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The Pain Coping Scale: 10 to 0, developed to assess coping during labor and birth. Adapted from " Wong–Baker Faces Pain Rating Scale " in Clinical Handbook of Pediatric Nursing (2nd ed., p. 373), by D. Wong and L. Whaley, 1986, St. Louis, MO: C.V. Mosby Company, for " Pain Medications for Labor & Birth " [PowerPoint slides], by P. Simkin, 2010, Waco, TX: Childbirth Graphics.  

The Pain Coping Scale: 10 to 0, developed to assess coping during labor and birth. Adapted from " Wong–Baker Faces Pain Rating Scale " in Clinical Handbook of Pediatric Nursing (2nd ed., p. 373), by D. Wong and L. Whaley, 1986, St. Louis, MO: C.V. Mosby Company, for " Pain Medications for Labor & Birth " [PowerPoint slides], by P. Simkin, 2010, Waco, TX: Childbirth Graphics.  

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In this column, Kimmelin Hull, community manager of Science & Sensibility, Lamaze International's research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued-including testimonies from blog readers about their own exper...

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... more important is the woman's ability to cope. Figure 2 illustrates the Pain Coping Scale, an adaptation of the Pain Intensity Scale that I developed to assess coping during labor and birth. If a woman rates her pain at 8 (very high) and her coping is also rated very high, she is not suffering. ...

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Objetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia...

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... Considering the increasing trend of preterm birth [2], its high resulting mortality and morbidity [29], and consequently the issues in maternal mental health and mother-child bonding [30], on one hand, lack of study in Iran, on the other hand, the present study aimed to evaluate the effect of supportive counseling on mental health in Iranian mothers of premature infants (primary outcome), mother-child bonding and infant anthropometric indices (secondary outcomes) in mothers of premature infants. ...
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Background: Premature birth can affect maternal mental health. Considering that the mental health disorder in mothers may play a vital role in the growth and development of their children, therefore, this study was conducted to determine the effect of supportive counseling on mental health (primary outcome), mother-child bonding and infant anthropometric indices (secondary outcomes) in mothers of premature infants. Methods: This randomized controlled clinical trial was carried out on 66 mothers with hospitalized neonates in the NICU of Alzahra hospital in Tabriz- Iran. Participants were randomly allocated into two groups of intervention (n = 34) and control (n = 32) through a block randomization method. The intervention group received 6 sessions of supportive counseling (45-60 minutes each session) by the researcher, and the control group received routine care. Questionnaires of Goldberg General Health and the postpartum bonding were completed before the intervention (first 72 hours postpartum) and 8 weeks postpartum. Also, the anthropometric index of newborns were measured at the same time. Results: There was no statistically significant difference between the two groups in terms of socio-demographic characteristics. After the intervention, based on ANCOVA with adjusting the baseline score, mean score of mental health (AMD: -9.8; 95% Confident Interval (95% CI): -12.5 to -7.1; P < 0.001) and postpartum bonding (AMD: -10.0; 95% CI: -0.6 to 13.9; P < 0.001) in the counseling group was significantly lower than those of the control group; however, in terms of weight (P = 0.536), height (P = 0.429) and head circumference (P = 0.129), there was no significant difference between the two groups. Conclusions: Supportive counseling may improve mental health and postpartum bonding in mothers of premature infants. Thus, it may be recommendable for health care providers to offer it to mothers. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N45 . Date of registration: October 29, 2018.
... 1. Physical injury to the baby and resulting psychological distress, and/or 75 2. Physical injury to the mother which results in psychological distress, and/or 3. Fear of physical injury to mother or baby and associated psychological distress, and/or 4. Psychological response to the experience of birth, including care received, which causes psychological distress of an enduring nature ...
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https://hydra.hull.ac.uk/resources/hull:17083 Background: A significant number of women experience childbirth as traumatic, with long-term negative sequelae. Little is known about the choices women make in subsequent pregnancy(s)/birth(s). Understanding the choices women make, and why, is necessary to offer appropriate support to women traumatised by their previous birth(s). Question: What choices do women make in the perinatal period, when they have previously experienced a traumatic birth? Method: Nine pregnant UK-based women who had previously experienced a traumatic birth were recruited to a longitudinal feminist grounded theory study, via online pregnancy and parenting forums. Interviews were carried out in early pregnancy, pre-birth, and postnatally (27 interviews). Results: Findings suggest that women gathered and analysed information from a variety of sources, often at an early stage (even pre-conception) to make choices about birth. Women made decisions throughout pregnancy in order to have the birth they wanted. Participants expressed difficulty in trusting healthcare professionals because of their previous experiences, and needed recognition that trust had to be rebuilt. Each woman located the power to support her birthplan in someone different. Anticipating a lack of support for their plans, women prepared for appointments as though each would be a battle. When each woman met the person whom she believed could agree her choices, if they offered support for her plans, she experienced relief. If that support was denied, it was devastating. If women were able to develop trusting relationships with healthcare professionals during pregnancy, this birth was likely to be a positive experience. Similarly, support from partners was an indicator for a positive birth experience. Conclusions: This thesis explores relationships between women, information, birthplans and trust, and proposes a care pathway for women who have previously experienced a traumatic birth. The care pathway advocates continuity of care from a single appropriate carer, who provides information, and supports the early formulation of a birthplan.
... 8 Although the benefits of the first hour for babies have been proven, unfortunately, its benefits for mothers, especially for mothers' mental qualities have not received due attention. This is while childbirth is an important and potentially a traumatic event for pregnant women, 10 and it is among the most intense emotional experiences in a woman's life that provokes emotions, excitement and mental symptoms which can be caused by trauma. 11,12 A lot of studies have also been conducted on the impact of postnatal depression on lactation, [13][14][15] but few studies have been carried out on the impact of early skin to skin contact and breastfeeding on preventing postnatal depression. ...
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Introduction: the implementation of the baby’s nine instinctive stages as a sacred hour after birth is very effective in starting breastfeeding. About half of newly delivered mothers have reported a traumatic childbirth experience often associated with mental health problems. The present study aimed to examine the effect of the sacred hour on the depression in traumatic childbirths. Methods: In this clinical trial, 84 mothers who had experienced a traumatic childbirth were randomly allocated into the intervention (n = 42) and control (n = 42) groups. The intervention group received sacred hour (baby’s nine instinctive responses), but the control group received only the routine care. Postnatal depression was evaluated as primary outcome at 2 week, 4-6 week and 3 month intervals after the delivery. The data were analyzed using t test, chi-square test and the repeated measures analysis of variance. Results: The results showed that the marginal total mean (SD: standard deviation) scores of depression in the intervention and control groups were 7.5 (2.6) and 9.6 (2.6); therefore, the mean difference (95% CI) between the groups (-2.1, (-3.2,-0.95)) was significant. Conclusion: The implementation of the sacred hour is recommended as a preventive approach to reduce the postnatal depression in women with a traumatic childbirth experience.
... Childbirth is an important and potentially traumatic event. 1 There is now substantial evidence that women can suffer from a range of psychological problems during this time. [2][3][4] According to DSM-V-A, a trauma is a stressful event in which a person experiences a feeling of threat, injury, or death for himself/herself or one of his/her loved ones. ...
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Introduction: Childbirth is a stressful event in every woman's life, leading to traumatic deliveries in half of the cases. This study aimed at describing mothers’ lived experiences which make them perceive their childbirth as traumatic. Methods: In this descriptive phenomenological study, based on the DSM-V-A criteria, 32 mothers who had perceptions of a traumatic event during their labor and delivery were explored through semi-structured interviews, and the collected data were analyzed using the Colaizzi’s method. Results: Four main themes could be extracted from the experiences of the mothers. The first theme was sensational and emotional experiences followed by clinical experiences, legal experiences and human dignity, and environmental experiences. The sensational and emotional experiences included four main categories (anxiety, fear, sorrow, anger). The theme of clinical experiences included two main categories (avoidable and unavoidable childbirth complications). The theme of legal experiences and human dignity included two main categories (non-observance of the charter of patient rights, and non-observance of human rights). The theme of environmental experiences also included two main categories (lack of proper supervision and management). Conclusion: To prevent traumatic childbirth and its negative effects, different psychological aspects of childbirth need to be identified.
... The absence of pain does not mean absence of negative emotional reaction or suffering (Simkin & Hull 2011). When women have a negative birth experience, they may develop childbirth related posttraumatic stress syndrome. ...
... When women have a negative birth experience, they may develop childbirth related posttraumatic stress syndrome. According to Lally et al (2014), midwives should recognize that, if a woman has any option of pain relief, she still needs professional support that enhances labour progression (Simkin & Hull 2011;Lally et al. 2014). Simkin and Hull for labour and minimize the likelihood of loneliness, disrespect and intolerable pain. ...
... In other words, women's constructions of midwives' attitudes and behaviour towards them reflect their views of how they perceived they were treated as opposed to physically what happened to them. The further finding that women lacked confidence in their midwives, being related to either the midwife's competency or level of control in the situation, reflect that women need to rely on and trust their midwives at a time of vulnerability (Briscoe, Lavender, & McGowan, 2016;Simkin & Hull, 2011). These assertions are strengthened by the finding that an unmet desire for support was a significant factor predisposing the development of PTSD-PC. ...
Article
Objective: Review primary research regarding PTSD Post-Childbirth (PTSD-PC) that focussed on Quality of Provider Interaction (QPI) from the perspective of women who developed PTSD-PC, or midwives. Background: Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). Women’s subjective experiences of childbirth are the most important risk factor in the development of PTSD-PC, with perceived QPI being key. Methods: A systematic search was performed for PTSD-PC literature. Reviewed papers focussed on either women’s subjective childbirth experiences, particularly QPI, or midwives’ perspectives on QPI. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced. Results: Fourteen studies were included. Three features of QPI contribute towards developing PTSD-PC: interpersonal factors; midwifery care factors; and lack of support. Conclusion: QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives should be grounded on evidence highlighted in this review, along with further high-quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives’ knowledge and needs regarding their role within QPI.
... Because the perception of birth trauma is in the "eye of the beholder," (Beck, 2004, p. 28), one's appraisal of the birth event is significant and cannot be undervalued, even if considered routine by hospital staff. Comments expressing perception of unsympathetic or nonsupportive caregivers, negative contact/interactions with delivery staff, and feelings of being ignored are important to note, and have been associated with PTSD following childbirth (Grekin & O'Hara, 2014;Harris, & Ayers, 2012;Simkin, 2011). Assess for warning signs for future PTSD following childbirth that may have developed in labor including feeling angry (blaming others), alone, unsupported, helpless, overwhelmed and defeated, and experiencing physical damage and/or a poor infant outcome (Simkin, 2011). ...
... Comments expressing perception of unsympathetic or nonsupportive caregivers, negative contact/interactions with delivery staff, and feelings of being ignored are important to note, and have been associated with PTSD following childbirth (Grekin & O'Hara, 2014;Harris, & Ayers, 2012;Simkin, 2011). Assess for warning signs for future PTSD following childbirth that may have developed in labor including feeling angry (blaming others), alone, unsupported, helpless, overwhelmed and defeated, and experiencing physical damage and/or a poor infant outcome (Simkin, 2011). ...
... Prenatal management that may aid in the reduction of symptoms postbirth can include suggesting that the women/couple learn labor and maternity care practices, master coping techniques for labor, and develop a birth plan (Simkin, 2011). An open discussion between the health care provider and woman can be used to strategize a course of care together once labor begins (Simkin, 2011). ...
Article
The trauma of birth is an international concern for all childbearing women globally. Since changes in 1994 to the Diagnostic Statistical Manual (DSM) which included childbirth as a potentially traumatic event, several clusters of researchers, particularly representing the Scandinavian countries, the United Kingdom, and Australia, have emerged. Their research findings appear in numerous publications; yet, what is known from these studies is based on a variety of methodological designs and differing measurement tools making it difficult to draw many firm conclusions (Ayers, 2004 Ayers, S. (2004). Delivery as a traumatic event: Prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clinical Obstetrics & Gynecology, 47, 552–567. doi:10.1097/01.grf.0000129919.00756.9c[Crossref], [PubMed], [Web of Science ®] [Google Scholar]; Ayers, Joseph, Mc-Kenzie-McHarg, Slade, & Wijma, 2008 Ayers, S., Joseph, S, McKenzie-McHarg, K., Slade, P., & Wijma, K. (2008). Posttraumatic stress disorder following childbirth: Current issues and recommendations for future research. Journal of Psychosomatic Obstetrics & Gynecology, 29, 240–250. doi: 10.1080/01674820802034631[Taylor & Francis Online], [Web of Science ®] [Google Scholar]). This review offers information obtained from frequently cited, current and seminal research studies describing the trauma of birth among women of the world.
... Consensus on the value of providing respectful care has emerged as the literature confirmed that the display of D&A behaviours by providers may instil fear in women [60] and affect their satisfaction and subsequent use of the health services [60,64,65]. Further, neglectful behaviour may instil a feeling of hopelessness which may lead to postpartum depression or stress disorder [66,67]. ...
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Background In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women’s perspectives. Methods We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth. Results We did not observe a statistically significant effect of the intervention on women’s perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities. Conclusion Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers’ positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.
... 52, p. 1608 The dysfunctional pain cues may be viewed then as emotional reactions, which are observed in the behaviour of someone who is, for example, feeling stressed, hopeless, threatened, or vulnerable. These are factors which may contribute to the notion of suffering in a childbirth context, 55,56 and it is argued that a fear of pain is in fact a fear of suffering. 56, p. 167 The dysfunctional cues may provide a deeper understanding of pain as suffering, when birthing women may be anxious due to previous traumatic childbirth experiences, negative associations or connotations with pain, or due to experiencing certain procedures during labour. ...
Article
Background: Standardised pain assessment i.e. the McGill Pain Questionnaire provide an elicited pain language. Midwives observe spontaneous non-elicited pain language to guide their assessment of how a woman is coping with labour. This paper examined the labour pain experience using the questions: What type of pain language do women use? Do any of the words match the descriptors of standardised pain assessments? What type of information doverbal and non-verbal cues provide to the midwife? Methods: A literature search was conducted in 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. A total of 12 articles were included. Findings: The analysis revealed six categories in which labour pain can be viewed: 'positive', 'negative', 'physical', 'emotional', 'transcendent' and 'natural'. Women's language comprised i.e. prefixes and suffixes, which indicate the qualities of pain, and figurative language. Language indicated location of pain, gave insight into other life phenomena i.e. death, and shared similarities with standardised pain assessmentdescriptors. Labour cues were 'functional', 'dysfunctional,' or 'neutral' (part of the physiological childbirth process), and were verbal, non-verbal, emotional, psychological, physical behaviour or reactions, or tactile. Conclusion: Labour can bring about a spectrum of sensations and therefore emotions from happiness and pleasure to suffering and grief. Spontaneous pain language comprises verbal language and non-verbal behaviour. Narratives are an effective form of pain communication in that they provide details regarding the quality, nature and dimensions of pain, and details notcaptured in quantitative data.
... can physically and mentally prepare for their upcoming birth. Birth plans need to be encouraged and respected by hospital staff (Carlton, Callister, Christiaens, & Walker, 2009;Lothian, 2006Lothian, , 2014Simkin, 2011; Table 1). ...
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In-depth interviews of a purposive sample ( n = 14) of grand multipara mothers (five or more births) was conducted to investigate the mothers’ embodied experiences of natural, technologically altered births and oxytocin inductions in U.S. hospitals from 1973 to 2007. A comprehensive secondary analysis of the lived experiences of natural birth and the high use of technology and oxytocin during birth, which was found in an original theme of a previous study, was explored. An overarching theme emerged of Embodiment of Birthing in U.S. Hospitals. Two patterns: Embodied Technological Altered Natural Births and Embodied Technologically Altered Induced Births were uncovered. Childbirth educators, doulas, and nurses are an integral part of creating changes in hospital settings, which discourage nonmedically indicated inductions and encourages changes in hospitals.