Subjective Birth Experience Research Articles

Childbirth-related posttraumatic stress symptoms – examining associations with hair endocannabinoid concentrations during pregnancy and lifetime trauma

Evidence has linked alterations of the endocannabinoid system with trauma exposure and posttraumatic stress disorder (PTSD). Childbirth-related PTSD symptoms (CB-PTSS) affect about every eighth woman and can negatively influence the entire family. While aetiological models of CB-PTSD include psychological risk factors such as maternal trauma history and negative subjective birth experience (SBE), they lack biological risk indicators. We investigated whether lifetime trauma and CB-PTSS were associated with long-term endocannabinoid concentrations during pregnancy. Further, we tested endocannabinoids as mediators between lifetime trauma and CB-PTSS and whether SBE moderated such mediational paths. Within the prospective cohort study DREAMHAIR, 263 expectant mothers completed trauma assessments and provided hair samples for quantification of long-term endocannabinoid levels (anandamide [AEA], 2-arachidonoylglycerol [1-AG/2-AG], and N-acyl-ethanolamides [NAE]) prior to their anticipated birth date. Two months postpartum, CB-PTSS and SBE were measured. Regression models controlling for relevant confounders showed no association between lifetime trauma and hair endocannabinoids during pregnancy, yet higher number of lifetime trauma events and lower hair AEA were significantly associated with CB-PTSS, with the latter finding not remaining significant when Bonferroni corrections due to multiple testing were applied. While hair AEA did not mediate the association between lifetime trauma and CB-PTSS, the effect of lower hair AEA on CB-PTSS was stronger upon negative SBE. Results suggest greater lifetime trauma and reduced maternal hair AEA during pregnancy may be associated with increased risk for CB-PTSS, particularly upon negative SBE. Findings confirm lifetime trauma as a CB-PTSS risk factor and add important preliminary insights on the role of endocannabinoid ligand alterations and SBE in CB-PTSS pathology.

Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids

BackgroundHaving a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms. MethodsMeasures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAMHAIR. ResultsA negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events. LimitationsAnalyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution. ConclusionsOur results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.

Does a mother's childbirth experience influence her perceptions of her baby's behaviour? A qualitative interview study.

Childbirth has become increasingly medicalised, which may impact on the mother's birth experience and her newborn infant's physiology and behaviour. Although associations have been found between a mother's subjective birth experience and her baby's temperament, there is limited qualitative evidence around how and why this may occur. This qualitative study aimed to explore mothers' childbirth and postnatal experiences, perceptions of their baby's early behavioural style, and whether they saw these as related. A qualitative semi-structured interview schedule collected rich in-depth data. Twenty-two healthy mothers over 18 years of age and with healthy infants aged 0-12 months born at term, were recruited from Southwest regions of England and Wales. Thematic analysis was performed on the data. Mothers experienced childbirth as a momentous physical and psychological process. However, they did not necessarily perceive the birth as affecting their baby's early behaviour or temperament. While some mothers drew a direct relationship, such as linking a straightforward birth to a calm infant, others did not make an explicit connection, especially those who experienced a challenging birth and postnatal period. Nevertheless, mothers who had a difficult or medicalised birth sometimes reported unsettled infant behaviour. It is possible that mothers who feel anxious or depressed after a challenging birth, or those without a good support network, may simply perceive their infant as more unsettled. Equally, mothers who have been well-supported and experienced an easier birth could be more likely to perceive their baby as easier to care for. Childbirth is a physical and psychological event that may affect mother-infant wellbeing and influence maternal perceptions of early infant temperament. The present findings add to prior evidence, reinforcing the importance of providing good physical and emotional support during and after childbirth to encourage positive mother-infant outcomes.

Postnatal traumatic symptoms and shame: A cross-sectional study examining the role of birth, breastfeeding, psychological flexibility and self-compassion

ObjectiveThis study aimed to examine factors associated with maternal post-traumatic stress (PTS) and shame, including adverse childbirth and breastfeeding events, subjective childbirth and breastfeeding experiences, psychological flexibility, and self-compassion. MethodsA convenience sample of 405 community-recruited mothers of infants (<2 years) from Australia and New Zealand completed an online cross-sectional survey. A series of hierarchical multiple regressions tested potential predictors of PTS and shame. ResultsBirth experiences (low autonomy/support and high fear) predicted PTS symptoms. Negative subjective birth experiences (low autonomy/support), negative breastfeeding experiences, younger maternal age and financial stress predicted shame. Addition of psychological flexibility and self-compassion improved both regression models. Psychological flexibility predicted both PTS and shame, and moderated relationships between both fear and low autonomy/support and PTS. Self-compassion predicted shame and moderated the relationship between low autonomy/support and shame. ConclusionSubjective experiences of birth and breastfeeding are important. Psychological flexibility buffers the impact of a difficult birth experience on PTS, and self-compassion on shame.

Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis

Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.

Effects of the glucocorticoid receptor gene (NR3C1) and subjective birth experience on the risk of postpartum depression and maternal bonding

Postpartum depression (PPD) is a serious health care issue that affects a substantial share of women giving birth. PPD is considered a severe stress response that is likely associated with impaired HPA-axis activity. However, genetic findings regarding HPA-axis effects on PPD are scarce and inconsistent. Inconsistencies may be due to the neglect of environmental (stressful) events such as perinatal trauma or averse subjective birth experiences associated with PPD. Therefore, the present study aims to investigate whether the NR3C1 gene and subjective birth experience interact on PPD and postpartum bonding to the child. N = 277 mothers provided gene samples and self-report data on PPD and postpartum bonding. We genotyped 11 polymorphisms on the NR3C1 gene (including the prominent BCL1) and conducted haplotype analyses. A negative subjective birth experience was associated with both PPD and maternal postpartum bonding. Our results further show a significant main effect of NR3C1 haplotype (F1, 275 = 6.42, p = .012, η2 =.023) and a haplotype x birth experience interaction (F1, 274 = 4.57, p = .033, η2 =.016) on PPD. We did not find any NR3C1 haplotype effects on bonding. Our results support the assumption that the glucocorticoid receptor coding NR3C1 gene is involved in the development of PPD. These gene effects become particularly important in presence of a negative environmental event such as the subjective birth experience. This finding allows more targeted preventions in terms of being particularly sensitive to potentially harming environmental influences that may present even stronger risk factors for genetically vulnerable women.

Hair glucocorticoids during pregnancy in the context of trauma exposure and their predictive value for the development of childbirth-related posttraumatic stress disorder symptoms

BackgroundChildbirth-related posttraumatic stress disorder (CB-PTSD) is gaining attention as a mental disorder with negative sequela for mothers and their offspring. Maternal trauma history is a well-known vulnerability factor for CB-PTSD symptoms (CB-PTSS). Furthermore, alterations of the hypothalamus-pituitary-adrenal axis have been linked to both trauma exposure and PTSD development. Hence, we investigated whether trauma history was associated with long-term glucocorticoid (GC) levels during pregnancy and their predictive role for CB-PTSS. Further, we examined whether GCs act as a mediator in the relationship between trauma history and CB-PTSS and whether this was moderated by the subjective birth experience. Methods212 women participating in the prospective cohort study DREAMHAIR provided hair samples for quantification of long-term integrated cortisol and cortisone levels prior to their anticipated birth date accompanied by measures of trauma history. CB-PTSS and subjective birth experience were assessed two months postpartum. FindingsTrauma history predicted elevated hair cortisol and hair cortisone during the third trimester of pregnancy, however associations did not remain significant when Bonferroni correction due to multiple testing was applied. Trauma history also predicted higher CB-PTSS. Hair GC levels during pregnancy neither predicted CB-PTSS two months after birth nor mediated the relationship between trauma history and CB-PTSS. The subjective birth experience moderated the relationship of hair cortisol and cortisone with CB-PTSS. ConclusionOur data suggest that a history of trauma contributes to a higher risk to develop CB-PTSS and elevated long-term GC levels during the third pregnancy trimester. Further, the predictive role of hair cortisol and cortisone levels for CB-PTSS may depend on subjective birth experience. This highlights the need to consider the latter in future investigations when examining the role of stress-related biomarkers in more severely affected samples.

The role of self-esteem on fear of childbirth and birth experience

ABSTRACT Objective Fear of childbirth (FOC), also referred to as tokophobia, can have detrimental consequences for a woman’s well-being during pregnancy and for their subjective birth experience. However, it is unknown what role self-esteem plays in the relationship between FOC and the experience of childbirth. This study investigates the relation between FOC and the birth experience, and the role of self-esteem in that relation. Methods We studied 125 nulliparous and parous Finnish women from their third trimester of pregnancy to 4–8 weeks postpartum. Path analysis with MLR estimation was conducted using MPlus to predict the childbirth experience according to prior self-esteem and fear of childbirth as well as their interaction. Also, age and parity were included as predictors of the birth experience, as well as their interactions with self-esteem. FOC was measured with the Wijma Delivery Expectancy/Experience Questionnaire – version A (W-DEQ-A), self-esteem with the Rosenberg Self-Esteem Scale (RSES), and birthing experience with the Delivery Satisfaction Scale (DSS). Results We found that self-esteem moderated the association between fear of childbirth and the subjective birth experience: the lower the self-esteem, the stronger the negative connection between FOC and the birth experience; and, reversely, the higher the self-esteem, the weaker the connection between FOC and the birth experience. Conclusions The results highlight intra-group differences between fearful women and contribute to theory formation. They can be used in clinical practice and when planning interventions to reduce negative birth experiences.

Epidural analgesia associations with depression, PTSD, and bonding at 2 months postpartum

The research aim was to study the possible effect of epidural analgesia, as well as other possible demographic/obstetric variables and subjective birth experience on postpartum depression, PTSD, and impaired bonding. This was a longitudinal study of 254 women who gave birth at the maternity wards of a large tertiary health center and responded to questionnaires at T1 (Childbirth Experience Questionnaire and level of fatigue question; in person, 1–4 days postpartum) and at T2 (Postnatal Depression Scale, Postpartum Bonding Questionnaire, and the City Birth Trauma Scale; online-two months postpartum). Obstetric and demographic data were taken from medical files. Having a previous psychiatric diagnosis and higher levels of fatigue significantly predicted worse outcomes in all measures (level of fatigue was not associated with the City Birth Trauma birth-related symptoms factor). Having higher education, being primiparous, worse birth experience, and longer second stage of birth predicted worse outcomes in some measures. Although epidural administration had no effect on any of the outcome variables, special attention should be devoted to women who had long second-stage births and/or suffering from postpartum fatigue to prevent postpartum psychopathology. In addition, demographic variables, such as primiparity, education, and prior psychopathology diagnosis should be considered to treat women and prevent postpartum psychopathology.

The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience.

The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.

Subjective Birth Experience Predicts Mother-Infant Bonding Difficulties in Women With Mental Disorders.

BackgroundThe subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders.MethodsThis study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses.ResultsAbout half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96*** (95% CI 0.94–0.98) vs. OR = 0.96** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled.ConclusionsA negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.

Birth Experiences, Breastfeeding, and the Mother-Child Relationship: Evidence from a Large Sample of Mothers.

BackgroundIt is a priority for public health professionals to improve global breastfeeding rates, which have remained low in Western countries for more than a decade. Few researchers have addressed how maternal perceptions of birth experiences affect infant feeding methods. Furthermore, mixed results have been shown in research regarding breastfeeding and mother-child bonding, and many studies are limited by small sample sizes, representing a need for further investigation.PurposeWe aimed to examine the relationship between subjective birth experiences and breastfeeding outcomes, and explored whether breastfeeding affected mother-infant bonding.Methods3,080 mothers up to three years postpartum completed a cross – sectional survey.ResultsMothers who had more positive birth experiences were more likely to report breastfeeding their babies. Moreover, mothers who perceived their birth as more positive were more likely to breastfeed their child for a longer period (over 9 months) than those who had more negative experiences. In line with recent research, breastfeeding behaviours were not associated with reported mother-infant bonding.ConclusionsMothers who reported better birth experiences were most likely to breastfeed, and breastfeed for longer. We find no evidence to suggest that feeding methods are associated with bonding outcomes.

Birth Experience Mediates the Association Between Fear of Childbirth and Mother-Child-Bonding Up to 14 Months Postpartum: Findings From the Prospective Cohort Study DREAM.

ObjectiveTo explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience.DesignWomen from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth.ParticipantsA community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study.ResultsIn a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders.Key ConclusionsThis study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience.Implications for PracticeFindings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.

Personality impacts fear of childbirth and subjective birth experiences: A prospective-longitudinal study.

BackgroundPrevious research suggests that less emotionally stable, less conscientious, less extraverted, and less agreeable women tend to suffer from higher fear of childbirth and experience their delivery as worse. Moreover, there is evidence that birth characteristics and unexpected incidents during delivery may impact women’s birth experiences. However, it remains unknown whether the role of personality in subjective birth experiences varies between women with different birth characteristics.MethodsWe used data from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a regional-epidemiological study among pregnant women, who were prospectively followed up in multiple waves across the peripartum period. During pregnancy, personality was assessed with the short version of the Big Five Inventory. The Wijma Delivery Expectancy/ Experience Questionnaire was used to measure fear of childbirth (version A) during pregnancy and subjective birth experiences (version B) within the first 10 days after delivery.ResultsLinear regressions revealed that lower levels of emotional stability, agreeableness, and extraversion predicted higher fear of childbirth during pregnancy. Moreover, personality affected subjective birth experiences especially in women with specific birth characteristics: Lower emotional stability predicted worse subjective birth experiences in women with (vs. without) a preterm delivery, and higher conscientiousness predicted worse subjective birth experiences in women with an emergency cesarean section (vs. spontaneous delivery). Subjective birth experiences were also worse in less emotionally stable and less open women with (general) anesthesia (vs. no anesthesia) during delivery. Finally, higher emotional stability predicted a subjective birth experience that was worse than expected, particularly in multiparous women and women without anesthesia during delivery.ConclusionsThese findings suggest that less emotionally stable, less conscientious, and less open women tend to experience their delivery as worse particularly in case of unexpected incidents (i.e., preterm delivery, emergency cesarean section, and necessity of anesthetics) and might thus profit from early targeted interventions.

Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study

BackgroundCertain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. MethodsThis prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. ResultsThe relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LimitationsThis study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. ConclusionPrenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.

Birth, breastfeeding, psychological flexibility and self-compassion as predictors of mother-infant emotional availability in a cross-sectional study.

This study aimed to examine relationships between objective childbirth and breastfeeding events, subjective childbirth and breastfeeding experiences, and emotional availability in the mother-infant relationship. Further, it aimed to test two psychological variables, psychological flexibility and self-compassion, as predictors of emotional availability. A convenience sample of 396 mothers of infants (<2 years) from Australia and New Zealand completed an online cross-sectional survey. Objective breastfeeding events (difficulties), negative subjective birth/breastfeeding experiences, poorer psychological flexibility, and lower self-compassion correlated with poorer emotional availability. After controlling for objective birth and breastfeeding variables using multiple linear regressions, better subjective breastfeeding experiences, psychological flexibility, and self-compassion predicted the mutual attunement aspect of emotional availability, whereas better subjective birth experiences and psychological flexibility predicted the affect quality aspect of emotional availability. Mothers' subjective experiences of birth and breastfeeding are important in understanding the early mother-infant relationship. Psychological flexibility and self-compassion are important predictors of emotional availability and may be useful targets for psychological intervention aimed at optimising early mother-infant relationships.

Differential predictors of birth-related posttraumatic stress disorder symptoms in mothers and fathers – A longitudinal cohort study

BackgroundEvidence on risk factors of birth-related posttraumatic stress disorder (PTSD) symptoms in mothers is increasing, whereas fathers are less examined. This study aims to determine differential predictors of PTSD symptoms in mothers and fathers. MethodsData derive from the DREAM study, including 1,146 mothers and 828 fathers. We assessed mental health, work, and sociodemographic factors during pregnancy, pregnancy- and birth-related factors, and birth-related PTSD symptoms using the Impact of Event Scale-Revised 8 weeks postpartum. Structural equation models were estimated to examine associations between predictors and latent factors of PTSD symptoms for mothers and fathers simultaneously. Scaled chi-square difference tests were used to investigate differences between both groups in predictors. ResultsClinically relevant birth-related PTSD symptoms were found in 2.3% of mothers and 0.7% of fathers. Depressive and anxiety symptoms, pregnancy complications, and poorer subjective birth experience predicted PTSD symptoms in both groups. Additionally, lower support during birth and an unplanned cesarean section predicted PTSD symptoms in mothers, whereas lower job satisfaction, higher job burden, being first-time father, lower education, and mothers’ lower support during birth were predictors for fathers. We found significant differences between groups regarding job burden during pregnancy, support during birth, and an unplanned cesarean section. LimitationsGeneralization of findings might be limited by self-selection bias and some systematic dropout. ConclusionsOur results suggest differential predictors of PTSD symptoms in mothers and fathers. For fathers, less examined factors such as work factors may be important. Identifying differential risk factors may lead to customized prevention and treatment offers.

Fertility intentions and the way they change following birth- a prospective longitudinal study

BackgroundWomen’s fertility intentions, their desired number of children and desired inter-pregnancy interval (IPI) are related to micro (personal) and macro (socio-cultural) level factors. We investigated factors that contribute to changes in women’s fertility intentions in Israel, a developed country with high birth rates.MethodsPregnant women (N = 1163), recruited from prenatal clinics and hospitals in two major metropolitan areas, completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (2 months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum.ResultsThe findings indicated that background characteristics were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was women’s degree of religiosity- the more religious they were, the more children they desired and the shorter their intended IPI. Women’s postpartum fertility intentions were mostly consistent with their prenatal reports. In regression models, women who were very-religious, more educated and had previously given birth were less likely to report a lower number of desired of children at postpartum, compared to their prenatal report. Women who reported greater birth satisfaction and gave birth for the first time were less likely to change desired IPI.ConclusionHaving a negative birth experience could adversely affect women’s fertility intentions. Yet, in a pronatalist and medicalized birth culture, social pressures may decrease the effects of birth experiences on fertility intentions.

Women's preferences for mode of second birth-A prospective study of two Israeli birth cohorts.

Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8weeks postpartum to understand their preferences for a second birth. Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.

Comparing birth experience and birth outcome of vaginal births between induced and spontaneous onset of labour: a prospective study.

In developed countries, around 25% of all births involve labour induction. Studies have indicated that labour induction negatively influences the birth experience as well as the birth process. However, the impact of labour induction when only considering vaginal deliveries has not been studied yet, which was the purpose of the present study. 186 women who gave birth vaginally took part in this prospective study. 95 women gave birth after spontaneous onset of labour (SL-group) and 91 women received a labour induction (LI-group). Eight to 72h after birth, the women filled in the revised version of the standardised Childbirth Experience Questionnaire, which examines the birth experience in four dimensions (Own Capacity, Perceived Safety, Participation and Professional Support). Medical details regarding birth and fetal outcomes were taken from the medical records. Birth outcomes (the number of epidural anaesthesia, the duration of birth, birth risks and childbirth injuries) as well as fetal outcomes (APGAR after 1 and 5min and arterial cord pH) did not differ between the groups. Regarding the subjective birth experience, the LI-group indicated significantly lower values for Perceived Safety and Participation compared to the SL-group, while there were no differences for the dimensions Own Capacity and Professional Support. Successful labour induction resulting in a vaginal birth did not negatively influence birth and fetal outcomes and only partly affected the women's birth experience. The negative impact of labour induction on the dimensions Perceived Safety and Participation should sensitize midwives in order to provide optimal support.