Postnatal Post-traumatic Stress Disorder Research Articles

Post-natal psychopathology and bonding with the infant among first-time mothers undergoing a caesarian section and vaginal delivery: Sense of coherence and social support as moderators

Objective: To investigate the protective role of sense of coherence (SOC) and perceived social support in the effect of emergency/elective caesarian section on post-natal psychological symptoms and impairment in mother–infant bonding.Design: Thirty-seven women delivering via an emergency C-section, 21 via elective C-section and 38 through a vaginal delivery were assessed six weeks post-partum (Time 1) as to their post-traumatic stress disorder (PTSD) and depressive symptoms, impairment in bonding and SOC and social support. Symptoms and bonding difficulties were assessed again six weeks later (Time 2). Main and interactive effects of mode of delivery and the protective factors were examined.Main Outcome Measures: Post-natal depressive and PTSD symptoms and mother–infant bonding.Results: An emergency C-section mode of delivery predicted an increase in PTSD symptoms in Time 2, but only among women with low levels of Time-1 social support. Time-1 SOC predicted a decrease in post-natal PTSD and depression.Conclusions: Social support might buffer against the potentially traumatic effect of an emergency C-section. SOC appears to constitute a powerful dimension of post-natal resilience.

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty-two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE-index) of parent–infant interactions. At 5 months postpartum, in-depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post-traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes.

The role of adult attachment style, birth intervention and support in posttraumatic stress after childbirth: A prospective study

BackgroundThere is converging evidence that between 1% and 3% of women develop posttraumatic stress disorder (PTSD) after childbirth. Various vulnerability and risk factors have been identified, including mode of birth and support during birth. However, little research has looked at the role of adult attachment style in how women respond to events during birth. This study prospectively examined the interaction between attachment style, mode of birth, and support in determining PTSD symptoms after birth. MethodA longitudinal study of women (n=57) from the last trimester of pregnancy to three months postpartum. Women completed questionnaire measures of attachment style in pregnancy and measures of PTSD, support during birth, and mode of birth at three months postpartum. ResultsAvoidant attachment style, operative birth (assisted vaginal or caesarean section) and poor support during birth were all significantly correlated with postnatal PTSD symptoms. Regression analyses showed that avoidant attachment style moderated the relationship between operative birth and PTSD symptoms, where women with avoidant attachment style who had operative deliveries were most at risk of PTSD symptoms. LimitationsThe study was limited to white European, cohabiting, primiparous women. Future research is needed to see if these findings are replicated in larger samples and different sociodemographic groups. ConclusionsThis study suggests avoidant attachment style may be a vulnerability factor for postpartum PTSD, particularly for women who have operative births. If replicated, clinical implications include the potential to screen for attachment style during pregnancy and tailor care during birth accordingly.

A review assessing the current treatment strategies for postnatal psychological morbidity with a focus on post-traumatic stress disorder

Objectiveto conduct a systematic review of randomised controlled trials investigating the efficacy of treatments used to manage postnatal psychological morbidity. Designa systematic review was conducted of studies in English published from 1995 to 2011. Studies were included in the review if they were randomised controlled trials and had extractable data on symptoms of psychological morbidity after an intervention designed to manage the disorders in postnatal women. Eight studies met the criteria and were included in the review. Findingsthe number of participants ranged from 58 to 1745. The interventions included group and individual counselling, debriefing and expressive writing. Authors of only three studies reported fewer symptoms of PTSD after the intervention. Those that appeared to be helpful were counselling and expressive writing. However most authors did not assess pre-existing PTSD. Key conclusions and implications for practicethe review revealed that there was no standardised scale used for diagnosis of post-traumatic stress disorder across the studies and no single efficacious treatment. A universal instrument for diagnosis of postnatal post-traumatic stress disorder is required. The intrapartum relationship with midwives appears to be an important contributor to prevention of PTSD and this requires further investigation.

Childbirth-related post-traumatic stress disorder and its treatment.

The phenomenon of childbirth-related post-traumatic stress disorder (PTSD) has become more widely recognised in recent years following changes in 1994 to the DSM criteria regarding how a traumatic event was defined. Emerging literature has predominately focused on prevalence rates and risk factors associated with this condition and on the use of debriefing techniques as an attempt to reduce or prevent the development of postnatal PTSD. However, little is known about the efficacy of psychological interventions that have been used to treat PTSD among postnatal women. This review summarises the limited evidence supporting the use of such treatments and discusses the significant challenges in developing and implementing psychological interventions for childbirth-related PTSD.

Cognitive behaviour therapy for postnatal post-traumatic stress disorder: case studies

Background. Approximately 1–2% of women suffer from postnatal post-traumatic stress disorder (PTSD) with wide ranging consequences for these women and their families . Appropriate treatment of women who have difficult or traumatic births is not yet established. Evidence in other populations shows that cognitive behavior therapy (CBT) is effective for PTSD and it is therefore the recommended treatment . However, a recent review of treatments for postnatal distress concluded that descriptions of postnatal counseling are largely generalized and non-specific, which makes them difficult to assess or replicate .Aims and method. The current paper therefore aims to describe the use of CBT interventions to treat postnatal distress, and to illustrate common themes or issues that occur in postnatal PTSD. This paper reports two case studies of women with postnatal PTSD and their treatment using CBT.Conclusions. In these cases, CBT was an effective treatment for postnatal PTSD. A number of implications are explored for the management of pregnancy and labor.

Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder.

Department of Psychology, University of Sussex, Brighton, United Kingdom Correspondence: Susan Ayers, PhD, C.Psychol., Psychology Department, University of Sussex, Brighton, BN1 9QH, UK. E-mail: [email protected]

Experiences of seeking help from health professionals in a sample of women who experienced domestic violence.

The present paper describes a qualitative study of women who suffered domestic violence. The aim was to explore their experiences of seeking help from health professionals and assess their psychological health. Purposive sampling was used to select a subsample from a larger sample of women who were screened for domestic violence as part of a study undertaken at Guy's and St Thomas' Hospitals in London, UK. In-depth, semi-structured interviews were conducted with the subsample of women during the postpartum period (up to 14 months). Interviews were conducted in women's homes and general practitioners' (GPs) surgeries. The sample consisted of 10 women who had experienced domestic violence in the past 12 months (including the current pregnancy), and six women who had experienced domestic violence in the past 12 months but not the current pregnancy. The main outcome measures included: women's experiences of seeking help from health professionals; and assessment for postnatal depression, post-traumatic stress disorder (PTSD) and psychological distress. Women scored highly on measures of postnatal depression and PTSD. With regard to seeking help, there was a tendency for women to regard GPs, and accident and emergency staff as less helpful compared with health visitors in responding to domestic violence. Lack of privacy, continuity of care and time constraints were dominant themes which emerged from women's contacts with health professionals. Very few women voluntarily disclosed domestic violence to a health professional and even fewer were asked directly about domestic violence by one. It is important for health professionals to enquire about domestic violence in a sensitive manner and provide a response that takes into accounts the complexity of women's needs. Domestic violence training is necessary to equip health professionals with the knowledge and skills they need to respond to domestic violence more effectively.

When delivery is torture — postnatal PTSD

The cases that worry us most are those where the mother has postnatal post traumatic stress disorder (PTSD). Often when she calls us, months or years after the birth, she does not know that is what she has, because it has not been diagnosed. Her GP and health visitor see her as a case of postnatal depression and she has been on anti-depressants, with or without tranquilizers, for a long time with little benefit.