Debriefing interventions for the prevention of psychological trauma in women following childbirth

Bastos, Maria Helena; Furuta, Mutsuhiro; Small, Rhonda; McKenzie‐McHarg, Kirstie; Bick, Debra

doi:10.1002/14651858.cd007194.pub2

Cited by 96 publications

(81 citation statements)

References 98 publications

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“…There is inconclusive evidence on the impact of debriefing programmes 237 and this needs to be robustly evaluated. l Many of the women we interviewed reported symptoms associated with PTSD, which was also the case among women who had a peripartum hysterectomy.…”

Section: Following Pregnancymentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Following Pregnancymentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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“…A recent Cochrane Review [25] concluded that women require improved emotional support during birth from their care providers to reduce the risk trauma. Health care professionals have an ethical, legal and professional obligation to provide safe and respectful care [26–28].…”

Section: Introductionmentioning

confidence: 99%

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Reed

Sharman

Inglis

2017

BMC Pregnancy Childbirth

186

154

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BackgroundMany women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.MethodsAs part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.ResultsFour themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.ConclusionCare provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

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“…Bastos, Furuta, Small, McKenzie-McHarg & Bick (2015) analysed in a Cochrane database review eight publications on debriefing after a traumatic delivery. They concluded that there is little or no evidence to support neither a positive nor an adverse effect of psychological debriefing in order to prevent psychological trauma in birth-giving women.…”

Section: Current Knowledge Of Interventions With Therapeutic Elementsmentioning

confidence: 99%

“…They concluded that there is little or no evidence to support neither a positive nor an adverse effect of psychological debriefing in order to prevent psychological trauma in birth-giving women. The Cochrane review also suggests that improved emotional care from health professionals may be needed in some delivery settings with high rates of obstetric interventions to reduce the risk of experiencing giving birth as traumatic (Bastos et al 2015).…”

Section: Current Knowledge Of Interventions With Therapeutic Elementsmentioning

confidence: 99%

Clinical aspects of childbirth-related anxiety

Nieminen

2016

Linköping University Medical Dissertations

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Debriefing interventions for the prevention of psychological trauma in women following childbirth

Cited by 96 publications

References 98 publications

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Clinical aspects of childbirth-related anxiety

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