Policy, service, and training provision for women following a traumatic birth: an international knowledge mapping exercise

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.

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

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

Policy, Service, and Training Provision for Women Following a Traumatic Birth: An International Mapping Study

Background: High numbers of women experience a traumatic birth, which can lead to Post Traumatic Stress Disorder (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 study 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 had national policies regarding the screening, treatment and prevention of a traumatic birth experience/PTSD. Service provision was provided formally in six countries (33%), or 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. Thirty-nine percent 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.

Postpartum Early EMDR Therapy Intervention (PERCEIVE) Study for Women After a Traumatic Birth Experience: Study Protocol for a Randomized Controlled Trial

Background. Up to 43% of women perceive giving birth as traumatic which may result in the development of posttraumatic stress disorder (PTSD) or related symptoms. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively influencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience. Methods. The PERCEIVE-study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or “care-as-usual”. Patients in the EMDR condition receive two sessions of therapy between fourteen (T0) and thirty-five days postpartum. All participants will be assessed at T0, and at nine weeks postpartum (T1). At T1 all participants will undergo a CAPS-interview about the presence and severity of PTSD symptoms. The primary outcome measure is severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at several midwifery practices in Amsterdam, the Netherlands. Discussion. It is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience. Trial registration. Trial register. NL73231.000.20. Registered on August 21, 2020. https://www.trialregister.nl/trial/8843

Psychological-physiological characteristics of vaginismus

While vaginismus can occur in some women during the first sexual intercourse, and sometimes in women who have not had any problems during previous sexual intercourse, this diagnosis can occur over time, depending on a traumatic event or problem they are experiencing. Vaginismus is divided into primary and secondary according to the time of its formation. The following are the reasons for the formation of the secondary form: Problems between couples A traumatic birth experience Abortion Exposure to sexual assault Rough gynecological examination, etc. One of the points to note is that the diagnosis of vaginismus may include additional symptoms. These are: Apareunia, Dyspareunia and Vulvar Vestibulitis Syndrome (VVS, Vulvar Vestibulitis). Although the symptoms we have listed are very similar to vaginismus, they are completely different from each other. Key words: vaginismus, trauma, Attachment, types of vaginismus, couple relationships, Dyspareunia, Vulvar vestibulitis, Aparoni

A longitudinal study of bonding failure related to aspects of traumatic birth experience among Japanese mothers

Background: A traumatic birth experience may affect mother-infant bonding. This study examined the relationship between aspects of traumatic birth experience and bonding failure for mothers at 1 month and 4 months after delivery. Methods: This longitudinal study surveyed 130 mothers at 1 month (T1) and 4 months (T2) after delivery. We performed multiple regression analysis with the Postpartum Bonding Questionnaire (PBQ) as the dependent variable and the Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), Relationship Questionnaire (RQ), Family Adaptation, Partnership, Growth, Affection, and Resolve score (F.APGAR), and demographic data as independent variables. Results: The IES-R and the EPDS were relevant factors for the PBQ at T1. The IES-R was not a relevant factor, but the EPDS was a relevant factor for the PBQ at T2. The IES-R at T1 was not a predictor for the PBQ at T2. The PBQ at T1 was the largest predictor for the PBQ at T2, when compared with the EPDS, F.APGAR, and dismissive attachment pattern (RQ) at T1. Conclusions: A traumatic birth experience had a strong influence on bonding failure at T1. However, the important factor affecting bonding failure was not a traumatic birth experience, but depression at T2. If a traumatic birth experience is accompanied by depression at T2, it may affect bonding failure. The bonding failure affected by the traumatic birth experience at T1 could affect bonding failure at T2. Health professionals should assess the degree of the traumatic birth experience and start to care for mothers at T1.

Effects of traumatic birth experience and transmission intergenerationalTravmatik doğum deneyiminin etkileri ve nesiller arası aktarımı

The birth is an individual and also important expression for women life. This experience can be perceived in a different way by each woman that can be defined by different feelings such as positive, negative or mixed. Some women perceive birth experience as a traumatic event. Traumatically perceived birth is considered an event that may trigger Posttraumatic Stress Disorder (PTSD) reaction. It is stated that traumatic birth experience may cause permanent or long-term negative consequences in women's life, may negatively affect future health, subsequent birth experiences and family relations. It is reported that birth is part of the continuity from past to future and the effects are not limited to the woman giving birth, but also that the subsequent generations, and even the other women around it, can influence the birth perceptions and experiences. There are many studies shows that the effects of traumatic events are transmitted to the next generation. This genetic transmission suggests that traumatic birth is a serious problem not only affecting the women who will give birth to nowadays but also having long-term consequences. From today's women to future generations, obstetrics and gynecology nurses have important responsibilities to prevent of reaching traumatic experience of birth, is a natural part of women's life. In this article, it was aimed to investigate the importance of traumatic birth concept, risk factors, existing effects and future generations in the context of literature and to draw attention to the responsibilities of the obstetrics and gynecology nurses.Extended English summary is in the end of Full Text PDF (TURKISH) file. ÖzetDoğum bireyseldir ve kadın için çok yönlü önemli bir yaşam deyimidir. Bu deneyim her bir kadın tarafından farklı algılanabilmekte, olumlu, olumsuz ya da karışık farklı duygularla tanımlanabilmektedir. Bazı kadınlar ise doğum deneyimini travmatik bir olay olarak algılayabilmektedir. Travmatik olarak algılanan doğum, Posttravmatik Stres Bozukluğu (PTSB) reaksiyonunu tetikleyebilecek bir olay olarak kabul edilmektedir. Travmatik doğum deneyiminin kadının hayatında kalıcı veya uzun vadeli olumsuz sonuçlar doğurabileceği, gelecekteki sağlığını, sonraki doğum deneyimlerini ve aile içi ilişkilerini olumsuz etkileyebileceği belirtilmektedir. Doğumun geçmişten geleceğe giden devamlılığın bir parçası olduğu belirtilmekte ve etkilerinin doğum yapan kadınla sınırlı kalmayıp, onunla birlikte çevresindeki diğer kadınların ve hatta sonraki nesillerin doğum algılarını ve deneyimlerini de etkileyebildiği bildirilmektedir. Travmatik olayların etkilerinin sonraki nesillere aktarıldığını gösteren pek çok çalışma bulunmaktadır. Bu genetik aktarım travmatik doğumun da sadece günümüzde doğum yapacak kadınları etkilemeyip daha uzun vadeli sonuçları olabilecek ciddi bir sorun olduğunu göstermektedir. Kadın hayatının doğal bir parçası olan doğum eylemini günümüz kadınlarının ve gelecek nesillerin travmatik bir deneyim olarak hatırlamalarının önlenmesinde kadın doğum hemşirelerine önemli sorumluluklar düşmektedir. Bu makalede travmatik doğum kavramı, risk faktörleri, ortaya çıkan mevcut etkileri ve gelecek nesiller açısından önemini literatür bağlamında irdelemek, konuya ve kadın doğum hemşiresinin sorumluluklarına dikkat çekmek amaçlanmıştır.