References

Adewuya A, Ologun Y, Ibigbami O. Post-traumatic stress disorder after childbirth in nigerian women: Prevalence and risk factors. BJOG: An International Journal of Obstetrics & Gynaecology. 2006; 113:(3)284-288 https://doi.org/10.1111/j.1471-0528.2006.00861.x

Diagnostic and statistical manual of mental disorders.Washington, DC: American Psychiatric Association; 2013

Andersen L, Melvaer L, Videbech P, Lamont R, Joergensen J. Risk factors for developing post-traumatic stress disorder following childbirth: A systematic review. Acta Obstet Gynecol Scand. 2012; 91:(11)1261-1272 https://doi.org/10.1111/j.1600-0412.2012.01476.x

Ayers S. Delivery as a traumatic event: Prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clinical Obstetrics and Gynecology. 2004; 47:(3)552-567 https://doi.org/10.1097/01.grf.0000129919.00756.9c

Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine. 2016; 46:(6)1121-1134 https://doi.org/10.1017/S0033291715002706

Ayers S, Wright DB, Ford E. Hyperarousal symptoms after traumatic and nontraumatic births. Journal of Reproductive and Infant Psychology. 2015; 33:(3)282-293 https://doi.org/10.1080/02646838.2015.1004164

Ayers S, Wright DB, Thornton A. Development of a measure of postpartum ptsd: The city birth trauma scale. Frontiers in Psychiatry. 2018; 9 https://doi.org/10.3389/fpsyt.2018.00409

Bailham D, Slade P, Joseph S. Principal components analysis of the perceptions of labour and delivery scale and revised scoring criteria. Journal of Reproductive and Infant Psychology. 2004; 22:(3)157-165 https://doi.org/10.1080/02646830410001723742

Clement S, Wilson J, Sikorski J. The development of an intrapartum intervention score based on women's experiences. Journal of Reproductive and Infant Psychology. 1999; 17:(1)53-62 https://doi.org/10.1080/02646839908404584

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item edinburgh postnatal depression scale. The British Journal of Psychiatry. 1987; 150:(6)782-786 https://doi.org/10.1192/bjp.150.6.782

Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth. 2000; 27:(2)104-111 https://doi.org/10.1046/j.1523-536x.2000.00104.x

Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth. The British Journal of Clinical Psychology. 2000; 39:(Pt 1) https://doi.org/10.1348/014466500163095

Dekel S, Stuebe C, Dishy G. Childbirth induced posttraumatic stress syndrome: A systematic review of prevalence and risk factors. Frontiers in Psychology. 2017; https://doi.org/10.3389/fpsyg.2017.00560

Elmir R, Schmied V, Wilkes L, Jackson D. Women's perceptions and experiences of a traumatic birth: A meta-ethnography. Journal of Advanced Nursing. 2010; 66:(10)2142-2153 https://doi.org/10.1111/j.1365-2648.2010.05391.x

Ford E, Ayers S. Stressful events and support during birth: The effect on anxiety, mood and perceived control. Journal of Anxiety Disorders. 2009; 23:(2)260-268 https://doi.org/10.1016/j.janxdis.2008.07.009

Ford E, Ayers S. Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology & Health. 2011; 26:(12)1553-1570 https://doi.org/10.1080/08870446.2010.533770

Garthus-Niegel S, von Soest T, Vollrath ME, Eberhard-Gran M. The impact of subjective birth experiences on post-traumatic stress symptoms: A longitudinal study. Archives of Women's Mental Health. 2013; 16:(1)1-10 https://doi.org/10.1007/s00737-012-0301-3

Harris R, Ayers S. What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’. Psychology & Health. 2012; 27:(10)1166-1177 https://doi.org/10.1080/08870446.2011.649755

Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.New York: Guilford Publications; 2017

Horowitz M, Wilner N, Alvarez W. Impact of event scale: A measure of subjective stress. Psychosomatic Medicine. 1979; 41:(3)209-218 https://doi.org/10.1097/00006842-197905000–00004

Milosavljevic M, Tosevski DL, Soldatovic I, Vukovic O, Miljevic C, Peljto A, Kostic M, Olff M. Posttraumatic stress disorder after vaginal delivery at primiparous women. Scientific Reports. 2016; 6 https://doi.org/10.1038/srep27554

NHS Digital. NHS maternity statistics, England 2018-2019. 2019. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2018-19 (accessed 3 September 2020)

Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: A review. Clinical Psychology Review. 2006; 26:(1)1-16 https://doi.org/10.1016/j.cpr.2005.07.002

Simpson M, Catling C. Understanding psychological traumatic birth experiences: A literature review. Women and Birth. 2016; 29:(3)203-207 https://doi.org/10.1016/j.wombi.2015.10.009

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine. 2006; 166:(10)1092-1097 https://doi.org/10.1001/archinte.166.10.1092

Stein MB, Walker JR, Hazen AL, Forde DR. Full and partial posttraumatic stress disorder: Findings from a community survey. The American Journal of Psychiatry. 1997; 154:(8)1114-9 https://doi.org/10.1176/ajp.154.8.1114

Wijma K, Söderquist J, Wijma B. Posttraumatic stress disorder after childbirth: A cross sectional study. Journal of Anxiety Disorders. 1997; 11:(6)587-597 https://doi.org/10.1016/s0887-6185(97)00041-8

Birth trauma: the mediating effects of perceived support

02 October 2020
Volume 28 · Issue 10

Abstract

Background

Many women experience their childbirth as traumatic, and 4-6% of mothers present with postnatal post-traumatic stress disorder.

Aims

To measure the relationship between obstetric intervention, perceived support in childbirth and mothers' experiences of postnatal trauma, and to identify salient aspects of the birth experience that are considered traumatic.

Methods

A total of 222 women in their first year postpartum were recruited between October and December 2018 via local mother and baby groups in southwest England (UK) and online social media pages. They completed an online survey regarding their birth experience. Further insight into mother's birth experiences was garnered through free-text responses in the survey.

Results

Overall, 29% of mothers experienced a traumatic birth and 15% met full or partial criteria for post-traumatic stress disorder. Feeling supported mediated the relationship between obstetric intervention and postnatal trauma symptoms.

Conclusions

This study reinforces the value of supportive healthcare professionals and the power of a nurturing environment, which can buffer the potentially negative effects of an obstetrically complicated birth on postnatal trauma symptoms.

In recent years, birth trauma has become the focus of much perinatal research. Childbirth can be a triggering event for mothers and lead to symptoms of postnatal post-traumatic stress disorder (PTSD), including intrusive flashbacks of the birth, avoidance of hospitals or future pregnancy, or feelings of irritability, fear, guilt and shame (American Psychiatric Association [APA], 2013). A systematic review estimated postnatal PTSD prevalence to be between 4-6% (Dekel et al, 2017). However, the experience of birth trauma affects many more women who do not meet the clinical cut-off for PTSD but display symptoms of traumatic stress after birth (Ayers, 2004).

Mothers who experience obstetric complications or high levels of medical intervention during birth are more likely to present with postnatal PTSD (Adewuya et al, 2006; Andersen et al, 2012; Milosavljevic et al, 2016). However, this is not a clear and linear relationship consistently found in the literature and it is important to note that obstetric complications are not a prerequisite for a traumatic childbirth experience (Czarnocka and Slade, 2000). A birth without complications may be appraised as traumatic if the mother experiences poor quality interactions with healthcare providers, leading to a negative perception of her childbirth experience (Elmir et al, 2010; Simpson and Catling, 2016). Recent reviews of birth-related PTSD present subjective birth experiences to be a more powerful contributing factor of trauma compared to obstetric factors (Ayers et al, 2016; Dekel et al, 2017). A subjectively traumatising birth can include high levels of distress, fear for the self and/or baby, lacking control over the birth or feeling unsupported (Garthus-Niegel et al, 2013).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month