common among them in medicine are the decision tree (DT), naive Bayes classifier (NBC), random forest (RF), support vector machine (SVM), artificial neural network (ANNs), deep neural network (DNN) or deep learning (DL) and convolutional neural network (CNN). Here, we review the main stages of ML, the principles of algorithms action, and the prospects for using AI to predict OH in real-life clinical practice.

Factor Affecting the Perception of Traumatic Childbirth: A Cross-Sectional Study in Pregnant Women Women

Objective: In order to experience all the processes of pregnancy and childbirth in a healthy way, it is necessary that the perception of traumatic birth is not high and the affecting factors should be known. This study was conducted to evaluate the factors affecting pregnant women's perception of traumatic childbirth. Methods: A cross-sectional and descriptive study consisted with 305 pregnant women, who was in the last trimester of their pregnancy. Data collected face-to-face using the Perception of Traumatic Childbirth Scale and the socio-demographic, obstetric and birth-related information form. Results: All of the pregnant women included in the study were married and their mean age was 28.04±5.20 years. The mean score of the pregnant women from the scale was 56.46±1.56 (Min-Max=0-120). Statistical significance was found between the score obtained from the scale and income status, the total number of miscarriages/mortal deliveries, mode of termination of the last delivery, fear experienced at the last delivery and anxiety experienced at the last delivery. Conclusion: A thorough understanding of the factors that influence and/or increase the perception of traumatic childbirth could contribute to the development of birth services as well as the protection and promotion of women's and pregnant's mental well-being.

The Maternal Psychophysical Knot

ABSTRACT The idea of birth trauma places a psychophysical knot at the center of the constitution of the psyche tied to maternal space. What does it mean that the maternal is seen as a site of trauma and regressive desire? How do women experience being this place? While Freud’s neglect of the importance of the mother and hyper-emphasis on the father has been visited and re-visited, from the angle of birth trauma, an idea he fought against fearsomely, we begin to witness something important concerning his efforts to move away from this battleground. Not to erase the mother, but to leave something Real there intact. Revisiting three wild speculations on the psychoanalytic meaning of birth, I ask about this maternal knot.

A Case Study Applying Cognitive Processing Therapy to Childbirth-Related PTSD: Treatment Considerations for the Postpartum Period

In sharp contrast to societal narratives framing the birth of a new baby as a time of unequivocal joy, childbirth-related trauma is relatively common and can result in postpartum PTSD. Research indicates that postpartum PTSD can have serious psychosocial implications during the perinatal period, a known critical developmental window shaping child and maternal heath across the lifespan. However, empirical research on the effectiveness of specific treatment approaches for childbirth-related trauma remains limited. Given the extensive effects and prevalence of postpartum PTSD, determining effective treatment options is a high priority. Cognitive Processing Therapy (CPT) is a gold-standard evidence-based psychotherapy for PTSD that has not been evaluated in the context of postpartum PTSD, and may be particularly well-suited for treating birth trauma. In the current case study, we describe the assessment and treatment of childbirth-related PTSD using CPT. By the end of the 14-session therapy course, the patient experienced a reduction in symptoms (City Birth Trauma Scale score dropped from 38 to 14), associated distress, and functional impairment. This case study suggests that CPT is an effective treatment for postpartum PTSD. We conclude with considerations to guide future research and treatment efforts.

Retrospective Observational Study of the Frequency and Interrelationships Among Neonatal Near Miss Criteria

ObjectiveTo evaluate the frequency and interrelationships among neonatal near miss (NNM) criteria and the anticipated workload for audits in high-income countries. DesignObservational retrospective descriptive study. SettingTertiary maternal and neonatal units at Mater Mothers’ Hospital, Brisbane, Queensland, Australia. ParticipantsCases of stillbirths (n = 483), neonatal deaths (n = 203), and live births (n = 66,353) from January 2016 to July 2022 (N = 67,039). MethodsWe identified eight prespecified NNM criteria nominated by perinatal experts. Primary outcomes were NNM frequency, their interrelationships, and related workload. We used descriptive statistics and analysis of variance and considered p < .05 significant. ResultsWe found 2,243 unique NNM cases (33.7/1,000 live births). The NNM ratio per 1,000 live births according to each of the eight criteria were: unplanned resuscitation at birth (25.09/1,000 live births), birth asphyxia needing surveillance for hypoxic ischemic encephalopathy (8.46/1,000 live births), metabolic acidosis at birth (8.04/1,000 live births), advanced resuscitation at birth (3.68/1,000 live births), seizures and/or stroke (0.96/1,000 live births), severe intraventricular hemorrhage and/or cerebellar hemorrhage (0.95/1,000 live births), moderate to severe hypoxic ischemic encephalopathy (0.9/1,000 live births), and severe birth trauma (0.44/1,000 live births). Almost one third of NNM cases met more than one criterion. Anticipated workload for monthly NNM audits varied from 0.04 to 2.8 cases per 1,000 live births. ConclusionDifferent sets of NNM criteria considerably alter the frequency of NNMs and the anticipated workload for NNM audits. Their interrelationships are likely attributable to the fact that some of the criteria are risk factors for or are part of the causal pathway for other NNM criteria. These findings can assist with the determination of a pragmatic NNM definition considering the feasibility of NNM audits in high-income countries.