Traumatic Childbirth Experience Research Articles

India’s Silent Struggle: A Scoping Review on Postpartum Depression in the Land of a Billion Mothers

Background: Postpartum emotional issues, including postpartum blues, postpartum psychosis, and postpartum depression (PPD), affect many mothers worldwide. The prevalence of postpartum blues ranges from 300 to 750 per 1,000 mothers, while postpartum psychosis has a prevalence of 0.89–2.6 cases per 1,000 births. PPD affects 100–150 new mothers per 1,000 births, and its prevalence can go above 25% globally. Depression in mothers can have long-lasting impacts on children and the next generation, affecting their growth, development, and relationships. However, the condition of PPD is frequently misdiagnosed, and women who suffer from it do not receive treatment. There is a lack of solid systematic evidence that looks at the overall burden of PPD and the risk factors that are associated with it in India. The awareness of PPD is critical in managing the symptoms and seeking professional support, and studies are needed to evaluate and assess the situation in India. Methodology: This study is a systematic literature review with a scoping review approach aimed at providing existing evidence on the awareness and prevalence of PPD in India. The search strategy for the electronic bibliographic search included a list of related terms and factors of awareness and prevalence of PPD. The search encompassed six prominent databases. The assessment tools used in studies from 2012 to 2023 study the factors using the Postpartum Depression Literacy Scale (PoDLiS) and the Edinburgh Postpartum Depression Scale, which measure the awareness and prevalence of PPD. Results: The study found a significantly low volume of studies conducted in India to determine the prevalence of PPD. The materials or studies accessible are hospital-based research with a minimal number of samples. The reported prevalence rate of postpartum depression (PPD) in India varies across different studies, ranging from 4% to 48.5%. Among mothers who gave birth either naturally or by cesarean section in a hospital setting, one study reported the lowest prevalence rate (4%). The prevalence of PPD among women in India is estimated to be 18% based on the average score across all research. A study that evaluated the moms in the community found that PPD was prevalent in new mothers at a rate of 21.5%. There are three studies, in particular, that focus on how aware people are of PPD. Two studies found that 54% of the family members of postpartum moms and women undergoing tertiary pediatric care are aware of PPD. Discussion: Many studies point to the lack of social support as a significant risk factor for mental health complications after delivery. History of depression, anxiety, adverse life events, partner abuse, low economic status, complications at childbirth, and a traumatic childbirth experience are some of the associated factors identified in the studies. Studies have also shown that women who undergo a cesarean section have a higher risk of developing PPD than those with a vaginal delivery.

The Relationship of the Traumatic Birth Perception of Women with Birth Memories and Recall.

A traumatic childbirth experience can have both short- and long-term health and well-being consequences for the woman and her family. If a woman experiences traumatic childbirth and retains negative memories for a long time, this may impact her future childbirth experience, mother-infant bonding and breastfeeding problems, and her relationship with other family members. The research was conducted to evaluate the relationship between women's traumatic birth perception and birth memory and recall. This descriptive study was conducted at Erzurum Research Hospital between August 16 and October 2021. Two hundred sixty women who met the inclusion criteria were included in the study sample. The personal information protocol, "Traumatic Childbirth Perception Scale," and "Birth Memories and Recall Questionnaire" were used to collect data. The participants' mean age was 30.13 ± 5.85, and 43.4% had their first birth. Of the participants, 45% had one living child, 72.9% had a planned pregnancy, and 62.8% had a normal birth. Whereas more than a third of women in the study perceived childbirth and childbirth processes as moderately traumatic, another third had a high and very high perception. The birth memories and recall mean scores of the mothers within the scope of the study were 81.09 ± 22.69. According to the study results, it was determined that women's birth memories and recall were negatively affected as their traumatic childbirth perceptions increased. It is possible to reduce traumatic childbirth perception with the continuous care and support provided by midwives during childbirth. Improving women's traumatic childbirth perception will also positively impact women's long-term memories of childbirth experience.

Posttraumatic growth in women after a childbirth experience: The influence of individual characteristics and intrusive and deliberate rumination.

This study targets women who had a self-defined traumatic childbirth experience to (a) explore the differences between sociodemographic-, obstetric-, and trauma-related variables in relation to the rumination style; (b) determine differences between intrusive and deliberate rumination in relation to posttraumatic growth (PTG) dimensions, and (c) test whether intrusive rumination is associated with deliberate rumination, which in turn is associated with PTG dimensions. A cross-sectional study design was employed using a web-based survey method for data collection. In total, 202 women who identified their childbirth experience as traumatic participated in this study. Intrusive rumination and deliberate rumination were positively associated with all dimensions of PTG in women following the traumatic childbirth event. Deliberate rumination fully explained the relationship between intrusive rumination and PTG aspects of relating to others, new opportunities, and personal strength, and partially explained the relationship between intrusive rumination and PTG aspects of spiritual changes and appreciation of life. The results suggest that deliberate rumination can contribute to explain the occurrence of PTG. These findings could help develop psychosocial interventions to maximize opportunities for deliberate rumination for women with traumatic childbirth experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Establishing the validity of a diagnostic questionnaire for childbirth-related posttraumatic stress disorder

Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing post-traumatic stress disorder (PTSD). Postpartum PTSD, or childbirth-related PTSD, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related PTSD are lacking. We examined the diagnostic validity of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (PCL-5) for detecting PTSD in women who have had a traumatic childbirth. The PCL-5 assesses the 20 DSM-5 PTSD symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy in regard to childbirth-related PTSD is unknown. The sample included 59 patients who reported a traumatic childbirth experience. A traumatic childbirth was determined in accordance with the DSM-5 PTSD Criterion A for exposure involving threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) were less than 1 year postpartum (for full sample: median = 4.67 months; mean = 1.5 years) recruited via Mass General Brigham's online platform or during postpartum unit hospitalization/ after discharge. Patients were instructed to complete the PCL-5 concerning PTSD symptoms related to childbirth. Other co-morbid conditions (i.e., depression and anxiety) were also assessed. They also underwent a clinician interview for PTSD using the gold-standard, Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). A second administration of the Checklist was performed in a sub-group (n = 43), altogether allowing for an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the PCL-5. Diagnostic accuracy of the PCL-5 in reference to the CAPS-5 was determined using the Receiver Operating Characteristic (ROC) area under curve (AUC); an optimal cutoff score was identified with Youden's J index. One-third of the sample (35.59%) met DSM-5 criteria for a PTSD diagnosis stemming from childbirth. The PCL-5 symptom severity score was strongly correlated with the CAPS-5 total score (ρ = 0.82, p < 0.001). The AUC was 0.93 (95% CI: 0.87-0.99), indicating excellent diagnostic performance of the PCL-5. A cutoff value of 28 maximized sensitivity (0.81) and specificity (0.90), and correctly diagnosed 86.44% of women. A higher value (32) identified individuals with more severe PTSD symptoms (specificity, 0.95), but with lower sensitivity (0.62). PCL-5 scores were stable over time (intraclass correlation coefficient, ICC = 0.73), indicating good test-retest reliability. PCL-5 scores were moderately correlated with depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale, EPDS, ρ = 0.58, p < 0.001) and Brief Symptom Inventory (BSI, anxiety sub-scale, ρ = 0.51, p < 0.001). This study demonstrates the validity of the PCL-5 as a screen for PTSD among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related PTSD on a large scale and help to identify women who might benefit from further diagnostics and services. Replication of findings in large postpartum samples is needed.

Exploring Caesarean Birth 6: Trauma Associated with Caesarean Birth

Emergency caesarean birth-related trauma accounts for 37.5% of Australia’s Birth trauma and is closely followed by forceps assisted vaginal birth at 33%. Birth trauma is a term that has only emerged in the past 20 years in response to the growing awareness of the many women who live with the ongoing negative physical and psychological impact of a traumatic childbirth experience.1 Birth trauma can result from different traumatic incidents, ranging from physical injury to the woman’s body and/or baby to psychological responses to certain birth events or the care received during childbirth.2

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

Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.

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

Women's birth experiences can range from positive and satisfying to negative and traumatizing. Midwives caring for women can also be exposed to these traumatic childbirth experiences. There is a paucity of research on the impact these experiences have on midwives and their practice. The PEO framework guided the research review question. Seven electronic databases were systematically searched. The quality of each included study was assessed using the tool appropriate to the study's methodological approach; Critical Appraisal Skills Program (CASP) criteria and the Mixed Methods Appraisal Tool (MMAT) Version 2018. The Consolidated Criteria for Reporting Qualitative Research (COREQ) tool was utilized to assess reported findings. Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to grade the confidence in the evidence of the qualitative research. Data were thematically analyzed to formalize the identification and development of themes. A total of 12 studies were included. Synthesis of the evidence generated one overarching theme, "Midwives, the forgotten victims", and three themes describing the essences of midwives' experiences: "Bruised and battered but still smiling"; "Wearing armour to protect my soul"; "Members of my team are holding me up, others are pulling me down". Midwives expressed feelings of shock, fear, responsibility, and powerlessness which may contribute to some experiencing serious mental illness. They reported a shaken belief in the normal physiologic birth process which consequently led to more defensive practice. Research is needed to identify high-quality interventions to support midwives after these events. This systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42021252033).

Traumatic childbirth experiences, effects and coping: A qualitative study

ObjectiveChildbirth experience and perception of birth are personal. It is important to understand how the traumatic childbirth experiences affected women and for the nursing care that would be given to them. The aim of the research was to determine the childbirth experiences perceived by women as traumatic, how they were affected by these experiences, and how they coped. MethodsThe study was a descriptive phenomenological approach study. The data were obtained through semi-structured, in-depth individual interviews. Content analysis was used in the analysis of the data. The mothers were contacted by using the social media platforms. Sixteen women were included in the research who expressed that they had traumatic childbirth experiences. ResultsIt was determined that women experienced severe fear and pain during childbirth, that they were in unsuitable maternity hospital environments, and that care was not taken for their privacy. At the same time, it was determined that they experienced disorders in the postpartum period connected to their traumatic birth experiences, that they postponed their pregnancy plans due to their fear of childbirth that developed connected to traumatic childbirth or that they did not want to become pregnant, and that they did not receive sufficient support from health personnel. ConclusionIt is necessary to provide privacy during childbirth, to take into consideration the decisions of women, and to provide for their continuous support by midwives.

Effect of early postpartum EMDR on reducing psychological complaints in women with a traumatic childbirth experience

This pilot study investigated the feasibility of postpartum Eye Movement Desensitization and Reprocessing (EMDR) for improving posttraumatic stress disorder (PTSD) symptoms, and its association with work absence, relationship difficulties, and development of psychiatric disorders in women with a traumatic childbirth experience who do not meet all criteria for PTSD. A randomized controlled study was conducted among 20 women (EMDR (N=11) vs. care as usual (CAU) (N=9)) who reported a traumatic birth. Outcomes were measured by questionnaires and a semi-structured interview. The results showed improvement of trauma-related psychological complaints for all women. EMDR appears to be more effective in reducing PTSD symptoms than CAU. Moreover, EMDR showed a small positive effect on work absence due to factors related to the traumatic childbirth experience. Results from the questionnaires were substantiated by interviews. However, due to the small size of the study, no statistically significant differences were found. In addition, no differences were found for relationship difficulties and development of psychiatric disorders. In conclusion, women with a traumatic birth experience may benefit from EMDR, even if they do not qualify for a diagnosis of PTSD. This study could be a starting point for future research aimed at early treatment that reduces trauma-related psychological complaints in postpartum women.

Traumatic Childbirth Experience and Childbirth-Related Post-Traumatic Stress Disorder (PTSD): A Contemporary Overview.

With this manuscript we provide an overview of the prevalence, symptoms, risk factors, screening, support, and treatment for women with a traumatic childbirth experience or childbirth-related PTSD. This overview is based on both recent literature and the authors' clinical experiences from the fields of obstetrics, psychiatry and medical psychology to provide up-to-date knowledge about recognizing, preventing and treating CB-PTSD from a clinical perspective. We pay substantial attention to prevention as there are many things health care professionals can do or not do to contribute to a positive childbirth experience, and save women, their infants and families from a sub-optimal start due to childbirth-related trauma.

A multilevel developmental psychopathology model of childbirth and the perinatal transition.

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

Midwifery Students' Traumatic Childbirth Experiences, Traumatic Childbirth Perceptions, and Levels of Fear of Childbirth.

Although childbirth is generally seen as a positive phenomenon, negative childbirth events can be experienced as well. Midwifery students are at risk of encountering traumatic events throughout their education. The primary aim of this research was to reveal midwifery students' experiences of witnessing traumatic events at childbirth. The secondary aim was to determine the effects of traumatic childbirth experiences witnessed by midwifery students on their traumatic childbirth perceptions and levels of fear of childbirth. This cross-sectional study was conducted between January 1 and June 30, 2021. The study sample consisted of 517 midwifery students in Turkey. Data were collected using a descriptive information form, the Traumatic Childbirth Perception Scale (TCPS), and the Visual Analog Scale (VAS) for measuring fear of childbirth. The majority (88%) of students witnessed a traumatic event at childbirth. The mean (SD) TCPS score was 59.7 (26.1), and the level of fear of childbirth measured with VAS was 5.1 (2.7). A moderate positive correlation was found between the VAS score and TCPS scores (r = .63; P<.001). Although the mean TCPS scores of students who witnessed a traumatic event were not signficiantly different from those who did not, their mean VAS score was higher than those who did not (P = .001). Among students who experiences traumatic events at childbirth, 35.8% stated that the traumatic events negatively affected their education, and 65.6% reported that they thought it would negatively affect their future professional life. Witnessing traumatic events at childbirth is associated with increased perception of childbirth as traumatic and fear of childbirth in midwifery students. Traumatic experiences can affect midwifery students' educational and professional lives. Educators in the field of midwifery should support students in coping with traumas.

The design, delivery and evaluation of ‘Human Perspectives VR’: An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD

A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.

Dignity and respectful maternity care as an essential step towards universal health coverage

Most women experience disrespect and abuse in delivery rooms instead of support, and respect. Disrespect and abuse of women seeking maternity care are becoming an urgent problem and creating a growing community of concern that spans the domains of healthcare research, quality, and education; human rights; and civil rights advocacy. Deprivation of respectful mother care is an important cause of traumatic childbirth experiences as much as inadequate care make mothers feel that they are forced to be in the delivery bed, exposed, and left with no help. Good communication between parturient and care provider is associated with higher patient satisfaction with care and safety. All maternity care personnel should take cognizance of the issue of respectful maternity care and take appropriate corrective measures. By providing respectful maternity care we will take a concrete step ahead toward the attainment of universal health coverage.

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

Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing." This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.

Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

Postpartum Early EMDR therapy Intervention (PERCEIVE) study for women after a traumatic birth experience: study protocol for a randomized controlled trial

BackgroundUp to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively influencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience.MethodsThe PERCEIVE study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or ‘care-as-usual’. Patients in the EMDR group receive two sessions of therapy between 14 (T0) and 35 days postpartum. All participants will be assessed at T0 and at 9 weeks postpartum (T1). At T1, all participants will undergo a CAPS-5 interview about the presence and severity of PTSD symptoms. The primary outcome measure is the severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at multiple midwifery practices in Amsterdam, the Netherlands.DiscussionIt is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience.Trial registrationNetherlands Trial Register NL73231.000.20. Registered on 21 August 2020.

Recommendations for improving primiparous women\u2019s childbirth experience: results from a multiphase study in Iran

BackgroundWomen's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births.Methods/designThe study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members.ResultsThe results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women’s sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique.ConclusionGiven the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

RESPECTFUL MATERNITY CARE (RMC): SAFE MOTHER HOOD

Pregnancy and childbirth are the momentous events in the lives of every woman worldwide and represents a time of intense vulnerability. The concept of “Respectful Maternity Care (RMC)” has evolved and expanded over the past few decades to include diverse perspectives and frameworks. RMC is not only a crucial component of quality of care; it is a human right. A women’s relationship with maternity care providers and the maternity care system during pregnancy and childbirth is vitally important. In 2014, WHO released a statement calling for the prevention and elimination of disrespect and abuse during childbirth, stating that “every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth.” Traumatic childbirth experience can have many negative effects, including poor mother-baby bond, unwillingness to breastfeed and poor quality of life. As facility-based birth and the use of skilled birth attendants continue to rise, a focus on quality and RMC remains critical for improving global maternal health. KEY WORDS: Safe Motherhood, maternity care, disrespect, abuse, childbirth

COVID-19 is associated with traumatic childbirth and subsequent mother-infant bonding problems

BackgroundKnowledge of women's experience of childbirth in the outbreak of the coronavirus (COVID-19) pandemic and associated maternal health outcomes is scarce. MethodsA sample of primarily American women who gave birth around the height of COVID-19 (n = 1,611) and matched controls, i.e., women who gave birth before COVID-19 (n = 640), completed an anonymous Internet survey about recent childbirth, birth-related traumatic stress (peritraumatic distress inventory; PTSD-checklist), maternal bonding (maternal attachment inventory; mother-to-infant bonding scale) and breastfeeding status. Groups (n = 637 in each) were matched on demographics, prior mental health/trauma and childbirth factors to determine the unique contribution of COVID-19 to the psychological experience of childbirth. ResultsMothers in COVID-19-exposed communities endorsed more clinically acute stress response to childbirth than matched controls (Z = 2.65, p = .008, OR= 1.38). A path mediation model revealed that acute stress mediated the relationship between study group and postpartum outcomes. Specifically, higher acute stress response in birth was associated with more childbirth-related posttraumatic stress disorder symptoms (β = .42, p < .001) and less bonding with the infant (β = .26, p < .001), including breastfeeding problems (β = .10, p < .01). LimitationsUse of a convenient internet sample introduces bias towards more educated women and reliance on retrospective self-report assessments may entail recall bias. ConclusionsCOVID-19 is a major stressor for delivering women. It can heighten traumatic childbirth experiences and interfere with successful postpartum adjustment. Clinical attention to traumatic stress in childbirth and problems with caring for the young during this pandemic is important.