Project

CA18211 - Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes

Goal: Unlike other sources of trauma, perinatal or birth-related trauma is relatively unrecognised. Evidence suggests up to 30% of women describe their birth experience as traumatic and experience some symptoms of intrusion, avoidance or hyper-arousal. Meta-analyses show post-traumatic stress disorder (PTSD) affects 4% of women after birth and up to 18% of women in high risk groups. Rectification of this situation is essential. In 2016, 5.11 million babies were born in Europe, indicating that up to 1.5 million women may have had sub-optimal birth experiences and over 200,000 may have developed PTSD as a result. Developmental research has firmly established that the quality of infant-parent relationships is a critical factor in early and later childhood development, consequently, a family-centred approach to any investigation of birth-related trauma is critical, as trauma can be transmitted within the family system. Given the enormous economic burden it places on women, health systems, and particularly children, relatively small improvements in services to prevent, detect and treat this problem can benefit society significantly. The main aim of this Action is two-fold. The Action will establish an international multidisciplinary network of researchers, clinicians, NGOs and SMEs to 1) consolidate and disseminate current evidence and coordinate a joint effort to seek ways to prevent, minimise and resolve birth-related trauma, and to optimise emotional and psychological outcomes for parents and families and 2) accelerate the translation of that knowledge into best practices that can be shared across Europe to reduce the societal and economic burden arising from birth-related negative/traumatic experiences.

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Antje Horsch
added a research item
Antenatal classes have evolved considerably and include now a discussion of the parents' birth plan. Respecting this plan normally results in a better childbirth experience, an important protective factor of post-traumatic stress disorder following childbirth (PTSD-FC). Antenatal class attendance may thus be associated with lower PTSD-FC rates. This cross-sectional study took place at a Swiss university hospital. All primiparous women who gave birth to singletons from 2018 to 2020 were invited to answer self-reported questionnaires. Data for childbirth experience, symptoms of PTSD-FC, neonatal, and obstetrical outcomes were compared between women who attended (AC) or not (NAC) antenatal classes. A total of 794/2876 (27.6%) women completed the online questionnaire. Antenatal class attendance was associated with a poorer childbirth experience (p = 0.03). When taking into account other significant predictors of childbirth experience, only induction of labor, use of forceps, emergency caesarean, and civil status remained in the final model of regression. Intrusion symptoms were more frequent in NAC group (M = 1.63 versus M = 1.11, p = 0.02). Antenatal class attendance, forceps, emergency caesarean, and hospitalisation in NICU remained significant predictors of intrusions for PTSD-FC. Use of epidural, obstetrical, and neonatal outcomes were similar for AC and NAC.
Antje Horsch
added a research item
Background Placenta Accreta Spectrum is associated with significant clinical maternal morbidity and mortality, which has been extensively described in the literature. However, there is a dearth of research on the lived experiences of pregnant people and their support partners. The aim of this study is to describe living beyond a pregnancy and birth complicated by PAS for up to four years postpartum. Participants experiences inform the development of an integrated care pathway of family centered support interventions. Methods An Interpretative Phenomenological Analysis approach was applied to collect data through virtual interviews over a 3-month period from February to April 2021. Twenty-nine participants shared their stories; six people with a history of PAS and their support partners were interviewed together ( n = 12 participants), six were interviewed separately ( n = 12 participants), and five were interviewed without their partner. Pregnant people were eligible for inclusion if they had a diagnosis of PAS within the previous 5 years. This paper focuses on the postnatal period, with data from the antenatal and intrapartum periods described separately. Results One superordinate theme “Living beyond PAS” emerged from interviews, with 6 subordinate themes as follows; “Living with a different body”, “The impact on relationships”, “Coping strategies”, “Post-traumatic growth”, “Challenges with normal care” and recommendations for “What needs to change”. These themes informed the development of an integrated care pathway for pregnant people and their support partners to support them from diagnosis up to one year following the birth. Conclusion Parents described the challenges of the postnatal period in terms of the physical and emotional impact, and how some were able to make positive life changes in the aftermath of a traumatic event. An integrated care pathway of simple supportive interventions, based on participant recommendations, delivered as part of specialist multidisciplinary team care may assist pregnant people and their support partners in alleviating some of these challenges.
Yvonne Kuipers
added a research item
Background: Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. Aim: To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. Methods: A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. Findings: Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships , including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. Discussion/conclusion: The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.
Antje Horsch
added a research item
This systematic review and meta-analysis aimed to determine mean estimates of prevalence rates for fulfilling all diagnostic criteria of posttraumatic stress disorder (PTSD) or at least showing significant levels of posttraumatic stress (PTSS) in relation to the traumatic event of childbirth. For the first time, both mothers and fathers were included in the synthesis. Studies were identified through systematic database search and manual searches, irrespective of language. Meta-analyses of 154 studies (N = 54,711) applied a random-effects model to four data sets, resulting in pooled prevalence rates of 4.7% for PTSD and 12.3% for PTSS in mothers. Lower rates of 1.2% for PTSD and 1.3% for PTSS were found among fathers. Subgroup analyses showed elevated rates in targeted samples (those with a potential risk status) most distinctly for maternal PTSS. The significant amount of heterogeneity between studies could not be explained to a satisfactory degree through meta-regression. Given the substantial percentage of affected parents, the adoption of adequate prevention and intervention strategies is needed. As this field of research is evolving, attention should be broadened to the whole family system, which may directly and indirectly be affected by birth-related PTSD. Further studies on paternal PTSD/PTSS are particularly warranted.
Julia Leinweber
added a research item
Introduction 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. Aim To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. Methods 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. Results 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.” Conclusions 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.
Susan Garthus-Niegel
added a research item
Background The 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. Methods This 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. Results About 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. Conclusions A 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.
Susan Garthus-Niegel
added a research item
The cross-sectional study INVITE ( IN timate partner VI olence care and T reatment pr E ferences in postpartum women) aims to examine treatment and counseling preferences and barriers in relation to the experience of intimate partner violence (IPV), depression and anxiety, and (childbirth-related) posttraumatic stress disorder (PTSD) among postpartum women in Dresden, Germany. Currently, the INVITE study consists of an interim sample of N = 1,787 participants with n = 891 completed interviews. Recruitment is ongoing, targeting a community sample of at least N = 4,000 women who complete various quantitative questionnaires via telephone interviews at 3–4 months postpartum. The differences in rates of IPV, postpartum depression and anxiety, and/or (childbirth-related) PTSD as well as treatment and counseling preferences and barriers between affected and non-affected women will be assessed. Further, predisposing variables, past and present stress exposure, enabling resources, as well as past and present health will be examined as predictors of service preferences and barriers. In this study protocol, the theoretical background, methods, as well as preliminary results regarding sociodemographic characteristics and birth-related factors of the interim sample are presented and discussed in terms of their socio-political relevance. Simultaneously assessing IPV, postpartum depression and anxiety, and (childbirth-related) PTSD will facilitate exploring comorbidities and concomitant special needs of affected women. Results of the INVITE study will therefore set the ground for well-aimed development and improvement of treatment and counseling services for the respective target groups by informing health care professionals and policy makers about specific preferences and barriers to treatment. This will yield the possibility to tailor services to the needs of postpartum women.
Antje Horsch
added a research item
Background Differences in reproductive health outcomes according to the mothers’ origins have been reported in Switzerland, for example, women from European countries and non-European countries. The Swiss Federal Office of Public Health has therefore called for specific Swiss-wide studies on migrant populations. This study explores the pregnancy and antenatal care experiences of Chinese migrants in Switzerland, intending to clarify their maternity care needs. Methods In-depth interviews of 14 Chinese mothers and 13 family members were conducted in Chinese or English and audio recorded. All audio-recordings were transcribed verbatim. All Chinese transcripts were translated into English. Thematic analysis was performed with the assistance of the qualitative data analysis software, MAXQDA Analytics Pro 2020. Results Five themes were extracted from the transcripts: (1) Motivations and concerns about having children, (2) The merits of the Swiss maternity care system, (3) The inconveniences and barriers of accessing Swiss maternity care services, (4) Strategies to deal with the inconveniences of the Swiss maternity care system, and (5) The need for culturally sensitive care. Conclusions The results of our study provide new knowledge and understanding of pregnancy experiences and antenatal care services of Chinese mothers and their families in Switzerland. Their unique positive experiences included: family planning, the continuity of maternity services, humane care with the privacy respected, personalized sensitive care needs, preferences for female obstetricians and obstetricians of Asian origin. Several barriers were highlighted, such as information seeking difficulties, communication difficulties, and a rigid appointment system. Reducing barriers enabling access to maternity care services within the Swiss healthcare system is necessary to provide equal quality maternity care for individuals, irrespective of their origins.
Antje Horsch
added 2 research items
Le stress post-traumatique lié à l’accouchement concerne jusqu’à 19 % des mères. Dans cet article, Dre Vania Sandoz, Camille Deforges, Valérie Avignon et Prof Antje Horsch,chercheuses au sein du Lausanne Perinatal Research Group, en détaillent les manifestations et les effets, et proposent des pistes pour le prévenir.
Background Intrusive memories (IMs) of traumatic events are a key symptom of posttraumatic stress disorder (PTSD), and contribute to its maintenance. This translational proof-of-principle study tested whether a single-session behavioural intervention reduced the number of childbirth-related IMs (CB-IMs) and childbirth-related PTSD (CB-PTSD) symptoms, in women traumatised by childbirth. The intervention was assumed to disrupt trauma memory reconsolidation. Methods In this pre-post study, 18 participants, whose traumatic childbirth had occurred between seven months and 6.9 years before, received an intervention combining childbirth-related reminder cues (including the return to maternity unit) with a visuospatial task. They recorded their daily CB-IMs in the two weeks pre-intervention (diary 1), the two weeks post-intervention (diary 2; primary outcome), and in week 5 and 6 post-intervention (diary 3). CB-PTSD symptom severity was assessed five days pre-intervention and one month post-intervention. Results Compared to diary 1, 15/18 participants had ≥ 50% fewer CB-IMs in diary 2. The median (IQR) reduction of the number of CB-IMs was 81.89% (39.58%) in diary 2, and persisted in diary 3 (n=17). At one month post-intervention, CB-PTSD symptom severity was reduced by ≥ 50% in 10/18 participants. Of the 8 participants with a CB-PTSD diagnosis pre-intervention, none met diagnostic criteria post-intervention. The intervention was rated as highly acceptable. Limitations The design limits the causal interpretation of observed improvements. Conclusion This is the first time such a single-session behavioural intervention was tested for old and real-life single-event trauma. The promising results justify a randomized controlled trial, and may be a first step toward an innovative CB-PTSD treatment.
Susan Garthus-Niegel
added 2 research items
Objective The aim of this study was to examine changes in perceived social support from early pregnancy to 2 years postpartum and to test whether these changes (a) differ between mothers and fathers or (b) vary as a function of the Big Five personality traits.Background Higher peripartum social support in (expectant) mothers and fathers has been associated with fewer complications during pregnancy and delivery as well as better parental and offspring health.Methods Prospective-longitudinal data from two regional-epidemiological samples from Germany were used: MARI (N = 396, including n = 293 mothers and n = 103 fathers) and DREAM (N = 2,819, including n = 1,689 mothers and n = 1,130 fathers). The Big Five personality traits were assessed during pregnancy in MARI as well as 8 weeks after the anticipated birth date in DREAM with short forms of the Big Five Inventory. Perceived social support was assessed during pregnancy, 4 months postpartum, and 16 months postpartum in MARI as well as during pregnancy, 14 months postpartum, and 2 years postpartum in DREAM using the short version of the Social Support Questionnaire.ResultsMultilevel analyses revealed that perceived social support decreased across the peripartum period, and this decrease did not differ between mothers and fathers. More extraverted, emotionally stable, agreeable, conscientious, and open parents perceived higher levels of social support across the peripartum period. The peripartum decrease of perceived social support was smaller in parents who were more extraverted.Conclusion Our findings suggest that especially extraversion plays an important role for high and stable levels of perceived social support across the peripartum period.ImplicationsParticularly highly introverted parents might profit from targeted social support interventions.
Objective: To 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. Design: Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth. Participants: A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study. Results: In 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 Conclusions: This 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 Practice: Findings 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.
Ljiljana Jelicic
added a research item
Background: Maternal prenatal anxiety is among important public health issues as it may affect child development. However, there are not enough studies to examine the impact of a mother's anxiety on the child's early development, especially up to 1 year. Objective: The present prospective cohort study aimed to examine whether maternal trait anxiety, perceived social support, and COVID-19 related fear impacted speech-language, sensory-motor, and socio-emotional development in 12 months old Serbian infants during the COVID-19 pandemic. Methods: This follow-up study included 142 pregnant women (Time 1) and their children at 12 months (Time 2). Antenatal maternal anxiety and children's development were examined. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Child speech-language, sensory-motor, and socio-emotional development were assessed using the developmental scale in the form of an online questionnaire that examined the early psychophysiological child development. Information on socioeconomic factors, child and maternal demographics, clinical factors, and perceived fear of COVID-19 viral infection were collected. Multivariable General Linear Model analysis was conducted, adjusted for demographic, clinical, and coronavirus prenatal experiences, maternal prenatal anxiety levels, perceived social support, speech-language, motor skills, and cognitive and socio-emotional development at the infants' age of 12 months. Results: The study revealed the influence of the COVID-19 pandemic on maternal trait anxiety. The association between selected independent factors and infants' development was found in a demographically unified sample except for employment and the number of children. There was a correlation between all observed developmental functions. Univariate General Linear model statistical analysis indicated that linear models with selected independent factors and covariates could account for 30.9% (Cognition) up to 40.6% (Speech-language) of variability in developmental functions. It turned out that two-way and three-way interactions had a dominant role on models, and STAI-T Level and COVID-19 related fear were present in all interaction terms. Conclusion: Our findings reveal important determinants of child developmental outcomes and underline the impact of maternal anxiety on early child development. These findings lay the groundwork for the following interdisciplinary research on pregnancy and child development to facilitate and achieve positive developmental outcomes and maternal mental health.
Susan Garthus-Niegel
added a research item
Background : The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers. Methods : Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2. Results : Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found. Limitations : Physical and mental health was assessed with a short questionnaire only (SF-12v2). Conclusions : On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.
Lola Ruiz-Berdún
added a research item
One of the factors that has historically been considered most important in combating child mortality has been the education of mothers. Among the strategies used to improve it is group education, which today is almost exclu¬sively the responsibility of midwives. But this was not always the case. This article focuses on the role of these professionals in the education of pregnant women in Spain, which began with the courses for mothers offered by the Escuela Nacional de Puericultura. From 1955 onwards, courses for pregnant women, aimed at disseminating methods for pain control in childbirth, began to become popular. The first two books published in Spain on the subject were launched in 1955 by a midwife and a doctor respectively, who had had to go abroad to be trained in these techniques. Initially it was the doctors who were most interested in spreading these pain control techniques, and specific units were set up in the large nursing homes of late Francoism. Some town coun¬cils also incorporated “birth preparation” into their service portfolio. But the real generalisation of maternal education came with the incorporation of midwives into Primary Health Care Centres at the end of the 1980s.
Anastasia Topalidou
added a research item
Background High numbers of women experience a traumatic birth, which can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) onset, and negative and pervasive impacts for women, infants, and families. Policies, suitable service provision, and training are needed to identify and treat psychological morbidity following a traumatic birth experience, but currently there is little insight into whether and what is provided in different contexts. The aim of this knowledge mapping exercise was to map policy, service and training provision for women following a traumatic birth experience in different European countries. Methods A survey was distributed as part of the COST Action “Perinatal mental health and birth-related trauma: Maximizing best practice and optimal outcomes”. Questions were designed to capture country level data; care provision (i.e., national policies or guidelines for the screening, treatment and/or prevention of a traumatic birth, service provision), and nationally mandated pre-registration and post-registration training for maternity professionals. Results Eighteen countries participated. Only one country (the Netherlands) had national policies regarding the screening, treatment, and prevention of a traumatic birth experience/CB-PTSD. Service provision was provided formally in six countries (33%), and informally in the majority (78%). In almost all countries (89%), women could be referred to specialist perinatal or mental health services. Services tended to be provided by midwives, although some multidisciplinary practice was apparent. Seven (39%) of the countries offered ‘a few hours’ professional/pre-registration training, but none offered nationally mandated post-registration training. Conclusions A traumatic birth experience is a key public health concern. Evidence highlights important gaps regarding formalized care provision and training for care providers.
Susan Garthus-Niegel
added a research item
Background : This study aims to examine whether physical activity (PA) before and during pregnancy and birth experience predict incident postpartum depressive (PPD) symptoms. Because PA may increase endurance and feelings of physical control, it may contribute to a positive birth experience and birth experience may mediate the association between PA before and during pregnancy and PPD symptoms. Methods : The study is part of the prospective-longitudinal cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM). Participants were n = 1,254 (expectant) mothers. PA was assessed during pregnancy, birth experience and PPD symptoms 8 weeks postpartum. Multiple regression analyses were performed, including potential confounders. Results : A negative birth experience was linked to PPD symptoms, when controlling for relevant confounders. There was no evidence for a link between PA before and during pregnancy and birth experience or between PA during pregnancy and PPD symptoms. PA at low and at vigorous intensity before pregnancy was associated with PPD symptoms, but not when controlling for confounders. Because PA was not associated with birth experience, no mediation analysis was performed. Limitations : The current sample was relatively homogenous (i.e., mostly German native speakers, primiparous, highly educated). Birth experience was assessed retrospectively at 8 weeks following birth. Conclusions : Our results highlight the importance of the birth experience in the development of PPD symptoms. Promoting a positive birth experience represents a promising approach to prevent PPD symptoms. Further research on the association between PA and PPD symptoms is warranted.
Susan Garthus-Niegel
added a research item
Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: ‘experience of pregnancy, birth, and parenthood’; ‘difficult care paths’; and ‘needs and their fulfillment’. The first theme consisted of three subthemes: (1) ‘reality does not meet expectations’, (2) ‘resilience under pressure’, and (3) ‘despair’. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants’ regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers’ search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.
Antje Horsch
added a research item
Background: Studies show that prenatal maternal anxiety may act as a risk factor for adverse birth outcomes, whilst prenatal social support may rather act as a protective factor. However, studies examining prenatal anxiety symptoms, prenatal perceived support, and neonatal and/or obstetric outcomes are lacking. Objective: This study investigated whether, in a community sample, prenatal perceived support: (1) had a protective influence on birth outcomes (gestational age (GA), birthweight (BW), 5-minute Apgar score, and mode of delivery); (2) acted as a protective factor, moderating the relationship between anxiety symptoms and the aforementioned birth outcomes. Method: During their third trimester of pregnancy, 182 nulliparous child-bearers completed standardized questionnaires of anxiety (HADS-A) and perceived support (MOS-SSS). Birth outcomes data was extracted from medical records. Results: (1) Perceived support did not significantly predict any birth outcomes. However, perceived tangible support – MOS-SSS subscale assessing perceived material/financial aid – significantly positively predicted the 5-minute Apgar score. (2) Perceived support did not significantly moderate the relationship between anxiety symptoms and birth outcomes. However, perceived tangible support significantly moderated the relationship between anxiety symptoms and the 5-minute Apgar score. Conclusion: When experienced within non-clinical thresholds, prenatal anxiety symptoms do not increase the risk of adverse neonatal and obstetric outcomes when perceived support is present.
Susan Garthus-Niegel
added a research item
Background: About 3–4% of women in community samples suffer from childbirth-related posttraumatic stress disorder (PTSD). Surprisingly, the recently developed City Birth Trauma Scale (City BiTS) was the first diagnostic tool for childbirth-related PTSD covering DSM-5 criteria for PTSD. Since no questionnaire on childbirth-related PTSD is available in German, we aimed to validate a German translation of the City BiTS and to provide information on its psychometric properties. Methods: A community sample of 1,072 mothers completed an online survey, which included questions on sociodemographic and obstetric characteristics, the German version of the City BiTS, the Impact of Event Scale-Revised (IES-R), the PTSD Checklist for DSM-5 (PCL-5), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-Anxiety). Results: Exploratory factor analysis (EFA) on a random split-half sample confirmed the previously reported two-factorial structure of the City BiTS. The factors “Childbirth-related symptoms” and “General symptoms” explained about 53%, 52% of variance. Internal consistency was good to excellent for the subscales and the total scale (Cronbach's Alpha = 0.89−0.92). In a confirmatory factor analysis (CFA) in the holdout sample the two-factorial solution reached the best model fit out of three models. Correlation analyses showed convergent validity of the City BiTS (total scale and subscales) with the IES-R and PCL-5 and divergent validity with the EPDS and the DASS-Anxiety. Limitations: Data were acquired in a community sample and prevalence rates might not be representative for mothers of high-risk groups, e.g., after preterm birth. Conclusions: The German version of the City BiTS is the first German questionnaire which allows to assess symptoms of childbirth-related PTSD according to DSM-5 criteria. Besides an improvement in clinical routine it will help to make data on prevalence of childbirth-related PTSD internationally comparable. In addition, this work provides a basis to assess childbirth-related PTSD in studies conducted with a longitudinal study design or in high-risk samples.
Antje Horsch
added a research item
Information on the impact of the COVID-19 pandemic on pregnancy and breastfeeding experiences, as well as on perinatal mental health in Switzerland is limited. In Switzerland, there are few national studies and little information. Using an anonymous online survey accessible after the first wave of the outbreak in Switzerland, we have investigated how this pandemic affected pregnant and breastfeeding women. Among women who completed the survey, 69.0% (1050/1518) indicated the first wave of the pandemic affected their personal habits, 61.0% (689/1131) were affected in their work and 40.0% (632/1573) reported impaired relations with healthcare services (different denominators correspond to the number of participants who answered the question). 36.8% (110/299) of women reported an impact of the pandemic on their current pregnancy experience or breastfeeding experience (8.2%, 46/555). Overall, 11.6% (170/1467) of participants who completed the validated screening tests for mental health symptoms (Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7, Perceived Stress Scale) presented a score compatible with symptoms of major depression, severe anxiety or high perceived stress, which is higher than in the pre-pandemic period according to literature. Risk factors independently associated with impaired mental health were being hospitalized, having symptoms of COVID-19, living with a person with COVID-19 symptoms, having comorbidities, having experienced reduced healthcare services, having restricted usual activities and being a housewife. Protective factors independently associated were a high level of education and living with a partner. Our findings suggest that the COVID-19 pandemic might have significantly affected the well-being and mental health of pregnant and breastfeeding women, directly in the case of exposure, and indirectly as a result of the potential modifications in their life habits and in healthcare facilities.
Antje Horsch
added a research item
Background . Certain 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. Methods . This 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. Results . The 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. Limitations . This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. Conclusion . Prenatal 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.
Susan Garthus-Niegel
added a research item
Extensive literature has shown that interparental conflicts and violence have detrimental effects on children's adjustment in childhood and adolescence. It is not equally well-understood how parental relationship satisfaction impacts infant communicational and personal-social development during the first year of life. This longitudinal study examines (a) the impact of maternal and paternal relationship satisfaction on infant development, (b) whether this prospective association is mediated by parent-infant relationship, and (c) a potential moderating effect of infant gender. Data were derived from the population-based cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM) including 1,012 mothers and 676 fathers. Relationship satisfaction and parent-infant relationship were assessed eight weeks postpartum, infant communicational and personal-social development were measured 14 months postpartum. Multiple linear regression, mediation, and moderation analyses were conducted for mothers and fathers separately. It was shown that paternal relationship satisfaction is a significant predictor of infant personal-social development. This prospective association was partially mediated by father-infant relationship. When postnatal depression was included in the analysis, however, father-infant relationship was not a significant mediator. The association in fathers is neither reduced nor increased as a function of infant gender. No similar effects were found in the mothers' sample. Parental relationship satisfaction did not significantly predict infant communicational development in either mothers or fathers. The study findings highlight the importance of paternal relationship satisfaction, father-infant relationship, and postnatal depression for infant personal-social development.
Antje Horsch
added a research item
Objective: The City Birth Trauma Scale (City BiTS) assesses posttraumatic stress disorder symptoms following childbirth (PTSD-FC). Recent studies investigating the latent factor structure of PTSD-FC in women reported mixed results. No validated French questionnaire exists to measure PTSD-FC symptoms. Therefore, this study first aimed to validate the French version of the City BiTS (City BiTS-F). Second, it aimed to establish the latent factor structure of PTSD-FC. Method: French-speaking women with infants aged 1 to 12 months old (n = 541) completed an online cross-sectional survey. Questionnaires included the City BiTS-F, the PTSD Checklist, the Edinburgh Postnatal Depression Scale, and the anxiety subscale of the Hospital Anxiety and Depression Scale. Additionally, sociodemographic and medical data were collected. Results: The two-factor model with birth-related symptoms (BRS) and general symptoms (GS) fit the data well, whereas the four-factor model was not confirmed. The bifactor model with a general factor and the BRS and GS gave the best fit to the data, suggesting that use of the total score in addition to the BRS and GS subscales scores is justified. High reliability (α = .88 to .90) and good convergent and divergent validity were obtained. Discriminant validity was calculated with weeks of gestation, gravidity, history of traumatic childbirth and event, and mode of delivery. Discussion: The City BiTS-F is a reliable and valid measure of PTSD-FC symptoms in French-speaking women. Both total score and BRS or GS subscale scores can be calculated. This psychometric tool is of importance for clinical and research purposes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Antje Horsch
added a research item
The women’s right to respectful and dignified care during labour and childbirth is strategically accepted [1]. As management committee members of the EU COST Action CA18211 network (‘DEVOTION’) focused on traumatic childbirth (www.ca18211.eu), we are concerned with ensuring a positive birth experience for all. We work on a pan‐European level to ensure women’s rights to give birth in a clinically and psychologically safe environment including during the current COVID‐19 pandemic.
Susan Garthus-Niegel
added a research item
In contrast to the large body of research on maternal perinatal depression, paternal perinatal mental health has received little attention; and longitudinal studies on paternal perinatal depression, following (expectant) fathers over time, are exceedingly rare. This population-based study aimed to (1) estimate prevalence rates of perinatal depression symptoms among German (expectant) fathers, (2) identify differential profiles of perinatal depression in (expectant) fathers, (3) determine modifiable predictors of latent depression profiles, and (4) estimate how membership in subgroups changes during the perinatal period. Data were derived from the longitudinal cohort study DREAM (Dresden Study on Parenting, Work, and Mental Health), including 1,027 (expectant) fathers responding to the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy and 8 weeks postpartum. Unobserved profiles of paternal perinatal depression and movement between profiles were investigated using latent transition analysis. A number of potential predictors with regard to lifestyle and current life situation were included as covariates. We found that rates of paternal depression symptoms decreased with 9% during pregnancy to 5% at 8 weeks postpartum. Further, four latent depression profiles emerged: most (expectant) fathers did not exhibit any depression symptoms (not depressed), whereas some reported mainly the absence of joy (anhedonic) and some experienced mainly self-blame and worries (anxious-worried). The depressive profile was characterized by endorsement to most symptoms of perinatal depression. Perceived social support and relationship satisfaction appeared to be protective against paternal depression symptoms. Differential transitioning or stability patterns in profile membership during the perinatal period were found, whereas the depressive profile showed to be the least stable. This prospective population-based cohort study is the first study to identify paternal perinatal depression profiles together with their predictors and changes during the perinatal period. Future research is warranted to examine whether the identified paternal depression profiles have differential outcomes, particularly in the context of person-centered prevention and intervention strategies. Further, longitudinal trajectories of paternal depression ought to be studied, taking into account additional measurement points as well as modifiable risk factors.
Julia Leinweber
added a research item
Zusammenfassung Empirische Studien dokumentieren Respektlosigkeit und Gewalt in der Geburtshilfe als globales Phänomen. Respektlosigkeit und Gewalt in der Geburtshilfe können das Wohlbefinden von Frauen und ihren Familien langfristig über den Zeitraum der Geburt hinaus beeinträchtigen. Um dies zu vermeiden, müssen nationale gesundheitspolitische Strategien die Wichtigkeit respektvoller Betreuung für eine qualitativ hochwertige Geburtshilfe anerkennen.
Julia Leinweber
added an update
Leinweber, J., Jung, T., Hartmann, K., & Limmer, C. (2021). Respektlosigkeit und Gewalt in der Geburtshilfe – Auswirkungen auf die mütterliche perinatale psychische Gesundheit. Public Health Forum, 29(2), 97-100. doi:10.1515/pubhef-2021-0040
 
Susan Garthus-Niegel
added a research item
Introduction: Some women keep on recalling intense labor pain experienced at childbirth to a degree that it may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference of and delivery by an elective CS in the subsequent delivery. Further, we investigated if co-occurring maternal demographic, somatic, and mental health factors related to the previous and subsequent delivery explain parts of a potential association. Material and methods: The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed by a numeric rating scale at pregnancy week 17, and at pregnancy week 32 the preference of an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was drawn from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. Results: Severe recalled labor pain at the previous birth was associated with a preference of an elective CS (OR 3.57, 95% CI 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference of an elective CS (aOR 2.12, 95% CI 1.24-3.62), but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as passed years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience, and fear of childbirth were also linked to preference and delivery by an elective CS. Conclusions: Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared to women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and irrespective of severe recalled labor pain, preference of elective CS was statistically significantly associated with actual delivery by elective CS.
Susan Garthus-Niegel
added a research item
Background : Evidence 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. Methods : Data 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. Results : Clinically 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. Limitations : Generalization of findings might be limited by self-selection bias and some systematic dropout. Conclusions : Our 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.
Antje Horsch
added a research item
Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic–pituitary–adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.
Antje Horsch
added a research item
Objective: Despite the prevalence of depression in women with gestational diabetes mellitus (GDM) and the relationship between mental health (depression and well-being) and metabolic health, little is known about mental health or its metabolic impact in GDM pregnancy. This prospective clinical cohort study aimed to investigate associations between 1) well-being and depression, and 2) mental health and weight/weight gain in women with GDM. Methods: We included 334 pregnant women with GDM treated at a Swiss University Hospital between January 2016 and December 2018. They completed two self-report questionnaires: The World Health Organization well-being index (WHO-5) at the first (29 weeks of gestation) and last (36 weeks of gestation) GDM visits during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at the first GDM visit. A cutoff of ≥11 was selected for this questionnaire to indicate the presence of elevated depression scores. Results: There was an inverse association between the well-being and depression total scores at the first GDM visit during pregnancy (r = − 0.55; p < 0.0001). Elevated depression scores at the first GDM visit were associated with subsequent weight gain in GDM pregnancy (β = 1.249; p = 0.019). Conclusion: In women with GDM, elevated depression scores during pregnancy are prospectively associated with weight gain. Depression symptoms should therefore be screened for and treated in women with GDM to reduce the risks associated with excessive weight gain during pregnancy.
Susan Garthus-Niegel
added a research item
Intimate partner violence (IPV) affects individuals and families from all backgrounds, regardless of their ethnicity, socio-economic status, sexual orientation, or religion. Pregnancy and childbirth could be a time of vulnerability to violence because of changes in physical, emotional, social, and economic demands and needs. Prevalence of IPV against women during the perinatal period is increasingly researched and documented. However, evidence on IPV prevalence among intimate partners as well as on the course of IPV over the perinatal period is scarce. The purpose of this review was to provide a narrative synthesis of the existing literature regarding the prevalence estimates of IPV among intimate partners over the perinatal period. Through this review, we also gained better insight into associated factors, as well as the various forms of IPV. Of the 766 studies assessing prevalence estimates identified, 86 were included, where 80 studies focused on unidirectional IPV (i.e., perpetrated by men against women) and six studies investigated bidirectional IPV (i.e., IPV perpetrated by both partners). Most of the included studies reported lower overall prevalence rates for unidirectional IPV postpartum (range: 2–58%) compared to pregnancy (range: 1.5–66.9%). Psychological violence was found to be the most prevalent form of violence during the entire perinatal period. Studies on bidirectional IPV mostly reported women's perpetration to be almost as high as that of their partner or even higher, yet their findings need to be interpreted with caution. In addition, our results also highlighted the associated factors of IPV among partners, in which they were assimilated into a multi-level ecological model and were analyzed through an intersectional framework. Based on our findings, IPV is found to be highly prevalent during the entire perinatal period and in populations suffering from social inequalities. Further research exploring not only the occurrence, but also the motivations and the context of the bidirectionality of IPV during the perinatal period may facilitate better understanding of the detrimental consequences on partners and their families, as well as the development of effective intervention strategies. Public health prevention approaches intervening at optimal times during the perinatal period are also needed.
Antje Horsch
added a research item
In this case control study, long-term gynecological, reproductive and sexual outcomes after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) were evaluated. The study was performed in a single referral hospital for PPH in Lausanne from 2003 to 2013. Each woman whose delivery was complicated by PPH and treated by UAE was included, and compared to a control group of women whose delivery was uncomplicated. Cases were matched by maternal age, parity, ethnicity, year and mode of delivery, birth weight and gestational age in a 1–3 ratio. A total of 77 patients treated by UAE for PPH were identified in our obstetrical database. Among them, 63 were included and compared to 189 matched patients (no PPH). The mean interval time between UAE and this study was 8.1 years. Time to menstrual cycle recovery after delivery (3.9 vs 5.6 months, p = 0.66), spotting (7.9% vs 7.2%, p = 0.49), dysmenorrhea (25.4% vs 22.2%, p = 0.60) and amenorrhea (14.3% vs 12.2%, p = 0.66) were similar between the two groups. There was no difference in the FSFI score between the groups (23.2 ± 0.6 vs 23.8 ± 0.4; p = 0.41). However, the interval time to subsequent pregnancy was longer for patients after UAE than the control group (35 vs 18 months, p = 0.002). In case of pregnancy desire, the success rate was lower after UAE compared to controls (55% vs 93.5%, p < 0.001). The rate of PPH was higher in those with previous PPH (6.6% vs 36.4%, p = 0.010). Patients treated by UAE for PPH did not report higher rates of gynecological symptoms or sexual dysfunction compared to patients with uneventful deliveries. The inter-pregnancy interval was increased and the success rate was reduced. In subsequent pregnancies, a higher rate of PPH was observed in those that underwent UAE.
Antje Horsch
added 2 research items
Objective: The workshop aimed to discuss and develop a statement on the current state of the evidence and opinion in the field of Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide some recommendations for research. Background: A group of international researchers, clinicians and a service user met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were identified and agreed as the focus of discussion at the meeting. Methods: 12 clinicians and researchers, invited for their known expertise in this or a closely related area (e.g. PTSD) met in Hull, UK to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The meeting focused on identifying areas of uncertainty, key areas of knowledge, emerging research and possible future research within the field. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity Keys points for discussion: Whilst there is a body of work in the field of FoC, work specifically focussed on tokophobia is more recent. It was agreed that there remains a wide range of issues, for which we need further evidence, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding of tokophobia, which gives rise to challenges for robust assessment and the identification of risk factors. An improved understanding of the aetiological and developmental aspects of tokophobia is required to underpin appropriate, effective and evidence-based interventions. The development and evaluation of pathways of care and the interventions these might incorporate, should be a focus of future research to explore the potential for positive outcomes. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research continues to be needed across all areas identified.
Introduction: Up to 30% of women view their childbirth as traumatic. This experience can lead to acute stress disorder or post-traumatic stress disorder. The negative impact of maternal post-traumatic stress disorder following childbirth reaches beyond the mother, potentially affecting her child's development and the couple's relationship. Research on paternal post-traumatic stress disorder following childbirth is scarce. Acute stress disorder is suggested to be an important predictor of post-traumatic stress disorder in mothers, but little is known about paternal acute stress disorder following childbirth. Furthermore, there is limited information about the comparison or relation of acute stress disorder and post-traumatic stress disorder following childbirth between parents. Aim: [1] To compare the prevalence rates and severity of acute stress disorder and post-traumatic stress disorder symptoms between parents following childbirth by taking anxiety and depression symptoms, as well as obstetric variables and previous traumatic events into account and [2] To determine if acute stress disorder is a predictor of post-traumatic stress disorder. Method: A prospective population-based design was used. N = 647 participants were recruited from future parents who attended appointments at the Obstetrics and Gynecology unit at a Swiss university hospital. Self-report questionnaires were used: Post-traumatic Diagnostic Scale in the third trimester of pregnancy (T1) and 1 month post-partum (T3), Acute Stress Disorder Scale at 1 week post-partum (T2), and Hospital Anxiety and Depression Scale at all time points. Obstetric and neonatal variables were retrieved from hospital records. Results: At T2, 63.9% of mothers and 51.7% of fathers presented symptoms of acute stress disorder. At T3, 20.7% of mothers and 7.2% of fathers had symptoms of post-traumatic stress disorder. Acute stress disorder was a predictor of post-partum post-traumatic stress disorder (Odds ratio: 8.6, IC 95% [1.85; 40.42]). Depression symptoms was a significant confounder in the prediction of post-traumatic stress disorder following childbirth, but not anxiety or previous perinatal loss. Conclusion: Little is known about parental differences in acute stress disorder and post-traumatic stress disorder symptoms following childbirth. Results indicate that both parents may suffer from acute stress disorder and post-traumatic stress disorder symptoms after childbirth and that acute stress disorder is a predictor of post-traumatic stress disorder after childbirth for both parents. Sensitization of maternity staff to these results may assist in earlier identification of and appropriate treatment for at-risk parents.
Susan Garthus-Niegel
added a research item
Background Posttraumatic Stress Disorder (PTSD) is a debilitating mental disorder. Certain drugs, such as morphine and nitrous oxide gas (N2O), are administered to individuals who just experienced a traumatic event (e.g., soldiers, injured civilians). It is therefore crucial to understand if they incidentally affect PTSD symptom development. Furthermore, such observations could pave the way for the development of pharmacological prevention strategies of PTSD. Methods In this prospective population-based cohort study (n = 2,070), we examined the relationship between morphine or N2O administration during childbirth, and subsequent childbirth-related PTSD symptoms at eight weeks postpartum. Pain during labour, prior PTSD symptoms, and birth medical severity were included as covariates in the analyses. Results In women who developed PTSD symptoms, N2O administration during childbirth predicted reduced PTSD symptom severity (p < .001, small to medium effect size). A similar tendency was observed for morphine, but was not significant (p < .065, null to small effect size). Both drugs predicted increased PTSD symptoms when combined with severe pain during labour. Limitations This study was observational, thus drug administration was not randomised. Additionally, PTSD symptoms were self-reported. Conclusions Peritraumatic N2O administration may reduce subsequent PTSD symptom severity and thus be a potential avenue for PTSD secondary prevention. This might also be the case for morphine. However, the role of severe peritraumatic pain in context of drug administration deserves further investigation.
Ibone Olza
added a research item
El impacto de la forma de nacer en el futuro de la civilización. Consecuencias a largo plazo de las alteraciones neurobiológicas perinatales. Video: https://youtu.be/NLZKfFq8Nao English: https://youtu.be/tN5cSNVpoe0 (from minute 46) Portuguese: https://youtu.be/f9-yk5Ro1Sk (from minute 46)
Lola Ruiz-Berdún
added a research item
Abstract Background Public patient involvement (PPI) generates knowledge about the health‐illness process through the incorporation of people's experiences and priorities. The Babies Born Better (BBB) survey is a pan‐European online questionnaire that can be used as a PPI tool for preliminary and consultative forms of citizens' involvement. The purpose of this research was to identify which practices support positive birth experiences and which ones women want changed. Methods The BBB survey was distributed in virtual communities of practice and through social networks. The version launched in Spain was used to collect data in 2014 and 2015 from women who had given birth in the previous 5 years. A descriptive, quantitative analysis was applied to the sociodemographic data. Two open‐ended questions were analyzed by qualitative content analysis using a deductive and inductive codification process. Results A total of 2841 women participated. 41.1% of the responses concerned the category “Care received and experienced,” followed by “Specific interventions and procedures” (26.6%), “Involved members of care team” (14.2%), and “Environmental conditions” (9%). Best practices were related to how care is provided and received, and the main areas for improvement referred to specific interventions and procedures. Conclusions This survey proved a useful tool to map the best and poorest practices reported. The results suggest a need for improvement in some areas of childbirth care. Women's reports on negative experiences included a wide range of routine clinical interventions, avoidable procedures, and the influence exerted by professionals on their decision‐making.
Susan Garthus-Niegel
added 2 research items
The parent-infant bond following childbirth is an important facilitator of optimal infant development. So far, research has mainly focused on mother-infant bonding. Data on fathers are still sparse. Parental mental health, such as posttraumatic stress symptoms (PTSD), may influence mother-infant relations and/or interactions. There is evidence that both parents can experience PTSD symptoms following childbirth (PTSD-CB). The aim of this study is to investigate the prospective relationship between parental PTSD-CB symptoms at 1 month postpartum and perceived parent-infant bonding at 3 months postpartum, while adjusting for antenatal confounders. A subsample was used for this study (n Totalsample 488, n mothers = 356, n fathers = 132) of an ongoing prospective cohort study. Future parents awaiting their third trimester antenatal appointments at a Swiss university hospital were recruited. Self-report questionnaires assessed PTSD-CB symptoms and psychological distress at 1 month postpartum, and parent-infant bonding at 3 months postpartum. Confounders included antenatal PTSD symptoms and social support measured via self-report questionnaires, and gestity and gestational age, extracted from medical records. Using structural equation modeling, the predictive ability of PTSD-CB symptoms at 1 month postpartum on parent-infant bonding at 3 months postpartum was assessed for both parents respectively. Maternal PTSD-CB symptoms at 1 month postpartum were found to be negatively prospectively associated with mother-infant bonding at 3 months postpartum; however, this effect disappeared after adjusting for psychological distress at 1 month postpartum. No such effects were found for fathers. There was no evidence of mediation of the relationship between parental PTSD-CB symptoms at 1 month postpartum and parental-infant bonding at 3 months postpartum via psychological distress at 1 month postpartum. However, such a mediation was found for maternal intrusion and hyperarousal symptom subscales. Results expand the current literature on the impact of PTSD-CB on parent-child relations to also include fathers, and to a community sample. Any adverse effects of mental health symptoms on parent-infant bonding were evidenced by 3 months postpartum only for mothers, not fathers. Our results may inform the development of prevention/intervention strategies.
Yvonne Kuipers
added a research item
Background: Because of the considerable negative effects of women's childbirth-related anxiety, fear and worries, and the time constraints that midwives perceive to assess women's antenatal emotional wellbe-ing, it is important that midwives can identify women with a more severe fear of birth with an easy to administer, validated tool. Objective: To investigate the ability of the two-item Fear of Childbirth Scale (FOBS) to discriminate between pregnant women with and without birth-related fear, compared with the 16-item Tilburg Pregnancy Distress Scale (TPDS). Methods: A diagnostic accuracy comparative cross-sectional study was performed, comparing two screening tests. Sensitivity, specificity, positive and negative predictive values and accuracy and discriminant property of the FOBS were determined and compared with the TPDS and with the negative affect 11-items TPDS (TPDS-NA) subscale. The TPDS and TPDS-NA were treated as reference standard to establish the discriminative potential of the FOBS for the presence or absence of antenatal birth-related fear. Participants: A sample of 396 Dutch women with uncomplicated pregnancies. Results: When compared with the 16-items TPDS, the FOBS showed a higher specificity (95%) than sensitivity (70%) to detect fear of childbirth. The FOBS items had a good predictive ability for fear and worries about the forthcoming birth (79%) and a conclusive ability for negative case-finding (92%). The FOBS showed good accuracy (89%). The FOBS discriminated women who were or were not classified as being fearful according to the TPDS (AUC .86). When compared with the 11 items TPDS-NA subscale, the FOBS validity and accuracy decreased: sensitivity: 51%; specificity 92%; positive predictive ability 65%; negative predictive ability 88%; accuracy 83%; AUC .82. Conclusion: When compared with the 16-items TPDS, the two-item FOBS shows to be an accurate tool for identifying the presence of antenatal birth-related fear in a sample of Dutch women with uncomplicated pregnancies.
Slavica Tutnjevic
added a research item
This study investigated the psychological impact of the COVID-19 pandemic in pregnant women from Bosnia and Herzegovina and Serbia during March and April 2020. 152 respondents filled out an online administered questionnaire assessing psychological impact of the COVID-19 pandemic, fear of COVID-19 infection and death, attachment styles, perceived social support and other relevant sociodemographic and life history variables. The results indicate that the COVID-19 pandemic significantly impacts the level of fear and overall psychological functioning of the pregnant women. Especially prone to increased stress reactions are those who have lower partner support, fearful and preoccupied attachment styles, and lower financial status. The results are discussed in terms of the need for a systemic approach to psychological screening for pregnant women. We also point out the need to carefully evaluate the use of the IES-R when applied to assess reactions to collectively experienced prolonged stressful events such as the pandemic. Full text available at https://psyarxiv.com/su3nv/
Paulina Pawlicka
added a research item
Introduction: The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants. Methods and analysis: It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.
Anastasia Topalidou
added a research item
Aim: The purpose of this study was to summarise the evidence of the clinical and psychological impacts of COVID-19 on perinatal women and their infants. Methods: A rapid scoping review was conducted based on methods proposed by Arksey and O’Malley, and the World Health Organization’s (WHO) practical guide for rapid reviews. We searched EMBASE, MEDLINE(R) and MIDIRS. Results: From 1,319 hits, 26 met the inclusion criteria and were included. Most of the studies (n=22) were from China. The majority of the publications are single case studies or case reports. The findings were analysed narratively, and six broad themes emerged. These were: Vertical transmission and transmission during birth, mother-baby separation, breastmilk, likelihood of infection and clinical picture, analgesia or anaesthesia, and infants and young children. The literature search revealed that there is very little formal evidence on the impact of COVID-19 on pregnant, labouring and postnatal women, or their babies. The clinical evidence to date suggests that pregnant and childbearing women, and their babies, are not at increased risk of either getting infected, or of having severe symptoms or consequences, when compared to the population as a whole, which contrasts with outcomes for this group in other viral pandemics. There is no evidence on the short- and longer-term psychological impacts on childbearing women during COVID-19. Conclusion: Despite this lack of evidence, many maternity services have been imposing severe restrictions on aspects of maternity care previously acknowledged as vital to optimum health (including birth companionship, breastfeeding, and contact between mother and baby). There is a critical research gap relating to the clinical and psychological consequences of both COVID-19 and of maternity service responses to the pandemic.
Mary Curtin
added a research item
Aims and objectives: To undertake a concept analysis of Humanisation in Pregnancy and Childbirth. Background: Humanisation in pregnancy and childbirth has historically been associated with women who do not require medical intervention. However, the increasing recognition of the importance of emotional and mental health as well as the physical outcome of pregnancy has meant that there is a need to identify clinical attributes and behaviours that contribute to a positive emotional outcome. Failure to support and protect the emotional health of the woman in pregnancy and childbirth can have effects on the long-term mental health of the mother as well as the long term physical and mental health of the child. Design: Concept Analysis. Methods: Eight step method of concept analysis proposed by Walker and Avant. Results: Defining attributes include being a protagonist, human being interaction and benevolence. Antecedents identified were a recognition of women's rights, birth models, professional competence and the environment. Consequences were identified for women and healthcare professionals. For women, increased feelings of confidence, satisfaction of the experience and safety. For healthcare professionals, increased satisfaction and confidence in their job and increased esteem in their profession. Conclusions: Humanisation of pregnancy and childbirth now encompasses all women regardless of care pathway. Humanisation does not obstruct the prioritization of life saving procedures or the use of medical intervention where required. Relevance to clinical practice: Women who are able to identify their rights when accessing maternity care will be better equipped to ensure their care planning is individualised. The identification of humanised care practices, attributes and behaviours can support healthcare professionals in the clinical area who wish to identify a pathway of humanised care in pregnancy and birth.
Antje Horsch
added a research item
The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Jonathan D Turner
added a research item
A poor socioeconomic environment and social adversity are fundamental determinants of human life span, well-being and health. Previous influenza pandemics showed that socioeconomic factors may determine both disease detection rates and overall outcomes, and preliminary data from the ongoing COVID-19 pandemic suggests that this is still true. Over the past years it has become clear that early-life adversity (ELA) plays a critical role biasing the immune system towards a pro-inflammatory and senescent phenotype many years later. Cytotoxic T-lymphocytes (CTL) appear to be particularly sensitive to the early life social environment. As we understand more about the immune response to SARS-CoV-2 it appears that a functional CTL (CD8+) response is required to clear the infection and COVID-19 severity is increased as the CD8+ response becomes somehow diminished or exhausted. This raises the hypothesis that the ELA-induced pro-inflammatory and senescent phenotype may play a role in determining the clinical course of COVID-19, and the convergence of ELA-induced senescence and COVID-19 induced exhaustion represents the worst-case scenario with the least effective T-cell response. If the correct data is collected it may be possible to separate the early life elements that have made people particularly vulnerable to COVID-19 many years later. This will, naturally, then help us identify those that are most at risk from developing the severest forms of COVID-19. In order to do this, we need to recognise socioeconomic and early life factors as genuine medically and clinically relevant data that urgently need to be collected. Finally, many biological samples have been collected in the ongoing studies. The mechanisms linking the early life environment with a defined later-life phenotype are starting to be elucidated, and perhaps hold the key to understanding inequalities and differences in the severity of COVID-19.
Anastasia Topalidou
added a research item
This paper presents a rapid evidence review into the clinical and psychological impacts of COVID-19 on perinatal women and their infants. Literature search revealed that there is very little formal evidence on the impact of COVID-19 on pregnant, labouring and postnatal women or their babies. The clinical evidence to date suggests that pregnant and childbearing women, and their babies are not at increased risk of either getting infected, or of having severe symptoms or consequences than the population as a whole. There is no evidence on the short- and longer-term psychological impacts of restrictive practices or social and personal constraints for childbearing women during COVID-19 in particular, or infection pandemics in general. The potential for adverse mental health consequences of the pandemic should be recognised as a critical public health concern, together with appropriate care and support to prevent and ameliorate any negative impacts.
Lola Ruiz-Berdún
added an update
From our colleagues Anastasia Topalidou, Gill Thompson and Soo Downe
COVID-19 and maternal mental health: Are we getting the balance right?
This paper presents a rapid evidence review into the clinical and psychological impacts of COVID-19 on perinatal women and their infants. Literature search revealed that there is very little formal evidence on the impact of COVID-19 on pregnant, labouring and postnatal women or their babies. The clinical evidence to date suggests that pregnant and childbearing women, and their babies are not at increased risk of either getting infected, or of having severe symptoms or consequences than the population as a whole. There is no evidence on the short- and longer-term psychological impacts of restrictive practices or social and personal constraints for childbearing women during COVID-19 in particular, or infection pandemics in general. The potential for adverse mental health consequences of the pandemic should be recognised as a critical public health concern, together with appropriate care and support to prevent and ameliorate any negative impacts.
 
Lola Ruiz-Berdún
added an update
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Lola Ruiz-Berdún
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Lola Ruiz-Berdún
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Lola Ruiz-Berdún
added a project goal
Unlike other sources of trauma, perinatal or birth-related trauma is relatively unrecognised. Evidence suggests up to 30% of women describe their birth experience as traumatic and experience some symptoms of intrusion, avoidance or hyper-arousal. Meta-analyses show post-traumatic stress disorder (PTSD) affects 4% of women after birth and up to 18% of women in high risk groups. Rectification of this situation is essential. In 2016, 5.11 million babies were born in Europe, indicating that up to 1.5 million women may have had sub-optimal birth experiences and over 200,000 may have developed PTSD as a result. Developmental research has firmly established that the quality of infant-parent relationships is a critical factor in early and later childhood development, consequently, a family-centred approach to any investigation of birth-related trauma is critical, as trauma can be transmitted within the family system. Given the enormous economic burden it places on women, health systems, and particularly children, relatively small improvements in services to prevent, detect and treat this problem can benefit society significantly. The main aim of this Action is two-fold. The Action will establish an international multidisciplinary network of researchers, clinicians, NGOs and SMEs to 1) consolidate and disseminate current evidence and coordinate a joint effort to seek ways to prevent, minimise and resolve birth-related trauma, and to optimise emotional and psychological outcomes for parents and families and 2) accelerate the translation of that knowledge into best practices that can be shared across Europe to reduce the societal and economic burden arising from birth-related negative/traumatic experiences.